Inspection on 21/05/08 for HMT Orchard House

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

HMT Orchard House 05/06/07

HMT Orchard House 30/05/06

HMT Orchard House 24/01/06

HMT Orchard House 23/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 HMT Orchard House Underdown Lane Herne Bay Kent CT6 5UD Lead Inspector Chris Woolf Unannounced Inspection 21st May 2008 09:20 HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service HMT Orchard House Address Underdown Lane Herne Bay Kent CT6 5UD 01227 373586 01227 749115 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) HMT Care Ltd Manager post vacant Care Home 10 Category(ies) of Physical disability (10) registration, with number of places HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th June 2007 Brief Description of the Service: HMT Care Ltd provides a specialist service for people diagnosed with Huntington’s Disease. There are two homes in the group. Both homes cater for people of either sex, and aged over 18 years of age. Orchard House is registered to provide accommodation and personal care for ten adults. The home is situated within easy walking distance of local shops and is near to the town and seafront. It can easily be accessed by rail, or by the M20/M2 motorways. Orchard House is a large, Edwardian, detached building, with ten single bedrooms on two floors (ground and first floor). All bedrooms have en-suite toilet facilities, and some also have a shower or a bath. The home has a passenger lift for easy access between floors. Residents are carefully assessed for their compatibility with other residents in the home, in order to provide a settled and homely atmosphere. The property has a garden at the front, and off-road parking. The access road is privately owned, and kerb-side parking is subject to wheel clamping and accompanying fines. There is an enclosed garden at the rear. The current fees for the service at the time of the visit are set at £1610 per week. However some of the existing residents are on lower protected fees. Information on the Home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is hmt-care@btinternet.com HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes Information for this report has been collated from an Annual Quality Assurance Assessment (AQAA) completed by the home. Comment cards received from 7 residents and 2 members of staff. Information received by us (the Commission) since the last inspection. We also made a site visit to the home, which lasted 7 hours and 50 minutes. The site visit was unannounced, this means that neither the staff nor the residents knew that we were coming. The home has recently appointed a new manager and she made herself available to give us any assistance we needed throughout the day. The responsible individual was also present and available for assistance for the majority of the day. The facilities manager was in the home for the morning and he provided us with all of the information we required regarding the building and health and safety. In addition to management staff we spoke with all of the residents, most in passing and 2 in more depth; the Physical Therapist who was working in the home on the day; and all of the staff on duty, 4 in more depth. We observed the interactions between residents and staff; administration and storage of medication; and lunch being served. A tour of the building was undertaken. A variety of records were examined, including care plans, staff recruitment files, fire and health and safety records, complaints file, menus, and the homes quality assurance records. The people who use this service prefer to be called ‘residents’ and this is the term that will be used to describe them throughout the report. What the service does well: The home provides a service specifically for people who have been diagnosed with Huntington’s disease. They have built up a good knowledge of the needs of the residents they care for, and are skilled at assessing and meeting these needs. A health care professional said, “The care is superb” HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 6 The revised care plans give good guidelines on the individual care needed by each resident. Residents are encouraged to be as independent as their illness allows. They are treated with dignity and their privacy is respected. Meals in the home are designed to meet the specific needs and problems of this group of residents and their likes and dislikes are taken into consideration. A dedicated staff team supports residents to lead the type of lifestyle that they prefer. A member of staff said, “The best thing about the home is the way the residents are treated. Its all for them, not for staff convenience”. The atmosphere in the home is friendly and welcoming. A health care professional said, “They always make me feel welcome”. A member of staff said, “I really like working here, it’s a great place, its very homely”. The home has good quality assurance procedures. There is a positive management team who are dedicated to running the home in the best interests of the residents. Resident comment cards included, ‘I like Orchard House very much’, ‘I’m just happy’, and ‘I am happy at Orchard House and I enjoy being here, I get to do the tings that I want to’. A staff comment card answered the question what does the home do well with, ‘Listen to complaints and acts on them. Service users are always kept in high esteem’. What has improved since the last inspection? The requirements made on the last report have all been met. Care plans have been revised and are currently being further updated to reflect the needs of the residents. Risk assessments are now in place for all assessed risks. Medication storage and recording has been improved. There are now sufficient staff on duty at all times to meet the needs of the residents. Other improvements include the purchase of a new staff-training package. Introduction of a staff-training matrix has been introduced. Mental capacity training for staff. Introduction of a new probationary induction system has been introduced for staff. Introduction of a concerns and suggestions box for staff to highlight areas for possible improvement HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 7 Professional working relationships have been forged with Guy’s Genetics clinic. Some environmental improvements have been made including additional swing free door closures, alterations to some ground floor rooms, and provision of a more appropriate smoking area. There has been an increase in day-to-day management hours for the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. HMT Orchard House DS0000061966.V363678.R01.