Inspection on 03/05/07 for Orchard

This inspection was carried out on 3rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Orchard 19/01/06

Orchard 10/08/05

Orchard 08/02/05

Orchard 27/10/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Orchard Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ Lead Inspector Kerry Kingston Unannounced Inspection 3rd May 2007 09:30 Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 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) bucketsandspades@norwood.org.uk Norwood Ravenswood Ltd T/A Norwood Mrs Susan Ravey Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19/01/06 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 are 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. The fees are £47611 per year to £188917 per year. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced site visit which took place between the hours of 11.00am and 5.30pm on the 3rd May 2007, to collect additional information to inform the report for the key inspection. The information was collected from a pre-inspection questionnaire, completed by the acting manager, surveys completed by four people who use the service (with help from their families), an advocate and five other professionals who are involved in the care of those who live in the home. Discussions with three staff members, the manager and two people who use the service took place. There was further communication with and observation of other people and staff during the course of the visit. A tour of the home and reviewing service user and other records was also used to collect information on the day of the visit. The home has excellent outcomes for service users in several areas. What the service does well: People who live in the home are helped to decide for themselves, as much as possible, what they would like to do and how they like to live. The home makes sure that people can do as much for themselves as possible, as safely as they can. People have plenty of activities that they can choose to do during the daytime and in the evenings. People are helped to keep in touch with their families and friends. Staff make sure that the people get very good food and can help to choose what is on the menu. People are helped to look after themselves properly and they go to the doctor or the specialist when they are not well. People who live in the home are protected and kept as safe as possible. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 6 Staff make sure the home is comfortable, looks nice and is a nice place to be for everybody who lives there. Many of the staff have worked in the home for a long time so they know everyone well, and they have had good training so that they know how to care for the residents in the best way. The home is very well run and the people who live there and what they think is very important to the manager and the staff. What has improved since the last inspection? 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. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 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.V330823.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. People who use the service experience good quality outcomes in this area. Prospective service users are admitted only after thorough assessment and planning processes. The home would follow admission policies and procedures and design the admission process to meet the needs of the prospective service user and those people already living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no admissions since June 2005 The assessment process was looked at during the last inspection. A survey received from a care manager noted that, ‘The assessment arrangements made sure my client got the best care.’ There is a detailed admission policy available within the home. Further information is available in the statement of purpose and Service User Guide, which are produced in appropriate formats. They include the procedures for admission. A possible prospective resident has already had social visits prior to the formal assessment/admissions process beginning. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 9 The manager described how they assess the needs of prospective residents, ensuring that even if their needs can be met they are not admitted if there is a possibility of any detriment to those already resident. There has been a fairly long-term vacancy because a suitable ‘candidate’ has not been identified as suitable to live in the home. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People who use the service experience excellent quality outcomes in this area. The home makes sure that people know as much as they can about their needs and how they are going to be helped by having a keyworker system and using relevant communication systems. The people who live in the home are encouraged to make as many choices and decisions as they can and they are supported to be as independent as they are able by constantly communicating with them and using robust risk assessments. This judgement has been made using available evidence including a visit to this service. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three care plans were seen. They are of a high quality and include communication, psychiatric need, eating and drinking, personal care, cultural issues, religious needs, healthcare, activities and leisure, family contact, behaviour, peoples’ likes/dislikes and how staff can help them to make choices and decisions. The basic care plan format is:Things I can do for myself/things I would like to do for myself/things staff need to remind me to do/things staff need to do for me/things I like/things I dislike. The residents are as involved in the care planning as possible and their involvement is noted on the plans. The care plans note the way staff should approach people and describe how they ensure their dignity, and how they treat people with respect and allow them to make their own decisions. The keyworker reviews care plans monthly, and annual reviews note long term and short term goals. More formal reviews are held as necessary and there is evidence that care plans and guidelines are changed as a result of these, to meet very quickly changing needs. There are also several documents that note that complaints, medication, door keys and bedroom furniture have been discussed/explained to people, their reaction and, if they are able, they have signed with their decision/choice. If they are not able, staff have interpreted their wishes or got parents/advocates to sign on their behalf. There are excellent risk assessments/care guidelines so that people are able to do as much as they can safely. This includes offering two to one support to individuals, so that they are able to access the community. Individual Personal Planning meeting notes are produced in symbols/pictures and simple language. Resident meetings are held monthly and minutes are produced in symbols and easy read format. A staff member has recently developed the new minutes format. Each person has a copy and this is helping to encourage most of the residents to participate in their meetings. The content of the meetings is excellent, and ensures that everyone knows what is going on in the home, who the new staff are and asks for their views on the service. There was evidence that their views are listened to and acted upon, for example there were several comments that residents didn’t like stuffed peppers, which were promptly removed from the menu. