Inspection on 16/03/06 for Orchard End

This inspection was carried out on 16th March 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard End 24/03/09

Orchard End 03/04/07

Orchard End 17/11/05

Orchard End 21/02/05

Orchard End 26/07/04

Orchard End 18/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Orchard End Church Lane Minsterworth Glos GL2 8JJ Lead Inspector Ms Tanya Harding Unannounced Inspection 16th March 2006 9:40 Orchard End DS0000055595.V286581.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 DS0000055595.V286581.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 DS0000055595.V286581.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard End Address Church Lane Minsterworth Glos GL2 8JJ 01452 750587 01452 750752 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) www.orchardendltd.co.uk Orchard End Limited Caroline Hopkinson Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 Brief Description of the Service: Orchard End is a residential care home for 12 adults who have a learning disability and may demonstrate challenging behaviour. Accommodation is provided in two separate units, one of which is the main house and the other a bungalow. The house has a large lounge/dining room, another lounge, main kitchen, small kitchen, computer room, toilet and a ground floor bedroom with its own shower. On the first floor there is a bathroom and three bedrooms, two of which have their own en-suite toilets. In another wing of the house on the first floor there are two bedrooms, a bathroom and two small offices. The bungalow has a lounge, conservatory which is used as a dining room, small kitchen, bathroom and six bedrooms, two of which have en-suite toilets and two have full en-suite facilities. The home is surrounded by large level gardens which are maintained to a high standard. There is also a swimming pool, and a sensory garden built in a Japanese style. The home keeps a few chickens and has an aviary. The home is situated in a rural environment on the banks of the River Severn approximately 8 miles from the City of Gloucester. The home is one of four homes known as Orchard End Ltd owned by C.H.O.I.C.E. Ltd. Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out on Thursday morning and lasted two and a half hours. The visit was supported by the deputy manager and the registered manager. Several of the service users were greeted. Some service users were out on activities and one person was getting ready to go out. Another service user was being supported on one to one basis in pursuing their hobby. All of the service users seen appeared well and contented. Medication administration records and staff recruitment procedures were examined. The majority of the key standards were assessed at the last inspection and this report should be read in conjunction with the last inspection report to provide a more comprehensive overview of the service provided. Some requirements have remained in this report, as these were still within agreed timescales and compliance will be assessed at the next visit. What the service does well: What has improved since the last inspection? What they could do better: The home continues to provide a high level of service. Risk assessments for the service users should be more individualised. Environmental improvements which have been suggested in the last report need to be implemented. Shortfalls in staff recruitment procedures need to be addressed in order to maximise the robustness of the process. Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 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 End DS0000055595.V286581.R01.S.doc Version 5.1 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 End DS0000055595.V286581.R01.S.doc Version 5.1 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): Not assessed on this occasion. EVIDENCE: The home has provided an update on their progress with implementing risk assessments for each service user as required in the last report. So far assessments have been completed for eight of the service users. Samples of risk assessments for a number of individuals were examined. It is recommended that risk assessments include more detail about the vulnerability of each service user, as this would dictate the amount and type of support which would need to be provided to minimise the risks. Orchard End DS0000055595.V286581.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): 13 and 16 Service users are supported to take part in meaningful community activities. The home operates in a way which recognises and respects service users’ rights to make choices. Where limitations are imposed on the service users’ freedom, there is a clear rationale and a comprehensive process of arriving at the decision that this is the best approach. EVIDENCE: Service users who live at Orchard End have opportunities to access a variety of activities in the wider community. Transport is provided by the home and staff are deployed as flexibly as possible to support people in college courses, accessing the leisure facilities and enjoying shopping trips. There are very few limitations in the home and grounds, with service users able to have unrestricted access to all communal areas and to the extensive gardens. For one person a stair-gate is present on access to their bedroom. This is because there are identified serious risks to the person’s safety if they were to leave their room unsupported under certain circumstances. There have been Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 Page 11 previous discussions with the home about the use of this restriction. It is acknowledged that the manager has taken the right steps and has spoken to the involved professionals and the person’s family as part of the ‘best interest’ decision. The use of the stair gate is being monitored to reduce any unnecessary inconvenience to the service user. The person has not been in the home that long and it is recommended that the use of the stair gate or any other physical restriction is reviewed at least every six month, or sooner if directed by changing needs. The aim of such review would be to determine whether this remains the most appropriate way of ensuring the safety and welfare of the service user and would need to be done at a multidisciplinary level. Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 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 Medication administration systems are robust and protect the service users from possible errors. EVIDENCE: Medication administration procedures were discussed and records of administration were examined. These were seen to be accurate and well maintained. There is a list of staff assessed as competent in administering medication. Some protocols in relation to ‘as required’ medication were due for renewal and the manager confirmed that this will be addressed. Medication storage was seen to be well organised. Medication in bottles and tubes was labelled with the date of opening. Orchard End DS0000055595.V286581.