Inspection on 10/11/06 for Orchard Close (2&3)

This inspection was carried out on 10th November 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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard Close (2&3) 09/02/06

Orchard Close (2&3) 22/08/05

Orchard Close (2&3) 10/03/05

Orchard Close (2&3) 10/12/04

Orchard Close (2&3) 26/02/04

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

CARE HOME ADULTS 18-65 Orchard Close (2&3) 2 & 3 Orchard Close, Rodney Road Wanstead London E11 2DH Lead Inspector Stanley Phipps Key Unannounced Inspection 10 to 28th November 2006 10:00 th DS0000025913.V318484.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 DS0000025913.V318484.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. DS0000025913.V318484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Close (2&3) Address 2 & 3 Orchard Close, Rodney Road Wanstead London E11 2DH 020 8518 8261 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) www.rchl.org.uk Redbridge Community Housing Limited [RCHL] Mr John Troy Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places DS0000025913.V318484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: Orchard Close (2&3) is a care home providing personal care and accommodation for up to fourteen adults with mental health support needs. It caters for service users - both male and female. The service is owned and managed by Redbridge Community Housing Limited and is located in a quiet residential area of Wanstead in the London Borough of Redbridge. It is also close to some small local shops and a bus route. The home was opened in March 1991 and comprises two houses that are adjacent to each other, but managed as one service. All bedrooms are single occupancy. Orchard Close (2&3) is by staffed on a twenty-four hour basis and work is carried out closely with service users in developing their; personal/living skills, confidence and self esteem. Particular emphasis is put on increasing service user’s presence in community living. It is run by a very experienced manager and deputy; and two senior support workers, one based in each house. The service is geared towards enabling each service user to access healthcare, leisure, spiritual and recreational pursuits in line with their individual choices. Most of the service users have been in the home for a considerable period of time and have grown older, with up to five individuals currently over the age of sixty-five. The registered persons have recognised that whilst every effort is made to provide a ‘home for life’ – this would depend on their ability to meet service users needs. A statement of purpose is available to all service users and a copy of the service users guide is each individual. Fees are range from £62.35 to £117.05 per week. Service users pay additional for toiletries, holidays and hairdressing – the prices of which are all variable. DS0000025913.V318484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. The inspection was carried out over two days beginning on 10/11/06 at 10.00 am and ending, on the 28/11/06. The inspection found many improvements to the service and this is positive as an outcome for service users. This included the experiences of the most recently admitted individuals. Further improvements are required to fully comply with the national minimum standards for younger adults and they are outlined later in this report. An assessment of menus, policies and procedures, records, service user plans and the environment was undertaken. Detailed discussions were held with staff, including the manager, senior on duty and, an interview was held with a relative as part of the case tracking of a service user. Formal interviews were held with two members of staff, and four service users, while detailed discussions were held with several others. The inspection also took into consideration written and verbal feedback from external professionals, written feedback from five members of staff, and up to eleven completed service user questionnaires. It was noted that most of the service users were keen to comment about their experiences in the home, which were in the main – positive. It was clear that the staff and management at Orchard Close were, providing an effective and important service to individuals with mental health support needs. What the service does well: Service users continue to maintain a good rapport with staff and in so doing enjoy a life that is comfortable at Orchard Close. They all have established routines, which they carry out with confidence and authority. The management and staff continued to promote the health and wellbeing of service users by ensuring that appropriate links are made with health professionals. Written feedback from health professionals clearly indicated that the staff worked in partnership with them, regarding the needs of service users. A continued strength of the service is, to encourage service user involvement, by giving them opportunities to make positive choices that may affect their lives. DS0000025913.V318484.R01.S.doc Version 5.2 Page 6 The organisation has maintained a good program in monitoring the service through regular, monthly provider visits. They were also keen to ensure that the views of service users are an integral part of their quality assurance mechanisms. The organisation also works positively with the Commission to improve standards in the home. Service users therefore benefit from this relationship. What has improved since the last inspection? What they could do better: Service user plans and risk assessments in House 2 must be kept updated at all times. An occupational