Inspection on 03/04/07 for Orchard End

This inspection was carried out on 3rd April 2007.

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 no outstanding requirements from the previous inspection report, but made 6 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 16/03/06

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 Lynne Bennett Key Unannounced Inspection 3rd April 2007 14:30 Orchard End DS0000055595.V329199.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 End DS0000055595.V329199.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 End DS0000055595.V329199.R01.S.doc Version 5.2 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 C.H.O.I.C.E. Ltd TBA Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16/03/06 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 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. Orchard End 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 five homes known as Orchard End Ltd owned by C.H.O.I.C.E. Ltd. The home has a Statement of Purpose and Service User Guide which are available from the team leader’s office in the bungalow. Fees for the home range from £989 to £1911 per week. These do not include payments for holidays, hairdressing or toiletries. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in April 2007 and included three site visits to the home. A pre-inspection questionnaire was provided prior to the inspection and comment cards were received from three health and social care professionals and five relatives. Time was spent monitoring the care being provided to people living at the home and talking to some of them about their lifestyles. The care of three people was looked at in depth that included observing them and their interactions with staff for one and a half hours. The manager and area manager were present for the visits. Staff were spoken with and their records were examined. Other records examined included care plans, quality assurance information and health and safety records. What the service does well: What has improved since the last inspection? Person centred planning is being put in place which will enable people to have more control of their lives. Risk assessments reflect what support staff need to give to people in order to minimise hazards and safeguard them from harm. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 6 Improvements to the environment are taking place, creating a private and secure area to store personal information in the bungalow and making good use of space in the main house to provide an office and small lounge. 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. The summary of this inspection report can be made available in other formats on request. Orchard End DS0000055595.V329199.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 End DS0000055595.V329199.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have access to the information they need which is regularly reviewed enabling them to make a decision about whether they wish to live at the home. An assessment of their needs and wishes are taken into consideration before offering them a place. EVIDENCE: The home has a Statement of Purpose and Service User Guide which the manager has plans to review in light of changes in the environment and the management of the home. The home has an admission’s policy and procedure that along with other policy documents is being reviewed by the organisation. Previous admissions to the home have been admitted with a full assessment completed by the organisation and a copy of the placing authority’s assessment. There have been no new admissions to the home. Orchard End DS0000055595.V329199.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A person centred approach to care planning will ensure that people are able to take control of their lives. People’s needs are being assessed and they are being supported to makes decisions about their lifestyles. Risks are being managed safeguarding from possible harm. Improving access to information for those with limited communication will ensure they are involved in these processes. EVIDENCE: The manager stated that person centred planning is being introduced as part of the organisation’s review of care planning. She has worked with two people to prepare their plans and these were available for inspection. In the meantime staff are maintaining other care plans until each person has a person centred plan. People chatted about their care plans and there was evidence that several people have been asked to sign theirs. The care of three people was examined in depth. This involved reading their care plans, one of which was the new version. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 10 The manager described how the new care plans are being developed. Records confirmed that the person might meet with the manager, their key worker, relatives and members of the Community Learning Disability Team. A holistic assessment of each person’s needs is completed and from this needs or actions are developed such as supporting a person to attend trampolining or enabling them to eat their meals in comfort. Staff spoken with have a good understanding of the needs of the people they support. Each person has a communication profile in place and there is some use of picture and symbol around the home. The manager stated that the team have worked closely with the Speech and Language Therapist to support people with limited communication and that she intends to make more use of photographs around the home. Reactive strategies are in place for some people. These are developed with a psychology team who regularly monitor and review them. There was evidence that any changes in behaviour are watched closely and the team is responsive, developing new guidelines for staff. Staff were observed using these strategies with a person enabling them to remain calm. A schedule of six monthly review dates are displayed in the office and reports in care plans indicated that these are being followed. Annual reviews are being scheduled and placing authorities supplying their record of these meetings. Some parents commented that they receive copies of these reviews but one said that they had not. Any restrictions in place within the home are noted within each individual’s care plans. Where appropriate a best interests meeting has been held and capacity to consent is recorded. People were observed being given