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 12 The home is developing a picture board system to provide people with a way of knowing what the meals are for the day, as requested in a resident meeting. A survey completed by another professional said that, “Staff try to accommodate choice as much as is reasonable given the duty of care”, and another said, “They are very supportive enabling my client to do what he wants.” All surveys received from the people who use the service, or their representatives (four of ten people) said that they always or usually make decisions about what they do each day and that they can always do what they want to. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 People who use the service experience good quality outcomes in this area. The people who live in the home are helped to lead a positive, fulfilling life by being offered plenty of activities that suit them, by being supported to stay in contact with people who are important to them and having good food available to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activity programmes are designed around the individual needs of people and an imaginative range of activities is offered. These include hydrotherapy, swimming, horse riding, donkey carting, Special Olympics, bowling, cookery, training for work experience and artworks. People choose their activities with their keyworkers for a term (similar to the school year) and review it after a set time. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 14 There are good opportunities for ‘going out’, usually an outing on a Sunday (in good weather) and to a local club once a week. Organised activities also take place in the house two evenings per week. Extra staffing is provided if necessary to enable people to access the activities during the day and in the evenings and at weekends. Two people spoken to said or indicated that they have plenty to do. One said that the music sessions are particularly good. One person spoke about his holidays and how much he enjoyed them. On the day of the inspection visit everyone went out for at least part of the day and were observed asking staff to go for walks or other activities, and staff responded quickly to such requests. One person showed me her make up and nails that she had been helped to do in a morning health and beauty session. Daily notes generally showed what the residents had been doing in the home additional to their planned daily activities, such as walks, watching television, listening to music and craftwork. One resident said that he liked the television and prefers to watch it on his own in his room, which he can choose to do. The manager and staff are aware of the need to access the wider community as a lot of the activities are centred on the village. The home ensures that some evening, leisure and daytime activities take place in the wider community and everyone accesses the wider community at least once a week. One of the nine surveys returned said that, “The organisation should be encouraged to allow greater diversity and integration into the community.” There was evidence of family being involved in all aspects of residents’ care (as appropriate). One person was enabled to visit a family member who lives abroad, with the support of two staff. She told me how much she enjoyed the experience. Most people’s families visit the home regularly or staff help residents to visit their relatives’ homes. People’s rights and responsibilities are recognised; ‘rules’ with regard to respecting each other and behaving responsibly are displayed on the noticeboard in easily understandable formats. Staff were observed treating people with great respect and sensitivity and ensuring their dignity, for instance unobtrusively helping them to display correct behaviour and eat safely. A survey said, “Strategies to manage behaviour could compromise dignity but staff endeavour to maintain this dignity.” One person has, recently, moved from the home to his own flat as he was helped to develop, so that he is able to live more independently. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 15 Menus have been developed from people’s choices and comments made in resident meetings. People confirmed that they choose alternatives if they do not like what is on the menu as the main course or the alternative. A dietician was consulted to check the new menus for nutritional content. The menu is being developed into a simpler format so that people can see what the meals are for the day. People said that they ‘liked their food’. Laminated cards in the kitchen show residents’ food preferences, any special diets or needs and any assistance or supervision that they may need to manage their meal comfortably. A care worker is designated as the ‘home maker’ and takes responsibility for cooking and food ordering. Residents help with shopping and can make their own snacks if they wish. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People who use this service experience excellent quality outcomes in this area. The home ensures that people are supported to look after their physical, emotional and mental health needs as well as their personal care needs. People’s choices and preferences are acknowledged and they are given as much control over their daily life as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans note all personal care needs, including how people prefer their support to be given. The care plan format is: Things I can do for myself/things I would like to do for myself/things staff need to remind me to do/things staff need to do for me/ things I like /things I dislike. The residents are as involved in the care planning as possible and their involvement is noted on the plans. Care plans look at individual’s needs and include cultural, religious and diversity issues. These are addressed as part of the care package. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 17 A large number of physical interventions were noted on the pre-inspection questionnaire. Staff were very aware of the excessive incidents and were able to fully explain the circumstances surrounding them. The care plan and records evidenced that immediate help had been sought for the person involved in the incidents, support from psychologists and psychiatrists was elicited and appropriate and timely action taken. Most staff have had training in physical intervention techniques. The usual one used is adopting a stance that discourages service users from uncontrolled behaviour and protects staff. The most ‘hands on’ intervention used is a two-person hold, where each staff member holds a resident’s arm, as described by the training. One of the senior staff (the deputy/acting manager) is a physical intervention trainer. All physical interventions are carefully recorded and reviewed by a panel that may ask questions as to why it was used and advise if further action/support is needed for the resident. Staff sign to say they have