therapist assessment must be carried out in view of the changing needs of service user that are older. The registered persons could look into and verify the qualifications of the registered manager with the appropriate professional body. Arrangements should be made to review the smoking arrangements and ventilation system in House 2, having consulted with service users and staff. Risk assessments should be carried out on all first floor bedrooms with doors that open fully allowing external access to the ground floor. This should be carried out with the occupying service user in mind, the possibility of accidents or the potential for self-harm. Action should be taken as appropriate to minimise any risk – identified. DS0000025913.V318484.R01.S.doc Version 5.2 Page 7 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. DS0000025913.V318484.R01.S.doc Version 5.2 Page 8 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 DS0000025913.V318484.R01.S.doc Version 5.2 Page 9 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): (2,5) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users continue to have their needs thoroughly assessed to ensure that the home is able to meet them. They also benefit from being actively involved in this process. Fees payable by service users are included in their individual contracts. EVIDENCE: The files of the two most recently admitted service users were assessed and a thorough assessment was carried out in each case. The assessments detailed the needs of the service users concerned and service user plans were developed for each individual as a result. Service users spoken to confirmed their involvement in the process and signed the document as part of their involvement in it. A suitably qualified professional with experience in the field of mental health carried out the assessments and it was noted that detailed information was acquired from the referring authority. This ensures that the decision to admit a service user is made by taking into consideration, all the requirements of the individual. In assessing the service user contracts, it was noted that the fees chargeable, were included in them. This is an improvement from the last inspection. The contracts detailed the rights and responsibilities of both parties and copies were on file for the individuals concerned. There was evidence that service users signed their documents and this is positive. DS0000025913.V318484.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) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plans generally reflected their needs, although in some cases their changing needs were not included. Opportunities are given to all service users in determining how they live. This is complimented by good risk planning in most instances. It could be made better once risk assessments for all service users are kept updated. EVIDENCE: Although there was evidence of good care planning in some areas of the home, it was observed in House 2 that several service user plans failed to reflect the changing needs of service users. This is despite the home having a good system of service user planning in place, with six-monthly reviews. Sound evidence was in place to indicate that service users were involved in the process with their individual key-workers, and this is positive. Service user plans were also sampled in House 3 and they were updated and reflective of the needs of service users, including that of the most recently admitted individuals. This was discussed with the registered manager and he informed that the service user plans were to be updated by the deputy manager. During the course of the second visit, some improvement was noted, but work was still DS0000025913.V318484.R01.S.doc Version 5.2 Page 11 required on some of the plans in House 2. For those individuals, without updated service user plans, it was difficult to see how their needs were adequately met. Service plans in both houses covered the health, social and specialist needs e.g. mental health support needs of individuals. There was evidence throughout the home that service users are supported to make decisions that affected various aspects of their lives. A good example of this is where a number of individuals are happy to attend the Ley Street day centre and arrangements were made for them to do so. Others were not so keen and that was respected. Some individuals chose to do very little and this included the decisions around going out e.g. choosing not to go on a trip to Margate in 2006. In interviewing one service user she was happy with visiting the paper shop, viewing TV, attending service user meetings and phoning her son. She confirmed that staff were very respectful of the decisions that she made. All service users have access to the advocacy services and it was noted that a number of individuals were supported to handle their financial affairs. In discussions with one individual, he spoke quite positively of continuing his love for football and support for Chelsea – and being able to do so at Orchard Close. His attendance to home games as a season ticket holder is quite a positive choice from his perspective. In another case a service user had to be admitted to hospital, through the assessment process, which was positive. From the records viewed, it was clearly established that the decision was in the individual’s best interest, though at the time the service user would not have agreed to being hospitalised. One hundred percent of the written service user feedback received – informed that individuals are actively involved in making decisions about their lives. This