Inspection on 05/09/06 for Orchard End

This inspection was carried out on 5th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 11/01/06

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 5th September 2006 9.15 Orchard End DS0000031631.V308146.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 DS0000031631.V308146.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 DS0000031631.V308146.R01.S.doc Version 5.2 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.V308146.R01.S.doc Version 5.2 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. 11th January 2006 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 and 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 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 where the company training, health and safety, and human resources departments are based. Information about the Home is available from the Home or Winslow Court on request. The fees are currently between £1415 and £2104 per week. On top of the fees the residents are expected to pay for personal items such as toiletries and clothes and personal services such as hairdressing and chiropody. Within the fees costs are included up to £500 a year towards holidays. If a holiday is planned with higher costs these will be agreed with the residents’ representatives. The residents may be asked to contribute to the cost of some leisure activities if these do not form part of their regular activity plan. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on a weekday between 9.15am and 2.30pm. The manager was on duty and assisted with the inspection process. All the residents were at Home for some of the inspection. They were introduced to the inspector who observed the staff interacting with them. The inspector joined two residents and one member of staff for lunch. As part of the inspection a sample of records and care plans were seen, medication was audited, two staff were interviewed in private and the building was toured. Information in the providers monthly visit reports and other communication with the Commission since the last inspection were all considered as part of the assessment process. Questionnaires were sent out to residents’ relatives and professionals involved with the service. Those returned indicated mostly positive views. One relative reported, ‘My son has been very settled in the Home, another said, ‘The staff are always friendly and welcoming’. Two felt concern that there is not always enough staff. A relative of one resident visited him and spoke in private to the inspector. She had not returned a questionnaire but felt her son received a good service and she found the staff committed and friendly. What the service does well: What has improved since the last inspection? Information in care plans has been expanded to give staff clearer guidance about how to respond to some of the residents’ behaviours and when physical restraint can be used. Information about medication in the care plans has been made clearer. Interview procedures have been improved and one of the residents is now going to be on the panel. More staff training is being run inhouse so it can be tailored around the needs of the residents and all staff are now attending communication training. The house has been redecorated throughout. The system to monitor health and safety hazards is being used more consistently and fire safety arrangements have been improved. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 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 DS0000031631.V308146.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 DS0000031631.V308146.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No new residents have been admitted since January 2004 so the assessment process has not been inspected on this occasion. If any vacancies do occur a new resident would move in from Winslow Court and their needs would already be well known by the providers. The manager reported at the last inspection that the recommendation to develop the Service User’s Guide into a more appropriate format was underway with support from the Speech Therapist. No new version has been forwarded to the Commission so this recommendation has been brought forward. Orchard End DS0000031631.V308146.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents’ needs and development goals are included in their care plans and these are being kept under review with the support of professionals. The residents are being supported to make decisions about their own lives and to take reasonable risks. They may benefit from being empowered to become more involved in planning or documenting their care. EVIDENCE: Detailed care plans are in place and these contain risk assessments and personal development goals. The plans are monitored during the provider’s monthly visits to ensure the information is kept up to date. The daily record forms contain many sections to help ensure staff record relevant information e.g. general wellbeing, meals, activities, personal care, family contact etc. The information recorded each day is collated by the keyworkers into monthly summaries. These help inform the manager of changes and any patterns developing. This information is used for the more formal six monthly review reports and meetings that the families and other professionals attend. The care information sampled for two residents showed that both have had reviews in the last six months. The reports showed all areas of their care needs are Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 10 being addressed. One showed that the family’s views about a possible health risk had been noted and action taken to address this. Risk assessments are appropriately balanced between enabling the residents to enjoy a good quality of life by partaking in activities and putting in reasonable measures to protect them e.g. the residents access the kitchen but some equipment and food is kept secure. The residents are being encouraged to make choices for themselves e.g. what to wear, what activities to do and what to eat. Communication systems have been developed with the help of the speech therapist to support this process. One resident does not cope well with clothes shopping but has been enabled to point out what he wants in a catalogue and staff are then going out to buy the required garments on his behalf. The manager reported