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 Systems for protecting service users from harm and abuse are in place. Improvements could be made to risk assessments to ensure these are more robust and safeguard the vulnerable residents. EVIDENCE: There are systems and procedures in place to ensure that any possible abusive or poor practices are identified and reported. The Organisation has implemented additional value base training for all staff, which looks at what is good practice and what constitutes abuse. The aim of this training is to raise awareness and understanding amongst staff of key principles in protecting vulnerable adults from mistreatment. As identified in standard 9, there are ways in incorporating issues about individual vulnerability into the risk assessments for each service user so that correct action can be identified and taken to avoid or minimise risks, such as identifying whether staff supporting a particular service user need specialist skills and knowledge, or whether there needs to be a greater staff ratio when people go out. The home continues to report and provide a detailed account of any untoward incidents which may adversely affect the service users in line with Regulation 37. All staff receive training in responding to aggression, which includes deescalation and use of physical interventions. Orchard End DS0000055595.V286581.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): Not assessed. EVIDENCE: The manager provided an update on the plans to improve the administration space in the bungalow. The plans have been changed to provide a more suitable accommodation for this and medication storage. The timescales for the improvements were not yet known. The home was very clean on the day of the visit. However, it was noted that the main building was quite cold and a freestanding heater was found on the upstairs landing. The home should follow this up and undertake any remedial action if necessary. Orchard End DS0000055595.V286581.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): 34 Procedures for recruiting staff are overall comprehensive and should ensure that only suitable staff are selected to work in the home. There are shortfalls in the quality of the information obtained for new recruits and for staff transferred within the company and this could compromise the robustness of the process and leave the service users more vulnerable. EVIDENCE: A number of staff files were examined for staff who have been recruited since the last inspection. There was evidence that the required pre-employment checks are carried out and references and proof of training are obtained. Some shortfalls were evident and will need to be addressed. For example the reference request form could be made clearer by asking the person providing the reference to state how long they have known the person. An application form for one employee only provided employment history from 2001. The regulations require for a full employment history to be provided. One staff member was re-employed by the home after a period of working elsewhere. However, there was no information on the application form that the person had previously worked here. The home has accepted an internal reference, and did not request a reference from the past care employer and this must be done. Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 Page 16 Discussion took place about the staff who come into the home from other homes within the company. Some staff may transfer from another home following a disciplinary process, but there appeared to be no formal system by which this information was passed on between the homes. The value of such information would be for the manager to help in their assessment and ongoing support of that staff member as well as to ensure that any possible risks to the service users are assessed. The supervision of staff is being addressed in line with the company procedures. This includes regular monitoring meetings during the first six weeks of employment. Samples of supervisions and of monitoring meetings were seen. It was noted that some supervisions lacked significant detail and did not provide a follow up to issues identified during monitoring meetings. Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 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): 39 There is a responsible approach to assessing quality and this should ensure that service users’ needs and views are the main focus of the service provided. EVIDENCE: The Organisation has established procedures to monitor every aspect of the service. Regular unannounced visits are carried out by the quality assurance co-ordinator and the necessary reports are forward to the Commission under Regulation 26. The manager has developed monitoring practices in the home which are based on measuring whether the support provided to the service users enhances their quality of life. There is an aim to promote good value base throughout the staff team with emphasis on person centred approach. Orchard End DS0000055595.V286581.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 3 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 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X X X 3 X X X X Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 Requirement Individual risk assessments must be completed for all service users in respect of the activities in which they participate. (Good progress made with this requirement) 2. YA10 23 A timescale must be identified within which separate office space will be created in which files belonging to residents can be kept securely. Remedial work must be completed to the lobby at the rear of the main building (by the downstairs toilet) to ensure it is in a good state of repair. Shortfalls identified in the text with regards to the information obtained for staff must be addressed. 30/04/06 Timescale for action 31/05/06 3. YA24 23 30/06/06 4. YA34 19 31/05/06 Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations Risk assessments should include more detail about the vulnerability of each service user, as this would dictate the amount and type of support which would need to be provided to minimise the risks. The use of the stair-gate or any other physical restriction should be formally reviewed at least every six month, or sooner if directed by changing needs. The aim of such review would be to determine whether this remains the most appropriate way of ensuring the safety and welfare of the service user and would need to be done at a multidisciplinary level. There should be evidence that issues identified during monitoring meetings are followed up through formal supervision. Supervision records should be sufficiently detailed to demonstrate how staff are being appraised on their performance and to identify development issues. Assess whether the heating in the main building (upstairs and downstairs) is sufficient for the purpose (this refers to some areas of the main building being quite cold at the time of the visit). 2. YA16 3. YA36 4. YA24 Orchard End DS0000055595.V286581.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000055595.V286581.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. 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!