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 HMT Orchard House DS0000061966.V363678.R01.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, & 4 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Prospective residents needs are assessed and they and their representatives have the information needed to make an informed choice about admission to the home. EVIDENCE: The Statement of Purpose provided by the home to all prospective residents includes a Charter of Rights for residents. This document has been recently updated. The home also has a brochure and this is also given to prospective residents and their representatives. The homes AQAA indicates that they are going to include photographs in the brochure to assist prospective residents in making decisions about the home. All comment cards received confirmed that the residents were asked if they wanted to move into the home and that they received enough information about the home before they moved in. Comments included, ‘I received enough information as I came to Orchard House for respite aprox 6 times a year before I moved in’, ‘Everything was explained to me. Some of my family members came to see the place, just to be sure it was good for me. Staff from Orchard House visited me in London HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 10 where I lived’, and ‘I knew it was the right place for me to live, because every one was really nice and kind to me’. Assessments seen were holistic and person centred and included physical, mental, cultural, religious, and diversity needs and an initial moving and handling assessment. The home tries to obtain a Care Plan and Risk Assessment from placing authorities but this is not always forthcoming. The home aim to pursue this more rigorously in the future. Residents spoken to both confirmed that someone had been out to see them to do an assessment prior to them moving into the home. One also said, “I am here part time”. Residents spoken to confirmed that their needs are met by the home and said, “Yes, very good”, and “I get support - I like smoking”. One comment card included ‘I agreed to be sent to Orchard House, just for the fact that my needs will be met, and am happy with that’. The home offers day visits and overnight stays at no cost to give prospective residents an idea of what it would be like to live there. Additional visits to the residents home are also made by senior staff, wherever possible, to familiarise the resident with staff they may meet again. In the event of an admission being agreed, the home ensures that the visiting staff member is on duty at the time of admission. A resident who was recently admitted to the home had been reluctant to move into residential care. She came in originally for respite care, but once there decided to move into the home on a more permanent basis. HMT Orchard House DS0000061966.V363678.R01.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 excellent. This judgement has been made using available evidence including a visit to this service. Residents are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: There was a requirement on the last report that care plans should be revised, kept up to date, and clearly reflect the needs of residents. The home has met this requirement. Care plans have already been revised comply and the home is currently undertaking a further revision to make the care plans more even holistic and to give better information to staff on how to meet the specific assessed needs of the residents. Care plans are initially drawn up from the homes assessment and where available the care management assessment. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 12 Care plans include personal goals, wants, needs and expectations; strategies to address needs; arrangements for specialist input; a reflection of the stage of disease and strategies to meet these; other health care issues specific to the individual; and a variety of risk assessments. Recent additions to the care plan include the introduction of ‘communication passports, favourite things information, and a likes and dislikes sheet. A key worker system is in operation in the home giving residents a named member of staff with whom they can discuss any needs or problems. All care plans are regularly monitored and audited both by the head of care and as part of the quality assurance programme. Each care plan is reviewed 6 monthly, or more often if there are changes in need. A staff comment card included, ‘We have regular care plan meetings and review cases’. Residents are supported to make decisions about all aspects of their lives. Residents spoken to confirmed that they have choices. Resident comment cards confirmed that residents make choices about what they do each day, their comments included, ‘I am given choices of what I want to do such as going out to the town or sitting in the garden or going to the pub or café or if I want to say in and watch TV’, ‘I have a choice of different activities’, and ‘Staff at times have to help me with my decisions due to my cognitive impairment’. Resident comment cards also confirmed that residents can choose what they do during the day, evening, and weekend. Their comments included, ‘I can do what I want within the confines of my