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

This inspection was carried out on 2nd June 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard Close (4 ) 06/11/07

Orchard Close (4 ) 28/09/05

Orchard Close (4 ) 02/06/05

Orchard Close (4 ) 17/02/05

Orchard Close (4 ) 20/08/04

Orchard Close (4 ) 02/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Orchard Close (4 ) 4 Orchard Close Morton Road London N1 3AS Lead Inspector Ms Edi O’Farrell Unannounced Inspection 2nd June 2006 11:50 Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Close (4 ) Address 4 Orchard Close Morton Road London N1 3AS 0207 354 9436 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) Maureen.powers@islington.gov.uk Islington Social Services Maureen Power Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28/09/05 Brief Description of the Service: Orchard Close is a care home for younger adults with learning disabilities who may have complex needs such as physical disabilities and, or sensory impairment. The home provides 24-hour care and support, which includes activities of daily living, personal care, eating & drinking, monitoring service users’ health and administering medication. In addition the service accesses community resources for service users and where possible, the use of public transport. Orchard Close was built in 1990 and is owned and operated by Islington Council. 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. Orchard Close is in a quiet secluded residential cul-de-sac near Rotherfield and Morton Roads. The home is situated relatively near to community facilities such as shops, pubs and a park. Public transport is available but not necessarily accessible for service users with physical disabilities. Essex Road rail station is nearby, and Highbury & Islington and Angel tube stations are within 20 minutes walking distance. There are several local bus routes and these have a limited number of wheelchair accessible buses. The home has access to suitable transport with a tail lift. The home has limited parking. Service users pay £51.35 per week as a contribution to the full cost, which is funded via Islington Social Service’s budget. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This, unannounced, visit took place on a Friday afternoon and lasted just over four hours. Five of the six service users were at home during the visit, and staff were observed interacting with them. Records were checked and two service user’s care was tracked. The service users have a variety of complex needs, including the use of non-verbal communication. Judgments about their views made in this report are therefore based on observation, examination of records, and the views of others. As a part of the inspection process the manager filled in a pre-inspection questionnaire. This gives the Commission a lot of information about the home, and the way that it is run. This information was then compared with the results of the visit to form the judgements contained in this report. A separate questionnaire was left with the manager so that she could tell the Commission how she thought the visit went. What the service does well: There is a very relaxed and friendly feel to the home; staff are very comfortable with inspections, and simply carry on as normal. They know the needs of service users and how these have to be met. There is a warm relationship between staff and service users, with the former being obviously pleased when service users gain new skills, or change behaviour. A parent described the service as ‘brilliant’. Service users’ needs are assessed, and staff correctly identify changing needs. Risk assessment and care planning are used positively to maximise the independence of each service user. During the visit one service user played the piano, and a staff member reported how changed he was since he had started attending a weekly, intensive, music course. Another service user’s file notes that she particularly likes going over bumps when taken out in her wheelchair. This level of detail is very important to this group of service users, as it makes a great deal of difference to their quality of life. Daily logs, and monthly review reports, give a good picture of the lifestyle of each service user. There is a good balance between individual and group activities, and in-house and community activities. All service users attend sessions at day centres and other structured activities, such as social clubs. Going to the cinema has been tried, but several service users have sight problems, so this is not popular. Despite the need for refurbishment the home is pleasant. It was extremely clean and tidy, and the cleaner was observed being very thorough in her work. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 4 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users’ needs are appropriately assessed prior to admission. EVIDENCE: Information about the home is available in picture and written formats. Service users, their relatives and advocates, and placing social workers, are encouraged to visit the home prior to referral. One young person has moved into the home since the last visit. There are detailed assessments in her file, as well as guidance on how her needs are to be met. Staff have been trained to meet specialist needs, and to identify individual styles of non-verbal communication. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users’ needs are assessed, and staff correctly identify changing needs. Risk assessment and care planning are used positively to maximise the independence of each service user. EVIDENCE: Two service users were case tracked. This included observation of staff and service user interaction, examination and cross-referencing of records, and phone discussions with a relative and reviewing social worker. Needs are identified using information from pre-admission assessment. This includes information from parents, health care professionals, school and day care staff, and previous placements. Likes and dislikes, and how each service user communicates these, are recorded. Daily record sheets have been individualised so that staff are triggered to report on the things that are most important for each service user. Each service user is reviewed on a monthly basis and the reports give a good picture of their lives. The level of disability means that the service users are largely dependent on staff to identify, and meet, needs. Staff are doing this well, and recording has vastly improved over time. It is particularly positive to note that service users’ moods are recorded, Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 10 and responded to, for example by giving a one-to-one in response to a ‘grumpy’ mood. This type of intervention is particularly important as the service users use non-verbal communication. During the visit one service user played the piano, and a staff member reported how changed he was since he had started attending a weekly, intensive, music course. Another service user’s file notes that she particularly likes going over bumps when taken out in her wheelchair. This level of detail is very important to this group of service users, as it makes a great deal of difference to their quality of life. Person Centred Planning, which is best practice in learning disability services, is based on a detailed knowledge of each service user. Staff at this home have a sound basis upon which to complete such plans. Once they are in place and working on a day-to-day basis the home could expect to exceed in these standards. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home promotes a varied lifestyle for the people who live there. Family contact is actively encouraged. A healthy diet and lifestyle is promoted. EVIDENCE: Two service user plans were examined. The menus were examined and briefly discussed with the chef. Service users were observed eating lunch, in some cases with staff assistance. Daily logs, and monthly review reports, give a good picture of the lifestyle of each service user. There is a good balance between individual and group activities, and in-house and community activities. All service users attend sessions at day centres and other structured activities, such as social clubs. Going to the cinema has been tried, but several service users have sight problems, so this is not popular. A BBQ was held on the Monday prior to the visit, which many of the parents attended. This was also used to introduce parents to the manager, and some service users, of the home that Orchard Close will be sharing facilities with Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 12 during the refurbishment of the home. As the temporary move will impact on the lifestyle of service users this demonstrates a positive approach to planning. The menu is varied, and choice was noted during lunchtime, in terms of food, and where to eat. Where staff were observed assisting service users this was in a very relaxed manner. During handover the nutritional needs of one service user were discussed, with staff demonstrating a sound knowledge of the importance of following guideline. One service user is fed artificially. There are full guidelines in the care plan, including the need for oral healthcare. The daily log includes a report on whether this has been carried out. Staff have been appropriately trained to carry out this procedure. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users’ health and personal support needs are met, but their wishes in the event of serious illness, dying, and death are not recorded. EVIDENCE: Assessment, care plans, monthly review, and daily reports, identify health and personal care needs, and how these are met. There are many examples of changing need, which staff have identified, and responded to, appropriately and effectively. There is a high level of health professional input including district nurse, continence adviser, dietician, psychologist, GP, and speech therapy. The combined health and personal care needs of the six service users are very complicated. Staff demonstrated during the visit a high level of knowledge of these needs, and how to meet them. As stated earlier in this report it was particularly good to see that emotional needs are being considered on a day-to-day basis. The medication administration charts of the two service users who were case tracked were checked. These records were checked with the content of the medication cupboard. There was some discussion about one prescription, Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 14 which was slightly ambiguous, but this was resolved during the visit, so no Requirement has been set. The current policy and procedure of illness, dying and death is limited to the action staff should take in the event of sudden death. This was discussed with the manager and deputy during the visit. This included stressing how difficult it would be for both staff and relatives, one of whom lives abroad, if such an event happened, and staff did not already have the information. As the six service users are of mixed racial backgrounds, including one person who is Muslim, knowledge of wishes and preferences is important. This is Requirement 1. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are protected by the home’s policies, procedures and practices. EVIDENCE: A recent complaint was discussed with the manager, and the informal feedback system briefly discussed. The manager reported that this system, which to date has been used for day-to-day concerns, is no longer to be used. In future all concerns are to be logged as formal complaints. Staff have attended adult protection training, and understand this and the whistle blowing procedures, and their responsibilities. Daily records, and the monthly review reports, demonstrate that staff are attune to the moods of service users, and what this might communicate. This includes methods of working with each service user so they are not discomforted, for example, where they are unable to move themselves. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Once the refurbishment is completed the service users will live in more pleasurable surroundings. EVIDENCE: The building was toured, and the planned refurbishment discussed with a deputy manager, and the manager. There have been no material changes since the last site visit. There is now a firm plan for the home to be refurbished, starting in July of this year. Relatives, staff, and the Commission have been kept informed and consulted about the proposals. Despite the need for refurbishment the home is not unpleasant, there is a welcoming and relaxed atmosphere. It was extremely clean and tidy, and the cleaner was observed being very thorough in her work. The Requirement from the previous inspection has been restated. The Commission is pleased to see that the Local Authority has included the upgrade of this home in their capital programme for the current financial year. Refer to Requirement 2. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 17 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 & 36 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff demonstrate competence in meeting the individual needs of service users. EVIDENCE: Staff training records were examined, staff were observed carrying out their duties, and the rota was examined. Staff demonstrated during the visit that they were competent to meet service users’ needs. Currently 23 of care staff have NVQ level 2 or above. Four members of staff are currently undertaking NVQ level 3, with three due to complete by July 2006. Three new members of staff are following a formal induction process, and will then follow LDAF induction. Recruitment files were not examined on this visit, but previous evidence has been that a stringent equal opportunities procedure is followed. The recruitment process for the three new staff was part of an audit of central HR procedures. This verified that the home follows correct procedure. Staff do not start in post until a CRB clearance is obtained. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 18 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): 37, 38, 39, 40, 41, 42 & 43 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home is well managed, in the best interest of service users. EVIDENCE: The manager and deputy managers were on duty during the course of the visit, and the manager completed a pre-inspection questionnaire. There is a very relaxed, and open, atmosphere to the home, with staff able to raise issues in handover, supervision, and in staff meetings. The Responsible Individual carries out monthly visits, and the reports are informative, and include actions points, which are followed up at the next visit. Staff and managers display a very obvious commitment to meeting the needs of service users. The manager and a deputy have completed NVQ4 and Registered Managers Award, and use their knowledge to the benefit of the service. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 19 There is a new Quality Assurance system in place, which is extremely comprehensive and systematic. If all the performance indicators were to be met, then this would have to be regarded as an excellent service. The one thing that lets the management of this service down is the lack of access to IT for staff other than managers. This was a Requirement set at the last inspection relating to staff training. This Requirement has been restated in this report under Standards 43. Refer to Requirement 3. The Requirement has been restated under a different Standard as training is only one element that is affected by the lack of IT access for staff. The Borough relies heavily on IT as it’s main communication system. Annual leave appraisal, booking training, and information about new policies and procedures are all IT based. As staff at the last inspection commented on, they feel discriminated against in comparison to office-based staff. Senior managers within the organisation must address this inequality. Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 20 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 3 2 3 3 3 4 3 5 X 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 3 3 3 3 3 3 2 Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 21 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 YA21 Regulation 12 Requirement The Registered Persons must ensure that the wishes of service users in the event of illness, dying, and death, are known and recorded. The Registered Persons must have the premises maintained, decorated and refurbished. Paintwork, woodwork and furnishings must either be replaced or repaired. This Requirement is restated with a new timescale. This takes account of the planned timescale of the refurbishment. The Registered Persons must ensure that staff have equitable access to key information. This must include access to training and appraisal documents and systems, as well as up-to-date information about the general activities of the Council. This Requirement is restated with a new timescale, and under a different Standard. Timescale for action 30/09/06 2. YA24 23 01/03/07 3. YA43 18 01/03/07 Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orchard Close (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU 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 (4 ) DS0000031851.V288081.R01.S.doc Version 5.2 Page 24 - 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!