Inspection on 05/09/05 for Orchard End

This inspection was carried out on 5th September 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Orchard End 05/09/06

Orchard End 11/01/06

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 Announced Inspection 5th September 2005 9:30 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 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 Stationary 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 E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 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 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 Ltd Care Home 5 5 Category(ies) of Learning Disability registration, with number of places Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: In addition to those listed on the previous page the following condition has been placed on the Homes registration: -The care staff to service user ratio must always be in excess of one staff to two service users. Date of last inspection 10 November 2004 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 saftey, and human resources departments are based at Winslow Court. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine announced inspection was carried out on a weekday between 9.30am and 12.45pm. The manager completed an inspection questionnaire to provide additional information. The residents and their representatives were provided with feedback questionnaires prior to the inspection. Those returned were generally positive, however one family commented on the recent changes in staff and residents and hoped the service would now stabilise under the new manager. Staff needed to assist the residents in completing their questionnaires but some made positive comments e.g. one resident said he liked the food. 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. The inspector met the residents briefly and saw them interacting with staff as two left to go on a holiday and the others went out to a planned activity. The manager and her line manager assisted with the inspection process. Staff were not interviewed on this occasion as they were busy supporting the residents. What the service does well: What has improved since the last inspection? Care plans, risk assessments and polices have been reviewed. The house was being decorated and made more personalised and homely. Staffing levels had been increased to four at times to allow for more off site outings and activities to be provided. Staff training arrangements had been further developed to equip staff to meet the complex needs of the residents. The Organisations Quality Assurance systems had been further developed and were leading to ongoing improvements across the service. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 6 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 E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,4. A new resident’s transition into the service had been appropriately managed. Every effort was being made to meet the assessed and changing needs of the residents. The information about the service made available to residents was not accurate and needed reviewing. EVIDENCE: One resident had recently left the Home. Good efforts had been made over many months to respond to his changing needs with the support of external professionals but it had been agreed recently that the service could not effectively meet his needs. With the consent of his family and funding authority he had returned to Winslow court where a higher level of staff support would be available. A new resident had visited and then moved in on a trial basis. He was reportedly settling very well. His needs were well known to the management team as he had been living at Winlsow Court for many years. A new assessment was not required as his current and detailed care plan was transferred across when he moved. His keyworker from Winlsow Court and his family had supported him throughout the transition. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 9 The residents had copies of the Service User’s Guide in a symbol format in their bedrooms. This document should be reviewed as in some places it referred to Winslow Court rather than Orchard End. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 10 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 standard(s) 6. Suitable arrangements were in place for assessing, planning and reviewing the residents’ needs. EVIDENCE: One resident’s care plans was seen. This contained detailed and useful information to guide the staff team. The intervention strategies had been based on risk assessments and covered a wide variety of situations and daily living circumstances. The resident’s care arrangements had been reviewed regularly every six months with his family. The new manager had been reviewing all care plan information to ensure it was up to date. She was aware that specific intervention plans should be developed in regards to the use of any sanctions or physical intervention/restraint. One resident was being provided with regular specialist support from the psychologist who was also meeting with the staff team each month to review the effectiveness of the intervention strategies in addressing the difficult behaviour patterns. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 11, 12, 17. Residents were being provided with a wide range of suitable and enjoyable activities and outings to meet their needs and provide a good quality of life. A healthy and varied menu was being provided and mealtimes were being made as relaxed and homely as possible. EVIDENCE: Two residents were leaving to go on a holiday with three staff. The other residents had also had holidays this year of which the Organisation pays the first £500 of the cost. The remaining residents went on an outing during the inspection as decorating was taking place. Activity timetables showed all residents were partaking in a wide variety of enjoyable and therapeutic activities e.g. trampolining, pottery, college outreach sessions such as woodwork, cookery, needlework, drop in centre. Local outings included shopping and meals out etc. Residents choose how to spend their free time e.g. listening to music and they were supported to indicate their choice using a PECS communication system. Some parts of the day were more structured to meet the residents’ assessed needs. One resident was doing a puzzle with a member of staff prior to going on the outing. The garden had been used to provide activities for residents during the summer and vegetables and flowers Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 12 were growing. Further plans were being developed for each resident to have their own section to grow what they wanted e.g. one resident particularly likes tomatoes. The menus seen showed that a good variety of meals were being freshly prepared with locally purchased produce. There was a reasonable degree of flexibility to mealtimes and staff eat with the residents. Some controls were in place regarding the seating during meals to reduce the likelihood of incidents developing between two residents who can upset each other during meals. Residents were being given the opportunity to take part in menu planning and staff were aware of things they disliked. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19, 20. Residents’ assessed health needs were being met. Medication was being appropriately stored and safely managed. EVIDENCE: The six monthly review report for one resident showed that dental, GP, and hospital appointments had all been attended and medication had been kept under review. A Nurse based at Winslow Court provides additional health support and advice when required. Speech and Language therapy and Psychology support is also available through the Organisation if a need is identified and no local health service provision is accessible. Medication was being stored in a secure cabinet and the keys were being held by the person in charge of each shift. Records showed doses had been given as prescribed and medication regimes were being reviewed by the GP and where appropriate the Consultant, at least every six months. Staff training was being provided by the site nurse based at Winslow Court and only staff assessed as competent were being allowed to administer medication. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 14 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 standard(s) - EVIDENCE: No comps or adult protection concerns had arisen since the last inspection. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 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 standard(s) 24, 25, 26, 28, 30. The house was suited to its purpose, it was being well maintained and looked homely. The arrangements for cleaning, repairs and maintenance were proving effective. Residents’ bedrooms were attractive and personalised. Infection control arrangements in one area were not fully in line with current best practice. EVIDENCE: The Home was being well maintained and kept clean and well organised. The layout meets the needs of the residents and the three communal areas and large gardens are regularly used. Many areas were due to be redecorated the week of the inspection and the painter was on site. The overall impression of the Home was one of comfort and homeliness. Some of the lounge furnishings were heavily stained and although new throws were going to be purchased consideration should be given to replacing these. The residents’ bedrooms were attractively decorated and full of personal possessions. Some additional storage should be provided in one room for supplies of personal care products. The three bedrooms in the original part of the building do not have sinks fitted. The manager agreed to review if one resident would appropriately use a sink if Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 16 it was fitted into his bedroom. Two other residents had been assessed as still not being able to safely manage this facility. The manager agreed to review the clinical waste arrangements and consider if the number of waste receptacles can be reduced. The laundry facilities were clean and in good order. Infection control arrangements were in place e.g. colour coded mops. The arrangements for dealing with soiled laundry need to be reviewed. See Standard 42. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36. Appropriate staffing levels were being maintained by a team of permanent and support workers. Staff were being appropriately trained and well supported. EVIDENCE: There had been some staff turnover with the manager and three other staff leaving. The team was made up of nine support staff, and efforts to recruit more staff were continuing. The rotas seen showed that sufficient staff were being provided on each day and night shift. Any vacant shifts were being covered by relief staff employed by the providers. The staffing levels had been increased to four at certain times to help facilitate activities. Three teams work in rotation with one worker sleeping-in and another providing waking night care. The day shifts are no longer than 8 hrs. to prevent staff becoming over tired. Training continues to be provided from Winslow Court and the training calendar displayed showed that core and specialist training courses were being held regularly e.g. emergency procedures for managing epilepsy, mini-bus evacuation, diabetes, autism, MAPA, adult protection, disability awareness, supervision. All staff had attended relevant courses and refreshers were being planned for through the supervision and appraisal system. Over 50 of the staff team had obtained a relevant qualification and two more staff were due to start their NVQ 2 in Care awards. New training in equal opportunities had been introduced including race equality and disability awareness. Staff were Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 18 being supported through supervision and appraisal systems, daily handovers and staff meetings. The Organisation also provides staff with free access to a confidential telephone support service. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, The Home was running well under the new managers enthusiastic leadership. Her registration needed to be completed and a deputy appointed to provide additional support. The Organisational management and quality assurance structures were robust and proving effective. Suitable health and safety arrangements were in place and being monitored frequently. Only one H&S recommendation was made. EVIDENCE: The previous manager Simon Goodchap left in July 05. The deputy Claire Williams, who had been supporting the previous manager since November 2004 had recently been appointed as manager. The deputy post was being advertised internally within the Organisation. The manager’s application for registration was pending and she had arranged to start the NVQ Registered Managers Award. Her line manager who is the registered manager of Winslow Court was providing her with supervision and support. Management support is also provided from a team of corporate staff who lead on training, human resources, health and safety etc. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 20 The Commission had been informed appropriately about significant incidents and events. The regulation 26 monthly provider monitoring visits had been carried out and a sample of three reports showed that the process was helping to regulate the service as a wide range of standards are assessed each month. It was positive that the requirements made following the last inspection had been actioned. There are other Quality Assurance systems in place such as an annual British Safety Council audit. The report from the March 05 visit was seen where the Organisation was awarded a ‘ Very Good/Four Star’ rating. Some recommendations were made by the BSC that will be reassessed at the next audit. The providers also plan to issue feedback questionnaires to residents, relatives and staff to assess if any areas of the service need to be improved. Health and safety arrangements were being monitored through a regime of periodic checks e.g. daily hot water testing, weekly first aid box checks. The electrical wiring had been recently tested. All staff had received fire training previously and refreshers were booked for later in September. The fire alarm went off during the inspection because of burnt toast. Staff were seen to calmly escort the residents outside while reassuring them. Fire equipment had been serviced in the last year, and the alarm system and call point were being tested weekly. The water system had recently been cleaned to reduce the risk of Legionella developing. The manager was reviewing the arrangements for products covered by the COSHH regulations. The regulations also cover other risks staff can be exposed to at work e.g. while handling soiled laundry. Arrangements for managing soiled laundry were not in line with the Home’s infection control policy or current best practice. The manager agreed to review these matters and make changes where needed. Appropriate records were being maintained and stored securely. All relevant policies were in place. These were under review to ensure they were accurate and specific to the service and premises. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 21 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 2 3 3 3 x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 3 3 x 3 x 2 Standard No 11 12 13 14 15 16 17 4 4 x x x x x Standard No 31 32 33 34 35 36 Score x x 3 x 4 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Orchard End Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x x 3 E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 22 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 Regulation Requirement Timescale for action 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. 4. Refer to Standard YA1 YA30 YA26 YA6 Good Practice Recommendations Review the Service Users Guide to ensure it is accurate and relates to the service. Review the arrangements for handling soiled laundry and how this is covered in the infection control policy. Review if one resident could now manage and benefit from having a sink fitted in his bedroom. Develop specific guidance relating to each residents need for the use of sanctions and/or physical intervention or restraint. Orchard End E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford 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 E52- E02 S31631 Orchard End V245623 050905 Stage 4.doc Version 1.40 Page 24 - 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. 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