Inspection on 02/06/05 for Orchard Close (4 )

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard Close (4 ) 06/11/07

Orchard Close (4 ) 02/06/06

Orchard Close (4 ) 28/09/05

Orchard Close (4 ) 17/02/05

Orchard Close (4 ) 20/08/04

Orchard Close (4 ) 02/03/04

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Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Orchard Close 4 Orchard Close Morton Road London N1 3AS Lead Inspector Joanne Sinclair Joyce Grant Unannounced 2 June 2005 10:00am nd 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 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 Stationary 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 G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Orchard Close Address 4 Orchard Close Morton Road London N1 3AS 020 7354 9436 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Islington Social Services Maureen Power Care Home 6 Category(ies) of LD Learning disability (6) registration, with number PD Physical disability (6) of places Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17/02/05 Brief Description of the Service: Orchard Close is a care home providing 24-hour care and support to younger adults with learning disabilities who may have complex needs such as physical disabilities and or sensory impairment. The home provides 24-hour support which includes activities of daily living, personal care, eating and drinking, monitoring service user’s health and administering medication. In addition the service aims to access community resources for service users and the use of public transport. The home is situated close community facilities which include shops, pubs, parks and a swimming pool. Public transport is available but not always accessible for service users with physical disabilities. The Essex Road overland station is nearby, the Angel and Highbury and Islington tube stations are fifteen minutes walk away, however stations are not wheelchair accessible. There are several local bus routes (271, 56, 476 and 341) and these have a limited number of wheelchair accessible buses. The home has access to suitable transport with a tail lift. The care home is situated in a quiet residential cul-de-sac. It was purpose built about twenty years ago. There is a main lobby with communal sitting rooms and dining areas. All the bedrooms are single occupancy and there is a pleasant secure garden. The home is owned and operated by Islington Council. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was undertaken over half a day in the presence of the registered manager. The focus of the inspection was to follow up adult protection issues and progress on requirements made at the last inspection mainly in relation to the proposed refurbishment programme, and staff NVQ assessments. The inspector toured the building, spoke to staff, reviewed a number of records and looked at service user case files. Most service users were attending their chosen activities. Staffing levels is relatively stable there are currently 2.5 vacancies and recruitment to vacant posts is due to start in two weeks with interviews expected before the end of July. What the service does well: What has improved since the last inspection? What they could do better: The environment: Redecoration and refurbishment is desperately required as identified in many areas of the home. The development of an effective quality assurance and monitoring system, which sets out to seek the views of service users and help improve and review the service. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 6 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 G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 5 Accommodation agreements are now being sent out to service users care managers ensuring that the unit’s terms and conditions are communicated to the service user and signed on their behalf. Care manager assessments ensure staff have up to date information and a good understanding of changing care needs. Improvements in daily recording demonstrated that service users individual needs and aspirations are met through a flexible and effective staff team. EVIDENCE: The requirement regarding accommodation agreements has been met. Agreements have been sent to care managers for signature and the documents were available for viewing. However two further amendments are necessary firstly to remove ‘draft’ from the agreements and secondly to identify the responsible adult (if not the care manager) as the signatory together with the reason why the service user is unable to sign the document. Three randomly selected user files were viewed. Individual records are kept for each of the residents and inspection of the records noted a full, up to date statutory assessment in place. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 Care plans are clear and consistent carefully reflecting the diverse needs of individual service users providing staff with key and appropriate information to meet individual needs whilst safeguarding the needs of all residents. EVIDENCE: Three of the five service user files were inspected. Each file included the multidisciplinary assessment, and service users current plan of care, setting out the needs of the resident and how they were being met by staff as well as demonstrating that plans are being regularly reviewed. Risk assessments were contained in each file showing where areas of risk were being considered both in the case of individual residents and any risk they may pose to other resident and how those risk are to be managed. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Service users benefit from the care staff’s ability to competently assess their preferences in relation to leisure and social activities, and maintenance of family contact ensuring service users are helped to maintain established relationships and meet new people. The meals in the home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: Within the capacity of service users understanding, the assessment of needs in all areas; social, emotional and physical lifestyle of the service users views are sought. In relation to leisure activities staff demonstrated appropriate use of knowledge and interpretation to assess and provide activities suited to individual preferences. One service user is now enjoying yearly vacations incorporating his love of music and a break by the sea. Contact and family visits are shown to be recorded and arrangement made for contact are in place. Arrangements were seen to be in place for service users to have home visits once a month incorporating a regular family meal. Records also showed parents involvement and visits to the unit. Meal times are congenial and on the day of inspection the chef was preparing lunch, which was shown to fulfilled dietary requirements for nutrition. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 11 Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 19 Understanding of service users physical emotional and personal support needs is demonstrated through staff training records, detailed care planning and review ensuring individual service users need are recorded and delivered as service users would like. EVIDENCE: Individual plans of care are available and detail all aspects of how service users health, personal and social care needs are identified and planned for. E.g. personal needs such as a service user need to have music in the bathroom. As noted under standard 6, care plans are detailed and showed evidence of review. Significant events are recorded in case records, and supported by risk assessments outlining how care is to be given. Risks assessments were viewed for swimming, bathing and showering to ensure each activity is undertaken safely and with regard to service users need for personal space, and time. Appropriate referrals were shown to be made to occupational health and physiotherapists. A psychiatrist has provided the team with training in mental health, to ensure staff understand the mental needs of the client group they work with and have up to date information. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The safety of service users is monitored more closely and the up date of procedures within the home, as far as able, ensures the protection of service users living there. EVIDENCE: Policy and procedures for dealing with adult protection issues are in place and shown to be followed. The manager discussed the outcome of two adult protection issues at the home where all relevant steps had been shown to be followed and outcomes recorded. Improvements were shown to be made in the agency adult protection guidance e.g. more detailed recording of service user information and staff written contacts, closer observation of practice and an outline of steps to be taken to ensure residents protection. Training records showed that all care staff had undertaken adult protection training in February this year. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 Major refurbishment of the building is proposed and the manager is aware of the steps to be taken to improve the environment for service users at Orchard Close which would better meet residents individual needs and lifestyles. EVIDENCE: The requirement made at the last inspection is ongoing. The manager provided a verbal progress report in respect of maintenance, re-decoration and refurbishment, which is ongoing. The registered manager discussed the prospective proposal which involves the possibility of major work being undertaken both internally and external to the building. This will involve maximising space and placing wash hand basins in each room, creating more private space for residents. The consultation process has not yet begun, as plans have not yet been finalised, although a feasibility study has been concluded. The registered manager is aware of the need to notify and keep the commission informed well in advance of any proposed changes and the need to undertaken consultation and assessments with residents and their families. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 Staff receive induction and foundation training and are currently engaged in gaining the required NVQ competencies required to meet residents care and support needs. EVIDENCE: The requirement made at the last inspection has been met. That is to ensure arrangements are in place for staff NVQ assessments to be marked so staff can complete the course and meet this years training target. The manager stated that a new training consortium has been identified for staff and arrangements are now in place for those staff affected to transfer and continue their course. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 Whilst the home reviews aspects of its performance through consultation and seeking the views of staff and relatives, a formal quality assurance and quality monitor system based on seeking the views of service users is still to be implemented across the borough of Islington services. EVIDENCE: The requirement made at the previous inspection has not been fully met. The quality monitoring system remains in the development stage. The registered manager has been given responsibility to develop a monthly management quality audit. The Quality audit, and ‘service user and carer’s questionnaire’ is still to be finalised by the borough, so service users views can be formally sought and recorded. Consultation with relatives is good but again there is a need for an effective quality monitoring system to be put in place. The manager is awaiting outcome of the capital bid which was not agreed at the time of inspection. Some discussion was had regarding whether the service should invest in the upgrade of the building or transfer the service. A full schedule of works is proposed, and a feasibility study conducted. Consultation Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 17 is proposed with residents and their families. The registered provider is aware that any proposed changes must be first communicated and forwarded to the commission. The health safety and welfare of service users is promoted through effective Health & Safety Procedures training of staff and assessment. COSHH assessments, water, gas electricity test were up to date. A fire point test was recorded as taking place recently in May this year and the manager has appropriately appointed a health and safety office and first aider. The home must retrieve and display the certificate of liability held centrally The health and safety poster is to be positioned in a prominent place. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x x x x 3 x x Standard No 31 32 33 34 35 36 Score x 3 x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Orchard Close Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 19 yes 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 39 Regulation Reg 24 Requirement Timescale for action 31/08/05 2. 42 Pt. V. Reg 25(2)(e) Reg.39 The registered person must ensure the implimentation of an effective quality assurance system to improve and review the service and acertains service user views. Action Taken: system developed but not yet implimented The registered manager must 31/07/05 display the Health & Safety Executive Law Poster in a prominent place. The registered person must and obtain and display the certificate of liability in accordance with the regulations. As soon as practicable, the registered person must commuicate any proposed changes to the service/building to the commission prior to any changes being made, eg if the premises of the care home are significantly altered or extended, or additional premises are acquired. Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 20 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 Good Practice Recommendations Orchard Close G58 s31851 Orchard v213776 020605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Centro 4 20-23 Mandela Street Camden Town London NW1 0DW 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. 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