access to kitchens with staff support where these are usually kept locked. Food is also locked away and people said that they have access to fresh fruit and snacks if they want them confirming where these items are kept in the communal rooms. People were observed being supported to make decisions about activities of daily living such as helping with household chores and what leisure activities to take part in. A team leader confirmed that she would be scheduling house meetings to take place regularly. The manager stated that no one in the home presently has access to an advocate. People require support to manage their finances. A team leader was observed administering people’s personal finance. She described the processes in place to monitor and check balances. Three people’s financial records were examined and found to be satisfactory. Risk assessments have been put in place as required at the last inspection. The manager is redesigning the format to give staff information about how Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 11 they are expected to support people to minimise risks. Samples were inspected. Discussion with staff confirmed their understanding of how risks can be minimised. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some people have access to a diverse range of social and educational activities. Concerns that the needs of people with limited communication are not being met are being addressed. People are supported to maintain relationships with family and friends. They are provided with a healthy diet enjoying nutritional and satisfying meals. EVIDENCE: At the time of the visits people were having access to a wide range of activities both on site and away from the home. Some people regularly attend day centres or college. Others have the support of a tutor at the home. Some people are being offered the opportunity to work for the organisation helping to do Regulation 26 visits with the area manager, or interviewing new staff. The area manager confirmed that this is paid employment. Each person has an activities schedule which is regularly reviewed. A team leader has been appointed to oversee activities and described what she is Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 13 planning to put in place which includes a variety of day trips, holidays and making greater use of the local vicinity for rambling or cycling. On the third day of the visit people were involved in helping with the gardening. They are hoping to grow plants in the greenhouse and have a vegetable garden. Some staff expressed concern that there appears to be a lot of activity for those people who are able to express their needs but that this is not true for those with limited communication. Daily records for two people appeared to back this up. During the in depth observation of people, one person did colouring for an hour and a half and during this time had two short positive interactions with staff. There was evidence in staff meeting minutes that this had been discussed and the manager confirmed that action was being taken to address these issues. Staff verified this. People are supported to attend church on a regular basis. Those spoken with said they enjoy going swimming, horse riding, the cinema and some were looking forward to going to a social club one evening. People were observed spending time in the garden. They have a swimming pool which they use in the summer. The manager confirmed that some staff are lifeguards and others have lifesaving certificates. Risk assessments are in place. People have regular access to their family and friends. Contact is recorded in their care plans. One person was observed being supported to make a telephone call to her mother to discuss arrangements for a weekend at home. Staff accompanied another person to visit their mother in Bristol where they spent the day at the Science Museum. One parent commented that the home will “pick me up to visit and take me home”. People were observed taking part in activities of daily living such as helping to vacuum communal areas, taking the rubbish out and helping to wash up and clear away. One person said that they like to bake cakes and staff confirmed that they are able to do this. People were observed choosing where to spend their time and with whom. The home employs a cook who makes a freshly produced main meal each day. Staff prepare a snack for tea each night. She stated that the menu reflects the likes of people and is changed regularly. People were observed having a meal of lasagne and salad or pork casserole. They said they enjoyed the food and confirmed that portion sizes are always good. There was evidence that fresh fruit is available and people were observed having regular access to drinks. People occasionally go out for meals or have a takeaway. A dietician has been involved with the home giving advice about the particular needs of one person. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive personal and health care support based on their individual needs. The changing needs of older people are recognised and respected. Medication systems are mostly satisfactory although further improvements will ensure that people are safeguarded from possible harm. EVIDENCE: The manager confirmed that health action plans are being developed with people. Each person also has records in their care plan which indicates their personal likes and dislikes, a communication profile and a record of healthcare appointments. Daily records also confirmed attendance at healthcare appointments. The manager said that the home works closely with the local Community Learning Disability Team. Comments from healthcare professionals indicate that they do not have any concerns about the home. Routines within the home are flexible and are identified in peoples’ care plans. Discussions with staff confirmed that they have a good understanding of the needs of people. Two people are over 60 and staff said that they are monitoring their changing needs in relation to the ageing process. Care plans Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 15 for one person indicate that a healthy eating plan has been put in place and that they have access to a dietician and continence advisor. People require support with the administration of their medication. Best interests and capacity to consent records are in place having been drawn up in an inter disciplinary