Inspection on 20/03/07 for Little Orchard

This inspection was carried out on 20th March 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 19/11/07

Little Orchard 20/02/06

Little Orchard 12/07/05

Little Orchard 18/01/05

Little Orchard 22/06/04

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Dalewood Respite Care

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Kestrel House, St Anne`s Opportunity Centre,

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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 Mike Murphy Unannounced Inspection 20 March 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.V325505.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.V325505.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.V325505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2006 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.V325505.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector between 11.30 am and 5.45 pm on a weekday in March 2006. The inspection methodology included discussion with the registered manager, staff and some service users, observation of practice, examination of records, a walk around the home and grounds, and consideration of information submitted in advance of the inspection by the registered manager and by service users, relatives and health and social care professionals who completed survey forms. The inspection finds this a well managed home which provides a safe and comfortable environment, provides good emotional and practical support to individuals, and enables service users to experience a varied lifestyle. All five places were occupied at the time of the inspection, therefore the home was not in a position to provide evidence beyond its referral procedure on its arrangements for assessing the needs of prospective service users. Its procedures for care planning and liaison with local health and social care agencies in meeting the needs of service users appear satisfactory. Care plans are detailed and are reviewed monthly. Service users have contact with services in the community and are accompanied by staff on shopping and other outings in Woodley, Reading and surrounding areas. Holidays were taken in Bognor Regis and Southend in 2006 and there are plans for breaks in Minehead and Bournemouth in 2007. While at one level service users appeared satisfied with the home’s range of activities they also indicated in comment forms that there may be some shortfalls in the current programme. Service users indicated confidence in the home’s manager to investigate any complaints. Other respondents to CSCI had not received any complaints since the last inspection and were positive in their views of the home. However, it is recommended that the home’s procedures be reviewed and be available in a form which takes account of the needs of service users. The home environment is generally satisfactory and evidence of refurbishment was noted on this inspection. Service users appear satisfied with the accommodation. Given the changing age profile of the service users it is recommended that the manager seek advice on falls risk assessment, including environmental factors. Staffing levels are satisfactory and staff retention is good – service users benefit from the continuity in relationships which this provides. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Ensure that all perishable foods are labelled with the date of opening and are consumed or disposed of within the time appropriate to particular foods. Seek advice on falls risk assessment and management in light of the changing age profile of service users Carry out a thorough and comprehensive review of the home’ policy and procedures governing the storage, control and administration of medicines in the home. Carry out a thorough review of the home’s complaints policy and procedure and that a summary of the complaints procedure be available in a form accessible to service users. Obtain the advice of the local Environmental Health Department on the prevention of Legionella developing in the home’s hot water supply. Please contact the provider for advice of actions taken in response to this Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 7 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.V325505.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.V325505.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 and 6 Quality in this outcome area is good. The home has a system in place for assessing the needs of prospective service users and deciding whether it likely to be in a position to meet those needs. Prospective service users therefore, can be assured that the home’s system aims to ensure that it can meet their needs should they decide to accept the offer of a place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last admission was over five years ago so it was not possible for the home to provide evidence of conformance to this standard. The registered manager described the process to be followed at referral and the home’s referral and assessment form was examined. All service users are admitted under the care management arrangements of a local authority. At the time of this inspection four service users had care managers in Wokingham and one service user had a care manager in Reading. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 10 The home’s referral and assessment form (reviewed in January 2004) provides for comprehensive information to be acquired on a prospective service user. This is supplemented by information provided by the referring care manager and other professionals involved with the prospective service user at the point of referral. Additional information is obtained from the prospective service user and members of his or her family. On conclusion of an assessment the information acquired is reviewed by the registered manager who would decide on whether the home was likely to be able to meet the prospective service user’s needs. An offer of a place is then made. Copies of the Statement of Purpose (SOP) (December 2005) and Service User’s Guide (SUG) (September 2005) were provided for inspection but were not assessed on this occasion. It was suggested that the SUG be amended when the complaints procedure has been reviewed (see below). The service does not offer intermediate care therefore standard 6 is not applicable. Little Orchard DS0000011396.V325505.