understood behavioural guidelines and risk assessments and they are followed consistently. Minutes of the staff meetings show that behavioural guidelines and staff working consistently are often under discussion. Residents also indicate that they agree with the guidelines, if they are able, which are explained to them by their keyworker. Care plans include healthcare, and all healthcare needs are properly recorded. Good healthcare records are kept, and follow up appointments are dealt with quickly. Health changes/needs are recognised very quickly, health charts are kept, as necessary, and are used to monitor any special conditions such as epilepsy - for instance, seizure charts can trigger a visit to the doctor and a referral to the specialist. A resident indicating some pain in her mouth/ear/face has been made an appointment at the dentist and saw the doctor last week so that the cause of her discomfort can be identified as soon as possible. Records showed that people receive support from specialist and primary health care services as necessary. There is a robust protocol noted on each individual care plan with regard to how staff administer medication and a document that notes (where applicable) that residents have been asked if they want help to self administer medicines. All residents currently have their medication administered by staff. Staff were seen administering medication safely, and it is safely stored in a medicine cabinet in the staff office. Medication administration records were not seen on this visit, and no medication errors have been noted. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 18 Only staff who are trained to administer medication give it, but not until after they have been assessed as competent by a senior staff member. The assessment is repeated annually and refresher training is offered every three years. One person’s family member noted in a survey that, “He has always had the best of attention and care.” Two doctors returned very positive surveys about the staff helping residents to meet their healthcare needs, as did the other professionals. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use the service experience excellent quality outcomes in this area. The home makes sure it listens to the service users by using varied communication methods and supporting people to say what they think, in different forums. It ensures that people are not abused by having very robust safeguarding adults and behaviour support procedures, and following them rigorously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three complaints were noted on the Pre-Inspection Questionnaire but these were not service user or care related complaints. It was discussed with the acting manager that any staff complaints/concerns not related to the care of the residents or the running of the home would be better separated from complaints/concerns made about the service offered or service delivery. The way to make complaints is explained to individuals by their keyworker, and their response is noted on their care plans. The complaints procedure is produced in a simple format which includes pictures and symbols and is included in the Service User Guide. How to use it is also included in residents’ meetings (on occasion). All the surveys received said that people know who to complain to and how to complain. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 20 The Commission for Social Care Inspection has received no information with regard to complaints about this service. The Commission for Social Care Inspection has received information, from the service, about one safeguarding adults issue. The service dealt with this issue, quickly and appropriately, referred to all the proper agencies and is awaiting the outcome from the investigating authorities. Ten protection of vulnerable adults incidents (safeguarding adults) were recorded between February 2006 and December 2006. Four were related to the incident dealt with by the appropriate authorities (above) and the other six are a result of the home’s procedure/policy of looking at any injuries, unexplained bruises or unusual behaviours by service users. The organisation has a panel of senior staff who look at all incidents that could be protection of vulnerable adults, as described above, offering advice, help and experienced analysis of situations. The home has very robust procedures for ensuring the protection of residents, particularly those with challenging behaviours, and a rigorous reporting system supports the procedures. The large number of physical interventions resulted from the rigorous recording system (as above) and the definition of physical intervention which includes non hands-on interventions such as the ‘protective stance’ (adopting a stance that discourages service users from uncontrolled behaviour and protects the staff member’s body). Staff had an in–depth understanding of safeguarding adults and two staff members gave an excellent description of how they would protect service users. Protection of Vulnerable Adults training is updated regularly. The home only supports people with their personal allowance - they are not involved in the overall financial arrangements of the residents. The organisation’s finance department deals with benefits, payments for care and other financial issues. The manager is not clear what the residents’ overall financial status is and it is not included in all residents’ contracts/statements of terms and conditions. The manager will attempt to clarify individual’s overall financial status with particular reference to income, expenditure and available funds. Individuals should be supported to be aware of their financial situation and it would assist the manager to ensure that they are protected from any form of financial abuse. Residents were observed to be very comfortable with staff, confident to ask for their needs to be met and give their opinions and views. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People who use the service experience excellent quality outcomes in this area. The home is well maintained and comfortable. The staff team use an imaginative approach to ensure that the environment meets individual’s and the groups’ physical, emotional and social needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is very clean and well kept. There were no odours or hygiene issues on the day of the visit. The laundry is well organised and well managed. An inspection by an environmental health officer in February 2006 resulted in no requirements or recommendations. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 22 The home is well decorated, with a redecoration programme being completed during 2006. Bedrooms seen were personalised and reflected individual’s tastes and personalities. One person showed me his ‘new’ downstairs room and indicated that he had chosen the colour and soft furnishings. Plans are in place to convert some areas of the building to meet the needs of a prospective resident. The ground floor has a flat for two people, as living away from the main group of residents meets their needs and the needs of the main group. The home has plenty of communal space that is imaginatively used to ensure the best living conditions for individuals and the group as a whole. All surveys (that asked the question) confirmed that the home is always clean and tidy. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 People who use the service experience good quality outcomes in this area. The home has a very well trained and qualified staff team, who are safely recruited and able to meet the needs of the people who use the service. Staff are supported to enhance and maintain their skills and knowledge levels by training opportunities, staff meetings and regular supervision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is fully staffed with a minimum of eight staff during daytime hours and three staff during night time hours. The manager ensures that extra staff are available, as necessary, such as enabling people to access activities or to support a person who has behaviour issues, for instance in the summer of 2006 a resident’s behaviour deteriorated and the manager negotiated extra staffing to support them while investigations and solutions were being formulated. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 24 Twenty-seven of the twenty-eight care staff have an NVQ 2 or above. One staff member, who had just transferred from another home in the village, felt it was ‘ the best home to work in to increase knowledge and experience.’ Twenty of the twenty-nine staff have worked in the home for over three years, which provides a very stable staff team and good relationships between staff and people who use the service. There were twelve training courses in January and February 2007. These included epilepsy awareness, 3DTV, protection of vulnerable adults, health and safety updates, administration of medicines and challenging behaviour. Staff spoken to confirmed that there are very good training opportunities for the team and for individuals. They said there is regular supervision and an appraisal system. The induction programme for new staff was noted on the rota and showed that staff on induction are additional to usual staff numbers, ‘shadowing’ experienced staff for varying lengths of time until they are assessed as competent to work alone. There is further training by shadowing if staff have any difficulties with any particular areas of work. Staff said managers ‘support staff through difficult times’. They described care given to service users as excellent. Staff meetings are held two weekly and the home has a staff information file which staff read, and sign that they have read and understood any new procedures, risk assessments, care plans or information necessary for them to carry out their role effectively. Staff recruitment records are held at personnel, which is ‘on site’ in the village but not in the home. There are very robust recruitment processes, which include comprehension of English for overseas staff. All the necessary checks to ensure staff are safe are completed and a very good induction process tests their competence and skills. Currently, a large percentage of new staff are recruited overseas, therefore the involvement of those who use the service is limited. A parent who returned a survey said ‘the staff are always helpful, in all matters’. Professionals commented, ‘staff continue to develop skills to support individual’s challenging behaviour’, ‘Staff are always willing to accept training or obtain skills as necessary’. A comment notes that, ‘Staff consistency could be better’, but, ‘This is acknowledged and is being worked on’. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 25 A resident said ‘I like my keyworker’, three people smiled when asked if they were treated well, and two people said, ‘The staff are good’, and, ‘I like living here’. Staff were observed treating people with respect and dignity, responding to their needs quickly and efficiently and working well as a team. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People who use the service experience good quality outcomes in this area. The people who use the service benefit from an efficiently managed home that is run to meet their needs safely. Their views are listened to and their safety assured by various effective quality assurance and health and safety procedures and checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is very well run. The registered manager is suitably qualified with 15 years’ experience of managing the home. She is currently supporting another home, as well as The Orchard. A management support system has been put into place to ensure that the home does not suffer from her limited availability. Senior staff are ‘acting up’ into more senior roles and this is also seen as a development exercise/opportunity for those staff. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 27 The registered manager retains overall responsibility and is very aware of all developments or issues within the home. The home has good management and record keeping systems. Staff spoken to said there was ‘excellent management’ which was supportive and open in style. The home has a quality assurance system that consists of monthly checklists done by a senior staff member who looks at all aspects of the care given to residents and the day-to-day organisation of the home, such as health and safety, maintenance, fire checks, staff meetings and menus. Resident care checklists include choices, communication, meetings, recreation and leisure, language and respect. Regular regulation 26 visits are made and notes of the visit are kept. There is a residents’ committee (the home has two representatives on this), residents’ meetings within the home and there is a ‘drop in’ advocacy service for people to use, if they choose. A monthly meeting takes place in the home to discuss if there are any issues to address from the quality assurance checklist or from any of the meetings. The home does not produce an annual development plan but there is evidence of forward planning, changes and developments being made, for example the method of producing resident meeting minutes in picture and symbols, redesigning areas of the building to accommodate individual’s needs and ‘engaging’ people in resident meetings. The manager agreed to look at producing an annual development plan for the home. The manager confirmed that all health and safety maintenance checks were done regularl. This was included on the monthly quality assurance checklist and staff training records showed that health and safety training is an ongoing cycle with refreshers at the necessary intervals. Staff are trained in physical intervention to make sure that they and the residents are kept as safe as possible in difficult situations. Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 28 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 3 X Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 29 NONE Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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.V330823.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. Extracts may not be used or reproduced without the express permission of CSCI Orchard DS0000011367.V330823.R01.S.doc Version 5.2 Page 31 - 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. 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