Inspection on 01/11/06 for Cherry Orchards Camphill Community Ltd

This inspection was carried out on 1st November 2006.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry Orchards Camphill... 24/09/07

Cherry Orchards Camphill... 18/01/06

Cherry Orchards Camphill... 08/09/05

Cherry Orchards Camphill... 08/12/04

Cherry Orchards Camphill... 26/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

Clouds House

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 Cherry Orchards Camphill Community Ltd Canford Lane Westbury On Trym Bristol BS9 3PE Lead Inspector Peter Still Key Unannounced Inspection 1st & 7th November 2006 10:10 Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.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 Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.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. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Orchards Camphill Community Ltd Address Canford Lane Westbury On Trym Bristol BS9 3PE 0117 9503183 0117 9593665 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) Cherry Orchards Community Limited Miss Gitte H. Knudsen Mr Stephen Sands Mrs Valerie Sands Care Home 21 Category(ies) of Past or present alcohol dependence (21), Past or registration, with number present drug dependence (21), Learning of places disability (21), Mental disorder, excluding learning disability or dementia (21) Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 21 persons aged 18 - 64 years of age Date of last inspection 18th January 2006 Brief Description of the Service: Cherry Orchards is a therapeutic community, set in 18 acres of land, yet it is within reach of local shops and amenities. It is registered to provide accommodation and personal care for people with mental health needs. The community is based upon the philosophy of Rudolf Steiner. The number of registered places includes all rooms inclusive of the co-worker’s rooms. The community feels that it works best with 12 residents. Voluntary co-workers live on site in the two main buildings with the residents, providing 24-hour support. Bedrooms are large with very pleasant views over the land. A large emphasis of the day-to-day living is based upon tending the land and the animals. There is a large landscaped garden with numerous areas to sit and relax. There is also a gardener and a part time therapist. The service is not suited for people who have difficulties with mobility. The cost of placement is £829.00 per week and people who wish to consider the Cherry Orchards are given information about the community and the service before they visit. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place principally over one day with a brief return to complete the process and provide feedback. This inspection visit coincided with a planned feedback to the service by the Mental Health Foundation, who had been commissioned to conduct a major external study to aid development of practice. Clearly this key meeting needed to take priority over supporting the inspection, however managers did provide good input and this also included the acting manager who had returned to the service following her interview with CSCI to become the third registered manager at the home. She replaces Mrs Van Rooy, who had left the service two years ago. Evidence was gathered from a number of different sources: - Information taken from the pre-inspection questionnaire - Information taken from three resident, two relatives and one professionals response to survey forms - Directly speaking with residents and a Trustee during the visit - Case tracking a number of residents - Speaking with co workers - A tour of the premises - Examination of some of the homes records - Observations of staff practices and interaction with the residents. The overall analysis is that the home is a positive, therapeutic and tranquil place to live, where residents are supported to make changes in their lives that make them happier. Requirements and recommendations from the last inspection had been addressed however, risk assessments, policies, procedures and documentation need to be reviewed or completed to ensure they meet regulations and protect residents. The responsible individual and registered managers may need external help to comply with some requirements. An action plan will be required, which identifies the priorities and timescale for action, which must be sent to the commission. Three urgent items have been identified for immediate action. The local Bristol adult protection protocol must be obtained and brought into use. The current adult protection policy for the Cherry Orchards service must be reviewed with the help of the adult protection coordinator so that it is clear and fully meets current requirements. Work place risk assessments must be produced for all identified areas of risk within all buildings on the property. What the service does well: Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 6 A superb environment is provided, set in large rural grounds and yet close to local amenities. The community has a very calming ambience, which is enhanced by the extensive grounds and a number of different buildings, offering a range of activity. Residents spoken with, talked of how the service supports them and of the respectful and helpful relationship with all staff, they also spoke of the beneficial way the community works, through positive communication and how people are valued as individuals. The ethos of the community is clearly crucial to supporting the personal life changes residents wish to make. Residents and staff talked about the organisation of the community, where everyone has responsibilities and decisions are made at ‘Gatherings’, where all points of view are valued. Relatives gave high praise for the care provided and a professional wrote about good communication, friendly and helpful support and praise in that the therapeutic service is recommended to other professionals. What has improved since the last inspection? What they could do better: It is important to ensure clarity concerning the different roles and responsibilities of trustees, the three registered managers and of other staff, and an organisational structure is needed. This information must be written into the statement of purpose and service user guide. The statement of purpose and service user guide must be reviewed and improved and it must include details of qualifications and experience of all staff. Managers must have job descriptions and voluntary co-workers must have a written description of their work and tasks. A homely remedies policy and procedure must be produced and the service must not purchase any medicine for staff. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 7 Two requirements remain outstanding from the last inspection: Resident’s risk assessments must be reviewed to ensure clarity and that all risks are assessed. These must include risk assessments for people who self medicate. The organisation must be mindful that enforcement action may be taken if requirements are not addressed The Cherry Orchards policy and procedure about complaints must be reviewed and guidance sought to ensure it is fit for purpose. A review of all the complaints documentation needs to be undertaken to ensure the information is up to date. One document did not have the phone number of the commission, whilst the printed home brochure did. Residents and their supporters and professionals must also be made aware of the complaints procedure. The Cherry Orchards must ensure it is in compliance with health and safety at work legislation and provide work place risk assessments for all buildings and areas of risk. 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. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 8 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 Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 9 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): 1, 2, 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The services admission procedure ensures that placement is only offered to those whose needs can be met. The statement of purpose and service user guide must be improved to ensure people have all the information they need about the service. EVIDENCE: The service has a comprehensive approach to the admission process for people wishing to become a resident, including an information pack with details about the service. Information about people wishing to have a placement is considered by managers and then shared with staff at a care circle meeting. The inspector attended part of one of these meetings. When prospective residents visit Cherry Orchards, two residents now have formal involvement in the process and a copy of their guidelines was given to the inspector. Care files of residents case tracked showed good communication with placing authorities and professionals and full pre placement assessments were seen. Prior to an admission, the service uses a structured approach called an assessment period with trial visit. The statement of purpose and service user guide must be reviewed with further information and clarity provided. One survey response to the Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 10 commission said that the brochure did not really give a proper view of Cherry Orchards – though the one-month trial period did. The statement of purpose and service user guide needs to include an organisational structure, which provides clarity about the roles and responsibilities of the trustees, the responsible individual and the other two registered managers. It is unusual for a care facility to have more than one registered manager, which makes it very important for people to be fully clear about the different roles and responsibilities of the management team. It will be necessary for the responsible individual to refer to the national minimum standards and care home regulations to ensure that all points required are included. It will also be necessary to include within the statement of purpose, the qualifications and experience of all staff and this will need to be kept up to date. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their needs will be met within a structured care planning processes. However residents risk assessments must be reviewed to ensure resident’s protection. EVIDENCE: The inspector attended a part of the weekly Care Circle meeting where staff plan their work with residents. Written Care plans produced by care managers were seen for two residents case tracked. Care plans were formally reviewed, include the resident and external agencies and were undertaken every six months. From correspondence seen with professionals, it was clear that good communication exists. Resident’s were supported by key workers who are senior members of staff and notes of their meetings with residents, were signed by both. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 12 The inspector found the system complex, with information held in different places, however staff were familiar with it and say it works for them. It was very thorough. Residents spoken with knew who their key workers were and said that they were fully included in the process and happy with the outcomes. Feedback from relatives also supported the care planning process. One resident said staff know what is best for them before they do, indicating that staff are very much in tune with residents needs. This resident talked about the realistic challenges that are given to residents and gave an example of cookery, where he/she did not feel it was appropriate but that two weeks into the course, found it was clearly just what the resident wanted. Resident’s talked about being very supported by all staff, who respected and valued them. They also made an important point about the culture of the community in that everyone is treated in the same way, whether it be resident or staff. Two resident’s spoken with felt their care programmes have helped to bring positive change to their lives and that they are stronger as a consequence. One resident talked about the time when they would leave the community and of issues around this. Residents spoken with said that if they had a difficulty, then it was always addressed swiftly and not left to become more of a problem and if needed, a meeting was held and one resident said the outcome was always helpful. A requirement will be repeated that all resident risk assessments must be reviewed. Many risk assessments had been reviewed recently but some dated back to 2003 without evidence of a review and some risk areas had not been assessed. A number of files were reviewed and the inspector had difficulty in being clear about the risk and information contained on the hand written forms. Some assessments related to the same risk and it was considered that the current system and way of recording could be confusing for staff. The acting manager supporting the inspector said she understood the steps to take to improve them, including reference to the national minimum standard and the need for a new form, with review dates. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 13 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. Residents will be given opportunities to participate in a stimulating and varied life, with a range of activity. A healthy diet is a key element for the community. EVIDENCE: The ethos of the community places great emphasis on the lifestyle opportunities available to residents. Cherry Orchards is set in 18 acres of landscaped grounds, which includes horticulture and the extensive use of home grown produce for the community. Residents are fully involved with preserving and the sale of produce at the farmers market. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 14 The grounds include many communal and quiet areas for residents to enjoy and this environment is a very important for residents. A building is used for candle making, and the products are used at Cherry Orchards and are also sold to raise funds. A healthy diet is promoted and resident’s involvement promotes this. Since the last inspection a significant building conversion project has been undertaken to provide a large arts studio, which has good north lighting and is developing into a valuable resource. The hall is used for a variety of activities and the floor had just been resealed. Music is a key activity and was well catered for. Most residents enjoy using the local community, including the library and gym. One resident was undertaking a languages course and another resident volunteers at the local Oxfam shop. Residents spoken with were happy with the level of activity and lifestyle. Staff spoken with were enthusiastic about life at Cherry Orchards and the varied skills and cultural influences enhance residents lives. Comments from relatives also supported this evidence: The organic food, calm atmosphere and regular life of the community with its rhythms and festivals is immensely healing; the programmes contribute to overall health and well being. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 15 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, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s personal and healthcare needs are protected and supported by a good system and knowledgeable staff. A homely remedies policy will protect residents. Risk assessments must be completed for residents who self medicate. EVIDENCE: Two residents spoken with said staff were respectful, listen and address their needs. One relative wrote about the importance of respect and of the positive outcomes. Details of resident’s healthcare were found within care files and diary entries are made to ensure appointments are held. Care plans show that formal reviews take place six monthly. Good communication with external professionals was also seen. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 16 The pre inspection questionnaire completed did not include details of professionals and it appeared there was a lack of contact; however, this was a wrong assumption since communication is significant and on going. A professional also completed a visitors comment card, giving good praise for the service provided. It will be important for this pre inspection section to be completed for the next inspection. Both residents and relatives made key points about the way emotional health needs were supported. These included: very pleased with the overall health and well being; a wonderful community in the way it cares for its residents and the strengths and wisdom of the therapeutic philosophy and practice; extremely happy with the care it is of the highest standard; I really believe Cherry Orchards is a brilliant place staff always listen and respect residents. The medication system was audited on a four weekly basis. The local pharmacist visited last year and gave advice. There has been a change of pharmacy and the acting manager will make contact with a view to gaining staff training and an external audit with the local pharmacy. The medication system was checked on the second day of inspection and found to be correct. Points of good practice provided to the service previously by the commission pharmacist were being complied with, however some homely remedies were seen in the medication cupboard and a requirement will be made to provide a policy and procedure for this. Homeopathic remedies were also seen in a locked cupboard within the service and the inspector was told that these were only for use by staff. Following further guidance to the inspector from the commission pharmacist inspector, information was given to the responsible individual who decided that the homeopathic remedies would be taken from their present location and given to staff to keep within their own private accommodation. Individual staff must have full responsibility for the purchase of any personal medicine, which is then a private matter for themselves. Risk assessments for residents who self medicate were not found and these must be included within the review of all risk assessments already mentioned in this report. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 17 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. Residents are supported by staff who listen to their views and who have received training about the protection of vulnerable adults. Ensuring the Cherry Orchards adult protection policy is fit for purpose and is understood, will keep residents safe. EVIDENCE: The inspectors reading of the current Cherry Orchards adult protection policy indicated that internal investigations could take place, before contact with the police or the adult protection coordinator. The responsible individual must ensure the Cherry Orchards adult protection policy is fully fit for purpose. An urgent requirement will be made for this to be undertaken without delay. The responsible individual may wish to communicate with the adult protection coordinator at social services to seek guidance. The managers must ensure the Cherry Orchards policy is revised. These points were discussed with the acting manager who said that steps would be taken to address it. On the first day of the inspection, there was misunderstanding of the terminology of what the Bristol adult protection protocol was, however it was found and seen on the second day. It would be helpful if all key documents relating to the policy of adult protection were kept in one place. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 18 Staff received training concerning the protection of vulnerable adults (POVA) in 2004 and further training by First Response is planned for 24/11/06. Two members of staff questioned about steps to take if they had any concern about possible abuse said that they would immediately take the matter to a senior member of staff. In house training was provided to staff at induction and also recorded at staff meetings. One staff supervision record noted that POVA had been discussed. Information for residents about how to make a complaint was reviewed and the phone number of the Commission had not been included within the section of the service user guide, pack, sent to people who wish to consider placement. This was also found at a previous inspection and a requirement will be made for this to be responded to. Two of three comments from relatives/visitors and one of three residents who responded, indicated they were unsure about the complaints procedure, which provides further evidence that the policy and procedures need to be reviewed. Two residents spoken with said that staff listen to their needs and take swift steps to address issues, they also said that if necessary a meeting would be called quickly to address concerns or difficulties. They said they were happy and confident that action would be taken if necessary and have been content with the way matters have been addressed in the past. All staff have had CRB checks and these were seen. One file reviewed for a new co-workers showed a CRB check plus a police check from the country they had come from. Concern about a previous member of staff, raised by residents, had been reported to the commission through regulation 37 reporting. This matter provided an example of how staff listen and respond to concerns raised by residents. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. An exceptional environment is provided, which enhances the wellbeing of residents. Work place risk assessments must be undertaken to protect residents and staff. EVIDENCE: Residents enjoy a comfortable and homely environment with a range of facilities. The wooden floor to the hall had been sanded and resealed since the last inspection and looked like a new floor. The main kitchen was homely, however there were plans to refurbish it. The other kitchen was also homely and spacious and both were clean and tidy. There are a number of plans for future improvements to the Cherry Orchards. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 20 The last inspection noted a problem with an identified bath, shower room and this was responded to following the inspection, unfortunately after the work was completed a leak was found and on the day of this inspection the bathroom was being completely refurbished, including the flooring. It was understood the work would be finished within a week. Work place risk assessments had been identified at the last inspection, to be completed for all buildings and areas of risk and a requirement will be made for these to be undertaken urgently. Since the task is significant the responsible individual may wish to seek external professional support. Urgent action is required to ensure residents and staff, are safe. A manager acknowledged that whilst no incident had occurred, the health and safety assessments must be undertaken. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 21 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): 31, 32, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff roles and responsibilities must be clear for the protection of residents. Residents are supported by a competent and qualified senior staff team and by co-workers who bring a range of skills and experience to the service. The service has robust recruitment practice, which protects residents. Resident’s needs are met by staff who undertake training and resident’s benefit from staff that receive regular supervision and support. EVIDENCE: Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 22 It has already been reported that there needs to be clarity about staff roles and responsibilities. The ethos of the community is such that all staff are regarded as equal and according to one of the managers, job descriptions for all staff would present complications for the Charity in having voluntary staff. The importance of clarity of staff roles and responsibilities was understood and descriptions of work and tasks will be produced. The acting manager recognised the need for her to have a job description and will ask for this. Qualified senior staff, carry out the key functions at the service. The inspector considered that staffing levels and staff competence was satisfactory to meet resident’s needs, bearing in mind that whilst the registration is 21 residents, managers currently consider 12 as a maximum. There were ten residents on the day of inspection. Residents spoken with felt there was sufficient staff and the service has a good track record for providing positive outcomes for its residents. The total staffing for the service, comprised nine staff working directly with residents, a gardener and a part time therapist and secretary. The community runs with staff that live and share their lives with residents to provided constant support and continuity. Two staff files were reviewed and both contained two references and evidence of CRB checks. Staff induction was also seen. There is a future plan to include residents in the recruitment process for new staff. Training opportunities and mandatory training are provided for staff and include in house events. Residents receive food hygiene training along side staff. The acting manager considered the staff training matrix recommended at the last inspection and agreed it would be a valuable management tool to establish. Supporting all staff with NVQ training has been a problem for the service since voluntary co-workers are not eligible to undertake NVQ level 2 or above, where they have not resided in this country for three years. Senior staff have a range of qualifications and experience and younger co-workers also come with experience or are undertaking degree courses, which are relevant to the work of the community; their diversity and skills are also valuable to the community. All residents spoken with said they relate well to all current staff and find coworkers help them with their lives. The inspector considers that whilst not all staff hold official qualifications, the outcomes for residents are good. The standard for care homes to provide a minimum of six staff supervisions a year is exceeded. Staff sign a form, which was reviewed to make a record that weekly supervision, of one hour had taken place, but notes of these sessions Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 23 are considered to be confidential and are not fully recorded. Detailed three monthly appraisals for all staff were undertaken and notes were seen for two staff; a copy of the guidelines for these was given to the inspector. Senior staff have peer supervision and the responsible individual and his wife have additional external supervision. The inspector was told that these are confidential and not recorded. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 24 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. The management team strive to continually improve practice and are open to guidance and resident’s views underpin the running of the service. Further oversight by Trustees will support effective management to ensure legislative requirements are met. The health and safety of residents will be protected by a review and implementation of policies, procedures and documentation, which includes risk assessment for both residents and the work place. