Inspection on 09/02/06 for Orchard Close (2&3)

This inspection was carried out on 9th 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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard Close (2&3) 10/11/06

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 Unannounced Inspection 9th February 2006 10:13 Orchard Close (2&3) DS0000025913.V282490.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 Close (2&3) DS0000025913.V282490.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 Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 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) Redbridge Community Housing Limited [RCHL] Mr John Troy Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named person over 65 years of age. Date of last inspection 22nd August 2005 Brief Description of the Service: Orchard Close (2&3) is a care home providing personal care and accommodation for up to sixteen adults (52-87) 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. The houses originally consisted of a total of twelve single and two double rooms, however the registered manager has advised that since the visit, they are using the shared bedrooms in both houses for single occupancy. In essence the service would be providing services for up to twelve service users. Orchard Close (2&3) is supported by staff on a twenty-four hour basis that work closely with service users in developing their personal/living skills, confidence and self esteem by increasing their 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. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place in just over four hours and was timed to observe the morning activities, monitor the service and follow up on the progress made since the last visit. Key to this was the assessment of all the national minimum standards that were not assessed at the previous inspection. It was clear from the findings of this report that a number of improvements had been made and this is positive for all service users living there. It was also noted that most of the standards assessed were met. There were some that were partly met, but they were mostly related to failings of the organisation as a whole. They are mainly around staffing recruitment and records held on staff. Although there have been significant improvements over the last year – a recent visit to the organisation’s head office indicated that for newly recruited staff, further improvements were required. A further visit was planned in April 2006 to determine whether the required improvements were satisfied. The Commission reserved its right to pursue enforcement action if the improvements were not achieved and the organisation has been written to separately about this. An assessment wad made of: the environment, service user plans, staffing training and recruitment records held by the home, the staffing rota, health and safety records and risk assessments. Formal interviews were held with two service users and one member of staff. Detailed discussions were held with the manager and a senior officer. Informal discussions were also with up to six service users and other members of staff on duty. What the service does well: Service users were quite settled on the day of the visit and they were all clear about their objectives for the day. They were observed moving around the home with confidence and authority as they went about their daily routines. They also had a good rapport with all staff on duty and this was positive to see. The manager and staff were also effective at ensuring that the healthcare needs of service users are acted upon and this includes their specialist needs i.e. mental health. One of the service users was in hospital at the time of the visit as a result of the deterioration in her health. It is a credit to the staff team that service users enjoy long levels of stability in relation to their specialist needs. Service users continue to make contributions to maintaining the home and this gives them a sense of ownership. What stood out at this visit was the fact that service users are supported to make positive choices in their lives. In so doing the home was actively promoting service user choice. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? There was evidence that service user plans now reflected their changing needs as from the sample viewed they were found to be updated and accurate. This was complimented by the fact that risk assessments were also updated in the cases viewed. From talking to the manager, it disclosed that the issue of promoting service users’ dignity had been addressed in individual supervision and at team meetings. On the day of the visit all service users spoken to confirmed that they felt, that their dignity was promoted. The complaints policy now makes reference to the Commission, providing details of the regulatory body in their complaints procedure. Service users and their relatives now have pertinent information regarding where they could take their complaint if they were unhappy with the home’s management of it. From the rota seen the registered persons had started their recruitment with a view to increasing their pool of permanent staff. A number of interviews were held resulting in the recruitment of one support staff member to the team another awaited the necessary satisfactory clearances. The registered manager had done some work with the staff team around providing consistent care to service users. One of the senior officers had also returned from a period of leave and there was a buzz of enthusiasm on the day of the visit. Another senior staff was on a long period of planned leave and to ensure consistency some changes were undertaken e.g. moving the deputy to cover house 2. This was strategic in ensuring that the expertise and skill mix of the team is used to achieve the best possible outcome for service users. There has been an improvement in the monthly monitoring of the service as reports were consistently provided to the Commission in line with regulation. It was disclosed that the training officer had accompanied the responsible person on one of the visits to meet with staff and to go through with them a newly introduced training and development personal record, for individual staff. It was also noted that training had been provided as a group for the staff entitled ‘Ageing and Mental Health’. This is positive in that the organisation had taken on board, that the service users were growing older. This training would go a long way in the future to assist staff in understanding some of the critical changes service users go through as they grow older. Action was taken to improve health and safety practices in the home. The storage of dry food was appropriate in both houses and the practice of freezing milk had ceased. Fridge/freezer temperatures were also more consistently monitored and as such, ensured the safety of service users and staff. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 7 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 Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 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 Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (3,4,5) At Orchard Close service users are assured that their needs would be met by the home and they have the opportunity to visit the home prior to deciding to live in it. Service users now have the benefit of contracts but require the fee component to be added to it. EVIDENCE: As part of the inspection the admission and care of the most recent service user was tracked. There were detailed assessment details in place for the individual, which helped in determining the suitability of Orchard Close in meeting his needs. Risk assessments were also carried out to identify and set out actions required to maintain the safety of the individual concerned. The needs were matched against the home’s statement of purpose and there was evidence that the service user was involved in this process. He was admitted on the basis that his needs could be met by the home. The service user during his interview informed that he had the choice of viewing the facilities at Orchard Close prior to determining that he wanted to live there. This he said allowed him to meet with staff and choose his room. He was happy with this arrangement, although he said that he was a bit apprehensive at first. He put this down to it being a new environment. This practice was in line with the home’s admissions process and promotes service user’s choice. All service users including the most recently admitted individual had the benefit of contracts issued to them. This was explained to them individually Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 10 and signed off as an indication of agreeing the terms set out in them. The contracts did not contain fees as required by regulation, however plans were in place to have them added to the tenancy agreement. This would ensure that service users are aware of their liability with regard to cost. A timescale is set in this report to achieve this outcome. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 11 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): (6,7,8,9) Service users benefit from having their needs adequately provided for at Orchard Close. They are involved in planning their care and consulted about life in the home. Their independence is enhanced through risk planning to ensure their safety. EVIDENCE: There was an improvement in this standard as the service user plans examined, bore evidence that their needs were not only identified, but also kept under review. From the plans reviewed there was evidence that the changing needs of service users were taken into account. More importantly service users were involved in this process and sign their plans in agreement and recognition of it. Each plan had identified goals for the service users concerned and needs were reviewed three-monthly or as necessary. It was clear that service users were supported to make decisions affecting their lives. From speaking with the most recently admitted service user, he indicated that enjoys information technology and hence he is supported to attend training at Redbridge College to pursue this. The same service user attends group therapy and staff work closely with him to ensure that he attends as it is in his best interests to so do. Further evidence was gathered from another service user who indicated that he enjoys football and so he was given the Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 12 support by staff to attend a home game at Stamford Bridge to see Chelsea play Liverpool in the Premiership. He is an avid supporter of Chelsea and they were at the time leading the table, needless to say, he was very elated during the interview. He also spoke of having his room repainted in blue- being a Chelsea fan and there were plans for his choice to be carried out. This is a strong area of the homes operations. All service users spoken to indicated that they are consulted on and take part in life in the home. This was observed on the day of the visit as a number of service users got together in House (2) and tidied the garden of leaves. One service user stated that he enjoys hovering and emptying the bins and he is actively involved in doing so. This is his contribution to the home. Service users take turns in making positive contributions, some more spontaneously than others. Whatever the contribution they reported that they were made to feel valued by staff and this was positive. There was evidence that service user meetings were held regularly and matters regarding the home discussed. Service users also contribute to the home by actively participating in surveys carried out by the organisation. This is a strong area of the homes operations. There was an improvement in this standard as risk assessments were in place for all service users including the most recently admitted service user. They were updated and service users spoken to were aware of them. Service users also signed them as evidence of their participation in the process. One of the risk assessments examined covered areas such as fire, handling food, finance and medication. Service users therefore are supported to take risks as part of a risk management strategy. This is positive. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,14,16) At Orchard Close service users participate in activities that reflects their interests and this includes leisure. In so doing they are actively involved with their local community and greater consideration has been given by the home to ensure that their rights/responsibilities are respected. EVIDENCE: Service users interests are identified mainly during their service user planning as well as at their regular meetings. There was good evidence that most were involved some form of activity that they were happy with. In talking with service users this, they all echoed this sentiment. It is true to say that they were operating at individual levels and had different interests. One service user goes out to meet up with some friends at a rehabilitation ward, while another is happy to have a pub lunch daily. Another is contented to get out to the bank and shops, while other individuals attend a day centre of their choice. One service user indicated that he meets up with his brother at Gants Hill up to three times per week and he also enjoys doing crosswords. Choices were very mixed, but whatever the choice staff supported service users to fulfil their interests. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 14 In pursuing their interests, it was clear that every service user was engaging with their local community. The frequency at which this was done varied from individual to individual, but most service users were comfortable with getting about in the community. On the day of the visit one of the service users who prefers being indoors took herself out for a walk into the local community and this was positively supported by the staff team. There is no limitation placed on service users going into the community and some were observed to go out even at the weekends. Service users are also actively involved in leisure activities of their choice and this ranged from going to pubs, cinemas, football matches in the case of one individual, viewing television, visiting the park in Snaresbrook and going on short breaks. They have the added advantage of having a wide range of television programmes, as SKY TV is available in both homes. It was recorded that service users went to Eastbourne for in period of four days in 2005 and from speaking with some of them – they quite enjoyed this. There was an improvement in the manner in which staff promoted the rights of service users and this was an issue at the last visit. The registered manager informed that he dealt with the issues raised at the last inspection visit on an individual basis in staff supervision and team meetings. At this visit staff on duty demonstrated their ability to promote the rights of service users. They (SU) were spoken to with respect, addressed by their preferred names and staff generally deported themselves in a professional manner. It was clear that they had a good working relationship with the service users. Service users interviewed confirmed that they were treated with respect and dignity and this included view of the most recently admitted service user. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 15 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): (18,19,21) Sound arrangements were in place to provide personal support to service users living at Orchard Close. Staff work closely with individuals to ensure that there physical and emotional needs are met. The wishes of service users regarding death are recorded with the intent of carryout out their wishes at the appropriate time. EVIDENCE: Each service user has a key worker who is responsible for coordinating the care and support package for the individual. Service user preferences for how they are supported is recorded in their service user plans and staff use this a guide to working with each individual. It was clear that service users preferences and needs varied e.g. some needed more prompting with personal hygiene or grooming. Service users had different times at which they preferred to go to bed as well as times for waking up. In interviews held with them, they were satisfied with the personal support provided to them. They knew their key workers by name and were able to clearly describe some of the work that was carried out with them. Service users spoken to were also satisfied with the support provided to them with regard to meeting their physical and emotional needs. Each service user was registered with a GP and was received input from a psychiatrist in relation to their mental health needs. Staff worked closely with each individual to identify when service users were having a physical concern e.g. coming down Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 16 with a urinary tract infection or when they were exhibiting signs of relapse. Whatever the need staff were adept to it and appropriate interventions are made to support the individual concerned. One service user who suffers with diabetes was well informed about the condition and praised the work including that of his key worker for the support he was given to lead a healthy lifestyle. There was evidence that another was in receipt of psychology input and he too was quite pleased with the way in which staff supported him to attend his group therapy. In the event of the death of a service user, a clear policy on death and dying is in place and this is accessible to staff. Arrangements are in place to record the wishes service users, with regard to death and dying. This information is recorded where provided. Community nurses would be involved should aspects of specialist care be required as a result of service users growing older. Emergency numbers including that of the on-call are accessible to staff if further assistance is required to deal with individuals whose health might be failing. In times of deterioration there was evidence that the home works closely with the relatives of the service user to ensure that the best possible care is provided to the individual concerned. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 17 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): (22,23) Improvements to the complaints policy now ensure that service users are clearer on how and where there concerns would be managed. Satisfactory adult protection guidelines are also in place to ensure that service users remain safe, whilst living at Orchard Close. EVIDENCE: The complaints procedure now had details of the Commission included in it to guide service users who may be unhappy with the home’s handling of a complaint. The policy is widely available to service users and their relatives and all service users spoken to were aware of it. At Orchard Close service users are encouraged to raise issues of concern at any time, if even if it meant when they felt comfortable about doing it. Staff interviewed were clear on the rights of service users to voice their concerns, as well as their role in supporting them to so do. From examining the complaints records, it was noted that they were minimal and satisfactorily handled. Satisfactory adult protection guidelines were in place for staff to act in situations of abuse. This includes action required under the whistle blowing guidelines. Staff are provided with adult protection awareness training and there were no incidents of abuse or alleged abuse in the home. There was evidence of a risk assessment in place, where there are issues of self-harm. This ensures that the action is put in place to ensure and promote the safety of the service user concern. The home is therefore good at promoting a safe place for service users to live. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 18 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): (25, 26,27,28,29) At Orchard Close service users are generally provided with a warm and homely environment- one that they are encouraged to interact with. They are comfortable with the facilities including their private spaces and furnishings. They are also involved in determining the décor of the home. Some improvement is now required to the communal areas to enhance a more homely feel to the home. EVIDENCE: All service users spoken to were happy with their bedrooms and in one case a service user was about to have his bedroom redecorated a few days after the inspection. He spoke of choosing his colour and was excited about the prospect of having his favourite colour blue, in there. Another service user was pleased that he had the largest room and he too indicated that he had a choice in the matter. In viewing the bedrooms in both houses (2&3), they were personalised to individual taste. All service users were independent and their private spaces reflected that. As some of them are getting older- this is taken into consideration and monitored to take into consideration any change in needs. All private spaces were well ventilated with adequate heating and lighting. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 19 There are adequate toilets and baths in the home to ensure both the privacy and independence of service users. On the day of the visit they were clean and had facilities to enable service users to safely use them. Service users spoken to were satisfied with the toilet and bathing facilities in the home. On the day of the visit service users were observed to be using the communal areas for various activities. They were observed negotiating the dining, lounge, corridors and stairs comfortably. What was positive about the environment was that it was peaceful throughout the visit. The television was on in House 2 and the radio in House 3, however service users were relaxed and were not in each other’s way. There were alternative spaces in both houses where service users could sit quietly and they were used at various points during the inspection. There is a need however to redecorate the communal areas, particularly the lounge in House 2, as the walls were dull and this took a bit away from the homely feel of the environment. In discussion with the senior person on duty, she confirmed that the communal areas were due for the cyclical decoration. Action needs to be taken to have the work done. Service users are independent at Orchard Close and as such there is no need for the provision of specialist equipment at this stage. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 20 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): (31,32,33,34,35) Service users benefit from having a dedicated staff team that have clearly defined roles and work generally well together in meeting their needs. Improvements in recruiting more permanent staff have had a positive impact on effectively supporting service users. Further improvements to the recruitment practice are required to ensure that service users are adequately protected. EVIDENCE: All staff have the benefit of a job description and a written contract. They also have access to a copy of the General Social Care Council’s code of conduct. In discussion with them, they demonstrated a clear understanding of their contributions in relation to achieving the philosophy of care at Orchard Close. Service users knew their key workers by name and were clear about their expectations of the staff team. There was evidence that all staff benefited from having a detailed induction and they were provided with particularly and more recently - training specific to the needs of the service user group. Service users had a good rapport with the staff on duty and indicated that staff are there for them when things were not going all that well. This is particularly important when service users are relapsing and/or having difficulty with their own motivation. An improvement was noted in this area, as the registered persons have recruited permanent staff to the team. From the most recent recruitment, one staff had actually started, while another was awaiting satisfactory clearances Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 21 before commencing employment. This would ensure that more consistent support is offered to service users, particularly when staff are away on leave or training. It is the service users interests for the organisation to continue its recruitment drive to ensure a full compliment of staff. The current staffing on duty i.e. two staff on duty in the mornings and in the afternoon, along with one waking in each house with one sleeping – in on nights was adequate in meeting the needs of the current service user group. The recruitment process of the organisation has been assessed for its robustness in relation to this standard. As part of this, the Commission recently visited the organisation’s head office to make a determination on this. It must be stated that there has been significant progress in the robustness of the organisation – with systems now in place that once applied, would result in the minimum standards being exceeded. However there were still areas for improvement identified in the process of newly–recruited staff. A further visit is planned in April 2006 to monitor progress in relation to this. As such it has been agreed to retain the current requirement related to recruitment in this report. From the records seen and speaking with service users, it was accepted that the training and support given to staff was adequate in meeting the holistic needs of the service user group. A training officer has been working closely with staff and a ‘training and development’ plan is in place. A staff development folder has been introduced in which the previous two years of training is logged. Additional training would also go into the folder as evidence of staffing development. The manager outlined plans to put staff forward to pursue a Certificate in Mental Health – Level 3 course and this has potentially significant benefits to staff, but service users alike. The progress and impact of this would be monitored in future inspections. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 22 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): (38,39,40, 41,42,43) At Orchard Close service users benefit from having a consistent management team that ensures that they are listened to. They are also assured that their interests are promoted through improved health and safety practices and the management’s accountability of the service. Service users rights and interests could be further protected by the maintenance of records in line with regulation. EVIDENCE: The manager of the service has been in that position for a very long time and as such knows each service user very well. He has also developed a very good working relationship with them and they were all comfortable with his relaxed approach. Staff interviewed informed that he is supportive, approachable and gives clear direction to them. His commitment to equal opportunities is in line with the organisation’s guidance and all staff have equal opportunities training as part of their induction. The organisation also reported that they were developing an Equality and Diversity Scheme and that training was provided to managers in this area. This is positive. The registered manager has a professional qualification in mental health, which is an asset to the service he manages. The organisation was advised to look into what is required for the Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 23 registered manager to achieve the Registered Managers Award. The person in control reportedly started looking into this, but there was no outcome to date. As such the recommendation previously made would be repeated in this report. There was evidence that an annual service user survey was undertaken and the results were published. The organisation is also exploring the engagement of an agency to provide training for service users over a ten-week period with regard to prepare service users for participating in staff recruitment. Service users would be expected to attend for one day per week and this is a positive move in relation to service user involvement. Service user development is measured at their annual reviews and this is well recorded. At these reviews the views of external professionals are acquired and this feeds into the quality monitoring process. An invaluable tool in monitoring quality has been the undertaking of monthly provider visits on the service. This has been consistent and gives the organisation and the Commission a picture of issues in the home – including the quality aspects. The policies and procedures in the home were satisfactory and available to all staff and service users – if required. They were found to be in line with regulation and the registered manager takes overall responsibility for their implementation. Staff interviewed showed a working knowledge of the key policies and procedures e.g. adult protection, handling service users finances, health and safety, medication, complaints and service user planning. The home’s record keeping has been generally sound, as most of the records viewed were well maintained and secure. However improvements were still required in relation to the records held on staff. This is the subject of monitoring by the Commission and involved visits to the organisation’s head offices to assess this. At the most recent visit, improvements were noted in relation to the recruitment records held on all categories of staff i.e. previously and most recently recruited staff. However further improvements are required and another visit is planned in April 2006 to assess this. There were improvements to the health and safety practices in the home in that all food was appropriately stored, the home has ceased freezing fresh milk and fridge freezer temperatures were now appropriately monitored. All other areas of health and safety practice in the home were satisfactory at the time of the visit. A clear management structure of the home is made available to staff service users and their relatives. A business and financial plan was not available for inspection and plans were in place to have one with the service managers by March 2006. This is an important document, as it should give an indication of the state of the business. Systems were in place for monitoring finance and the daily operations of the home (Monthly provider visits). The human resource department takes responsibility for monitoring recruitment practices and the Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 24 commissioning of training including – training for the registered manager. There was adequate insurance cover for the home as valid certificate was on display to confirm this. Service users therefore have some assurance that the service is monitored for its effectiveness. Evidence of the financial plan is required to compliment this. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 25 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 X 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 3 26 3 27 3 28 2 29 3 30 X STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 X 3 3 3 2 3 2 Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 26 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. Standard YA5 Regulation 12 Requirement The registered persons are required that the fees are included in either the contract or the tenancy agreement of service users. The registered persons are required to redecorate the communal areas of the home, beginning with the main lounge in House 2. A plan outlining how the other areas would be completed should be sent to the Commission. The registered persons must operate thorough recruitment procedure and ensure that they hold records of staff that are in line with Regulation 17 (Schedule 2) of the Care Homes Regulations 2001. (This is a previously made requirement). The registered persons are required to hold staffing records in line with Regulation Schedule 2 of the Care Homes Regulations 2001. (This is a previously made requirement- See above) The registered persons are required to have a business and financial plan for inspection. DS0000025913.V282490.R01.S.doc Timescale for action 05/04/06 2. YA28 23 30/06/06 3. YA34 19 30/04/06 4 YA41 17 30/04/06 5. YA43 25 30/04/06 Orchard Close (2&3) Version 5.1 Page 27 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. Refer to Standard YA37 Good Practice Recommendations The registered manager should liaise with the professional body (Learning Skills Council) to verify whether his qualifications and training would amount to the equivalent of an NVQ level 4 in Management and Care Award. Orchard Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 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 Close (2&3) DS0000025913.V282490.R01.S.doc Version 5.1 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!