illness’, ‘I can do what I want to do at any time of the day. For example I can sleep when I want, and watch the TV programmes I like’, and ‘This is sometimes effected by staff sickness, if I want to go out. But majority of the time I do what I want’. Staff said, “They have quite a lot of choices, whether to stay in bed or get up, whether to fill out electoral forms or not, choice if they wish to refuse medication, choices in everything”, and “They have lots of choices, Linda (Responsible Individual) is all for what makes them comfortable”. The AQAA commented that the home recently ascertained that a resident used to be particularly fond of a Scottish stout and they were successful in finding an outlet that could provide it. The home holds regular resident meetings at which time they can discuss any specific choices they wish to make. Residents who wish to are supported to manage their own monies. The home is does not act as appointee for any resident, this is dealt with by the resident themselves or their family or other representative. Many of the staff have received training in the Mental Capacity Act during the past year, this has helped them to understand the choices that can and should be made by the residents. There was a requirement on the last report regarding risk assessments. This has now been met and risk assessments are in place for all assessed risks. These assessments are accompanied by behaviour guidelines where needed. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 13 HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16, & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their life style. Social, cultural and recreational activities meet their individual expectations. Meals are planned to meet residents dietary needs and to satisfy their preferences EVIDENCE: Residents are helped to take part in valued and fulfilling activities. Currently no resident is in paid employment. However, one resident likes gardening and grows tomatoes in the homes greenhouse. He indicated that he is looking forward to the new allotment being available and has expressed the wish to attend the allotment and do gardening 5 mornings a week. Other residents are encouraged to take part in the activities which they enjoyed prior to HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 15 entering the home. Evidence was seen of a resident visiting an art exhibition in Whitstable. Another resident expressed the wish to go horse riding as she used to work with horses in the past. This is currently being looked into by her key worker. A comment card included the comment, ‘I would like to go horse riding with my key worker and go on holiday’. Staff support the residents to participate in the local community. Care plans indicated that recently residents had been to Herne Bay shopping and for lunch, into town to purchase new clothes, to the cinema, to the bandstand, and walking in the park. Where residents wish to attend religious services this is supported by the home. One resident recently expressed the wish to attend church but, although he is asked each week, he has so far not taken advantage of the opportunity. Residents said, “I go to town on a Monday”, “I go to the cinema”, and “We go out for a pub lunch”. When asked about activities one staff member said, “Swimming is being planned, they go shopping, for walks, to the sea front, some relaxation, and one likes painting”. Residents are supported to get away for holidays, although some prefer not to go away. The payment arrangements for holidays are recorded in the contract. Holidays tend to be for 4/5 nights at a time as this has been found to be best for the residents. Evidence was seen of residents going to Blackpool, Cornwall, and day trips to France. Staff encourage the residents to maintain their family links and friendships. A resident said, “I go home with my husband at weekends”. Friends visit the home and are regularly invited to supper. The home facilitates a support group for the residents families and friends. They also hold events such as bar-b-ques to which families and friends are invited. Routines in the home are flexible and promote independence and choice. Residents confirmed that the staff always knock before entering their bedrooms. Evidence was seen in the care plans that residents choice of name is recorded and it was witnessed that these were the names that the staff used. Residents can choose whether to sit with others or on their own and were observed moving freely about the home on the day of the site visit. Some of the residents like to smoke and there is a dedicated smoking room on the first floor and an area on the patio where they can smoke if they so wish. The home operates a 4 week menu. There is one main dish on the menu each day, but the cook always lets the residents know what is on offer and offers alternatives. A list of food likes and dislikes for each resident is recorded in the care plan and a copy is also kept in the kitchen. Because of the Huntingtons residents tend to need a high calorific input . They also often have difficulties in swallowing. These issues are taken into account in meal planning. Food and drinks are available between meals, day or night. Where residents need meals pureed these are served in separate portions allowing a variety of tastes and textures. Special diets are catered for as needed. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 16 Currently these include diabetic and pureed diets. Where assistance is needed with eating this is given in a sympathatic manner that respects the residents dignity. A record is kept of food that is eaten and food refused. Residents said “The food is good”, and “I get a choice”. Staff comments about the meals included, “Its fantastic”, and “They get a variety, we have a 4 weekly rota”. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 17 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 excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Resident’s preferences about personal support are recorded in their care plans. They are able to choose when they get up, go to bed, have a bath, and take part in chosen activities. A resident said, “They support me”. Resident comment cards included the comments, ‘I am awake a lot at night and I am given support by the night staff’, ‘I feel I am well taken care of while at Orchard House’, and ‘I feel that I am looked after well’. Staff said, “They have baths when they want, they are offered daily”, “No day is the same, we adapt our day to them”, and “If they want to stay in bed its up to them”. A visiting HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 18 health care professional said, “Every day is different, I’m pleased to be part of it”. Personal support is given in private. When asked if their privacy and dignity were respected residents commented, “Yes, very much so”, and “they always know how to treat us”. Each resident is allocated a key worker with whom they can relate and discuss any problems. Staff said, “We have a key worker system”, and “I became a key worker last week”. Where technical aids and equipment are needed they are available and are regularly serviced. A visiting health professional said, “They listen, we needed hoists and the management took it on board and arranged it”. A variety of aids were seen in the home including an assisted bath, a mobile hoist, raised toilet seats, a special chair, and sit on scales. The health care needs of the residents are met by the home supported by a team of multi-disciplinary health care professionals. The home employs a Physical Therapist who visits 6 times a month. She performs soft tissue manipulation to prevent stiffness and to maintain as much mobility as possible, and also massage. Residents said, “I do exercises”, and “I like massage”. The homes AQAA states that they have ‘Forged professional working relationships with Guys Genetics clinic’. Evidence was seen in the care plan s of contact with Huntington’s Specialist, doctor, chiropodist, optician, dentist, continence nurse, and physical therapist. When asked if her health care needs were met a resident said, “Yes, very good”. Medication storage and recording has been improved since the last inspection. There was a requirement on the last report regarding medication and all parts of the requirement have now been met. The receipt, administration, and disposal of drugs are sufficient to allow an audit trail. Storage of medication is satisfactory. All staff who administer medication have received training. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Residents are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse. EVIDENCE: The home has a clear complaints procedure and a copy is on display in the home. The homes AQAA states, ‘We take all grievances and complaints seriously and investigate very thoroughly’. Resident comment cards and residents spoken to confirmed that they know who to speak to if they are not happy and how to make a complaint. Comments received included, ‘The staff are very sensitive to my needs. They make the effort to ensure I am happy and well’, ‘Yes, I can speak to a number of staff and the home owner’, ‘I tell my key worker and he will write what I say’ and ‘Speak to manager’. Staff comment cards confirmed that they know how to deal with concerns and complaints. One added, ‘I usually forward the concerns to the management if am unable to settle it’. The home has received 7 complaints have been since the last inspection One of these was sent to the Commission. All complaints are properly recorded and have been dealt with appropriately. A concerns & suggestions box has been introduced into the home. Staff are encouraged to HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 20 make suggestions, which can be anonymous, regarding any improvements that they consider could be made to the service. Residents are protected from abuse. No new member of staff is employed until a satisfactory check of the Protection of Vulnerable Adults register has been received. The home has clear policies on safeguarding of vulnerable adults and these include a whistle blowing policy. All staff receive training in how to recognise possible abuse and the steps to take if they suspect abuse. There has been one safeguarding adults investigation since the last inspection. The home made a referral to the provisional POVA list but this has since been dismissed. The home’s AQAA says that the company reference request now asks whether the previous employer has made a referral to POVA. ” Residents monies are managed by the resident themselves or their representative. The home is not appointee for any resident. The home looks after small amounts of petty cash for some residents. These monies are kept safe and appropriate records are maintained. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 21 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, 26, 27. 28, & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home is well maintained. It is bright, cheerful and free from offensive odours. A resident said, “Its always clean”. Resident comment cards confirmed that they consider the home is always, or usually fresh and clean. Comments included, ‘Orchard House is kept at a high standard of cleanliness’, ‘I always have a clean room and the bathroom is always clean’, and ‘My room is very clean. I have clean bed every day’. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 22 The home is well maintained. Bedrooms are set out over two floors and there is the choice of lift or staircase access to reach the upper floor. The garden area is accessible to the residents and includes a flower garden, lawn, greenhouse, and vegetable patch. The home is well situated with easy access to Herne Bay shopping and coastal resort. The access road to the home is a private road with restricted on road parking, but there are some dedicated off road parking spaces available. Since the last inspection some environmental improvements have been made including additional swing free door closures, alterations to some ground floor rooms, and provision of a more appropriate smoking area. The company’s facilities manager has responsibility for all aspects of fire safety, health and safety, and environmental issues. He holds a National Examination Board in Occupational Safety and Health (NEBOSH) certificate. Risk assessments are completed for all areas that could present a risk to the residents. The regular meetings of Senior Management have a fixed agenda that includes premises and environment. The homes AQAA states, ‘Ongoing environmental reviews take place to ensure that with a change in resident mobility, appropriate alterations or adaptations are made to ensure equality of access within the building’. Each of the residents has their own bedroom and all have en-suite toilet facilities, some also have a bath or shower. Residents are able to personalise their rooms to their own choice. The bedroom of a resident who is a football supporter is currently being refurbished to take this into account. Another resident’s husband was contacted to ascertain her colour preferences before the redecoration of the bedroom prior to her admission. A resident said, “I like my room”. Residents are encouraged to hold their bedroom door key and the key to the mini vaults in there rooms, where they wish. In addition to the en-suite toilet facilities the home also has communal toilets, an assisted bathroom, and a shower room. There are a variety of communal areas available to meet the needs of the residents including a lounge/dining room, a further lounge, a second dining area, and a kitchenette. Smoking is allowed in the dedicated smoking room on the first floor or on the balcony at ground floor level. The home has up to date infection control policies and procedures. Infection control facilities include wash hand basins & paper towels in all rooms; appropriate laundry sacks for soiled linen; and personal protective clothing. There is a dedicated laundry room with a washing machine with specified programming ability to meet disinfection standards. Staff are trained in Infection Control, and food safety. One member of staff said, “I am currently doing an infection control course and will be finished by 16th June”. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 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 in the home are trained, skilled and in sufficient numbers to support the residents, and the smooth running of the service. EVIDENCE: Staff at the home are trained to meet the specific needs of the residents. The homes AQAA says, ‘All staff have access to the Genetics Consultant and Counsellor from Guys hospital as the team now visits to the home. This is a far more effective use of time and effort and allows effective dissemination of information, and more training, from a highly specialised team, working with people with Huntingtons Disease’. The AQAA also explains that ‘Cognitive impairment often leads to disinhibited behaviours therefore NAPPI (NonAbusive Psychological & Physical Intervention) and/or Studio 3 (specialist training in managing aggressive & violent behaviour) training is accessed’. All new staff are employed for a probationary period of 6 months during which HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 24 time there is a planned programme of induction training which meets with Skills for Care specifications. A staff comment card included, ‘I had a week’s induction which gave me good chances to do my job’. Currently 50 of the staff working at the home hold NVQ at levels 2 and/or 3. Staff commented, “I already had NVQ 2 & 3 before I started here”, and “I did NVQ 2 at college”. An additional 20 of staff are working towards this qualification. One staff member said, “I am going to do my NVQ when I finish my probationary period”. 30 of all staff have other externally accredited training, i.e. nursing, counselling and NEBOSH. Staffing levels in the home have been increased since the last inspection following the requirement made at that time. There are now sufficient staff rota’d to be on duty to meet the needs of the residents. Staff said, “Yes, there are definitely enough staff on duty”, “Yes, there sufficient apart from the occasional last minute sickness”, and “sometimes it’s a bit hard but mostly O.K.”. A resident comment card said, ‘I am always treated well even when staffing levels are low’. One staff comment card included, ‘There are staff who often call in sick, these unusual situations often put other staff under strain’. The management have recently introduced a more rigorous staff sickness policy and sickness absence is beginning to improve. A recommendation has been made that staffing levels should be kept under review, particularly at times of staff sickness. Staff meetings are held regularly. Day staff meetings are 2 monthly and night staff 3 monthly. Minutes of these meetings are recorded. The home has good recruitment practices. No new member of staff is employed until, an enhanced disclosure has been submitted to the Criminal Records Bureau, and a satisfactory check of the Protection of Vulnerable Adults register has been received. However, the home had already identified that there had been a couple of lapses in getting 2 satisfactory written references prior to employment starting. The home were already actively chasing up the missing references at the time of the site visit. Therefore a recommendation has been made about this rather than a requirement. All staff are issued with the General Social Care Council Code of Conduct and the AQAA confirms that, where applicable, this is in the first language of the employee. Any gaps in employment history are explored and documented during the recruitment process. The home has a training and development programme, and staff comment cards confirmed that they receive sufficient training to help them carry