Inspection on 19/11/07 for Little Orchard

This inspection was carried out on 19th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Little Orchard 20/03/07

Little Orchard 20/02/06

Little Orchard 12/07/05

Little Orchard 18/01/05

Little Orchard 22/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Little Orchard 75 Woodlands Avenue Woodley Nr. Reading Berkshire RG5 3HQ Lead Inspector Andrea Leverett Unannounced Inspection 19th November 2007 11:30 X10015.doc Version 1.40 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 Little Orchard DS0000011396.V349748.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 Older People. 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. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Orchard Address 75 Woodlands Avenue Woodley Nr. Reading Berkshire RG5 3HQ 0118 969 6847 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Frazer John Noel Dennison RNMS Mr Frazer John Noel Dennison RNMS Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2007 Brief Description of the Service: Little Orchard is a care home providing twenty-four hour care and accommodation for up to five older people who have a learning disability. The service aims to provide service users with a secure, relaxed and homely environment in which their care, well being and comfort is of prime importance. The proprietor believes that personal development should continue throughout the whole of life. Little Orchard is an extended bungalow with five single bedrooms. The home is situated in a residential road within walking distance to the Woodley shopping precinct, sports centre and doctor’s surgery; amenities within Reading town are within a ten minute drive, and public transport is available. Car parking spaces are available at the front of the property. There is a secluded garden to the rear of the building with mature plants, a patio and seating. Weekly fees are between £717 and £823 per week. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 11:30am and was in the service for 5 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. This unannounced Key inspection took place on the 19th of November 2007. 2 people who use the service were spoken with as well as 1 staff member and the manager. A tour of the premises was undertaken during the site visit and 3 people who use the services files and staff files were inspected. Judgements about quality of life and choices were taken from direct conversations with and observations of people who use the service, followed by discussion with support staff and evidencing records held at the home. Feedback from people spoken to have been taken into consideration and comments have been reflected in this report. The inspector concluded that people are given a good service at Little Orchard. A high standard of support and access to health services is provided here and good progress has been made towards meeting requirements and recommendations made at the last inspection. No requirements or recommendations have been made at this inspection but 2 recommendations remain outstanding from the previous inspection. What the service does well: The Home is small and has good consistent staffing which enables an individual person centred approach to care to be provided. Feedback from people who use this service and observation at the site visit showed that people living in the Home are treated with the dignity and their choices are sort, respected and acted upon. Staff took time to respond and interacted sensitively to peoples needs and it was clear that people felt able to ask for support. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 6 Some typical responses included: “ Staff are nice to me they are like friends” “ I like living here we have jokes and staff are very good.” The Home offers a range of activities in keeping with peoples needs and wishes and has the benefit of its own transport, which enables people to have good access to the community. It was clear that the staff took time to get to know people and explore their needs and wishes in terms of activities. Care plans gave good information about peoples social and therapeutic needs and included such things as likes and dislikes, social interests, friendship groups, shopping trips, walks out, day centres, lunch clubs, church services and yearly holidays. People who use this service were very positive about the staff and felt very supported by them. It was also clear that peoples diverse needs and wishes were given a high priority in the Home and peoples self confidence and feelings of self worth were evident. Examples were seen of the manager working sensitively and respectfully to meet people’s complex needs and supporting people’s individuality and rights. Regular reviews are undertaken for people who use the service and regular house meetings take place to seek people’s views about the service they receive. What has improved since the last inspection? The homes homely remedies procedure now includes a signed consent form from the persons GP to say it is appropriate to administer particular over the counter medicines. The Home now has its own whistle blowing policy in place, which is in line with local authorities procedures for dealing with adult protection issues. People living in the Home are benefiting from a programme of refurbishment and decoration and people spoken to say they liked the Home. The homes bathroom has been refurbished since the last inspection and the Home now has a walk in shower and some of the homes flooring has also been upgraded in laminated wood. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 7 The manager informed the inspector that advice had been sort from the environmental health officer regarding the prevention of Legionella in the homes hot water supply and that no action was required. An inspection of the homes kitchen and food storage showed that food is now being stored and labelled appropriately. 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. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, People who use the service experience good quality outcomes in this area. People who use this service can be confident that their needs will be assessed before they move into the Home and that these will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three assessments and care plans of people living in the Home were inspected as part of a case tracking process. No one has moved in to the Home for several years but assessments seen showed that people did have their needs comprehensively assessed prior to moving into the Home. This information also included a care manager assessment. Assessments included mobility, personal care incontinence, communication, social activities and general likes and dislikes sheet. Risk assessments were also in place for all key areas of need including falls risk assessments. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 10 Assessments also included aims and objectives and care assistance required and this information was reflected in the peoples care plans. Observation on the day of the site visit and records seen showed that care plans are followed and the Home is able to demonstrate that it can meet people’s specialist needs. The Home is small and has good consistent staffing which enables an individual person centred approach to care to be provided. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience good quality outcomes in this area. People who use this service benefit from having comprehensive health; personal and social care needs set out in an individual plan of care, which is followed. The home has a medication policy and medication records are generally up to date. Medication systems are in place that follows good practice. People who use this service feel they are treated with dignity and respect and their right to privacy is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated previously peoples care plans were detailed and comprehensive and included all needs as detailed in their assessments. Records also showed that these were being regularly reviewed. Good detailed daily reports are also maintained. Health records show that access to routine and specialist health Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 12 services are provided and people living in the Home confirmed that they had regular access to Doctors, dentists, optians and chiropody. No one living in the Home currently administers his or her own medication and this seemed appropriate to the inspector. An inspection of the homes medication records and medication storage showed that medication was being administrated appropriately. All staff that administers medication has received appropriate training and medication care plans gave good guidance and information relating to individual medication needs. Medication Administration Record sheets were up to date and accurate and the homes homely remedies procedure now includes a signed consent form from the persons GP to say it is appropriate to administer particular over the counter medicines. Feedback from people who use this service and observation at the site visit showed that people living in the Home are treated with the dignity and their choices are sort, respected and acted upon. Staff took time to respond and interacted sensitively to peoples needs and it was clear that people felt able to ask for support. Some typical responses included: “ Staff are nice to me they are like friends” “ I like living here we have jokes and staff are very good.” Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience good quality outcomes in this area. The experiences of people who use this service match their expectations and preferences in terms of social, cultural, religious and recreational needs. People living in the Home are supported to maintain contact with family and friends and are supported to exercise choice and control over their lives. People living in the Home receive a wholesome and appealing diet in pleasing surroundings and at times convenient to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home offers a range of activities in keeping with peoples needs and wishes and has the benefit of its own transport, which enables people to have good access to the community. Daily records seen and discussions with people who live at the Home showed that social activities are consistently provided. It was clear that the staff took time to get to know people and explore their needs and wishes in terms of activities. Care plans gave good information Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 14 about peoples social and therapeutic needs and included such things as likes and dislikes, social interests, friendship groups, shopping trips, walks out, day centres, lunch clubs, church services and yearly holidays. The dining room is nicely decorated and furnished and people living in the Home were observed being supported with their lunch in a sensitive and respectful manner. The manager has regular meetings with people to plan menus and they are able to go food shopping with support from staff. Feedback from people living in the Home was positive regarding the food; people said they could have snacks and drinks whenever they wished. Records are kept of meals taken and individual daily records gave good information to evidence that peoples food intake was being monitored. Health records also showed that people are weighed regularly. An inspection of the homes kitchen and food stocks showed that a varied range of food is purchased. Visitors are welcome at any time and feedback from people who live at the Home and the manager showed that people are supported to maintain contact with families and friends. Some typical responses included: “ I go for walks to the shops and in the car, staff are very good they help me a lot.” “ I like the food, I can have what ever kind of food I like, I have a cup of tea and cakes before I go to bed.” “ I go to the day centre and I like to go to church.” “ Staff are nice to me, I see my friends, I can get up and go to bed when I like.” “ Someone comes with me to go shopping.” Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience good quality outcomes in this area. On the whole people who use this service are aware of their rights with regard to making a complaint and can be confident that their concerns and complaints will be listened to and acted upon. People are protected from the risk of abuse by the home’s Adult Protection policy and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home has a complaints procedure that includes all the information required by this standard. The manager informed the inspector that he is currently reviewing the procedure to make it more accessible to people living in the Home. Discussions with some people evidenced that on the whole they were aware of their right to make a complaint and would be comfortable doing so and the Home has had no complaints in the last Twelve months. The Home undertakes regular individual reviews of peoples care and has regular house meetings to get feedback regarding the care and support provided. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 16 The Home now has its own whistle blowing policy in place, which is in line with local authorities procedures for dealing with adult protection issues. Discussions with one staff member evidenced that they understood their role and procedures for the reporting of suspicion or evidence of abuse. Records seen also confirmed that they had undertaken adult protection training and the manager informed the inspector that this training is ongoing. Comments included: “ I don’t have any complaints but if I did I would talk to Fraser (the manager).” Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People who use the service experience good quality outcomes in this area. People who use this service benefit from living in a Homely environment, which is well maintained and clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken and the Home was clean, well presented and odour free. Bedrooms were pleasantly furnished and spacious and it was clear that people are encouraged to furnish their rooms with personal items. People living in the Home are benefiting from a programme of refurbishment and decoration and people spoken to say they liked the Home. The homes bathroom has been refurbished since the last inspection and the Home now has a walk in shower and some of the homes flooring has also been upgraded Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 18 in laminated wood. A tour of the Home and information taken from maintenance records evidenced that equipment and facilities are serviced and maintained appropriately. The Home also has a maintenance book, which evidenced that maintaince issues are identified and acted on promptly. The manager informed the inspector that advice had been sort from the environmental health officer regarding the prevention of Legionella in the homes hot water supply and that no action was required. An inspection of the homes kitchen and food storage showed that food was being stored and labelled appropriately and fridge and freezer temperatures are monitored. The garden area is landscaped and well maintained and is accessible to people who use wheelchairs. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use the service experience good quality outcomes in this area. People who use this service can be confident that their needs will be met by sufficient number of staff that is trained and competent to carry out their role. People living in the Home are protected by appropriate staff recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An inspection of the homes staffing rota’s and discussions with people who use the service and one staff member showed that people living at Little Orchard benefit from good staffing levels at all times. The Home has one waking night staff, two staff on the morning and afternoon shift with additional staff at key times during the week to facilitate community activities. Observation on the day of the site visit and training records seen showed that staff have the skills and are appropriately trained to carry out their roles. Training in the Home is ongoing with staff having undertaken a range of core training, including medication, Health & Safety, Moving &Handling, First Aid, Food Hygiene and Adult Protection. Over 50 of staff is trained at level 2 NVQ or above. All new staff starts with the national induction standards and an in house induction supervised by a senior staff member. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 20 A sample of staff files were inspected and these evidenced that all appropriate recruitment checks were being undertaken. Staff files included Criminal Record Bureau checks, 2 written references, application forms and dates of employment. People who use this service were very positive about the staff and felt very supported by them. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience excellent quality outcomes in this area. The support of people who live at Little Orchard is enhanced by a staff team that is led by a competent and experienced manager, who ensures that the home is run well. The health safety and welfare of people living in the Home are promoted and protected and on the Home is run in their best interests. This judgement has been made using available evidence including a visit to this service. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 22 EVIDENCE: The owner and registered manager is a registered nurse and have an NVQ4 in management and care. He has extensive experience in the care of people with a learning disability and is well qualified to manage the home. The staff structure is comprised of the manager, the deputy manager, a senior care worker and care workers. Lines of accountability within the home are clear. Feedback from people living in the Home and staff showed that they felt supported by the manager and owner. It was evident throughout the inspection that people’s needs were met to a high standard and the management of the environment were maintained appropriately. It was also clear that peoples diverse needs and wishes were given a high priority in the Home and peoples self confidence and feelings of self worth were evident. Examples were seen of the manager working sensitively and respectfully to meet people’s complex needs and supporting people’s individuality and rights. Regular reviews are undertaken for people who use the service and regular house meetings take place to seek people’s views about the service they receive. The manager is currently developing surveys to gain feedback from relatives, friends and other professionals involved in supporting people who live at the Home and a recommendation remains from the previous inspection regarding this. The finances were checked for two people living at the Home. Money was kept securely and records and receipts were in place to evidence money spent. The manager informed the inspector that people’s finances are audited once a month by him and by the bookkeeper on an annual basis. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 24 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. Refer to Standard OP16 Good Practice Recommendations It is recommended that a summary of the complaints procedure be available in a form accessible to service users. Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Little Orchard DS0000011396.V349748.R01.S.doc Version 5.2 Page 26 - 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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