that the long-term use of symbol systems has benefited some residents greatly. The care plans have been expanded to include more specific guidance about how staff should respond to each residents’ behaviour patterns and under what circumstances, if any, can physical intervention be used. A multi-agency approach is used to develop intervention strategies with input from the relatives, psychologist, speech therapist and consultant psychiatrist. Some residents are able to contribute and say what they find most helpful when they are upset, anxious or angry. They are asked by one person and not put under pressure to join and talk at meetings. Incidents are recorded in full and monitored. Behaviour charts are set up when needed to provide information for the psychologist. Two residents’ behaviour patterns have been correctly linked to health problems that have then been treated with good results. One resident has been provided with private sessions with the psychology assistant to help him manage his emotions. Other examples were given of where strategies have been successful enabling the use of ‘as required’ medication to be stopped and risk assessments downgraded. A discussion was held about the methods being used to manage some residents’ behaviour. These repercussions, (termed sanctions) have been agreed with the psychologist as part of the intervention plans. Records indicated some were punitive and their duration quite lengthy e.g. if a resident fails to control his anger after being warned he is not allowed access to a favourite item that afternoon and has to wait for the following afternoon. The monthly summaries do analyse incidents when a resident has become upset and aggressive but they do not show clearly which intervention strategy was used and what is being deemed as most effective. Consideration should be given to increasing the level of analysis and at the same time developing more positive and adult approaches and consequences. One resident has a tick chart to help him manage his behaviour through sections of the day. This positive approach is proving successful. The appropriateness of having the chart on display in the entrance hall should be reviewed. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 11 Links have now been made with the Herefordshire Person Centred Planning coordinator. It is hoped that staff training will be provided soon. Work to involve residents in recording information about their lives and wishes has been started. Staff supported one resident to display his holiday photographs in a computer slide show. He has enjoyed watching this and showing it to his family. This type of inclusive work should be continued and could be developed for care planning and reviews. Orchard End DS0000031631.V308146.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are being offered opportunities to take part in appropriate activities both outside and inside the Home. Their rights are being respected. They are being well supported to maintain personal relationships with friends and family. A good variety of meals are being provided and the residents’ food preferences are being taken into account. EVIDENCE: A relaxed homely routine exists and the residents are encouraged to make choices about where to spend time in the house, what indoor activities they do and what food they eat. Where restrictions on choice have been put in place these are on the basis of a risk assessment e.g. coffee and tea are locked to prevent some residents making hot drinks continuously, but cold drinks are always available. Each resident has a personalised activity plan. Until recently these have included regular college sessions but from September 06 the college has withdrawn these. The manager and staff have made good progress in finding Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 13 replacement activity sessions for each resident so their routines are not disrupted unduly. Other regular activities have not been affected such as swimming and walking with the ECHO group, pottery sessions at Winslow Court, horse riding, pub trips and walks to the village shop. Records showed that some residents declined outings at times preferring to spend time in their bedrooms following personal hobbies such as watching videos, listening to music and using their computers. Some residents reportedly enjoy sitting in the garden and using the large trampoline. Activities are linked to the aim of residents developing life skills. These include needle work, ironing, cooking, woodwork, food and personal shopping, craft sessions and literacy sessions. A lot of effort has gone into the gardening project in the last two years. A good amount of vegetables have been grown with the residents’ involvement and there are plans to make pickles and chutneys. The resident with a sensory impairment grows the flowers from seed and tends them with staff support. Several staff are authorised to drive the Home’s vehicle to facilitate outings and day trips of interest and holidays are arranged. Contact is actively promoted between residents and their relatives. Keyworkers are responsible to ensure relatives are kept in touch. The mother of one relative who spoke to the inspector reported that the staff did keep her appropriately informed of any health and care issues. Some residents go to stay with their relatives and others have visits in the Home. In some cases staff drive the residents to enable them to visits their family. In one case the staff remain in the locality and then bring the resident back after their visit. Links with people the residents have known and liked in the past are maintained through the activity sessions held at Winslow Court and joint outings. Links with the local community have been developed and some residents attend the local social club. Communication aides are being used daily including symbol systems, signing and specific verbal prompts. The organisation’s speech therapist has been involved in the development of these aides and programmes based on each resident’s specific needs and strengths. Information about the Home has been developed in a pictorial form to help the residents understand it e.g. pictures in the kitchen indicate that food should be covered once opened. There are plans to use picture cards more to help communicate about outings. Some specific arrangements are in place to