forum. Medication is presently stored in the bungalow and brought across to the main house when needed. Medication must be kept securely at all times. This includes when being transported around the site. The area manager confirmed that the manager had requested an additional medicine cabinet for the main house some time ago but that this had not yet been supplied. The team leader described systems in place for the administration of medication. Records and medication were examined and found to be satisfactory. It was noted that night staff signatures are not included on the signature list. The manager also stated that they have not yet received training in the administration of buccal midazolam. Team leaders have completed medication training with a pharmacy. No other evidence of competency was available. One person needs to have insulin administered and at present staff who have been trained by a nurse from the local practice are administering this. A protocol has also been put in place. Due to changes in the staff team the home has been trying to arrange for additional training for new staff but at present are having difficulty arranging this. They are in discussions with the surgery about how this can be arranged. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that any concerns will be dealt with through the complaints procedure and will be acted upon. People are not being safeguarded from possible abuse due to the lack of confidence of some staff in the processes within the organisation. EVIDENCE: The home has a complaints procedure that is displayed in the home. This is produced in a format which uses text and symbol. Comments from parents indicate that they are aware of this procedure. The home has recently received two complaints that were responded to within 28 days to the satisfaction of the complainants. There was evidence in the complaints file of the action taken and the outcomes of each complaint. People spoken with said they would talk to their key worker or the manager if they have concerns. A complaint was received earlier this year and two independent senior managers were asked to investigate work practices. The complaint was not upheld. Staff said that they attend training in MORE (Management of Response to Emotion) with annual refresher training being provided. They also have the support of a psychology team and members of the local Community Learning Disability Team. Reactive strategies state that the use of physical intervention is as a last resort. Staff verified this. ABC and physical intervention records are completed to describe incidents of challenging behaviour and can be crossOrchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 17 referenced with each other and daily notes. Staff were observed de-escalating a situation following guidelines from a person’s care plan. Staff have completed training in abuse either as part of their Learning Disability Award Framework course or NVQ Awards. The manager has attended an enhanced safeguarding of adults course with the local adult protection team and this will be offered to some staff. Discussions with staff identified that they have a good understanding of the issues around abuse and safeguarding adults as well as the organisation’s whistle blowing procedure. During the inspection several staff made allegations about a member of staff stating that they did not feel comfortable expressing these concerns to management after the recent investigation. These concerns were passed onto the area manager who immediately took the appropriate action. After the inspection the area manager confirmed that investigations were completed. Copies of which were supplied to us. She also indicated what action she would be taking to work with staff to enable them to voice their concerns to management. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ongoing maintenance and improvements within the home make sure that the environment continues to meet the needs of people living there. Systems are in place to monitor the safety of the home and to maintain a clean and hygienic setting. EVIDENCE: There are substantial improvements in progress to meet with requirements issued at previous inspections. In the main house the ground floor has been redesigned to provide a purpose built kitchen, office, toilet and small lounge. In the bungalow a team leader’s office has been built which will provide secure accommodation for care plans and medication. This will create additional space in the conservatory where there are plans to provide comfortable seating. Once this work is completed communal areas will be redecorated. The home has systems in place for the repair of day-to-day maintenance issues. A walk around the environment was completed and individual rooms were seen on the invite of people living at the home. It was noted that several Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 19 of the bathrooms and toilets had no toilet paper or paper hand towels in place. The manager thought that the toilet paper may have been removed. There is also a tear in the lounge carpet in the bungalow. At the time of the visits the home was clean and tidy. Staff have responsibility for cleaning the home with the support of people living there. Personal protective equipment is provided for staff. Hazardous products are stored securely. The laundry area was satisfactory at the time of the first visit. During the visits it was reported that the water in the kitchen in the bungalow was not running at the appropriate temperature and staff were using kettles to supply water at the correct temperature. The cook also commented that water pressure in the main house was low. Builders who are involved in the current renovations had also commented on this. The manager said that the thermostatic valve in the kitchen needed replacing and that a part had been ordered. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from having a team with a mixture of skills, knowledge and experience working in sufficient numbers to ensure the smooth running of the home. EVIDENCE: There have been considerable changes at the home in the past twelve months. A new manager is in post and nine staff have left. The result is a team with a mixture of knowledge, skills and experiences. Existing staff speak positively of their new colleagues saying they bring with them new ideas and ways of working. Similarly new staff recognise the knowledge and experience of existing staff and say that they have been supported through their induction. Half of the staff team have a NVQ in Care. This meets with the National Minimum Standards. Not all staff have the necessary training or specialist knowledge required to perform some health related procedures such as administer insulin or buccal midazolam. (See Standard 20) Files for new staff were examined and found to be excellent. Each person had an application form in place with a full employment history. Where this was Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 21 missing there was evidence that the manager had obtained this information at interview. At least two written references are obtained with a Povafirst or Criminal Records Bureau check in place prior to appointment. We are contacted prior to appointing a person without a Criminal Records Bureau check and a risk assessment is in place. There was also proof that the manager is contacting former employers where the person has worked with adults or children to ascertain their reason for leaving. Evidence of identity and a photograph are also in place. New staff confirmed that they complete an induction programme and shadow staff. The manager stated that new staff have supervision every week for the first six weeks. Examples of induction programmes were inspected. New staff also have access to the Learning Disability Award Framework. A training matrix is maintained for the home confirming access to mandatory training and refresher courses as well as specialist training in autism, mental health, epilepsy and diabetes. There is evidence that staff have access to open learning and other resource information in the home. Team leaders have attended training in appraisal and supervision skills. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are areas of management and administration which are of a high standard and there is a clear developmental plan to improve the service provided. Creating an ethos of openness and transparency will have positive effects on the outcomes for people. EVIDENCE: The manager has recently been appointed to post and will be applying to us to become the registered manager. She is working towards her NVQ Level 4 Award and has completed a certificate in management. She has substantial experience working in this area of care and was formerly the deputy manager for the home. She discussed her developmental plans for the home which include developing person centred planning, addressing issues about access to social and educational opportunities for all people, supporting and nurturing the staff team and improving the environment of the home. There was Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 23 evidence that she has made a start on many of these areas. Some staff expressed worries that they did not feel confident with the organisation’s whistle blowing procedures and as a result are reticent to discuss any concerns they may have about the practice of other staff. (See Standard 23) A quality assurance system is in place which involves people living at the home. They took part in a survey the outcomes of which were published in a development plan for the home. Each month an unannounced visit is completed by the area manager who said that she is now being accompanied on these visits by a person living at another home in the group. A written copy of the last visit gave details of their feedback. Health and safety systems are in place monitoring fridge and freezer temperatures, fire systems, water temperatures and portable appliances. Data supplied on the pre-inspection questionnaire was verified by records in the home. Fire equipment within the home was due to be serviced. The manager is developing a fire risk assessment and said that all managers will be meeting to discuss which format to use. Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 24 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 2 2 3 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 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 25 No 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 YA1 Regulation 6 Requirement The Statement of Purpose and Service User Guide need to provide people with current information about the service to ensure they can assess whether the home meets their needs. When medication is being transported around the site it must be stored securely to ensure people are safeguarded from possible harm or errors. Training in the administration of buccal midazolam must be provided for night staff to ensure people can access this medication at all times. Staff must feel confident that they can use whistle blowing procedures to safeguard people from possible harm. Carpets in the communal areas must be fit for purpose and not pose a hazard to people living at the home. Sufficient quantities of water at the right temperature must be available to ensure that crockery and utensils can be washed maintaining satisfactory standards of hygiene in the DS0000055595.V329199.R01.S.doc Timescale for action 01/07/07 2. YA20 13(2) 20/04/07 3. YA20 13(2) 20/04/07 4. YA23 13(6) 01/10/07 5. YA24 23(2)(b) 01/07/07 6. YA30 16(2)(j) 01/07/07 Orchard End Version 5.2 Page 26 home. 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 YA7 YA20 YA20 Good Practice Recommendations Ways in which communication can be promoted for people with limited communication should be researched and put in place. The signatures of night staff should be recorded so that any mistakes or errors can be investigated. Access to accredited medication training and a competency audit of staff skills in medication administration would provide additional safeguards to protect people from possible errors. Training in the mental capacity act should be provided to staff to prepare them for the impact of changes in legislation. Whistle blowing procedures should be revisited with staff. Providing paper towels in toilets will reduce the risk of infection. Changing the toilet roll holders may prevent toilet paper being used inappropriately. Dishwashers in the kitchens would make sure that crockery and utensils are hygienically cleaned. 4. 5. 6. 7. YA23 YA23 YA24 YA30 Orchard End DS0000055595.V329199.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V329199.R01.S.doc Version 5.2 Page 28 - 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. 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