is a strong area of the homes operations. Risk assessments were in place for all service users and in most cases, they were linked to the service user plans. As with the service user plans, risk assessments in House 3 were updated and reflected the current situation with individuals. In House 2, there were some risk assessments that did not reflect the current position for service users. This, like the service user plans needed to improve. In the instances where they were updated, service user’s safety were preserved, and their independence promoted. In speaking with one service user with diabetes, he was quite aware of the reasons for limitations in what he ate. In another case the individual spoke of the risk to his health if he did not have his insulin. It was clear service users were involved in their risk assessments and having them updated, was key to preserving their health and welfare. However, updated risk assessments must be in place for all service users. DS0000025913.V318484.R01.S.doc Version 5.2 Page 12 There is a missing persons procedure in place at the home and during the course of the year, the staff and management at the home, have had to use it. It was accepted that the steps taken, were aimed at promptly acting on promoting service user’s safety. DS0000025913.V318484.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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. At Orchard Close service users benefit from participating in appropriate activities, both internally and in the community. They are supported to develop and maintain their social and personal networks and encouraged to exercise their rights, which are respected and promoted by staff in the home. The nutritional requirements of service users are adequately provided for. EVIDENCE: Each service user had their interests identified through service user planning and regular meetings. Each individual also had schedule of activity for the week. It was noted that the levels of interests in doing things varied from service user to service user and at times the mental state of the individual was a key factor in determining the level of participation one commits. Over fifty percent of the service users attended the Ley Street Day Centre several days per week. One service user attended Redbridge College, having an interest in computers and another attended a Jewish Day Centre once per week. Most service users were happy to continue participating in activities that were fulfilling to them. Other examples of this including, going out for bus rides DS0000025913.V318484.R01.S.doc Version 5.2 Page 14 visiting friends, attending a therapy group at Goodmayes and visiting the drop in centre at Mellmead House to play pool and snooker. This is positive. At Orchard Close, service users are integrated into their community, although some do so more frequently than others. This includes the use of local shops, pubs, newsagents and staff worked closely with individuals to promote their community presence. Service users interviewed indicated that they could go out whenever they want to. One service user stated that he was happy in the home and did not wish to be getting out too much. During the course of the inspection a number of individuals were out doing different things and this ranged from visiting friends to having a pub lunch. Some service users also enjoyed getting out on the weekends and this is positive. There was no limit placed on service users in using the community. During an interview with the relative of a service user, she was extremely commendable about the staff and management’s support for her sister. She is involved and notified about the care provision of her sister and was quite pleased with this. She felt welcome in the home and informed that the service user’s daughter and friend pay regular visits to the home. Several other service users go out visiting friends and one of the most recently admitted service users spoke positively about maintaining his relationship with one of his friends that lived far away. During the inspection one service user was visiting her brother, while a staff member was observed accompanying another service user to see to see his brother in hospital. One service user informed that his sister was due to attend his review, which followed the inspection. While visiting service users bedrooms, family photos were on walls and a positive culture is encouraged between families, friends and service users. Several other service users had planned arrangements to see their relations, as well as their friends. This is strong area of the homes operations. Service users rights and responsibilities were promoted throughout the home, by consulting and involving them in decisions affecting their lives. At Orchard Close service users play an active part in maintaining their home e.g. helping to clean the kitchen floor and, tidying their personal spaces. From speaking with individuals they were quite pleased with making a contribution – as one person put it; ‘it is nice to look after your own, whenever you can’. Service users are encouraged and supported to maintain their skills and as such staff were observed prompting and encouraging them in a respectful manner. All service users have the opportunity to hold keys to the their rooms and the front door. One individual even confirmed that he had a key to the gate, as he sometimes gets back slightly after the time that the gate is shut. Service users have unrestricted access to all areas of the home and grounds and, most made use of it. Throughout the inspection staff were engaged with service