try to meet one resident’s needs that are associated with a sensory impairment. The staff are familiar with what he wants and his methods for asking for support. Each resident has development goals such as learning new personal care skills. The manager is considering how to expand these to include longer term aims. This process should link into the person centred planning process so the aims are developed with the resident and other important people in their lives. Menus are in place that show a good variety of healthy meals are being offered to the residents. A vegetarian option is offered or an alternative if a resident Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 14 does not like these options. Plenty of fresh fruit and vegetables are being provided and are made available at all time. The meals are arranged in a flexible manner depending on what the residents choose and what activities they are taking part in. A record of the food eaten is kept as part of the residents’ daily notes. The meals are eaten with staff at two tables in a relaxed atmosphere. Residents are encouraged to help in the kitchen. As part of quality assurance arrangements consideration should be given to how an annual nutritional review could be arranged. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is excellent. This judgement has been made using available information and a visit to this service. The residents are having their personal care and health needs met in a sensitive manner. Medication is being safely stored and generally well managed. EVIDENCE: Care records showed that residents were bathing or showering daily and their other personal care needs are being met. Appropriate gender care is being given whenever possible. A female worker gave an example of how she helps ensure the residents’ dignity is maintained when she assists them with bathing. Staff were observed to respect the residents’ privacy e.g. one resident’s request not to let the inspector see his bedroom was respected. Links with local health professionals are well established and all residents are registered with a GP and dentist. Annual health checks are being provided by the site nurse based at Winslow Court. External links with health professionals are also in place e.g. the consultant psychiatrist. Additional health support is accessed through the team of specialists based at Winslow Court that includes a psychologist and a speech and language therapist. Health concern records are used to log any issues that arise and health is included in the monthly care summaries and the six monthly review reports. One resident recently underwent an operation and was very well supported to cope with this Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 16 procedure, for example the speech therapist supplied information to inform him of what would happen and staff used this to prepare him. The medication is being stored securely in an appropriate cabinet that was well organised. This is located in the laundry which is not ideal because of potential cross infection and the humidity damaging the medication. This was raised with the manager at the last inspection and she has been monitoring the temperature each day. Records showed that over the summer it was regularly 24°c which is the maximum acceptable temperature. Consideration should be given to moving the cabinet into the office. Each resident has a medication profile and the information contained in these has been expanded so they are now more helpful to staff. Photos are in with the records to help avoid administration errors. The administration records were clear and showed that doses are being given as prescribed. A system is in place where a second worker signs a separate record to show they witnessed the medication being administered. The doctors involved are keeping all residents’ medication under review. One recent change had not been reflected in the medication profile and by the pharmacist on the pre-printed charts. The manager agreed to get these updated promptly. Some residents are prescribed medication to be given only under certain circumstances. The protocols seen to guide staff in these cases were clear and up to date. Although staff keep the medication key on them, consideration should be given to providing a key safe with a digital code. Only staff authorised to give medication should then be given the code. A medication policy is in place and staff are not permitted to administer medication until they have shadowed a colleague giving medication 15 times and received training from the nurse based at Winslow Court. She then observes them giving medication before they are deemed competent. Staff are also being provided with more in-depth training from the supplying pharmacist. Those who undertake this in future will attend an accredited course. Audits are being carried out by the supplying pharmacist as an additional quality assurance measure. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The views of the residents and their representatives are listened to and acted on. Effective arrangements are in place to protect residents from abuse. EVIDENCE: Policies and procedures are in place for the management of complaints and any adult protection concerns. None of the residents have independent advocates however all have a designated keyworker and family members who act on their behalf. All staff have recently received refresher training about adult protection and their duty to report any abuse or concerns they become aware of. Any new staff attend this training as part of their two week induction programme. Guidance for staff about the use of physical intervention is in place to help protect residents. Since the last inspection the manager identified concerns about financial arrangements for one resident and made robust efforts to follow this up through the appropriate agencies. Suitable arrangements are in place now for the future and the responsibility for resolving any past issues remains with the funding authority. An allegation about one worker, made in December 2005, was investigated under multi-agency adult protection procedures and the matter has recently been concluded. During this protracted investigation the providers took steps to ensure the residents were safeguarded and the worker remained suspended. The manager and providers cooperated with the multi-agency process, however the family of the resident involved and other agencies were not satisfied with the initial outcome. Significant negotiations followed until a Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 18 consensus was agreed and the worker dismissed. The manager reported that the family are now satisfied with the outcome and their relationship with the service has not been negatively affected. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 19 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): 24, 25, 26, 28, 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The residents have a comfortable clean home that is being well maintained. They have access to a pleasant garden, communal facilities, and their bedrooms have been personalised. EVIDENCE: The house is detached and has a large attractive garden. It is situated in a very rural location, which is beneficial to the residents in terms of quietness. The location does not easily facilitate the residents becoming part of a local community, however links have been made through staffs’ ongoing efforts. The exterior of the home is in good condition and the interior continues to be well maintained. All communal areas have been redecorated since the last inspection. A responsive repairs service is in place with an on-call system. There are five bedrooms two of which have en-suite facilities. The bedrooms showed that they continue to be clean, comfortable and nicely personalised. The lounge, dining/art room and large conservatory are attractive and appropriately furnished. Some residents choose to spend time in their bedrooms and often some are out for part of the day which helps prevent the communal space becoming crowded. Communal bathrooms, toilets, a laundry Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 20 and a kitchen are also provided. All areas were attractive, clean and suitably equipped. The care staff do the cleaning and laundry and cleaning schedules are in place. Staff also try to engage the residents in helping e.g. tidying their bedrooms and ironing. Suitable infection arrangements are in place and clinical waste and sharps are being disposed of safely. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 21 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): 32, 33, 34, 35, 36. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are being supported by a competent staff team in sufficient numbers to meet their needs. They are being protected by the homes recruitment practices. Effective training and support systems are in place for staff. EVIDENCE: A minimum of three staff are on duty during the day and when the manager and senior are in the Home there are four or five, unless they are covering a gap on the rota. This level of staffing provides reasonable flexibility for residents to access their activities, outings or health appointments. Since the last inspection two permanent staff have left, one was part-time and one a full time waking night worker. These positions are now being recruited to. Any gaps on the rota are being covered by staff doing extra hours or by relief staff from Winslow Court. As detailed above the main staff team is supported by a team of specialised staff. Staff training arrangements are managed centrally. A rolling programme of core and basic training is provided at Winslow Court. Existing staff who need refreshers are called to attend these sessions as required. New staff attend these courses during their two week induction period. They work through a foundation programme over the first three to six months which leads to them Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 22 gaining their Learning Disability Award Framework. When they initially start work in the home they shadow their colleagues for seven shifts. Once they are established in post staff are expected to work towards gaining an NVQ award. Currently only 30 of staff are qualified and four staff would like to enrol on a course this September. The manager is unsure if availability of places will be limited at Hereford College. If this is the case consideration should be given to accessing the award through a different training provider to allow all four staff to enrol. Some specialised training is routinely provided for staff e.g. Autism Awareness, Adult Protection, and Epilepsy. Positive Approaches to Challenging Behaviour and Physical Intervention training are also provided with annual refreshers to help ensure good practice is maintained. A training plan for the year ahead is in place and clear training records for each worker are being kept. The manager has been arranging for training to be held in the Home whenever possible as she feels this aids team building and allows the training to be focused on the specific needs of the residents. Two sessions of the now mandatory communication training have been held in-house. Consideration should be given to providing staff with specific training in relation to sensory impairment. Two staff were spoken with in private. They were both positive about the residents and felt that they are provided with a good standard of care. They have attended appropriate training and are finding their supervision sessions helpful. Both were enthusiastic and had ideas about how the service could be further improved. Staff on duty interacted with the residents in a friendly and appropriate manner. They demonstrated an awareness of their needs and agreed boundaries. There have been some difficulties ensuring all staff consistently follow the agreed intervention plans. The manager has taken steps to address this and progress is being made. The more regular staff meetings have helped improve this area but close monitoring needs to continue. On the whole the standard of recording was professional and appropriate e.g. in care notes and the communication books. One entry in one resident’s care notes, ‘typically stubborn at times today’, may indicate that the worker does not fully understand the residents’ disabilities and their associated behaviours. The manager should monitor the quality of recording and provide additional training or supervision where necessary. Recruitment is managed centrally from Winslow Court where a personnel (HR) officer is based. The main files are held at this office and copies are sent to the home. The manager has recently checked