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 Quality in this outcome area is good. A comprehensive care plan is in place for each resident. Care plans include assessment of needs, plans to provide support where required, and evidence of liaison with health and social care agencies in the community. These aim to ensure that residents’ needs are met and that they are supported in maintaining their independence. Arrangements for the storage and administration are generally satisfactory but the policy and procedure underpinning this aspect of the home’s work would benefit from review in order to support good practice and minimise risk to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Current information on each service user is retained on two files: a care plan and a file for health and social care information. The files of four service users were examined. Care plans include a photograph of the service user and information categorised under such headings as ‘general health’, ‘self-care’, ‘domestic living skills’, ‘medication’, ‘communication’, ‘friendships’, ‘daily activities’, ‘finance’, ‘wishes in the event of death’, ‘moving and handling Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 12 assessment’, ‘weekly activities diary’, ‘moving and handling assessment’, ‘leisure’ and ‘domestic living skills’. The mix of headings varied according to the needs and abilities of service users. The entries under each heading generally included a summary of the service user’s abilities, wishes, preferences and needs. Risk assessments covered ‘seizures’, incontinence, ‘deafness related’ and ‘discomfort’. Care plans are reviewed and updated monthly. Daily notes are written up three times every 24 hours and generally consist of a summary of the service user’s activities. The second file again included a photograph of the service user, summary medical information, notes of visits by the chiropodist, weight, contacts with GPs and other health professionals, correspondence with health and social care professionals, contracts, copies of care management assessments, notes for reviews and records of annual reviews carried out under care management. All service users are registered with a local GP. A chiropodist visits every six weeks. Service users have access to annual dental and sight checks through community dental and optician services. Specialist learning disability services are accessed through the community learning disability team (CLDT). Other healthcare services are sought through GPs. Medicines are prescribed by the service user’s GP and are dispensed by a local branch of Boots Chemists. Medicines are administered by staff. The home has a policy governing the storage and administration of medicines. The policy document was examined during this inspection. The policy includes reference to prescribed medicines, ‘non-prescribed’ medicines and ‘homely remedies’. It was unclear what medicines would be included in the ‘non-prescribed’ category. The policy would benefit from review and updating and should include reference to staff training, assessment of staff competence, homely remedies, and the arrangements for the disposal of unwanted medicines. With regard to ‘homely remedies’ the home has a letter from a GP authorising the administration of Paracetamol and over the counter medicines as required by service users. It also has a separate but more specific list of medicines to be administered under this category which has been drawn up by a pharmacist. The list includes the maximum dose of each medicine which can be administered before seeking medical advice. The GP’s letter is dated 2003 and the pharmacist list 1998. It is recommended that these be updated, be drawn up as one procedure, and be incorporated into the home’s updated policy on medicines. The manager is to introduce a notebook for recording medicines returned to pharmacy. Staff training is conducted in-house by the manager and some staff have attended the Boots one-day training course. Staff undertaking NVQ training at Level 3 may include a module on medicines. Reference sources for staff include a copy of the Royal Pharmaceutical Society of Great Britain (RPSGB) guidelines published in 2001, a copy of the BMA guide to medicines published in 1999, and notes on medicines currently in use which have been drawn up Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 13 in-house. This is a good range of references but more recent editions of the RSPGB and BMA texts are available and it would be advisable to have the most recent edition. The arrangements for the storage of medicines appear satisfactory for a home of this size – a metal cabinet affixed to the wall in the office and a small refrigerator. It was noted that prescribed creams had been opened for use but that the date of opening had not been recorded on the pack. Medicines Administration Records (‘MAR’ sheets) were examined and appeared in order, no gaps or other irregularities were noted. In examining care plans it was noted that they include a list of current medicines for the service user. The MAR chart is normally a more reliable record of medicines currently prescribed and the practice of listing medicines in care plans should be reconsidered. Staff were observed to treat service users with sensitivity and there appeared no reason to think that individual privacy was compromised. All service users wore their own clothes. The manager said that medical examinations and consultations are carried out in the privacy of the service user’s own bedroom. The standard on dying and death was not assessed on this inspection but it is noted that the wishes of each service user have been recorded in their care plan. This is a good practice. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. Service users participate in a variety of social and recreational activities (including holidays in the UK) which aim to meet individual needs, provide a variety of experiences, improve resident’s well-being and maintain contact with the wider community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four of five service users in this home are over 65 years of age and the fifth service user is 58 years old. Activities are described by the registered manager as “age appropriate”. The home is located in a residential area and there is a shopping centre within walking distance. The amenities of Reading town centre are less than three miles away and there are frequent buses to the town. On the morning of the inspection one service user had been to Reading with a member of staff. Service users regularly attend a range of support services in the community. These include a lunch club, a social club run by a local church, a day service, craft group, and an evening club once a week. Two service users were expecting to go to the evening club in Whitley Wood on the day of the inspection. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 15 There is a cinema complex not too far from the home but the manager said that service users had not been there recently. Service users had been to a pantomime at Reading theatre over the most recent Christmas holidays. Service users and staff occasionally go to a local pub for lunch or to a café at a local church. In 2006 service users had holidays in Bognor Regis and Southend. In 2007 service users and staff plan to have holidays in Minehead and Bournemouth. The manager intends to review the range of activities this year. Contact with families and friends is variable. One service user has visitors on a regular basis, others occasionally. Service users have regular contact with befrienders from a local church, an Age Concern advocate and a Mencap visitor. Service users are supported in maintaining as much independence as possible and the majority are able to articulate theirs needs and wishes and to participate in decision making. Meals are prepared and cooked by care staff. Breakfast is served between 7.30 am and 9.00 pm and usually consists of cereal, toast, preserves and tea. The manager said that a cooked breakfast used to be served on Saturdays but demand for this had declined and that a brunch is now available later in the morning on Saturday. Lunch, served between 12.30 and 1.00 pm, is a light meal. On the day of inspection it consisted of soup, rolls and fresh fruit. Other lunch choices on menus included beans on toast, ‘hot dogs’, or cheese and biscuits, and on Sundays, roast meat and vegetables, followed by dessert. Dinner is served between 5.30 pm and 6.00 pm. Items on the menu may include beef stew and dumplings, lemon chicken and rice, corned beef and salad, and on Sundays, a choice of sandwiches. Desserts included fresh fruit salad, cheesecake or yoghurt. Fresh fruit is available throughout the day and drinks are provided as required. Service users are consulted on the menu and alternative dishes are provided where a service user does not like the main choice of the day. On the day of this inspection it was noted that lunch was served at a pace appropriate to the abilities of the service users. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 16 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, 17 and 18 Quality in this outcome area is adequate. The home has a policy governing the management of complaints and has a copy of the local authority’s policy on the protection of vulnerable adults. Service users expressed confidence in the manager to respond to any concerns. Together these aim to ensure that any dissatisfaction expressed by service users is effectively addressed and to protect service users from abuse. However, the complaints and whistle blowing polices require updating and a summary of the complaints policy should be available in a form acceptable to service users. These will strengthen the home’s arrangements for the protection of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy which outlines the process for dealing with complaints and states that complaints will be dealt with within 28 days. However, the policy does not suit the needs and abilities of the service users in two respects. Firstly, the policy is not presented in a format which might be readily understood by service users. This was discussed with the manager. The home has a good Service User Guide in picture format and it was suggested that the complaints policy could be presented in that format. Secondly, the policy states that if a complaint is ‘serious’ then the complainant should submit their complaint in writing. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 17 There are two points here; all complaints are serious to a complainant and should be treated as such, and secondly it seems inappropriate in a service such as this to expect service users to put their complaints in writing. The policy includes contact details for CSCI and for the Local Government Ombudsman. However, it is incorrect in stating that complaints about CSCI’s handling of a complaint should be made to the office of the Local Government Ombudsman. CSCI has its own complaints procedures. The home has a copy of Wokingham District Council’s complaints procedure. The record of complaints was examined and it was noted that the most recent entry was made in 2004. The manager said that any dissatisfaction expressed by service users is normally dealt with at the time by staff. This view is supported by service users responses in questionnaires submitted prior to the inspection visit. Service users were supported by staff at a day centre in completing the questionnaires. In answer to the question ‘Do you know how to make a complaint?’ service users answered “I would tell Fraser (the proprietor and registered manager) and he would help me to sort it out”, “I tell them” and “(tell) staff or manager”. Relative/Visitor and care professional respondents all reported that they had no reason to complain about the home, and professional respondents had not received any complaints about it. CSCI has not received any complaints about this service since the last inspection in February 2006. Service users are registered to vote. The home does not have its own policy on the protection of vulnerable adults (POVA) but does have a copy of the current West Berkshire policy on the subject. It does have a policy on whistle blowing but this seemed incomplete and would benefit from review and updating. Staff have attended training events on POVA run by Wokingham and Bracknell councils and by a training organisation on contract to Wokingham Council. Staff have received basic training in understanding aggression and violence and the manager reports that if an episode of aggression occurs then the matter would also be discussed in supervision. Arrangements for looking after service users money appear satisfactory. The manager acts as appointee for one service user and Age Concern acts as appointee for two service users. Other service users either manage their own money or are assisted by their family in doing so. Arrangements are in place for the secure storage of cash. All service users have either a bank or post office account. All transactions are recorded and receipts for purchases are retained. The manager checks all accounts monthly. The balance for two service users was briefly checked and found to be in order. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is adequate. The home provides a comfortable and safe environment for residents and is well located for the amenities of Woodley and Reading town centres. Standards of accommodation are generally satisfactory and will be improved for service users when refurbishment of some areas is completed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located in the residential area of Woodley, just under three miles from Reading town centre. It is a short distance from local shops. There are frequent buses to Reading from the locality. There is limited car parking in the driveway but no pressure on street parking in the locality. The nearest railway station is Earley on the Reading to Waterloo line. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 19 The building is a detached bungalow which has been adapted for its current use. There is a short drive with parking for two or three cars to the front and a medium sized garden to the rear. All of the accommodation is on the ground floor and all areas are accessible by wheelchair. The accommodation consists of an entrance hall, office, bathroom and WC, separate WC, five single bedrooms, utility room, kitchen, dining room and living room. None of the bedrooms have en-suite facilities but all have a sink. Access to the garden is through the dining room or living room – a ramp enables wheelchair access from the dining room. The garden comprises a patio area, lawns, flowerbeds, shrubs and mature trees. The garden is furnished with a barbeque, garden table and chairs. The home is well established in the area and the manager reports that relations with neighbours are good. At the time of this inspection a bathroom was being thoroughly renovated and new tiling, flooring and fittings were being installed. Plans are in place to decorate other areas of the home during the summer. Areas of carpet are to be replaced by more practical non-slip flooring. The communal accommodation is comfortable, clean and quite well furnished. There is a television in the lounge and a portable music centre in the dining room. The utility room has a domestic model washing machine and dryer which are considered sufficient for current use. These may need to be replaced by more robust models as the needs of residents change. The kitchen is equipped with a domestic model gas hob, electric oven, microwave, electric kettle, electric toaster, dishwasher, boiler and fridge/freezer. There appeared to be sufficient storage units and work surfaces for current needs. Bedrooms vary in size – a photograph of each bedroom is in the service user’s guide – and those visited were comfortably furnished and had been decorated in line with the wishes of the service user. All radiators are covered. All areas of the home visited were clean and tidy although some points of detail require attention. There was no evidence of PAT testing on portable electrical equipment over the past year. Items of food opened in the fridge had not been labelled with the date of opening. A bin in one of the WCs did not have a lid. The temperature of the hot water in areas used by service users is regulated. The temperature of the hot water at outlets in the kitchen and laundry are not regulated but the manager said that service users do not use these areas unsupervised. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 20 The manager said that the home has not required adaptations or special equipment to date other than rails to provide support around the bath and WC (these had been removed at the time of this inspection to allow refurbishment of that room). It has recently been necessary to acquire a hoist and it is acknowledged that the needs for more aids will need to be kept under review in line with the ageing profile of the service users. One service user uses a wheel chair to get around the home and a stand for support in her room. Service users seem very comfortable and secure in the home. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is good. Staffing levels are satisfactory and, in conjunction with local training providers, the proprietor provides training and staff development across a range of subjects. This aims to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The present staff establishment provides for two care staff in the morning, two in the afternoon and one waking care staff at night. The registered manager lives nearby and said that he is on call at all times. Care staff carry out a range of care and domestic tasks. Four out of six staff have acquired NVQ2 or above. No new staff have been appointed since the last inspection, therefore staff files were not examined on this inspection. The inspector at that time reported that ‘A sample of staff recruitment files, demonstrated that good recruitment procedures are in place. Personnel files are well organised and meet the required standard’. The manager said that he would normally advertise a vacancy in local newspapers but may try out a new local website when a vacancy next arises. Job applicants are required to complete an application form, provide two references, have an enhanced CRB check and attend an interview. The application form was examined and suggestions for amendment were made in Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 22 relation to the disclosure of convictions and more precise dates of starting and leaving periods of employment. Staff are provided with a copy of the GSCC codes of practice on appointment. The home is accredited by ‘Investors in People’ which reflects a positive commitment to staff training and development. The registered manager has acquired NVQ4 in management. The deputy manager has acquired NVQ3 in care. Three staff have acquired NVQ2. One is currently pursuing NVQ 3 and another member of staff is about to start the NVQ3. In 2006 a skills audit was carried out by a training consultancy, ‘Skills2Care’ and the results of a training needs analysis was drawn up for each member of staff. The manager reports that over the course of the past year staff undertook update training in manual handling, first aid, care of medicines, POVA, and food hygiene. The manager said that he is currently considering the application of the new induction and foundation training published by Skills for Care (formerly ‘TOPSS’). Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 23 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, 36 and 38 Quality in this outcome area is good. This is a well managed home which appears to be providing good care outcomes for service users. Arrangements for health and safety appear thorough and aim to ensure the safety of service users staff and visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The proprietor and registered manager is a registered nurse, has acquired the NVQ4 in management, and has extensive experience in the care of people with a learning disability. The manager is therefore, 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. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 24 The manager is in the home almost every day and believes that this provides him with sufficient opportunities to assess the quality of the service. The manager has formulated a development plan for 2007. This includes plans for developments in staff training, maintenance and redecoration of parts of the building, and increasing the range of activities for service users. The home does not conduct a stakeholder survey at present. Feedback is obtained informally. The home is responsive to CSCI requirements and recommendations. CSCI received seven completed comment cards from the ‘Relatives/Visitors’ of service users. All were positive in their views of the home. All felt welcomed when they visited, were able to see their relative in private, were kept informed of important matters, and were satisfied with the overall care provided by the home. Five of seven respondents were aware of the home’s complaints procedures and none of the respondents had had cause to complain about the care. Comments included: “Home is very well managed, all staff are very caring and make life fun, enjoyable and interesting for the service users. The service users’ opinions are always asked for and their choices are catered for where possible. This is a very good home – by far the best I have come across”; “Since [name] has lived at ‘Little Orchards’ she is more settled and much happier. Not only is she signing, but she is now speaking a few basic words which can only be put down to the special care that Frazier and the staff give. It is a happy home which you can feel as soon as you walk through the door”; “The Orchards have provided a friendly stimulating home for [relationship] and [name] enjoys going back The Orchards at the end of any visit”;” I have always found the staff very warm and extremely helpful. I have no worries about the care of [name] at all. She is always very happy”. The two professional respondents were also positive in their views of the home. Neither had received any complaints about the home, both found that the home communicated clearly and worked in partnership with them and both were able to see service users in private. One added, “I am very impressed with the caring attitude of Frazer and his staff have towards the service users. I visit every 8 weeks and there is a happy, contented atmosphere. The staff are friendly and have a positive attitude towards the service users”. The impression gained during the course of this inspection would concur with these views. The service users seemed at home and contented. Service users and staff interacted well and staff were responsive to service users needs. One service user commented, “This is a nice home isn’t it?” Service users participated in the completion of survey forms which were returned to CSCI in advance of the inspection. The manager said that staff at a day centre assisted service users in completing the forms and that staff in the home were not involved. All service user respondents ticked ‘Always’ in response to the question on whether they receive the care and support they need. All felt that staff listened and acted on what they said and that staff were always available Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 25 when they