CARE HOME ADULTS 18-65
Hft - Orchard View 7 Waterloo Road Bidford On Avon Warwickshire B50 4JP Lead Inspector
Maggie Arnold Unannounced Inspection 7th February 2006 10:00 Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 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 Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 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. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hft - Orchard View Address 7 Waterloo Road Bidford On Avon Warwickshire B50 4JP 01789 490730 01789 772790 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) www.hft.org.uk Home Farm Trust Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th September 2005 Brief Description of the Service: The home is a purpose built, large bungalow for six people with severe learning and physical disabilities. It is part of the Arden Vale Scheme located on a rural campus of the parent body, Home Farm Trust. The site has another 2-unit home for a total of 9 residents, and a large activity centre, which most residents use to some degree during the week. All bedrooms are single without en-suite facilities, there are vanity sinks in each bedroom. The home is fully wheelchair accessible. There are three bathrooms, two with specialist baths (easibaths) and a walk in shower room. There is an enclosed garden area. It is paved with border shrubs, water feature and garden furniture and is easily accessible for service users. The home is near to the village of Bidford on Avon, where there are a number of local amenities. Stratford is approximately 9 miles away, Redditch is 12 miles and Evesham is 8 miles away, where there are a variety of facilities available. Full personal care is provided. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday between the hours of 10.00 am and 12.30 pm. Two care staff were on duty to meet the needs of the three residents. The manager was available for the last hour of the inspection. The main focus of the inspection was to check compliance with requirements arising from the last inspection and to scrutinise the remaining core standards. The scope of the inspection was limited due to manager being recently recruited and only available for the last hour of the inspection. The time the inspector spent in the home was limited by the home having a prior arrangement to go bowling immediately after lunch. What the service does well: What has improved since the last inspection?
Since the last inspection the home has recruited a new manager. The manager advised that she intended to apply to become a registered care manager in the near future. There was a noticeable improvement in the overall quality of recording. Records were easy to cross reference, succinct and up to date. In particular there was a significant improvement in the healthcare records of the residents. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 6 For example, records showed that the home had consulted with other professionals regarding the specific needs of a resident. Records of a confidential nature were securely stored. This evidenced that requirements arising from the previous inspection report had been met. Development work has also been undertaken to improve the records of activities that have been undertaken or proposed. It was pleasing to note that the home had a large poster detailing proposed monthly outing for the forthcoming year. Work was in progress to upgrade the home’s garden. This will make the outdoor environment much more accessible and stimulating for the residents. What they could do better:
A requirement arising from a previous inspection for residents’ contracts to include further details regarding what is/ is not included in the home’s fees remains outstanding from previous inspections. There has been a significant improvement in the residents’ dietary records and menus. Details such as whether the fruit and vegetables are fresh, frozen or tinned would further improve the records. Records should also be maintained of the types and amounts of fruit or vegetables that are used when making soups or liquidised drinks. More nutritionally balanced options must be offered for teatime meals. Records of incidents such as falls or bruising must note when there is no further cause for concern. The medication cabinet, both inside and out, is to be maintained in a clean and hygienic manner. Daily administration record (MAR) sheets must always be completed. Reasons for gaps in the records are to be investigated and noted on both the MAR sheet and the resident’s file. The numbering receipts and recording of where shared receipts are to be located could further improve records of residents’ finances. Wherever possible copies of training certificates are to be held on file. In the event of such evidence being unavailable staff should sign and date the training sheets to verify attendance/completion of the training. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 7 Unless a risk assessment indicates otherwise hot water outlets, accessible to residents, must be maintained at approximately forty-three degrees centigrade. More frequent monitoring checks are required in the event of very high or low hot water temperatures. The records could be further improved by varying and noting the times the checks took place. 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. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 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 Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 The lack of clarity in some parts of the residents’ contracts results in the residents not being sure what services are/ are not included in the home’s weekly fees. EVIDENCE: A requirement arising from a previous inspection for contracts to include further details remains outstanding. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 10 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): Not assessed on this occasion EVIDENCE: Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 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, 16 & 17 Residents well being and confidence is promoted by a variety of stimulating activities. The daily routine of the home helps to ensure residents’ rights and responsibilities are promoted and respected. The lack of a fully nutritionally balanced menu potentially compromises the health and well being of the residents. EVIDENCE: Records seen evidenced that the home offers a variety of age appropriate for the residents. Social activities include bowling, hydrotherapy, shopping, craftwork and gardening. All of the residents attend a Home Farm Trust day centre located on the same site as Orchard View. The number of days attendance varies in accordance to the residents’ needs and preferences. The home also has a planned programme of monthly day trips for the forthcoming year. These include visits to the theatre, a wildlife sanctuary and Cadbury World.
Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 12 Within the constraints of group living, the home encourages individual choice, independence and freedom of movement. Care plans and accompanying records evidenced that residents are encouraged to do as much as possible for themselves. This may be a small task such as taking items to the laundry, helping to set the table or assisting with baking. Subject to risk assessments and with the exception of other residents’ bedrooms, residents have unrestricted access to the home and gardens. There are ample places in the home, which allows residents to choose whether they wish to be alone, or in the company of others. Throughout the visit it was noted that staff talked and interacted with the residents and not exclusively with each other. A discussion took place regarding how food intake records and the menus might be improved. It is recommended that records include details of the type of fruit and vegetables used and whether they are fresh, frozen or tinned. The teatime menu options are not nutritionally balanced. Records showed that a dietician had also recently made the same observation. It is recommended that the home consult further with the dietician for guidance as to how the menus may be improved. Records of specific dietary requirements and food intake have improved since the previous inspection. There was also clear evidence that the home had consulted with other professionals regarding the specific dietary needs of a resident. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 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): 19 & 20 The failure to maintain detailed records of the residents’ physical health care needs compromises the welfare of the residents. The failure to adhere to the homes medication polices and procedures place the residents’ health at risk. EVIDENCE: Discussions with the staff and manager combined with records seen demonstrated that requirements arising from the previous inspection, regarding standards nineteen and twenty, had been met. For example, records seen evidenced the involvement of a dietician and steps taken to acquire liquid medication. Records seen clearly recorded when there were concerns such as a resident having a fall or feeling unwell. However the records did not indicate when there was no longer a cause for concern. The registered person must ensure that, in the event of such circumstances, records indicate when there is no longer a cause for concern. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 14 The home has a corporate policies and procedures for the safe management of medication. The majority of medication is issued in a monitored dosage system (MDS) and recorded on accompanying daily medication administration (MAR) sheets. The medication cabinet was securely stored in a locked cupboard. It was pleasing to note that the there is a good system in place to monitor stocks of medication. There were a number of missing entries on the MAR sheets and the medication cabinet was sticky and grubby. Details of cranberry juice had been recorded on a MAR sheet. This should be recorded on diet/fluid charts. The MAR sheets are only to be used for their stated purpose. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Procedures are in place that help to protect the residents from abuse. EVIDENCE: Standard 22 was not fully assessed on this occasion. Neither the Home nor the Commission for Social Care Inspection have received any formal complaints regarding the service in the last twelve months. The Home has a corporate complaints procedure, which is routinely reviewed. The documents were not looked at on this occasion. A discussion took place regarding an incident involving an Orchard View resident, which took place at the Home Farm Trust resource centre. The manager acknowledged that the incident had raised some concerns and present guidelines were being reviewed. A check of residents’ personal allowances found the balance of monies to be correct. Advice was given as to how the records could be further improved. For example, the numbering of receipts and notes on the individual resident’s records noting where joint receipts are held. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 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): Not assessed on this occasion. EVIDENCE: As on previous inspection the home was very clean, comfortable and free from excess clutter and unpleasant odours. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Not assessed on this occasion. EVIDENCE: Due to time constraints Standard 34 could not be assessed on this occasion. The recently recruited manager advised that she was in the process of familiarising herself with all the relevant procedures and paperwork. Wherever possible copies of training certificates are to be held on file. In the event of such evidence being unavailable staff should sign and date the training sheets to verify attendance/completion of the training. This is an outstanding requirement arising from the February 2005 inspection. Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 18 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): 42 Hot water maintained above the safe levels places the residents at risk of scalding. EVIDENCE: As on previous visits the home was very clean with no unpleasant odours. A brief tour of the kitchen found that food was appropriately stored. For example, food in the refrigerator was stored on the correct shelves. Foodstuffs such as opened cheese and meats were covered with cling film and dated. The home maintains monthly records of hot water temperatures. A check of one hot water outlet recorded a temperature of 50 degrees centigrade. In accordance with the Department of Health guidance hot water outlets accessible to residents should be maintained at approximately forty-three degrees centigrade. In order to reduce the risk of residents suffering from scalds or burns the home must ensure that hot water temperatures are maintained at a safe level. A discussion took place as to how the records of hot water temperatures might be further improved. For example, the time of day the temperature was checked.
Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 19 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 x 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 3 ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 x 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x x x x x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 x 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 2 x x x x x x 2 x Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 20 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. Standard YA5 Regulation 5(1b&c) Requirement Contracts require further detail in order to ensure that the resident are clear regarding what services are/not included in the homes weekly fees. This remains outstanding from previous inspections. 2. YA17 16(2)i. Sch.13 The registered person must ensure that more nutritionally balanced options are offered for teatime meals. The registered person must ensure that, in the event of health care concerns such as illness or a fall, records indicate when there is no longer a cause for concern. 28/04/06 Timescale for action 16/06/06 3. YA19 12(1)(a) 14/04/06 Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 21 4. YA20 13(2) The registered person must ensure that: Medication is stored in hygienic conditions. Reasons for missing entries on the daily administration medication (MARs) sheets must be investigated. The outcome of the investigation should be noted on the MARs and the resident’s healthcare files. MARs are used only for their stated purpose and not for the intake of cranberry juice. This is an outstanding requirement arising from the February 2005 inspection. Wherever possible copies of training certificates are to be held on file. In the event of such evidence being unavailable staff should sign and date the training sheets to verify attendance/competion of the training. The registered person must ensure that hot water temperatures accessible to the residents are maintained at a safe level. 14/04/06 5 YA35 18.1.c.i 16/06/06 6 YA42 13(4)(c) 14/04/06 Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 22 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 YA17 Good Practice Recommendations 1 Details such as whether the fruit and vegetables are fresh, frozen or tinned would further improve nutritional records. Records should also be maintained of the types and amounts of fruit or vegetables that are used when making soups or liquidised drinks. It is recommended that the home consult further with the dietician for guidance as to how the teatime menus might be improved. The numbering of receipts and recording on file where joint receipts are held could further improve residents’ financial records. It is recommended that the home varies the day and time that hot water temperatures are monitored. The monitoring records would be further improved if such details were clearly recorded. 2 3 YA23 YA42 Hft - Orchard View DS0000004245.V282731.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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