CARE HOME ADULTS 18-65
Orchard Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ Lead Inspector
Stewart Mynott Unannounced Inspection 19th January 2006 11:15 Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Orchard Address Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 01344 755582 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) Norwood Ravenswood T/A Norwood Mrs Susan Ravey Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Orchard is part of Ravenswood Village and is registered to provide support and care for eleven adults between eighteen and sixty-five years of age with learning disabilities. Two of the service users live in a flat that is linked to the main house. Several service users also suffer mental health problems and present challenging behaviour. The aims and objectives of the home is to provide a secure and comfortable home; encourage and support residents to make decisions and choices in their lives; support and assist service users to make and maintain satisfying relationships; assist service users to develop their skills; and enable service users to engage in valued day time occupation and use the community facilities. Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection during the weekday lasting for 4 hours. The purpose of this inspection was to examine the lifestyle, the staffing and management arrangements in the home. Time was spent observing the daily life including lunchtime and interactions with staff and service users. During this time there was discussions with most of the staff on duty and service users who were at home during the inspection. Many service users were engaged in their busy daily activities and most service users were at home at different times during the inspection. Not all service users were able to communicate directly and staff assistance helped in this area. One relative was also available for discussion. Time was spent with the deputy manager who was on duty to discuss aspects of the home. Records relating to the management of the home and a limited number of service users records were examined to further evidence discussion and observations during this inspection. What the service does well: What has improved since the last inspection?
The home is currently going through a cyclical redecoration to enhance the décor within the home. The home continues to maintain a high standard of care as confirmed through observation and discussion with service users, a relative and staff on duty.
Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 6 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. Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 7 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 Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Prospective service users are admitted only after thorough assessment and planning including trial visits to “test drive” the home. EVIDENCE: A new service user has moved into the home within the last 8 months. Staff confirmed that an assessment had been carried out to ensure the service users needs could be met. Trial visits had been arranged to allow the service user to “test drive” the home. The assessment and transition reviews were examined and found to be thorough with the timing of the admission occurring to meet the service users requirements. The key worker for this service user explained their role in the admission and subsequent involvement and support provided. There is a detailed admission policy available within the home with further information available in the statement of purpose. Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6 to 10 were not assessed during this inspection. EVIDENCE: Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Service users have the opportunity to choose from a very wide range of appropriate activities and leisure pursuits both within the village and wider community. Daily routines and house rules promote independence, individual choice and freedom of movement, subject to any restrictions agreed in the individual plan. Service users are offered a varied and culturally appropriate menu. EVIDENCE: There has been some redevelopment to the activities and leisure pursuits provided in the day service program for each service user. With the appointment of “lifestyle opportunity managers” detailed information about social, educational, therapeutic and leisure opportunities available both within the village and wider community has been produced. Staff members and in particular key workers assisted service users to choose from this range to “build” a new day services program to meet their individual needs and interests. Evidence taken from day service and leisure timetables indicated that there is a wide range of stimulating and appropriate activities provided. Two service users confirmed their satisfaction with their current planned
Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 11 activities and were able to discuss their experiences. One service user has employment within the village. During the inspection the atmosphere was busy with service users and staff arriving and leaving at various times to attend organised activities. It was observed that service users were free to move around the home with staff supervising and providing support as required. Staff interacted with service users in a professional manner with an emphasis on service users choice, which was demonstrated throughout the inspection. Daily routines and house rules promote independence, individual choice and freedom of movement, subject to any restrictions agreed in the individual plan. Staff support service users maintain links with family and friends. One relative felt that they were always made welcome and felt involved in the life at the home. The home benefits from a “homemaker” who is responsible for preparing the main meals at the home. The homemaker confirmed that the menus are prepared in advance with alternatives for main meals. The menus seen were varied with a good rotation of choice. Enough of each choice is prepared to ensure service users choose at the time of the meals with the remainder used for staff that take their meals with service users. The homemaker confirmed that he has attended cultural training and both the menu and food preparing is checked on a regular basis to ensure all cultural observances are strictly followed. Lunchtime was observed and service users and staff were relaxed enjoying their meal together both in the main house and in the flat. Service users confirmed that they had no complaints with the menu. Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18 to 21 were not assessed during this inspection. EVIDENCE: Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were not assessed during this inspection. EVIDENCE: Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 to 30 were not assessed during this inspection. EVIDENCE: Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 A professional, knowledgeable and dedicated staff team that receive a good level of training, support and supervision support service users. Service users are protected by the implementation of the provider’s robust recruitment policy and procedures. EVIDENCE: Throughout the inspection staff were observed to support service users in warm and professional manner. Staff members were interested, motivated and comfortable with the service users they were supporting and demonstrated a good ability to communicate and understand service users that had some difficulty with verbal communication. Staff spoken to clearly understood their roles and had a detailed understanding of service users care and support needs and worked together as a cohesive team. Through ongoing training and regular input from the cultural advisor, the cultural needs of service users are understood. Service users that were able to express an opinion were positive about the staff team. Through clear records it was identified that there are currently 33 care staff employed at the home (excluding the registered manager). 19 staff have completed at least an NVQ level 2 which represent over 50 of this large staff team. A further 11 staff are currently progressing through this qualification. Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 16 There are normally five or six support staff in the main house with a further two staff on duty in the flat. This high ratio includes regular one to one support required by some service users living at the home. The recruitment of new staff is carefully coordinated within the village following the provider’s robust recruitment policy that was available in the home. The deputy manager confirmed that interviews are held and demonstrated the use of documents relating to the selection of potential staff, which includes a written assessment. The deputy manager had a sound understanding of the selection process. Staff spoken to confirmed the deputy manager’s account of the recruitment and selection procedures. Two staff personnel records were viewed and found to contain all necessary pre employment checks to ensure new staff fitness to work with service users. Two staff that had been employed at the home for less than six months were spoken to in relation to their induction and training program. Both staff stated they had completed their induction program and felt very supported by the team within the home. Induction records relating to the progress of these staff were available and complete. Both staff stated that during their six-week induction they had attended an eight-day training program within the village to include all main topics relating to their roles. Each staff member has an individual training record that details the training completed and copies of certificates. Staff spoken to confirmed there was a good training program available and that their training needs and progress is discussed during supervision sessions. Record seen were organised and the registered manager had completed evidence of an audit. Training records revealed that staff have attended a varied training program to include topics relevant to the needs of the current service users. Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 The leadership and management style at the home ensures a high standard of care is consistently delivered to each service user. Service users benefit from a well run home. The home benefits from the monitoring and evaluation of the quality of the services and systems provided by the home to include views from service users and their representatives. The health, welfare and safety of service users is promoted and protected by conscientious monitoring and safe working practises. EVIDENCE: The registered manager has been in post for some time and has completed all relevant qualifications in respect of her post. A stable and professional senior team supports the registered manager. The registered manager and senior team clearly “set the standard” in the home. All staff spoken to felt the team was approachable with clear and open management processes. Staff felt that the management ethos and clear direction contributes to the high standards of care for service users. Staff also felt that their views are valued and felt included in decision-making.
Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 18 The registered manager has effective quality monitoring systems to evaluate the success of the home. One staff member spoken to audits the health and safety systems on a monthly basis and reports findings to the registered manager. Many records seen had been clearly audited by the registered manager. In common with other homes in the village a “lay monitor visit” occurs on a regular basis, which includes a panel of relatives from other homes. The last visit occurred November 2005, which recorded a positive outcome. Service users are encouraged to contribute their views through service users meetings and one service user attends the monthly service users committee meeting in the village. A relative spoken to also confirmed that there are regular committee meetings held by relatives with the attendance of senior management from the village. The relative confirmed that the staff and management in the home are always interested in their views and senior management are accessible. The health safety and welfare of service users and staff is closely monitored by one support worker and the registered manager. The support worker responsible for this explained that she undertakes an audit on a monthly basis. Records for these audits were examined and were very thorough covering all areas of the home. Records relating to fire safety, gas and electrical safety, hot water temperatures, food hygiene, equipment servicing, accident reporting and risk assessments for safe working practises were examined and complete in all cases. Ongoing training in topics relating to health, safety and safe working practises is provided for staff on a regular basis as evidenced in training records. Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 3 4 3 X X 3 X Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 20 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. Refer to Standard Good Practice Recommendations Orchard DS0000011367.V274427.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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