users, although several individuals wanted their own space and was allowed to DS0000025913.V318484.R01.S.doc Version 5.2 Page 15 maintain that. Service users were addressed by their preferred names, asked whether it was okay to access their rooms and most importantly had their wishes carried out. There was a range of menus in place and service users confirmed that they contributed to them during the course of their meetings. Minutes from the most recent meetings bore evidence that menus are discussed. Although the menus were set service users could opt for something different on the day. Staff were involved in preparing the meals and the specialist dietary needs of individuals were well-catered for e.g. diabetics. One service user enjoys making his lunch and is supported to so do. Another enjoys lunch out and this is also encouraged. Meals consumed are recorded to ensure that the nutritional needs of service users were not only monitored but, adequately met. One service user was observed being offered healthier options in managing his blood glucose levels and this is positive. A supply of fresh fruit was available to service users, and there were adequate supplies of fresh and frozen foods in the home. The manager informed that fruit is purchased every other day. Staff supporting service users with nutrition and meals had food hygiene training. Lunch was fairly relaxed and all service users and a relative spoken to were happy with meals in the home. One individual indicated that his favourite was lamb casserole and this was on the menu. Food storage was of a high standard and there was regular monitoring of fridge/freezer temperatures. This is a satisfactory aspect of the homes operations. DS0000025913.V318484.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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy personal support in a manner that is suited to them. Sound arrangements are in place to provide for their physical and emotional needs. This is complimented by the staffing input with medication, enabling service users to maintain good standard of health. EVIDENCE: The needs of service users were generally detailed in their service user plans. All service users spoken to, spoke positively about their experience with staff in offering them personal support. One service user stated, ‘ I go to bed after viewing sky TV and wake up earlier if I have an appointment’. Feedback assessed indicated that all service users go to bed at times, best suited to them. All service users spoken to were able to describe the work of their key – workers, in supporting them. In several cases service users required prompting and/or more intense support to achieve their daily objectives – personal or otherwise. At the time of the inspection, one individual was quite unwell and an appropriate plan was in place to support the individual. It is a credit to the staff for the way in which they provided support in a sensitive manner to service users that were experiencing various levels of distress. DS0000025913.V318484.R01.S.doc Version 5.2 Page 17 All service users were registered with a GP and had input from a psychiatrist for input for their specialist needs. There was evidence that service users are given opportunities to manage their healthcare by providing information to them as well as access to other professionals e.g. the diabetic nurse, district nurse or psycho-geriatrician. In one case a service user takes responsibility for administering his insulin at certain times in the day. Staff were instrumental in enabling this outcome and the individual concerned was quite pleased with this. Interviews held with staff indicated that they were knowledgeable about the physical and mental health needs of the service user group. This is useful as they were able to initiate actions when a service user relapsed or becomes physically unwell. Records viewed bore evidence of several interventions that were crucial to promoting the health and welfare of service users. This included annual health checks to the GP and dentists, six monthly visits from the opticians and various appointments with the chiropodist, district nurse and community psychiatric nurse. Service users are assured that their health and wellbeing is provided for. Service users receive good support with their medication, which for most is an integral aspect of their healthcare support. Given the fact that their special needs are that of mental ill health, it is important that service users and staff alike understand the importance of medication. Interviews held with both groups indicated that they knew the drugs in use and the desired effect. At the time of the inspection, two service users had the ability to manage their medication and a risk assessment was in place to support this outcome. One of the service users also collects his medication and attends his external appointments independently. Good guidelines were in place for staff, where ant-coagulant and diabetic drugs were in use. Two staff are involved when administering controlled drugs with signatures to confirm the occurrence. This is good practice. Drug storage, monitoring and recording was of a high standard. Staff responsible for administering medication did have appropriate training and this included training in dealing with some emergencies e.g. supporting someone in hypoglycaemic shock. The registered manager did have a recent copy of the British National Formulary at hand for staff should they need to refer to issues around medication. The medication bubble pack was under review with plans in place to introduce in January 2007 - re-sealable