Inspection on 24/10/05 for Apple Orchard

This inspection was carried out on 24th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apple Orchard 22/06/07

Apple Orchard 07/06/06

Apple Orchard 28/02/06

Apple Orchard 08/03/05

Apple Orchard 07/06/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Apple Orchard The Green Dean Road Newnham-on-severn Glos GL14 1AQ Lead Inspector Mr Simon Massey Unannounced Inspection 24th October 2005 12.00p Apple Orchard DS0000016365.V250288.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 Apple Orchard DS0000016365.V250288.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. Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Apple Orchard Address The Green Dean Road Newnham-on-severn Glos GL14 1AQ 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 Mr Graham Fredrick Jeremiah 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.V250288.R01.S.doc Version 5.0 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. 7/03/05 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 which is used for activities, training, meetings and social groups. This also incorporates a sensory room and leisure facilities. Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours on 24th October. The inspector spoke with the manager and 3 members of staff. The premises were inspected and also care files and records. The inspector spoke to, or had contact with 8 of the 9 service users. The inspector is grateful to the staff and service users for their co-operation and positive approach to the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 6 The new care plans need to be completed for all of the service users and the home needs to demonstrate that they have an effective reviewing process in place for these plans. The home needs to demonstrate that service users have the opportunity to identify any personal goals and objectives, and that these are incorporated in to the relevant plans. 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. Apple Orchard DS0000016365.V250288.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 Apple Orchard DS0000016365.V250288.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): None of these Standards were inspected during this inspection. EVIDENCE: The home currently has one vacancy and the manager stated that they are currently receiving preliminary enquiries from placing authorities. Apple Orchard DS0000016365.V250288.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): 6,7&9 The home has a care planning system in place that needs to be further developed to ensure that people’s future needs are identified and met. EVIDENCE: The home has begun a process of transferring care plans to a new format and a sample of these were examined. The new format presents the information clearly and is divided into sections covering the key aspects of care provided. There is a need for the system to be further improved so that these plans also include any goals and objectives that have been identified. There is also a need for these plans to be developed so that potential future increasing needs are identified. The home must ensure that the reviewing process of the new plans incorporates an assessment that will provide this information. There is also a need for the key-workers and service users to be fully involved in the care planning process and it is recommended that staff training is provided in this area. Records showed regular recording of information relating to the daily activities and care of the service users. The new care plans contain risk assessments on various activities, and these need to be completed for all the service users. Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 10 The previous report required the home to address the issue of service users being referred to as “boys and girls” by members of the staff team. During this visit this term was used on a few occasions by the registered manager and it is again made a requirement that the home addresses this issue. This terminology is inappropriate and should not be used. Apple Orchard DS0000016365.V250288.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): 12,13,14,&17 The home provides a stable and relaxed environment that presently meets the lifestyle needs of the service users. EVIDENCE: Seven of the 9 service user were spoken to during this visit and 6 of these were able to communicate their satisfaction with the range of activities that they are supported to undertake. Examples were given of hobbies and interests and other events that are organised within the home. People are supported to use local amenities, either independently or with staff assistance. Day-care activities involve attending the local college and participating in courses and organised activities. Individual rooms contain equipment for entertainment according to personal requirements and service users questioned said they were happy with their rooms. The adjacent building, that houses various equipment for use by the service users, is well used. One service user had had a birthday party there the previous weekend. Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 12 Service users confirmed that they are supported to have visits from friends and relatives. People also said that their privacy was respected by staff and other service users. Service users are involved in the daily domestic chores such as cooking, cleaning and shopping. People are encouraged to take responsibility for their rooms and some people receive assistance to complete their own laundry. The kitchen was well stocked with fresh and frozen products at the time of the inspection and service users expressed satisfaction with the quality and quantity of food. One person who is a vegetarian said that whilst they were pleased with the food they thought that more vegetarian choice could be provided and this should be considered by the home. Apple Orchard DS0000016365.V250288.