CARE HOME ADULTS 18-65
Orchard Hill 100 Orchard Hill Little Billing Northampton Northants NN3 9AG Lead Inspector
Stephanie Vaughan 5th October 2005 08:30 Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 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 Hill DS0000063584.V255585.R01.S.doc Version 5.0 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 Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Orchard Hill Address 100 Orchard Hill Little Billing Northampton Northants NN3 9AG 01604 403602 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) Compass Care Limited Mrs Melanie Jane Lennon Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No person falling within the category of MD, Mental Disorder excluding Learning Disability or Dementia, may be admitted into the home unless that person also falls within the category LD, Learning Disability ie Dual Disability. 1st August 2005 Date of last inspection Brief Description of the Service: 100 Orchard Hill is a detached Home which provides personal care and support to 4 service users who require care due to a Learning Disability, some of whom may have an additional Mental Health Disorder. This is one of five homes run by the providers Compass Care and benefits from the support of a wider organisation. The home is situated near to a large shopping centre and has good transport links to other areas of Northampton. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was conducted over a period of four hours during which the inspector made observations and spoke to two of the residents. A limited tour of the premises was conducted which involved viewing the communal areas Case tracking is the method used during inspection where two residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. One staff file was viewed and two members of staff were spoken to. Prior to the inspection a period of 90 minutes was spent in preparation, which included a review of previous inspection reports, previous requirements, the service history and notifications. Two recommendations and eight requirements and were made following the previous inspection both recommendations have been addressed however five of the eight requirements remain outstanding. The Commission for Social Care Inspection have received one complaint about the service, which has been fully investigated by the provider and whist the complaint has not been upheld the investigation has highlighted areas for improvement in the way that complaints are processed by the organisation, training and record keeping. Previous issues associated with the Protection Of Vulnerable Adults have been addressed within a multidisciplinary setting and appropriate action has been taken to investigate the issues and where necessary prevent reoccurrence. However the management still need to ensure that they have robust systems in place to manage the risk of residents’ aggression both within the home and when residents meet with those from other homes. What the service does well:
Residents are fully assessed prior to admission and benefit from regular reviews. Residents confirmed that they were supported by the staff to make decisions about their lives and there was a good example of one resident being supported to give up smoking, which was documented in an appropriate care plan. Residents confirmed that they were supported to manage their finances and appropriate risk assessments are in place. Residents have access to advocacy services.
Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 6 Residents spoken to confirmed a good level of satisfaction with the lifestyle provided at Orchard Hill. One resident commented that they were just ‘like a family’ A key worker system is in place and a key worker spoken to demonstrated a good understanding of the residents needs A limited tour of the premises was conducted, the communal areas being homely, comfortable and well maintained. Residents confirmed satisfaction with their environment. Residents are supported by staff with practical tasks such as cleaning their rooms. One resident expressed great satisfaction with opportunities to utilise his gardening skills learned at college and has made vast improvements to the garden areas. What has improved since the last inspection? What they could do better:
Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 7 The Statement of Purpose does not reflect the current service provision and must be reviewed. Residents’ contracts are out of date and do not reflect the current charges; these must be amended and reissued. Although residents have preadmission assessments and regular reviews the individual plans of care do not fully address the residents’ needs, provide sufficient instruction to staff about how the needs are to be met or evidence that these are addressed. Risk assessments do not currently address all of the risk factors identified within the assessments or the care plans particularly related to potential high risk anti social behaviour and aggression between residents. In one instance the care being provided for a resident was not compliant with the conditions issued by the placing authority and although these conditions may no longer be appropriate it is essential; that this is reviewed to accurately reflect and document the current requirements. The individual plans of care and risk assessments are currently being reviewed and standardised within the organisation, however four previous requirements were made following the last inspection and the time scale has elapse without obvious improvement. The timescales are therefore extended; however need to be addressed as a matter of urgency. The Registered Manager is required to submit copies of the relevant revised individual plans of care to the Commission for Social Care Inspection One resident with a specific health need had been referred for a review of the management of his condition. However records indicated that routine tests that should have been conducted by the home had been inconsistent since the beginning of September, with four omissions for that month and no entries for October. This was addressed during the inspection. The Commission for Social Care Inspection have received one complaint about the service, which has been fully investigated by the provider and whist the complaint has not been upheld the investigation has highlighted areas for improvement in the way that complaints are processed by the organisation, and relate to training and record keeping and these must be addressed. One staff file was viewed and seen to be in order, however the temporary Home Office clearance was dated 2003. The Registered Manager confirmed that this had been followed up and that the staff member was unable to access post from her previous address to obtain the necessary documentation. The Registered manager was advised that this should be followed up with the home Office in writing and a copy stored in the staff file. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 8 There is no formal Quality Assurance Programme in place to obtain routine feedback from residents about their perception of the service, which should be used to inform service development and to ensure residents satisfaction. Following changes to the ownership of the company all policies and procedures are currently being reviewed and whist the Commission recognises the work involved in this, considers it reasonable, for the safety of residents that staff have access to the updated policies by the end of the year. 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 Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 9 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 Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 10 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): 1, 2 & 5 The existing Statement of Purpose and residents’ contracts do not reflect the current service provided or fees charged. EVIDENCE: There have been significant changes within the organisation during the last five months, including a change of ownership, roles and responsibilities, however the Statement of Purpose, has not yet been reviewed to accommodate these in order that existing and prospective residents and others have access to up to date information. There have been no new residents admitted to the home since the last inspection, however care plans of existing residents evidenced a thorough assessment process. Residents spoken to confirmed that the home was able to meet their needs and that the staff respond appropriately as their needs change. Residents files contained signed contracts dated 2003, the Registered Manager confirmed that the charges had been increased since this date however no further contracts have been issued to residents. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 11 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 Individual plans of care do not provide staff with appropriate and detailed instruction about how the needs of the residents are to be met. EVIDENCE: It is of concern to the Commission for Social Care Inspection that despite four requirements made in the last inspection report individual plans of care failed to address the shortfalls identified. Outstanding issues relate to the care plans for the needs identified in the pre assessments, detailed instruction to staff, risk management and accuracy of the conditions of placements. However the Registered manager confirmed that the content and format of the plans had been reviewed and that these had been sent for typing and electronic storage to facilitate regular updating. As a result of this the organisation intends to standardise the format within the group. Whilst this is likely to provide improvements for residents and staff organisational delays may well impact on the level of care and safety of residents and should be addressed as a matter of urgency. The time scale is extended for the associated requirements.
Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 12 The Registered Manager is required to submit copies of the relevant revised individual plans of care to the Commission for Social Care Inspection Residents spoken to confirmed that they were supported by the staff to make decisions about their lives and there was a good example of one resident being supported to give up smoking, which was supported by an appropriate care plan. Residents confirmed that they were supported to manage their finances and that they had access to advocacy services. Any limitations on residents’ activity were noted to be based in their best interests and to be supported by appropriate documentation and explanation. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 13 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): 16 & 17 Resident’s routines, activities and meals benefit residents in their daily lives. EVIDENCE: Residents spoken to confirmed a good level of satisfaction with the lifestyle provided at Orchard Hill. One resident commented that they were just ‘Like a family’ Residents are involved in a wide range of activities within the local community including employment, leisure and educational occupation. One resident has taken responsibility for the maintenance of the grounds and hopes to be able to extend this interest to other homes within the group. Residents confirmed that they were treated well by the staff and that privacy is maintained. One resident expressed an interest in having a key to the front door and management confirmed that this was due to be considered at a forthcoming review. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 14 Residents confirmed satisfaction with the food available; menus have been revamped and are based on the residents’ preferences and choices. The Sunday roast is now specified and provides more variety. Residents are encouraged to practice independent living skills and are actively involved in the preparation of their own meals. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 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 Residents have access to appropriate personal support, however the management of healthcare must be improved to ensure the well being of residents. EVIDENCE: Residents confirmed that routines were flexible at Orchard Hill within the constraints of their planned activities. A key worker system is in place and a key worker spoken to demonstrated a good understanding of the residents needs The home has some staff shortages at present and recruitment is ongoing, management are mindful of the need to reflect the age range, gender, race and culture of residents in their staff. Current shortages are being supported by the flexibility of existing staff and known agency support. Individual plans of care evidenced that residents have access to specialist support such as Speech and Language Therapists, Community Leaning Disability Teams, Podiatry, Dental Services and specialist nurses. Residents confirmed access to appropriate medical services and annual health checks and flu vaccinations. One resident with a specific health need had been
Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 16 referred for a review of the management of his condition. However records viewed indicated that routine tests that should have been conducted by the home had been inconsistent since the beginning of September, with four omissions for that month and no entries for October. Medication administration records were found to be in order. Staff spoken to confirmed access to recent training in the safe administration of medication. The Registered manager is currently reviewing the arrangements for residents to have access to Homely Remedies. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 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 Residents are able to express their concerns and complaints are generally managed well. The Protection Of Vulnerable Adults has improved to ensure residents are protected. EVIDENCE: Residents spoken to confirmed that they knew how to complain should the need arise and confidence that their complaints would be handled appropriately. The Commission for Social Care Inspection have received one complaint about the service, which has been fully investigated by the provider and whist the complaint has not been upheld the investigation has highlighted areas for improvement in the way that complaints are processed by the organisation, and relate training and record keeping and these must be addressed. Previous issues associated with the Protection Of Vulnerable Adults have been addressed within a multidisciplinary setting and appropriate action has been taken to investigate the issues and where necessary prevent reoccurrence Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The premises are suitable for the stated purposes, being homely, safe and well maintained EVIDENCE: A limited tour of the premises was conducted, the communal areas being homely, comfortable and well maintained. Residents confirmed satisfaction with their environment and that the broken windowpane noted at the last inspection had been repaired. Residents are supported by staff with practical tasks such as cleaning their rooms. One resident expressed great satisfaction with opportunities to utilise his gardening skills learned at college and has made vast improvements to the garden areas. The home was clean and hygienic throughout. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 19 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): 31, 34 & 35 Staffing levels and staff training is managed to meet the needs of residents. and improvements to the recruitment processes have been made. EVIDENCE: The organisation has undergone significant changes and challenges during then last six months, which has impacted on the staffing levels due to disciplinary action and dismissal. The organisation continues in their endeavours to recruit new staff and are mindful of the necessary qualities required for the residents within the home. Existing vacancies are currently covered by the flexibility of the remaining loyal staff with known agency support. The Registered manager confirmed that the outstanding Home Office Clearances had now been rectified and that although staff had not been employed without them, they were now held on file. One staff file was viewed and seen to be in order, however the temporary Home Office clearance was dated 2003. The Registered Manager confirmed that this had been followed up and that the staff member was unable to access post from her previous address to obtain the necessary documentation. The Registered manager was advised that this should be followed up with the Home Office in writing and a copy stored in the staff file. Staff confirmed access to appropriate and mandatory training, which most recently has comprised Food Hygeine, and Safe Administration of Medication
Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 20 Training, with further training in Breakaway Techniques planned for the near future. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 Quality Assurance systems are not in place to ensure residents’ views are sought in a systematic way and the findings used to develop the service. EVIDENCE: The Commission for Social Care Inspection receives regular monthly reports about the home from the Responsible Individual. However there is as yet no formal Quality Assurance Programme in place to obtain routine feedback from residents about their perception of the service. The Registered Manager confirmed that she had recently attended a training programme on this issue and had plans to develop an appropriate format for this to be implemented Following changes to the ownership of the company all policies and procedures are currently being reviewed and whist the Commission recognises the work involved in this, considers it reasonable, for the safety of residents that staff have access to the updated policies by the end of the year. Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 22 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 x x 2 Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 x 1 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score 3 x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Orchard Hill Score 3 1 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x DS0000063584.V255585.R01.S.doc Version 5.0 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA1 YA5 YA6 Regulation 4 5 (b & c) 12 .1, 14.2 Requirement The Statement of Purpose must be reviewed to reflect the current service provision Residents contracts must be amended and reissued to reflect the current terms and conditions Individual plans of care must be reviewed to ensure that care plans are developed from the needs identified in the pre admission assessment and care management reviews in order that care plans provide detailed instruction on the management of these needs. Timescale extended to 01/11/05 Care plans must contain detailed and specific instruction to staff regarding the management of challenging behaviour, personal care and any other needs that the resident may have and must evidence that these have been addressed Timescale extended to 01/11/05 Risk management practices must be reviewed to ensure that any risks associated with the residents’ activities are identified, assessed and
DS0000063584.V255585.R01.S.doc Timescale for action 01/12/05 01/12/05 30/09/05 4 YA6 12.1 30/09/05 5 YA6 13.4 01/09/05 Orchard Hill Version 5.0 Page 24 6 YA6 7 YA6 managed, to ensure safety of residents and others Timescale extended to 01/11/05 12.1, 14.2 When the management of residents care deviates from that required by the placing authority the written authorisation must be obtained and included within the individual plan of care Timescale extended to 01/11/05 17 Copies of the relevant revised individual plans of care and risk assessments must be submitted to the Commission for Social Care Inspection 12, 13 & 17 Routine tests to monitor a residents medical condition must be documented, undertaken and recorded as directed by the medical practitioner The recommendations made as a result of a recent complaint investigation by the provider must be implemented 01/09/05 01/11/05 9 YA19 04/10/05 10 YA22 22 01/12/05 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 YA34 YA39 Good Practice Recommendations The temporary Home Office clearance dated 2003.should be followed up with the Home Office in writing and a copy stored in the staff file Quality Assurance systems should be developed to ensure residents’ views are sought in a systematic way and the findings used to develop the service The review of policies and procedures should be completed and made accessible to staff by the new year. 3 40 & 42 Orchard Hill DS0000063584.V255585.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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