bubble packs to preserve drugs that may pop out accidentally. The new pack would also have the name of each service user at the bottom and a slot for the service user’s photo. This is a strong area of the home’s operations. DS0000025913.V318484.R01.S.doc Version 5.2 Page 18 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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are assured that their complaints would be acted upon – once raised. At Orchard Close adequate systems are in place to safeguard service users from abuse. EVIDENCE: A satisfactory complaints procedure is widely available to service users and their relatives. During interviews held with service users and a relative, it was clear that they were aware of the procedure. At the time of the visit the complaints record detailed a complaint, dated 13/7/05 – and this was handled satisfactorily. Service users are encouraged to raise concerns at any time and, in their monthly meetings, checks are made to determine whether there are issues affecting them. Staff demonstrated a sound awareness with regard to service user’s right to complain, as well as their role in enabling them to so do. This is positive. At the time of the visit, there were no adult protection issues in the home. Satisfactory adult protection procedures and protocols were available to staff working with vulnerable service users. This is complimented by the provision of adult protection training for all staff. Staff interviewed demonstrated a sound understanding of protecting vulnerable adults and were clear on their role in reporting suspicions and allegations of abuse. For individuals that were at risk of self-harm, risk assessments were in place to keep the risk/s to a minimum. Service users are generally safe at Orchard Close, particularly given the improvement in staffing recruitment, identified under staffing. DS0000025913.V318484.R01.S.doc Version 5.2 Page 19 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): (24,26,28,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users continue to enjoy an environment that is homely, generally safe, clean and satisfactorily maintained. Improvements to several of the communal areas have given the home an added lift. Private spaces are furnished to good standards. Some actions are required to enhance safety in the home. EVIDENCE: The registered persons took action in carrying decorative works to the communal areas of the home and service users spoken to were quite pleased with it. One service user in House 2, commented, ‘our home is all painted up now – it is much nicer. Isn’t it’. It was clear that the individual was pleased with the work carried out. At the time of the visit curtains were also being replaced with blinds, which looked quite bright, airy and attractive. When asked their views about the change, service users and a relative described the improvements as – ‘brilliant’. What was also positive was that it was coming up to Christmas and this added a nice feel to the environment. The home remained generally fit for its purpose, however, it was noted that a number service users were getting older and as such issues around safety and mobility would become more of issue. In this respect the registered persons DS0000025913.V318484.R01.S.doc Version 5.2 Page 20 need to have an occupational therapist assessment carried out on the home, to ensure that the physical environment is best suited to meet the changing needs of service users, in a safe manner. This assessment would be helpful in identifying aids and/or adaptations that would be necessary to support service users to maintain their independence at Orchard Close. It needs to be carried out sooner rather than later to ensure that action required could be taken before a surge of incidents e.g. service users falling over. During the course of the inspection, it was noted that the volume of smoke in the lounge (designated smoking area) House 2 was excessive. This is due to the fact that a number of service users are heavy smokers. There is an extractor device, which is extremely noisy, particularly when turned up. This results in the television being turned up quite loud for service users to hear their programmes. Staff expressed some concern over being exposed to the effects of passive smoking and to a lesser extent – noise pollution. Staff in trying to keep a favourable balance would open the windows to create more natural form of ventilation. However, in the colder months such action would also cause considerable discomfort to both service users and staff. This may lead to some staff in order to protect their health, choosing not to engage with service users, when they are sitting in the lounge referred to. The registered persons should review the arrangements for smoking in House 2 in consultation with staff and service users, to achieve a more comfortable environment for all. Several bedrooms were looked at with the permission of service users. The furnishings and fixtures were satisfactory and service users were pleased with them. Rooms were personalised to individual taste and choice. Heating, lighting and ventilation were also satisfactory in the rooms viewed. All bedrooms were lockable to promote the privacy of service users. Staff have the capacity to override this, in the interest of health and safety. Some bedrooms on the first floor contain doors that open fully, allowing service users good light and ventilation and this is positive. However, there may be a danger if a service user becomes unwell or has an accident from toppling off over a very short barrier, onto the grounds below. The