Inspection on 11/01/06 for Orchard End

This inspection was carried out on 11th January 2006.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard End 05/09/06

Orchard End 05/09/05

Orchard End 10/11/04

Orchard End 06/07/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Orchard End Auberrow Wellington Herefordshire HR4 8AL Lead Inspector Jean Littler Unannounced Inspection 11th January 2006 10:00 Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard End Address Auberrow Wellington Herefordshire HR4 8AL 01432 839038 01432 839038 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) Winslow Court Limited Miss Claire Louise Williams Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care staff to service user ratio must always be in excess of 1 staff to 2 service users. 5th September 2005 Date of last inspection Brief Description of the Service: Orchard End is registered to accommodate five people with learning disabilities and who may display occasional challenging behaviour. It is a five-bedroom bungalow with an additional bedroom that is used as an office/staff sleeping in room. There are good-sized communal rooms and spacious gardens that allow for a range of activities. The Home is situated on the outskirts of the village of Wellington, which is about 5 miles from Hereford city. Orchard End, whilst registered in its own right is owned by Winslow Court Ltd. a company that comes under the umbrella organisation called Senad. The Home retains close links with Winslow Court which is a larger Care Home in the area. The company training, health and safety, and human resources departments are based at Winslow Court. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out on a weekday between 10am and 12.45pm. The manager was out for the first part of the inspection so two of the support workers on duty assisted with various parts of the inspection process. The residents were at Home and were observed interacting with staff and taking part in the college art class. The providers monthly visit reports to the Commission, and other communication with the Home since the last inspection were all considered as part of the assessment process. What the service does well: 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 End DS0000031631.V277485.R01.S.doc Version 5.1 Page 6 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 End DS0000031631.V277485.R01.S.doc Version 5.1 Page 7 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 fully assessed at the last inspection so were not reassessed. The manager reported that the recommendation to revise the Service User’s Guide and make it more user friendly has been noted and work is currently underway. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 8 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, 10. Professional advice is sought when needed and staff have the skills to judge how best to respond to each resident depending on their frame of mind and emotional needs. Suitable arrangements are in place for assessing, planning and reviewing the residents’ needs, although these could be made more Person Centred. Information about the residents is being kept in confidence, and records are being accurately maintained and stored securely. EVIDENCE: Personal information is stored securely in the office and staff are aware of the need to keep this information confidential. One care plan was sampled and the information was found to be up to date. Clear guidance was in place to guide staff about how to meet the resident’s needs. The daily records were professionally written and contained useful information about the resident’s general wellbeing, meals, activities, personal care etc. A review had been held in May 05 and another was booked for later in January 06. One worker spoken with had not attended the review of the resident she keyworks as the meeting had been arranged for a day she could not attend. Links should be made with the Herefordshire Person Centred Planning co-ordinator to begin work towards implementing this approach into the Home. Efforts should also be made to empower resident to plan their own review meetings e.g. make invitations, Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 9 choose who should attend, make a video or use photographs to show the activities they enjoy etc. One resident who has been unsettled over the last few weeks was being supported by staff to reduce his anxiety levels and get back into his routine following the festive period. The psychologist who supports the Home had been consulted. The staff on duty were all working consistently to reassure the resident and reduce any stress triggers e.g. he was not asked to join in with the art class. It is positive that the work to support two residents to tolerate each other more during meal times has been successful. A flexible approach to this issue has now been introduced and staff arrangements the seating based on both residents’ frame of mind prior to each meal. The manager has not actioned the recommendation made at the last inspection to develop specific intervention plans about the use of sanctions or physical intervention/restraint. The need to ensure staff have clear guidance and boundaries in this area to protect residents was discussed and the manager agreed to have the guidance in place by the end of February. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 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): 15, 17. Good efforts are made to support the residents to maintain close relationships with their families. Nutritious meals are being provided in a flexible and homely manner. EVIDENCE: Over the Christmas holiday period staff went to great lengths to ensure the residents were able to visit their relatives. Arrangements included staff accompanying residents to Wales, Liverpool and London. One resident stayed with his family for the first time in many years and because of the success of the visit he has been invited again. This is a very positive step and the staff should be commended for supporting the relationship to develop in this way. Contact during the rest of the year is maintained through visits and phone calls. Staff also reported taking residents to visit relatives on mothers or fathers day and for birthdays. Meals are prepared and cooked by staff in the domestic kitchen. The residents are involved in food shopping and choosing what they eat. The menu is based around their preferences and a sample seen showed a good variety of meals that included fresh fruit and vegetables. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 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. Good efforts are being made to ensure residents’ personal care needs are met in a personalised and considerate manner. Residents’ health needs are being given high priority and health professionals are involved. Advice should be taken about how to best support one resident to lose weight. EVIDENCE: The staff are aware of how the residents prefer to be supported with personal care tasks. Many examples of good practice were given e.g. flexible times for bathing and showering, the choice about which worker helps with shaving, being offered the option of using the Jacuzzi bath, having a foot massage, using face masks etc. The way the rota is structured has recently been changed so a male worker is on each team so appropriate gender care can be offered each day. Care records sampled showed that the resident had recently been to the GP, dentist, optician, and podiatrist. Staff and the resident’s family have been advocating for him about an ongoing health problem. These efforts have resulted in a scan being carried out and other tests to help with the diagnosis. One resident has been advised by the GP to lose weight. Early signs seem to indicate that the focus of a diet is having an adverse affect on the resident’s behaviour. There are now plans to lock the fridge and food storage cupboards. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 12 These restrictions should only be put in place on the basis of a risk assessment and following consultation with key people e.g. the psychologist who supports the service. Medication management was not assessed, however it was noted that the storage cabinet has been relocated from the office into the laundry. The manager agreed to monitor the humidity and temperature levels of the room as the conditions may have a detrimental effect on the medicines. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 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): 23. Steps can be taken to further protect residents from abuse. EVIDENCE: No complaints or adult protection concerns have been received by the Home or the Commission since the last inspection. Training in adult protection is provided by the Organisation however not all staff have attended this yet. As detailed above guidance for staff about the use of physical intervention needs to be put in place to help protect residents. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 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): EVIDENCE: The majority of these standards were assessed at the last inspection so have not been re-assessed. The Home was clean, warm and homely. The residents’ bedrooms seen were attractive and comfortably furnished. Some rooms and communal areas have been decorated recently and the kitchen has been refurbished. A new kitchen floor is due to be laid to finish the work. The recommendation to review how soiled laundry is managed has been actioned and appropriate arrangements are now in place. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 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): 33. Appropriate staffing levels are being provided to meet the residents’ needs. EVIDENCE: Since the last inspection there has been some turnover amongst the staff team. This put some strain on the service as the posts became vacant in close proximity to each other. Two new workers have recently started work and efforts continue to recruit to two other posts. The rota for January and most of February were seen. Existing staff working extra hours and some by relief workers covering from Winslow Court had covered the majority of vacant shifts. The staff spoken with were positive about the residents and they were working in a calm and professional manner. Staff liaised with the college art tutor so she was appropriately informed about any issues that would impact on her sessions e.g. one resident attending a horse riding session. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 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 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, 42. The Home is running smoothly and the residents and staff team are benefiting from a positive management approach. Health and safety management systems and policies are in place, however these are not being consistently implemented. EVIDENCE: The manager was registered with the Commission in November 2005. She has relevant experience from working at a senior level within Winslow Court and in the deputy role at Orchard End. She has attended managers training courses such as staff supervision and is currently working towards the NVQ Registered Managers Award. The manager’s hours are not included in the care element of the Home’s rota, however she often works at weekends and ensures she maintains a good knowledge of the residents’ needs. The post of senior/deputy has recently been advertised and a member of the support staff team is due to take up this post in February 06. Staff reported that the manager is approachable and helpful and has settled into her role well and is leading the team effectively. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 17 Health and safety arrangements were sampled. Appropriate risk assessments are in place in regards to the care of the residents and these have been kept under review. The manager reported that maintenance issues and repairs are now being dealt with more promptly. The Organisation provides a monthly log book to capture all the monitoring information e.g. fridge and freezer temperatures, hot water temperatures, fire panel checks etc. The December and January records that were sampled showed these checks had been completed very sporadically. Separate fire safety records showed that all staff had been involved in recent evacuation drills and that the alarm and other equipment was being regularly serviced. Four fire doors were wedged open to allow freedom of movement between both bedroom areas and the central communal rooms. Professional advice must be taken about this practice. If the doors need to be opened during the day then automatic closure devices may need to be fitted. The Fire Safety risk assessment needs to be amended to reflect the decision that is made. Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 X 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 4 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 X X 2 3 X X x 2 x Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 19 NA 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 YA42 Regulation 23 Requirement Seek professional advice regarding the practice of wedging open fire doors during the day when the Home is occupied. Follow the advice given and ensure the Fire Safety risk assessment reflects the actual practice in the Home. Timescale for action 31/01/06 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. 2. 3. Refer to Standard YA1 YA26 YA6 Good Practice Recommendations Review the Service Users Guide to ensure it is accurate and relates to the service. (Brought forward, work is ongoing). Review if one resident could now manage and benefit from having a sink fitted in his bedroom. (Brought forward, a full review has not yet been carried out). Develop specific guidance relating to each residents need for the use of sanctions and/or physical intervention or restraint. (Brought forward, the manager agreed to action this before March 06). Complete a risk assessment before restricting residents DS0000031631.V277485.R01.S.doc Version 5.1 Page 20 4. YA19 Orchard End 5 YA20 from accessing food storage areas in the kitchen. Consult the psychologist about the possible effects on one resident of staff focusing openly on his need to lose weight. Monitor the humidity and temperature of the area where the medication cabinet is located, and ensure this does not effect the integrity of the medication. Revise the medication profile so it includes details of the condition the medication has been prescribed to treat. Arrange for all staff to attend adult protection training as soon as possible. Consider how residents can be empowered to plan their own review meetings and have their own Person Centred Plan. Review why the programme of health and safety checks are not being completed in line with the Organisations expectations. 6 7 8 YA23 YA6 YA42 Orchard End DS0000031631.V277485.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 End DS0000031631.V277485.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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