CARE HOME ADULTS 18-65
Orchard Court Residential Home 3a Orchard Gardens Thurmaston Leicestershire LE4 8NS Lead Inspector
Kim Cowley Unannounced Inspection 18th October 2005 12:30 Orchard Court Residential Home DS0000048204.V254536.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 Court Residential Home DS0000048204.V254536.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 Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Orchard Court Residential Home Address 3a Orchard Gardens Thurmaston Leicestershire LE4 8NS 0116 2640086 0116 2697926 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) Active Care Partnerships Limited Vacant Care Home 20 Category(ies) of Learning disability (20), Physical disability (20) registration, with number of places Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The home can receive residents within the registration categories LD (Learning Disabilities) and PD (Physical Disabilities) The number of persons who can receive residential accommodation at any one time shall not exceed 20. The home can admit persons of either gender. No person may be admitted to the home who falls within category PD unless that person also falls within category LD I.e. duel disability. To be able to admit the person, falling in the category SI, named in variation application number 56695 received on 6 October 2003. 14th June 2005 Date of last inspection Brief Description of the Service: Orchard Court is a residential care home that provides care for up to 20 residents with learning disabilities and associated needs, including physical disabilities and challenging behaviour. The home is situated in a purpose-built bungalow. This is divided into three individual units (Cedar, Willow and Rowan), each providing different levels of support depending on residents needs. The home is in a residential cul-de-sac in the village of Thurmaston. It has extensive grounds that are secure and secluded. Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on a weekday. When undertaking inspections the Commission for Social Care Inspection (CSCI) focuses on the outcomes for residents living in a home. In order to do this, the inspector ‘case tracked’ three residents. This means the inspector checked their care records and met with them. In addition the inspector talked to other residents, the Acting and Deputy Managers, and two of the carers. Further care and other records were examined. The home was commended in one area. One Requirement and one Recommendation were made. What the service does well:
Orchard Court provides high quality and progressive care in a homely and stimulating environment. Of particular note is the staff team (both managers and carers). Those interviewed were dedicated professionals with enthusiasm for the work they do. The Acting Manager was praised by all her staff and the following comment was made, ‘She is one of the best. You can approach her about absolutely anything without reproach.’ The inspector spent time in each bungalow and met with a number of residents. All appeared happy and relaxed. Relationships between staff and residents were seen to be excellent. Staff are knowledgeable about the residents they care for and committed to helping them determine their own fulfilling and varied lifestyles. Residents’ preferences about their personal care are actively sought. This is commended. Care plans are flexible and regularly updated as staff find out new and better ways to care for residents. Staff encourage residents to express their views. The Acting Manager said ‘All our residents have ways of communicating if they are not happy about something. If they can’t do this verbally they use other ways, for example body language, to tell us when something is not right.’ Care records set out residents’ likes and dislikes. Key workers build up relationships of trust with residents and encourage them to express any anxieties they might have. Policies and procedures are in place to protect residents from abuse, and the staff on duty were familiar with these. Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 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 Court Residential Home DS0000048204.V254536.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 Court Residential Home DS0000048204.V254536.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): EVIDENCE: These Standards were inspected at the last inspection on 14.06.05. Orchard Court Residential Home DS0000048204.V254536.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): EVIDENCE: These Standards were inspected at the last inspection on 14.06.05. Orchard Court Residential Home DS0000048204.V254536.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): EVIDENCE: These Standards were inspected at the last inspection on 14.06.05. Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 11 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 Staff work with residents to find out how they would like their personal care given. Local health care professionals provide services to the home. Medication is securely kept and properly administered. EVIDENCE: Residents’ personal care needs are initially assessed prior to their admission. Once in the home they are subject to continual review. The Acting Manager said ‘For the first three months we are on a learning curve until we find out what they like. For example we discovered that one resident likes to lay the bath for at least 20 minutes. If she comes out sooner than that she gets distressed.’ Residents’ preferences about their personal care are actively sought. This is commended. Care plans are flexible and regularly updated as staff find out new and better ways to care for residents. Records show that where possible residents use local community health care services. If specialist care is needed this is catered for at a centres where staff are experienced in working with residents with learning disabilities. Residents have regular ‘MOTs’ at a local ‘Well-Person’ clinic. District Nurses give advice and training staff in basic nursing techniques, for example administering
Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 12 insulin. Other services provided include physiotherapy, speech and language therapy, aromatherapy, and hydrotherapy. No residents presently self-medicate. The three qualified nursing staff at the home train the seniors who give out medication. Staff work with consultants towards helping residents to reduce their medication. If medication has been used previously to control behaviour, staff try and use alternative methods so that medication can be stopped. The home’s contract pharmacist inspected the arrangements for medication on 5.9.05. Two recommendations (regarding the temperature of the fridge and the need for a procedures manual) were made. The Acting Manager said these have been met. Orchard Court Residential Home DS0000048204.V254536.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, 23 Residents are ‘listened to’ and staff find ways to help them express any concerns they may have. All staff are trained in protecting residents from abuse. EVIDENCE: The Acting Manager said ‘All our residents have ways of communicating if they are not happy about something. If they can’t do this verbally they use other ways, for example body language, to tell us when something is not right.’ Care records set out residents’ likes and dislikes. Key workers build up relationships of trust with residents and encourage them to express any anxieties they might have. One member of staff described in detail how a resident he cares for communicates with staff. ‘I suspect that he understands everything staff say and he indicates yes and no by nodding. So a lot of communication is possible and we can help him to develop the lifestyle he wants.’ The home has a written complaints procedure, which meets minimum standards. This is displayed in the entrance to the home. It should be updated and the name of the previous CSCI inspector removed. The Acting Manager regularly corresponds with relatives and they are reminded of the home’s complaints procedure through newsletters and other correspondence. A copy of the last inspection report was also sent to them. Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 14 Policies and procedures are in place to protect residents from abuse, and the staff on duty were familiar with these. All staff have adult protection training during their induction. Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 15 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): EVIDENCE: These Standards were inspected at the last inspection on 14.06.05. Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 16 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): EVIDENCE: These Standards were inspected at the last inspection on 14.06.05. Orchard Court Residential Home DS0000048204.V254536.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): 37 The home is well run, but to meet legal requirements a Registered Manager must be appointed. EVIDENCE: The home is still without a Registered Manager. This must be rectified in order for the home to meet Regulations. Orchard Court Residential Home DS0000048204.V254536.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 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Orchard Court Residential Home Score 4 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X X X X X X DS0000048204.V254536.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? No 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 37 Regulation 8 Requirement The home has now been without a Registered Manager for over 18 months. This situation must be rectified and a suitable candidate put forward to CSCI. Timescale for action 05/12/05 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 22 Good Practice Recommendations The home’s written complaints procedure, which is displayed in the entrance to the home, should be updated and the name of the previous CSCI inspector removed. Orchard Court Residential Home DS0000048204.V254536.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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