registered persons should carry out a risk assessment for the individuals occupying these rooms, to ensure that risks to service users are low. The home was generally clean and pleasant. Most service users commented that the home is always clean and tidy and this is positive. The laundry facilities were satisfactory and there are facilities for cleaning hands throughout the home. Policies and procedures for infection control were in place and staff were knowledgeable with respect to infection control. Service users and staff live and work in an environment that is hygienic. DS0000025913.V318484.R01.S.doc Version 5.2 Page 21 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): (32,34,35,36) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive care and support from a staff team that is committed and motivated. This is enhanced through the provision of consistent staffing with training that is specific to the needs of service users. Improvements in the organisation’s recruitment practices now mean that service users are in safer hands. A wellsupported staff team is in place to provide care and support to service users. EVIDENCE: Staff observed during the course of the inspection demonstrated good commitment to supporting each and every service user in the home. They understood the needs of the service user group and were skilled listeners. They worked well in motivating individuals some of whom, proved difficult to engage. All service users were happy with the efforts of staff, with most, stating that the carers listen and act on what they say. Sixty- per cent of the staff had achieved at least an NVQ level 2 in care, with at least two achieving an NVQ level 3, as this is recognised to provide greater insight into the needs of the service user group. One member of staff has started a VRQ in Mental health and plans were in place for others to pursue this, which is thought to be appropriate in working with the current group. The staff team is mixed in terms of gender and ethnicity and this provides a solid platform for meeting the diverse needs of the service user group. Records DS0000025913.V318484.R01.S.doc Version 5.2 Page 22 assessed indicated that staff maintained positive relationships with professionals in the best interests of individual service users. During previous inspections, it was identified that the recruitment practices of the organisation were unsatisfactory and needed improving. The Commission had set out clearly the areas that required improvement, as there was a lack of robustness and consistency across the organisation in recruiting staff and maintaining staffing records, in line with regulation. As a result, arrangements were made earlier in the year (2006) to monitor progress and change, during which it was established that there was significant improvement in this area. The recruitment practices in relation to new staff had improved with systems in place to ensure consistency across the organisation’s services. The records held on existing staff had also improved and the organisation was held in high esteem for the work it carried out to ensure that its recruitment practices – promoted the safety of service users. There was evidence of a training and development plan for staff in the home. Staff had been provided with training that was pertinent to the job they do and this was true for all levels of staff. Some of the further training planned included: First Aid, NVQ, Mental Health Awareness, Health and Safety, Food Hygiene, Equality and Diversity and, Oral Hygiene. There was evidence that staff were in receipt of a detailed induction and staff spoken to were happy with the level and quality of training that was provided by the organisation. Staff demonstrated a sound understanding of the service users’ needs and this is positive. Feedback received from one community mental health professional stated; ‘I am extremely impressed with the standard of care and support provided to residents – in respect to the skills and knowledge of the staff’. It is therefore appropriate to state that service users are assured that their needs could be met by the home. Staff interviewed informed that they were in receipt of regular formal supervision and from the records seen – this was observed. They also felt supported and are encouraged to contribute to the service through regular team meetings, handovers and informal discussions. Staff were also aware of the grievance and disciplinary procedures of the organisation and their was evidence that staffing appraisals had started in the home. DS0000025913.V318484.R01.S.doc Version 5.2 Page 23 DS0000025913.V318484.R01.S.doc Version 5.2 Page 24 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): (37,39,41,42,43) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management systems enable service users to receive a good standard of care at Orchard Close. A dedicated manager remains in place and leads a committed group of staff in supporting service users. Improvements in maintaining ‘records required by regulation’ along with good health and safety practices ensure that the home a safer place to live and work. A business and financial plan is now available for the home. EVIDENCE: The registered manager continues to maintain positive and professional relationships with staff to ensure that good standards of care are maintained. Staff were comfortable with his relaxed and open-door approach, which also benefits service users. One staff referred to him as ‘fantastic’ in his leadership of the team. The organisation has launched its equality and diversity scheme and from discussion held