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 & 20 The staff team provide a good standard of personal care and involve outside professionals for input and support. EVIDENCE: The home has implemented the requirements and recommendations to their medication system following the inspection completed by the CSCI pharmacy inspector. An error was identified in the administration of some medication in that it was not being dispensed from the original packet, and this was brought to the attention of the manager. All other medication was correctly stored and administered. Evidence was seen that medication has been regularly reviewed. The home has accessed specialist input for one service user whose behaviour has recently become occasionally unpredictable and inappropriate. Following intervention the behaviour is now being monitored to see what further action is required. All service users questioned said they were happy with their key-workers and received sufficient support and help with their personal care. The care plans contain details of the amount of personal care and input that is required for each individual. Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 14 The files examined showed service users are receiving medical and dental checks. All staff have now had medication training. The Commission has received the appropriate notifications that are required following incidents or issues within the home. Apple Orchard DS0000016365.V250288.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): These standards were not examined in detail during this visit EVIDENCE: The complaints procedure was not examined during this visit but service users questioned, stated they felt able to take concerns to staff and the manager or owner. As previously mentioned service users were positive about the role of the key-worker and the inspector observed people interacting with staff in a relaxed and comfortable manner. The issues surrounding the recent departure of a staff member were discussed with the manger and the inspector was satisfied that the correct action has been taken so far. Following the requirement made at the last inspection the manager has obtained the relevant information about the new requirements under POVA. Apple Orchard DS0000016365.V250288.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): 24,25,27&30 The home provides a comfortable and safe environment that is reasonably well maintained. Some refurbishment is being undertaken and more is planned. EVIDENCE: The home is currently making improvements by updating one bathroom and providing another with a bath/shower. One bedroom has also been converted into an en-suite. There are also plans to convert two other bedrooms into ensuites. Other decoration and updating is planned and a requirement has been made that the Commission be provided with a schedule of the planned work for the coming 12 months. 8 of the bedrooms were seen and these were all personalised and reasonably decorated, though some will require attention soon. Service users were observed making use of their rooms and several stated they were happy with their accommodation. Two service users with limited communication skills showed their bedrooms to the inspector and it was evident they were happy and comfortable in their personal space. The communal areas were clean and comfortable, though as commented in the previous report, some of the décor in the large hallways, upstairs and down, is looking a little worn. Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 17 The raised toilet seat and frame in the downstairs toilet needs to be replaced. Overall the home appeared clean and hygienic and provides a homely and comfortable environment. Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 The home has followed the correct recruitment procedures for the appointment of new staff. EVIDENCE: The home has appointed 2 staff since the last inspection and examination of records showed that the correct procedures have been followed. All staff files seen contained the required information. Supervision records were not seen but the manager stated that staff had been receiving regular supervision and that staff were up to date with the required statutory training. A more detailed inspection of staff training and induction will be undertaken at the next inspection. Apple Orchard DS0000016365.V250288.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): These Standards were not inspected during this inspection EVIDENCE: Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 20 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 X X X x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X 2 X X 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score X X X 3 X x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Apple Orchard Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000016365.V250288.R01.S.doc Version 5.0 Page 21 x Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 22 no 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 2 Standard YA6 YA6 Regulation Requirement Timescale for action 30/12/05 30/11/05 3 YA17 4 5 YA30 YA24 6 YA9 7 YA6 15(1)&(2)(b) The home must ensure that future needs are assessed and identified 12(4)(a)&(b) The home must ensure that appropriate language is used when referring to the service users 13(2) The home must ensure that all medication is dispensed form the original packet and not transferred to alternative containers for dispensing 23(2)(n) The home must replace the raised toilet seat in the downstairs toilet 23(2)(b) The home must supply the Commission with details of the planned renovations and repairs for the coming 12 months 13(4)(c) The home must ensure that all risk assessments are up to date and appropriately reviewed 15(2)(b) The home must ensure that up to date care plans are in place for all service users and that these are regularly reviewed 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 Apple Orchard DS0000016365.V250288.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 2 Refer to Standard YA17 YA6 Good Practice Recommendations The home should review whether sufficient choice is provided to service users on a vegetarian diet The staff should be provided with training in care planning, including the person centred approach the process Apple Orchard DS0000016365.V250288.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Apple Orchard DS0000016365.V250288.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. 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