through every staff file and informed the HR manager of any information that is missing. Appropriate procedures are in place and applicants are required to complete an application form. Job descriptions are in place, and contracts and training agreements issued. The manager has interviewed applicants with the support of her senior or the HR officer and records kept. To improve this process she has recently developed more specific interview questions for each job role. One recruitment file was sampled. The required checks for the worker had been obtained prior to the Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 23 worker starting their employment. They did start their induction at Winslow Court prior to a CRB being returned, however they did not have any contact with vulnerable people during this time. A checklist is attached to each recruitment file. This had not been fully completed or signed off by the manager. It would be good practice if this was carried out and if the manager saw all references rather than just discussing them over the phone with the HR manager. In line with good practice all staff are having new CRB checks carried out every three years. It is very positive that the manager plans to enable one of the residents to join the interview panel in the future. Staff are being provided with supervision sessions with a line manager at least bi-monthly. The staff spoken with said these were helpful and their training needs were discussed. Staff are supported in other ways e.g. through daily handovers and staff meetings that sometimes include the professionals based at Winslow Court. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 24 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, 39, 40, 41, 42. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are benefiting from a well run home focused on their right to lead a fulfilling life. Procedures and record keeping systems are in place to safeguard their best interests. Their health and safety is being promoted. Quality assurance systems are in place but these need to be further developed to ensure the service continues to improve. EVIDENCE: The manager was registered with the Commission in November 2005. She has relevant experience and qualifications. 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. She is directly supported by a senior and by a line manager based at Winslow Court. Staff and residents’ relatives reported that the manager is approachable and committed. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 25 Some quality assurance systems are in place e.g. monthly provider monitoring visits and health and safety checks. The manager has been proactive in asking for feedback from residents’ relatives by sending them questionnaires. Staff have assisted the residents to complete questionnaires and have been asked to complete their own as well. Aims for the service have been developed with the involvement of the staff team but it was not clear if these were formulated from the feedback in the questionnaires. The aims included more staff training issues and more resident involvement in care planning. Staff feedback included ideas about activities being more age appropriate. A more formal quality assurance system is due to be introduced through Winslow Court. Periodic reports should demonstrate that feedback is linked to development plans and a cycle of continuous improvement. Company policies and procedures are in place and the manager reported that these have been kept under review. Records are being stored securely and the information is being kept up to date. Records relating to the resident’s finances were not sampled on this occasion; however these are checked as part of the provider’s monitoring visits. As quality assurance systems are further developed consideration should be given to having residents’ monies audited annually by an independent person or in more depth during one of the monthly monitoring visits. It is positive that one resident’s relatives have recently taken over the role of appointee from the providers. The manager is supported to stay up to date about health and safety matters through the safety coordinator based at Winslow Court. A health and safety check list is used for each month that includes daily, weekly and monthly checks. Overall these records showed a high level of monitoring is taking place e.g. daily hot water temperature checks. The manager reported that all equipment has been serviced appropriately e.g. central heating 9/05. Door closure mechanisms have now been fitted to communal rooms to allow the residents the freedom to move around unrestricted. Accidents and incidents are being recorded and monitored through the monthly provider’s visits. Risk assessments are in place relating to the environment, work tasks, and the residents’ care needs. These are being kept under review. Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 26 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 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 3 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 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 x 3 3 2 3 3 3 X Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 27 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. 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.. Refer to Standard YA1 YA6 YA18 Good Practice Recommendations Review the Service Users Guide to ensure it is accurate and relates to the service (Brought forward). Increase the scrutiny of any behaviour intervention plans. Ensure the most effective arrangements are in place that assist the residents to take responsibility for themselves as adults. The manager should use the checklist system in place to evidence she is satisfied that all recruitment information has been received and are satisfactory. Support more care staff to gain an NVQ Award in Care to meet the standard of at least 50 of care staff being qualified. Consider finding another training provider if places are limited. Continue to develop quality assurance systems to ensure the service is continually improved. 3. 4. YA34 YA35 YA32 5. YA39 Orchard End DS0000031631.V308146.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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.V308146.R01.S.doc Version 5.2 Page 29 - 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!