This inspection was carried out on 14th February 2006.
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.
CARE HOME ADULTS 18-65
Orchard Care 202 Weston Road Meir Stoke-on-Trent Staffordshire ST3 6PE Lead Inspector
Sue Jordan Unannounced Inspection 14th February 2006 09:15 Orchard Care DS0000008320.V283312.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 Care DS0000008320.V283312.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 Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Orchard Care Address 202 Weston Road Meir Stoke-on-Trent Staffordshire ST3 6PE 01782 342123 01782 595654 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) Orchard Care Mrs Carol Ann Forys Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Orchard Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th August 2005 Brief Description of the Service: Orchard Care is a large two storey detached house situated in a residential area of Weston Coyney. The Home is registered with the Commission for Social Care Inspection to care for four younger adults with a learning disability. At present there are four gentlemen living at Orchard Care. The property is situated on a main road with access to the rear of the property. The gardens are spacious, secure and well maintained and there is a patio area with ample seating and private lawned area. The inside of the property is homely and domestic in character. Orchard Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report must be read in conjunction with that from September 2005. The key standards have all been inspected over a twelve-month period. The Home has been facing very high-risk challenges since the last inspection and as a result this inspection focused on the action being taken to safeguard all of the service users and staff. What the service does well: What has improved since the last inspection?
Additional information and clarification regarding fees has been added to the contracts. They have been put into place for all of the residents. Records are now being made of the medication as it comes into the Home. Improvements have been made to the environment. Orchard Care DS0000008320.V283312.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 Care DS0000008320.V283312.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 Care DS0000008320.V283312.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, 3, 5 Present circumstances are hindering the Home’s ability to meet the needs of all of the residents. However the manager and the social work team are addressing this. EVIDENCE: A current Statement of Purpose was not available during this visit. The manager thought that it might have been taken by staff undertaking their NVQ award. She agreed to obtain a copy. Concerns have been raised recently as to whether the Home can continue to meet the needs of one of the residents. These difficulties have also impacted on the Home’s ability to meet the needs of the other residents. Assessments have been undertaken by an Occupational Therapist and the risks involved in providing support have been continuously reviewed and amended. Changes in staffing structures and behavioural management strategies have not had the positive result hoped for. The evidence suggests that every attempt has been made to adapt to the service user’s changing needs. The manager has involved external professionals including speech therapy, behavioural services and care management and a review planned and organised. Orchard Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 9 The contracts between the Home and the service users contains all of the required elements. They were amended in 2005, to include more information as to what is and what is not included in the fees. They also stipulate the circumstances in which a service user may be asked to leave and a four-week period of notice. The contracts have been signed by the service users and/or their families. Orchard Care DS0000008320.V283312.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 Strategies have been implemented to manage the present high-risk situations, however a permanent solution is now being sought, which will safeguard all of the service users and staff. EVIDENCE: Comprehensive risk assessments are in place and there is evidence that these have been reviewed and amended as and when necessary. Restrictions and limitations are justified and explained in risk assessments. Behavioural management strategies are agreed and strictly adhered to. Care planning continues to be high priority. The present circumstances are creating high-risk situations to the residents and the staff. The manager and staff have assessed all of the risks and strategies have been put in place. It is noted however that these risk assessments are placing limitations and restrictions on all of the service users and as a result the manager is seeking a permanent solution. Orchard Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 11 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): 13, 14, 16 The daily lives and routines are being affected by the present challenges. This is being addressed. EVIDENCE: The Home is presently having difficulties facilitating the ‘lifestyle’ standards. The efforts of the staff team have to be concentrated onto one service user in order to maintain the safety of all the residents. The Home has increased their staffing levels but the size of the environment and the coping abilities of the residents means that there is a limit to this. Although the staff still try to ensure that each of the residents go out into the community daily, they are not able to make permanent plans due to the current challenging and inconsistent atmosphere. Daily routines are also dictated by the current situation and the risks identified are having a disabling effect on all of the residents. Orchard Care DS0000008320.V283312.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): 18, 19, 20 Personal care and health needs are recorded in the care plans and support given accordingly. EVIDENCE: Personal care needs are identified within the care plans and delivered accordingly. The service users’ records contain evidence that health needs are monitored and access to the appropriate medical professionals arranged. The manager reported that records are now being kept of all medication coming into the Home. Orchard Care DS0000008320.V283312.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): 23 Every effort is being made to safeguard all of the residents and staff. EVIDENCE: The staff have received training in physical intervention, although the level relevant at the time of training is no longer applicable. The intervention required at this present time is leaving some of the less experienced staff and the service user vulnerable and this also has to be taken into account when rotaring the staff. The behavioural management strategies and risk assessments have to be constantly reviewed and amended. The present atmosphere is very restrictive for all of the residents and impinges on their rights and freedom within the house. This is being addressed appropriately. Orchard Care DS0000008320.V283312.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): 24 Further work has been completed to ensure that the residents are comfortable in their home environment. EVIDENCE: There have been a number of improvements to the Home’s environment both internal and external. A new bathroom floor has been fitted and the small dining room redecorated. The front door has been re-panelled and connected to the fire alarm system. The radiators are gradually being covered throughout the Home. Orchard Care DS0000008320.V283312.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): Inspection of this section did not take place on this occasion. EVIDENCE: Orchard Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 16 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): 39 The manager and the proprietor are due to undertake a quality audit of the service on 21.02.06. EVIDENCE: The manager and the proprietor are due to undertake a quality audit of the service on 21.02.06. Orchard Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 17 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 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X 3 X X X x Orchard Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 18 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 Care DS0000008320.V283312.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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