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 25 EVIDENCE: There is a fine balance in ensuring residents are safe and protected and that the culture of Cherry Orchards, which supports residents so well, is also protected. This is the key responsibility and task for the Charity. Resident’s say the way the service is run, works for them, providing positive outcomes; this was also supported by relatives and a professional who responded to the commission with comment cards. A co-worker said that there was not a great emphasis placed on policies due to the nature of the community. The way the service is run can make it difficult to interpret the regulations and national minimum standards, ensuring they can be in line with the ethos of the service and yet remain compliant with legislative requirements. This was discussed and managers understood, they need to find ways of ensuring legislative requirements are met and that policy and procedure is understood and followed by staff. The inspector was given a copy of the services policy on quality assurance, which demonstrates a commitment to make this a priority task. The report by the Mental Health Foundation will provide a valuable reference point, when considering the quality of the service and future development objectives. The responsible individual said a copy of the report would be sent to the commission. The report had taken a long time to complete since the author had been sick and it was essential that they provided the feedback. It will be important for the service to establish surveys to gain written feedback from residents, their supporters and professionals involved with their care. One resident raised an issue with the inspector about difficulties they may experience at the point they leave the community and a Trustee spoken with during the inspection also raised the issue of the difficulty in obtaining feedback from past residents. A manager considered that residents need to put all their energies into their new life and that this may be a reason for the service not having feedback responses. Managers have done well to pursue this and agreed to consider further ways of trying to gain feedback. Residents do complete a survey questionnaire after they arrive and then again nine months after. Analysis of these will be helpful. Evidence at the inspection indicates that Trustees are working hard to support development of practice and quality assurance, they bring a wide range of valuable skills. Regulation 26 visits, now completed by Trustees had needed to Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 26 be more informative and those read before this inspection were considered to helpful to be the management team, providing depth, covering key issues and raising important points. The last report seen at the CSCI office was dated 17/08/06 and the responsible individual was reminded that it is necessary for these to be sent to the commission on a regular basis. Since Trustees are now completing the monthly unannounced visits and will talk with residents, CRB checks must be obtained and five of the six Trustees will need this. At least a POVA First check must be completed before the current Trustee with the Regulation 26 brief makes her next visit. The Trustee spoken with talked about the way he and his colleague Trustees are working hard to support the service and of the complexity of need of people who use it. He said there is now a strong Trustee group, with each member bringing their own area of expertise. He said he has documentation from Camphill about the role of Trustees and that a training/induction event is also offered. During the inspection there was discussion about equality and diversity and a good deal of evidence was provided to demonstrate that this aspect is crucial within the ethos of the service. It was said that equality and diversity flows through the community. There is an open culture of feedback and people are given confidence to challenge and everyone is valued for their point of view, and who they are. The service includes people from many cultures and different food and cultural experiences are enjoyed by everyone. This includes singing, dancing and newspapers. One resident is undertaking a languages course. Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 27 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 2 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 2 X 2 X 3 X X 2 X Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 28 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 YA23 Regulation 13(6) Requirement a) The current Cherry Orchards service adult protection policy to be reviewed to ensure it is fit for purpose by 30/11/06 b) Provide staff with training to ensure understanding of the adult protection policy. The telephone number to be included with the address of the commission, in all related documentation. a) Health and Safety, Work Place risk assessments to be produced for all buildings on the property and including all risk areas. (Previous timescale of 31/03/06 not met) b) The provider must produce and send CSCI Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 29 Timescale for action 28/02/07 2 YA22 22(7a) 17/11/06 3 YA42 13(4a,c) 28/02/07 an initial list of priority risk areas to be assessed by 24/11/06 c) The priority assessments to be completed by 08/12/06 c) Provide an action plan to complete remaining assessments by 08/12/06 4 YA9 13(4b,c) Risk assessments to be produced for individual residents, which clearly identify the risk with actions and strategies to reduce the risk. One assessment is to be produced for each risk identified and will include review dates. (Previous timescale of 31/03/06 not met) A homely remedies policy to be produced. Residents who self medicate to have risk assessments in place. (Previous timescale of 31/03/06 not met) Review the service user guide to ensure it meets regulations and national minimum standards. Provide an organisational structure, including relevant qualifications, experience and responsibilities of the responsible individual, registered managers, all staff and trustees. Review the statement of purpose to ensure it fully 31/01/07 5 6 YA20 YA20 13(2) 13(2) 22/12/06 15/12/06 7 YA1 5(1a-f(2)(3) 6(a,b) 02/03/07 8 YA1 4(1a,b,c) 6(a, b) 02/03/07 Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 30 complies with the regulations and national minimum standards. 9 YA34 4(b, i) CRB checks are to be undertaken for Trustees and at least a POVA First check is undertaken before a Trustee undertakes a regulation 26 visit. 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 © 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 Cherry Orchards Camphill Community Ltd DS0000026530.V317930.R02.S.doc Version 5.2 Page 32 - 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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