CARE HOME ADULTS 18-65
Orchard Close (4 ) 4 Orchard Close Morton Road London N1 3AS Lead Inspector
Ms Franki Solomon Unannounced Inspection 28th September 2005 10:00 Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 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.V254452.R01.S.doc Version 5.0 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.V254452.R01.S.doc Version 5.0 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.powerslington.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.V254452.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd June 2005 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 and not wheelchair accessible. The Essex Road overground station is nearby, the 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. Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second statutory inspection for the year April 2005 – March 2006. (The first was on the 2nd June). The inspection concentrated on those key standards not assessed at the last inspection. The inspection was over a period of one day and lasted 5 hours. The inspector was assisted by the Registered Manager. Files were examined, a tour of the building and a group of staff spoken to. Some service users were at their chosen activities, and those at the home were occupied in activities of their choice. The inspector would like to thank the home for their hospitality and cooperation. What the service does well: What has improved since the last inspection?
The home has implemented a quality assurance audit system to gain information and to improve the standard of service delivery to service users. The home’s Health & Safety Executive Law Poster is displayed in a prominent place. Staff’s training profile, viz; statutory requirements for training is complied with. The Registered Manager has made arrangements to ensure staff receive basic training and the National Vocational Qualification (NVQ) training. Appropriate training enable staff to have the necessary qualifications,
Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 6 knowledge and skills to deliver a professional service to vulnerable service users. 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.V254452.R01.S.doc Version 5.0 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.V254452.R01.S.doc Version 5.0 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): Not assessed on this occasion. EVIDENCE: Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 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): 7&9 Given the complex communication methods from service users, all staff are good at assessing and meeting service users needs. Service users are able to take responsible risks. EVIDENCE: All arrangements were in place for the home to assess and assist service users’ to make choices wherever possible. Service Users’ care plans demonstrated assessments were undertaken and reviewed. Staff were observed with service users. They demonstrated professional and committed support. A sample of service users’ Care Plans were inspected. All Service Users have high and complex needs and had their Risk Assessments in place which were under regular review. Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 16 and 17. Service users have complex and high needs and within their limitations the home ensures service users experience a fulfilling and participatory life. Service users enjoy a good varied diet and meals are served in a manner suited to service users indications. EVIDENCE: Arrangements were in place. None of the service users are capable of undertaking employment. Some service users were seen to go out with an escort and another was assisted to go to a Day Centre. Facilities at Day Centres for people with complex needs are not easily available or accessible. The home also accesses resources through specialist organisations such as a Snoozelen facility. Service users are escorted to such places as the library and to do shopping. Within the service users’ capacity of understanding the home and its staff provide individual choice. Communication is not always verbal but through getting to know and become familiar with service users’ non-verbal and body language forms of communications of their needs. Some service users have family who are actively involved in their Care Plans and their choices.
Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 11 Menus were seen. These demonstrated a varied and nutritional diet. Service users either eat in a group or alone according to their preference. Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. The home observes medication regulations and ensures service users’ welfare, well-being and safety. EVIDENCE: All arrangements were in place. None of the service users are able to selfmedicate. Administration, storage and disposal policies and procedures are adhered to. A sample of medication administration charts were examined. These were correct in that medication recorded on the administration records sheet tallied with the medication seen. Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. A Complaints procedure is in place, however, given service users have complex needs and have no verbal communication staff do their best to interpret any possible complaints service users may have and take appropriate action. With the involvement of service users’ relatives, and observing staff with service users, the home provides a safe place for service users. EVIDENCE: All arrangements were in place in terms of a Complaints Procedure and a Complaints Book. Given that none of the service users had verbal communication, the inspector was unable to communicate with the service users. The manager explained the complex and non-verbal communication of service users meant that formal complaints were not received and that the home had no complaints since the last inspection. However, she produced a “Feedback book” where issues are recorded. The inspector examined the feedback book which demonstrated that any ‘minor’ issue was noted, discussed and acted upon appropriately to reach a satisfactory solution for service users where possible. Staff spoken to were clear of the Complaints procedure and the significance and importance of Whistle Blowing. Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30. The home was clean, but run down and shabby, in need of redecoration and refurbishment. EVIDENCE: The home was built 15 years ago and apart from the kitchen which had been refurbished a year ago, the rest of the home was clean but scruffy and in need of refurbishment and redecoration. Woodwork was badly scuffed, wall paper and walls were smudged and carpets were worn with heavy traffic wear and marks. The present floor covering is not ideal for a home where wheelchairs are in constant use. A requirement has been made. Standard 30 – (1) Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35. Staff training was potentially good but fails in follow up resources for staff which means that all value of training is lost and has a negative impact on service users. EVIDENCE: A sample of staff training files were seen. Basic and essential core training was given. Earlier NVQ training had been abandoned due to the trainer being unavailable. Some of the staff had been in employment for many years and the home could not evidence induction training, nor could staff recall whether they had had induction training. Staff expressed strongly their dissatisfaction at the lack of the resource of computer access to enable them to follow up training that was only available ‘on-line’ on the Personal Computer, such as Training on Intranet, Training Appraisal, and online communication. This dissatisfaction was such that they expressed the view that “there was no point in talking to the CSCI inspector about their training issues”. Staff used such expressions as “discrimination” Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 16 since they claimed all other Islington establishments had access to on-line training resources, but not such off-site satellite establishments as the home. The manager informed she had made every effort to gain such resources from the Provider for staff but to no avail. A requirement and a recommendation have been made. Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 17 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): Not assessed on this occasion. EVIDENCE: Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 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 X X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Orchard Close (4 ) Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000031851.V254452.R01.S.doc Version 5.0 Page 19 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 YA30 Regulation 23 Requirement Timescale for action 02/04/06 2 YA35 The Registered Person must have the premises maintained, decorated and refurbished. Paintwork, woodwork and furnishings must either be replaced or repaired. 18(a)(c)(i)(ii) The Registered Manager must 10/01/05 ensure that staff are able to access training material and training appraisal so that staff may be suitably qualified, competent and experienced for the health and welfare of service users. Staff must have on-going and up to date training appropriate to the work they are to perform. 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 35 Good Practice Recommendations Some staff have been in employment in the home for several years, since which time statutory requirements
DS0000031851.V254452.R01.S.doc Version 5.0 Page 20 Orchard Close (4 ) through the Care Standards Act 2000 have been introduced. It would be good practice to consider a basic refresher course to all staff who have not had formal induction training. Orchard Close (4 ) DS0000031851.V254452.R01.S.doc Version 5.0 Page 21 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.V254452.R01.S.doc Version 5.0 Page 22 - 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!