needed them. Only one said that there are always activities which they can take part in, other ticked ‘Usually’ or ‘Sometimes’. Three out of four were very positive about the meals; one added “Oh Yes! They are very nice. All the people who live at Little Orchard help to plan the menu but the staff do the cooking”. Service users expressed confidence that the manager and staff would ‘sort out’ any complaint. One added the comment “I like Little Orchard and I would like to stay there – I don’t want to move anywhere else. Sometimes some of the other ladies are a bit nasty but we usually sort that out and they are all right”. Arrangements for dealing with service users money appear satisfactory. The manager acts as appointee for one service user and Age Concern acts as appointee for two others. Other service users either manage their own money or are assisted by their family in doing so. Arrangements are in place for the secure storage of cash. A file is in place for each service user. All service users either have a bank or a post office account. All transactions are recorded and receipts for purchases are retained. The manager checks all accounts monthly. The balance for two service users was briefly examined with the manager and found to be in order. The manager is endeavouring to establish individual staff supervision so that all staff receive supervision at least six times a year. A structure for the process is in place and staff reported that they receive regular supervision. Supervision meetings are recorded and the notes are agreed and available to both parties. Meetings are agreed in advance and the structure includes a regular agenda, scope for discussion of any other matter that a supervisor or supervisee might wish to raise, and points for action. Arrangements for maintaining safe working practice appear satisfactory. The manager reports that the ‘Skills2care’ staff training audit conducted in mid 2006 did not identify any significant gaps in mandatory training. Training in moving and handling, fire safety, food hygiene, infection control and first aid is organised in conjunction with the local authority. Fire training, which included a fire drill, was carried out in September 2006 (another fire drill is due soon). The training includes watching a fire safety video and the fire drill includes evacuation of the premises with service users. The home has not had a visit from the fire officer for a few years. A fire risk assessment was carried out in August 2006. The manager had downloaded fire safety information from the website of the Communities and Local Government Department. Emergency lighting is checked monthly by home staff and quarterly by contractors. Fire fighting equipment is checked annually. Fire alarms are tested weekly and checked quarterly by contractors. The manager reports that portable electrical appliances (‘PAT’) are due to be tested in the near future. The homes fixed electrical wiring was tested in January 2003 and was deemed satisfactory although it was noted that the Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 26 assessing electrician noted a number of items that required attention. Gas appliances were checked in May 2006. Hot water temperatures are regulated in outlets in service users bedrooms, the bathroom and WC (40 degrees Celsius on the day of inspection). The hot water is not regulated in the kitchen or laundry (61 degrees on the day of inspection) but the manager said that service users are always supervised by staff in those areas. The home did not have evidence of testing for Legionella and the manager was advised to seek advice from a local environmental health officer in respect of this. The home has a system in place for recording accidents. Records for 2006 were examined and it was noted that these included a number of falls. Although these had not led to serious injury to any service user, given the changing age profile and potentially increasing frailty of service users, the manager was advised to contact the local fall team with regard to techniques for conducting falls risk assessments. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 2 17 3 18 3 2 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 3 X 3 X 3 2 X 3 Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 28 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. 1 Standard OP38 Regulation 13 (4) Requirement The registered manager is required to ensure that all perishable foods are labelled with the date of opening and are consumed or disposed of within the time appropriate to particular foods. Timescale for action 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP9 Good Practice Recommendations It is recommended that the registered manager seek advice on falls risk assessment and management in light of the changing age profile of service users It is recommended that the registered manager carry out a thorough and comprehensive review of the home’ policy and procedures governing the storage, control and administration of medicines in the home. It is recommended that the registered manager review the range of social activities with service users and other stakeholders It is recommended that the registered manager carry out DS0000011396.V325505.R01.S.doc Version 5.2 Page 29 3 4 OP12 OP16 Little Orchard 5 6 OP18 OP38 a thorough review of the home’s complaints policy and procedure and that a summary of the complaints procedure be available in a form accessible to service users. It is recommended that the registered manager review the home’s guidance on whistle blowing and ensure that all aspects of this are available to staff It is recommended that the registered manager obtain the advice of the local Environmental Health Department on the prevention of Legionella in the home’s hot water supply. Little Orchard DS0000011396.V325505.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 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. 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