out their roles. The home has purchased a new staff-training package, and a stafftraining matrix has been introduced. In addition to induction and NAPPI training staff are kept up to date in the mandatory and protection of vulnerable adults training . At the time of the site visit all were either up to date or booked to attend courses. Staff spoken to all confirmed that they had done this training. One said, “I am currently doing Infection control and will finish by 16th June”. Additional Equal Opportunities training has been offered to HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 25 some of the senior team at the unit and it is planned to extend this to other staff. Training in the Mental Capacity Act has been made available to staff. Some of the Huntington’s training is now being done in house. The Regional Care Advisor visits twice a year and staff are also encouraged to visit professional study days. All staff who administer medication have received training in this subject. The homes AQAA says, ‘All staff receive well in excess of the statutory training requirement’. Staff confirmed that they receive the regular supervision that they need to carry out their jobs effectively. Residents spoken to said, “The staff are nice, a good laugh, they sing”, and “the staff are beautiful”. Resident comment cards included, ‘The staff are good and approachable’, ‘Staff are lovely’ and ‘Yes, they are attentive to my needs, they often act on my best interest such as advocating on my behalf Staff commented, “Its really enjoyable”, and “I love working here”. A health care professional said, “The staff are very keen, I think they are amazing”. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 26 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, 38, 39, & 42 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, and has effective quality assurance systems. The health, safety and welfare of residents and staff are promoted and protected EVIDENCE: The company has a clear management structure. The Responsible Individual was in day to day control of the home during the period where no manager was in post. She holds an honours degree in Psychology, is a Registered HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 27 Nurse, and has 20 years experience with the client group and 25 years experience in management. A new manager has recently been appointed, she holds NVQ 2 & 3 and a Diploma in Holistic Therapy and will be undertaking her Registered Managers Award and applying for registration. She has worked in the home for 2 ½ years in the role of Senior Carer. The new manager is being trained and actively supported by the Responsible Individual. With the appointment of the new manager there has been an increase in day-to-day management hours for the home. Fortnightly meetings are held of the Senior Management team with a fixed agenda covering all aspects of both the day to day operations of the home and a strategic planning overview. The Senior Management team consists of The Finance Director, Chief Executive Officer (who is also the Responsible Individual), Facilities Manager and Quality Assurance Co-ordinator. The management approach of the home creates an open, positive and inclusive atmosphere. Staff confirmed that they get support from the management and their comments included, “They are great, really good. At weekends they are here really quickly if needed”, “Yes very much, any problems I go to the senior or Rachel (manager)”, “They are always there if I have a question”, and “Rachel if fantastic”. Residents said, “The management are beautiful”, and “the managers are nice”. The visiting health care professional said, “the Management are supportive and accommodating”. The home has effective quality assurance and quality monitoring systems. Questionnaires are sent out annually to residents, relatives, and staff. Results are collated and included in the Annual Survey Report, which includes recommendations based on the results. The next circulation of questionnaires is planned for July 2008. There was a slight delay in circulation due to the Commissions comment cards being sent out, and the responsible individual being more involved in the day-to-day management of the home for some time. Internal audits are carried out on medication, personal files, food temperatures, food books, and finances. Regulation 26 visits are carried out and documented. The home has an Annual Development Plan and a Business and Financial Plan. Performance Management Targets are in place. The health, safety and welfare of residents and staff are promoted by the home. The Facilities Manager who is NEBOSH trained is responsible for all aspects of Fire Safety, Health and Safety, and environmental issues. All staff are up to date or booked on courses in the mandatory health and safety related subjects. The home has a current fire risk assessment and all fire checks and fire training is up to date. Risk assessments are carried out for both environmental and care risks. A staff comment card included, ‘I have (a slight disability), and the company accommodates for me well. i.e. risk HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 28 assessments’. All equipment is regularly maintained. All accidents are recorded appropriately. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 4 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 3 4 X X 3 X HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA33 YA34 Good Practice Recommendations Staffing levels need to be kept under review to ensure that the needs of residents are met at all times, particularly at times of staff sickness. 2 written references should be obtained for all members of staff prior to employment commencing. HMT Orchard House DS0000061966.V363678.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 HMT Orchard House DS0000061966.V363678.R01.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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