with the manager he expressed his commitment to it. As stated in previous reports he is a qualified Registered Mental Nurse, which DS0000025913.V318484.R01.S.doc Version 5.2 Page 25 is an asset to the service. He has undertaken training in Dementia and diabetes, which is relevant to the changing needs of the service user group. However, it still remains outstanding for the registered persons to verify whether his qualifications are equivalent to the NVQ level 4 in management and Care. The previous recommendation would be repeated in this report. There was good evidence that the organisation has stepped up its quality assurance mechanisms for the service. Service user surveys have been carried out as well as a quality audit of the service. The latter of the two was fairly comprehensive and would go a long way, once the recommendations are acted upon to improving the quality of services provided to individuals. Service users are given opportunities to be involved in staffing recruitment and this gives them some ownership of the service. Staff are also involved in contributing to the service development and this is positive. There was evidence that policies and procedures were kept under review and a timetable to concluding the review was made available at the inspection. An annual development plan was in place for the home and regular monthly provider visits are carried out on the service. In most cases they detailed the position of the service with follow up action/s as and when required. This is a strong area of the home’s operations. Service users have access to their files and this is clear as most are involved in their care planning. There was an improvement in the quality of records held by the organisation, particularly in relation to staff. Service users are now assured that staff working with them, have been thoroughly vetted. Other records held by the home were updated and secure, although improvements were required in relation to updating risk assessments and service user plans. The management and staff have generally maintained a safe environment at Orchard Close. One of the senior staff has responsibility for monitoring health and safety and systems were in place to ensure that various safety checks, tests and routines were regularly carried out. This is complimented by having appropriate policies and procedures in place that are understood and carried out by staff. Some of the checks carried out included; the fire alarm 12/11/06, water tank (6/5/06), gas safety (5/10/06) and monthly water temperature checks, which is due to be increased to weekly. There was a Food and Hygiene inspection on 7/11/06, which was satisfactory and the replacement of the air filters. Issues of maintenance that impacted on safety are reported and acted upon fairly quickly and this included the repair of a leaking tap. Most of the key risk assessments were in place safety signs were appropriately posted throughout the home. Health and safety issues are also monitored by; the housing officer - quarterly, internally on a monthly basis and through the DS0000025913.V318484.R01.S.doc Version 5.2 Page 26 registered provider monthly monitoring visits. Health and safety in the home was satisfactory. A clear management structure remained in place at the home and a business and financial plan was made available for inspection. Service users can be reassured that the service is managed well financially and in line with their interests. This includes sound arrangements for monitoring the financial operations of the home. The human resources department manages recruitment and training, including that of the registered manager. Adequate insurance was in place for the home. Service users therefore benefit from a home that maintained and developed for their benefit. DS0000025913.V318484.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 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 CONCERNS AND COMPLAINTS CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score Standard No 22 23 Score 3 3 2 4 X 2 x ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 DS0000025913.V318484.R01.S.doc LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 Score 3 3 4 3 x 4 x 3 3 Version 5.2 Page 28 21 x 43 3 DS0000025913.V318484.R01.S.doc Version 5.2 Page 29 NO 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. 1. 2. Standard YA6 YA9 Regulation 12, 3 13 Requirement The registered persons are required to maintain update all service user plans in House 2. The registered persons are required to ensure that all risk assessments are updated in House 2. The registered persons are required to have an occupational therapist assessment carried out on the home. Timescale for action 21/02/07 21/02/07 3. YA24 23 31/03/07 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. 3. Refer to Standard YA24 YA6 YA37 Good Practice Recommendations The registered persons should review the smoking arrangements and ventilation (House 2), in consultation with service users and staff. The registered persons should carry out risk assessments on the first floor bedrooms occupied by service users in relation to the full-opening balcony doors. The registered manager should liaise with the professional body (Learning Skills Council) to verify whether his DS0000025913.V318484.R01.S.doc Version 5.2 Page 30 qualifications and training would amount to the equivalent of an NVQ level 4 in Management and Care Award. DS0000025913.V318484.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000025913.V318484.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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