Inspection on 22/10/08 for Orchard House

This inspection was carried out on 22nd October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard House 28/09/07

Orchard House 07/12/06

Orchard House 10/02/06

Orchard House 04/11/05

Orchard House 10/02/05

Orchard House 04/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Orchard House 92 Brookfield Road Bedford MK41 9LJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nicky Hone     Date: 2 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Orchard House 92 Brookfield Road Bedford MK41 9LJ 01234363222 01234344448 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Angela Bradley Type of registration: Number of places registered: Bedfordshire County Council care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Age range: 18 - 65 years Category: Learning Disablilty (LD) Gender: Male & Female Maximum number of service users: 4 Period of stay: Respite only - up to a maximum of 6 weeks Until reprovision of this service takes place, the premises must be safe, and meet service users` individual and collective needs Date of last inspection Brief description of the care home Orchard House is a respite service located in Bedford. The accommodation and grounds are owned and maintained by Aldwyck Housing Association, with Bedfordshire County Council providing the staffing and care support. It is a condition of registration that the service would have moved and been rebuilt by November 2005, as it does not currently meet the environmental requirements of the National Minimum Standards for Younger Adults, this has not happened. It is hoped that the service will remain in the Care Homes for Adults (18-65 years) Page 4 of 35 4 Over 65 0 Brief description of the care home local area, but at the time of this inspection, there were still no definite timescales for this to take place. The accommodation comprises of a bungalow, which is intended to provide respite care for up to 4 people with learning disabilities at any one time. Stays are limited to a maximum of six weeks. There are four single bedrooms, a shared kitchen, bathroom, separate toilet, laundry room, and a lounge/dining area. The accommodation would not meet the needs of individuals with a physical disability. Community facilities and shops are a short distance from the home, which is also in easy access of local transport routes. There is parking to the front of the property, and there is an easily accessible garden area. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: For this inspection we (the Commission for Social Care Inspection) looked at all the information that we have received, or asked for, since the last key inspection of Orchard House. This included: - The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in June 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who stay here. The AQAA also gives us some numerical information about the service; Care Homes for Adults (18-65 years) Page 6 of 35 - Surveys which we sent to the home to give to people who stay there, their relatives/carers and to staff. We received 7 replies: 2 from service users; 2 from relatives/carers; and 3 from staff; - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; and - Information we asked the home to send us following our visit. This inspection of Orchard House also included two visits to the home, on 22nd and 24th October 2008. No-one knew we were going to visit on those days. We spent time talking to people who were staying at Orchard House, the staff and the manager. We looked round the bungalow and observed what was happening. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. What the care home does well: What has improved since the last inspection? What they could do better: We found a number of things the home could do better, which means we have made a number of requirements. Some of the things the home could do better include: - give the manager enough time to do her job properly - make sure all care plans give staff good guidance on how each person needs to be supported - make sure peoples confidentiality and privacy are upheld at all times - have enough staff on duty so that peoples needs can be met, and offer staff enough training so they can do their jobs well Care Homes for Adults (18-65 years) Page 8 of 35 - offer people more opportunities to do things they enjoy, both in the home and in the community - make sure meals are healthy, nutritious and served in a pleasant way - decorate and clean the home so that it is as comfortable as possible for the people who visit. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available about the service for people thinking about moving here, and assessments are carried out so that people know the home can meet their needs. Evidence: The home has produced a Statement of Purpose and Service User Guide. The Service User Guide includes pictures and symbols, is written in large print, and uses easy language, so is suitable for most of the people who use the respite service. It tells people what they can expect from the home, and what the home expects of them. We saw a copy of the Service User Guide on the notice board in the hall. The manager is setting up a useful pack for new people, which includes the Statement of Purpose, Service User Guide, information on how to comment or complain, a contract, a medication consent form and so on. Each person who is starting to use the service goes through a transition period which suits them. This can include short visits with or without their main carers, staying for Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: tea, and overnight stays. The manager told us the transitions are worked out for each person at their own pace. The manager explained that when a referral from social services is received, it includes a full assessment of the persons needs, so the home can decide whether they can offer the person a place. We looked at the documents the home keeps about one person who is new to the service. We found a detailed assessment from the persons social worker. The staff had completed the homes own assessment by visiting the person in their own home, and then the staff had added more assessment information each time the person visited Orchard House. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all of the support plans are clear and detailed enough to give staff sufficient guidance on the way each person wants to be supported. Evidence: Each person has a care plan in place. Earlier in the year, the staff had started to develop a more person-centred plan for each of the people who stay at the home. The manager showed us one that was complete. It included a lot of good, detailed information and gave a clear picture of the person and how they like to be supported. The person had helped staff to complete this, and it included photographs and pictures. Sections of the plan included Important things about me, things that make me happy, leisure things I like and how they will be achieved, things I do not like and so on. During our second visit we spoke to one of the people staying at Orchard House, who told us he had helped staff to write his plan. In the AQAA the manager had said she would have these new care plans in place for Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: everyone by August 2008. However, during the inspection she told us this had not been possible due to the number of people who use the service. The first plan we looked at, of someone who had arrived for their stay four days before our visit, was not in the new style. Some of the information in this plan had come from another home where the person had stayed. The plan gave staff some information about the person, but was not complete, and did not give staff clear enough guidelines, especially about the persons medical conditions, for them to know how to support her fully and keep her safe. There were two alert pages in the file, each giving different information about the same issues. In one file we saw that a risk assessment has been completed about supporting this person out in the community. There were no assessments of any other risks that might affect this person. Confidential information about people was not handled properly. The manager made a telephone call to a doctor during our visit, about one of the people staying at the home. She used the telephone which is in the lounge/dining room, so all four people staying at the home, the staff and the inspector all heard information which should have been confidential. Care plans and other written information is kept in a locked cupboard in the hall, however, care plans for the people currently staying are kept in an unlocked cupboard in the dining area. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not enough opportunities for people to take part in leisure activities and outings of their choice, and meals are not served in a pleasant way, or in a way which would encourage people to be more independent. Evidence: People staying at Orchard House continue with whatever day services they usually attend during the week. Records of activities undertaken by people when they are staying at Orchard House showed that people do very little in the evenings and at weekends. For example, it was recorded that during the weekend before we visited, one person had done three activities, one person had done one, and the other two people had done nothing. One person who had been staying at the home for about twelve days had helped with hoovering the lounge the day after he arrived, and had done nothing else. Staff told us that people had done all sorts of activities, but these Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: had not been recorded. Some of these additional activities were recorded on the daily records, but not all. On the second day we visited, all four people went out for a meal and then to Tesco to do the shopping for the weekend. They were given little choice about whether they wanted to go, and they all had to go to a particular restaurant because staff knew that one of the four would not tolerate going anywhere else. Unless activities are planned in advance, when additional staff are on duty, most of the time everyone has to go to the same place, as two staff cannot be divided any other way (see Staffing section of this report). One person was doing a jigsaw puzzle when we arrived. She was finding it very hard because the puzzle was so old that the picture was scratched and blurred, and the pieces were damaged. Staff said the puzzle was probably donated. As people come to Orchard House for a short break for themselves and their carers, they do not often see their families during their stay. However, staff support people to contact their families if they want to, especially by telephone. Two of the people who arrived for their stay during the second day of our inspection have known each other since they were very young. They enjoy each others company so their respite stays are arranged, whenever possible, at the same time. On the first day we visited, we saw the evening meal being served. We were disappointed in the way this was done. One person offered to set the table: he was given four plastic beakers and a jug of squash. When people sat down to eat there was nothing else on the table: no cutlery, no serviettes, no salt and pepper or sauces. Each persons meal was put onto a plate in the kitchen, and passed through the hatch to them, with a spoon on the plate. People had to use their fingers to get the food onto the spoon, as they had no other cutlery, and then there were no serviettes to wipe their fingers. People were asked what they would like for pudding, but staff did this as a general question to the group which was not appropriate for the people who were there. In the end, no-one had pudding. When people arrive on Friday to stay for the weekend, one of the first tasks is to decide what meals they would like during the weekend. Once the menu is written, a shopping list is put together, and everyone goes to Tesco to do the shopping. Two people chose what they want to eat from a book full of pictures of meals. We had already commented that there had been sausages several times on the menus we looked at. Staff had told us that people had chosen the meals, and on the Friday they chose sausages again. Although using pictures is a good way for most people to make choices, we were concerned that a whole book of pictures might be quite confusing for Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: some people, and that some of the meals might not be recognisable. We recommended that staff think further about how people can be supported to make choices. A third person staying at the home made it clear she was happy to eat whatever was chosen by the others, and do whatever the staff decided. We did not see any evidence of the fourth person, who does not use words to communicate, being supported to make any choices, other than staff reminding the two more vocal people that they should remember the other persons wishes as well. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their personal care in the way they prefer, and their healthcare needs are met while they are staying at Orchard House. Evidence: The new support plans show that people are supported with their personal care in the way they prefer. As this is a respite service, peoples main carers are responsible for making sure their health needs are met. Staff will make sure people get medical treatment if they need it while staying at the home. During our first visit, we were concerned that the guidelines for managing one persons diabetes were not signed or dated so we had no way of knowing if the guidelines were current. We asked a nurse to check this. The guidelines were still appropriate, and the nurse felt that the home was managing the persons diabetes properly. This person was able to administer her own diabetic medication, with staff support, but staff had to record the persons blood sugar levels every two days. The manager was the only staff member trained to do this which meant she was having to come to the home during her time off if the blood sugar needed to be checked. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: During our first visit we observed the guidelines being followed, and medical advice was sought as needed. We looked briefly at one persons medication file. This person had just arrived and the staff had not had time to complete the task of signing in all the medication. The staff were not signing the Medication Administration Record (MAR) to show who had checked the medication in. There had been one error in medication administration since our last inspection: the staff followed the correct procedures to make sure the person did not come to any harm. Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know they can talk to staff if they have any concerns. Records indicate that staff have not received up to date training on how to keep people safe. Evidence: The way in which people can complain is described in the middle of the statement of purpose, and includes contacting CSCI if the complaint is not dealt with satisfactorily. We recommended it would be better to have the procedure more obviously available, perhaps on the notice board. People we spoke with said they would talk to the staff or their families if they were not happy. In the AQAA the manager told us that no complaints have been received. Records of staff training indicated that three of the five permanent staff had not received training in Safeguarding of Vulnerable Adults (SOVA) recently enough (one in 2005 and two in 2006). We learnt after the inspection that one person had had this training the day before we visited but the manager had not told us, and it was not on the record. We also learnt that the other two people had both recently completed an NVQ 3 or 4, which had included a module on safeguarding. Again, this had not been made clear on the record. We did not see records of training done by the agency staff who were on duty, although they told us they had received the same training as the permanent staff. Care Homes for Adults (18-65 years) Page 20 of 35 Care Homes for Adults (18-65 years) Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Orchard House is not maintained, decorated or kept clean enough to offer the people who stay here a comfortable, homely and pleasant place to stay. Evidence: We have been told for several years now that Orchard House was to be replaced with a more suitable building (part of the Councils programme of re-provision of respite services). However, this has still not taken place. The building does not meet the National Minimum Standards. It is very cramped with only one small lounge/dining room which is just about big enough for two comfortable chairs and a two-seater sofa, and a small dining table which four people can sit at. This area also doubles up as the office, so there is a cupboard for files, a computer table, and shelves for other office equipment such as the telephone and fax machine/photocopier. A shelf along the wall behind the dining table held several files, communication book, diary and so on. The hallway is very narrow and the bedrooms, which are quite small, do not have ensuite facilities or even a washbasin. The manager told us that the building had been completely decorated and refurbished when the service moved into it three years ago. Since then, some decoration has been done, and some of the carpets in the bedrooms replaced with hard flooring. The Housing Association is responsible for the Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: maintenance of the building. When we visited, the home was not decorated or maintained well enough and looked tatty and grubby. Carpets in the hall and lounge/dining room were stained; most areas of the home needed decorating because the paint was scuffed or missing; and there were large cracks in the plaster over the dining table, in the lounge, and in the hallway. There were screws, or screw holes in the walls in the hallway and in some of the bedrooms, where pictures or a TV bracket had once been. One of the bedrooms smelt strongly of stale urine, and in another bedroom the curtains were not hanging properly from the rail. The hard flooring that has been laid in the bedrooms was similar to that we have seen in other homes in toilets and bathrooms, and was covered in black marks, so did not look homely. Lighting in the lounge was very poor. There were two ceiling uplighters, both of which were hanging crookedly, and were full of bits. There was no mirror in the bathroom. The manager told us it had been broken so she was looking for a perspex mirror to put in its place. We subsequently learnt that the mirror had been broken several weeks before our visit. The pipes in the bathroom under the washbasin were filthy, the toilet brush was old and dirty, and there was a thick black cobweb on the ceiling. The separate toilet smelled of stale urine. In the kitchen, the floor was very dirty under and around some of the appliances, the dishwasher was dirty, and the freezer was badly rusted and the handle had fallen off. The manager told us a new freezer was on order. The manager and resource manager told us that the home was much better then it had been - they said a lot of clutter had been removed from the lounge/dining room, especially files and office equipment. There was still far too much office equipment in the room for it to look and feel homely. Care Homes for Adults (18-65 years) Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment and supervision are done well, however, there are not always enough staff on duty to meet peoples needs and training records indicate that staff have not received sufficient training to make sure they know the best way to support each person. Evidence: Rotas show that there are always two staff on duty when there are people staying at the home. Some days this includes the manager, who works two of her five shifts each week as a support worker. We are concerned as to whether this level of staff is enough. Support workers not only have to support the people staying at Orchard House, they also have to do all the cleaning, cooking, laundry and so on, as well as dealing with medication and money. On days when up to four people arrive to stay, staff find it very busy, booking in peoples medication and money, as well as welcoming people, settling them in and talking to them about what they want to do during their stay. We saw this on the Friday evening we were at the home, when only two new people (not four) arrived. Staff also had to work with people to sort out what they wanted to eat at the weekend so that they could write a shopping list for the shopping trip which took place later in the evening. All four people had to go out together (see Lifestyle section of this report). Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: We are also concerned that when only two staff are on duty, if one person does not want to go out, other people might not be able to go out, as one support worker would not be able to take three people out alone. Staff said that other staff are phoned and come in to work if needed, but this is usually planned in advance and is not very practical for spur-of-the-moment decisions. This happened on the second evening we visited, as the manager was the second member of staff but wanted to stay for the inspection. It took staff a lot of time, and a lot of phone calls, to find someone able to come at such short notice. There are five permanent staff, including the manager. Two of these staff started working at Orchard House in March 2008. The manager said three staff had been offered a job recently, and will start when clearances are received. There will still be two vacancies. A lot of agency staff are used, but some of them have been working full time hours at Orchard House for a long time. One of the agency staff we spoke with had been at Orchard House for two years. We looked at the records the home keeps about two of the staff. There was a proforma in place, showing that all the necessary documentation is in place in their personnel files, which are held centrally at County Hall. We spent a morning at County Hall in June 2008 checking a random selection of files of staff who work across the County Councils registered services. Generally all the required information was available on the files we looked at. Some staff have been employed for many years, and started long before the current requirements were in place. The Council has worked hard to get as much information as possible, and has ensured, for example, that Criminal Record Bureau (CRB) checks have been done, and are renewed every three years. Staff training records had not been fully updated since June 2008, so it was difficult for us to know whether or not staff have received adequate training. According to the record, one member of staff has a National Vocational Qualification (NVQ) in care levels 2 and 3, one has level 2, and the manager has level 4. One of the senior staff told us she has completed four days of a six-day communication coordinators course, which she is cascading to the other staff. Three staff have done a course on deafness awareness. We saw records to show that the homes own staff receive regular supervision sessions with the manager. The manager also carries out supervision with any agency staff who regularly work at the home. Care Homes for Adults (18-65 years) Page 25 of 35 Care Homes for Adults (18-65 years) Page 26 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of this home is not good enough to make sure that people who stay here receive the best possible service. Evidence: The manager told us she completed her NVQ level 4 in care in May 2008, and started the Registered Manager Award (RMA) which she is about half way through. Although this inspection has resulted in several requirements, the manager has shown, by what she wrote in the AQAA and in our discussions, that she is aware of some of the areas where the home can improve. In the report of our last inspection we made a requirement that Staffing, support and systems must be sufficient to enable the manager to have sufficient time to carry out her manager role. The manager still does two of her five shifts each week as a support worker. The results of this inspection, and the number of requirements made, indicate that she still does not have enough time to carry out the management role effectively. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: The manager talked to us about the quality assurance system that is in place. The Council has developed a quality audit which is based on CSCIs KLORA (Key Lines of Regulatory Assessment). Audits are carried out on a number of areas of the service provided. Informal meetings are held with the people who stay at Orchard House, to plan menus and activities. One of these meetings took place while we were at the home. It was very informal, but three out of the four people there were able to join in and say what they wanted on the menu, and what they wanted to do (see Lifestyle section of this report). There was little evidence however that the fourth person was supported to make any choices. The manager told us that each person is given a questionnaire to fill in at the end of their stay, so they can make any comments about the stay. An annual survey has also been planned for some time, but has not been done yet. In the AQAA (received four monthe before the inspection) the manager wrote that she was trying to find a venue to hold a meeting for all carers of the people who stay at the home: during the inspection she told us she was still trying to arrange this. A representative of the County Council (the provider) visits the home every month, as required by the regulations, and writes a detailed report of the visit. We are somewhat surprised that the issues we have found, particularly about the environment, have not been identified before, and addressed. We checked the fire log. The fire alarm had been tested weekly, and the emergency lights tested monthly (except in August) as required. One of the senior staff carries out a fire drill each month with staff and the people staying at the home. There was a very brief fire risk assessment in place: the manager explained that staff would be attending a course in November so that they could complete a full fire risk assessment. From the training records we saw, not all staff have had enough training in the topics related to health and safety (that is fire safety, infection control, first aid, moving and handling and food hygiene). Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 5 5 The home must ensure that 30/11/2007 all service users contracts are concluded without further delay. (Previous timescale of 30/6/05, 31/01/06 and 30/01/07 partially met). Care Homes for Adults (18-65 years) Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 All care plans must contain 31/12/2008 full, up-to-date guidance for staff on the persons support needs. So that people can be supported in they way they need and prefer. This requirement is repeated. 2 9 13 All risks to people staying at Orchard House must be assessed and management guidelines for staff put in place. So that people can be supported to take risks as part of an independent lifestyle. 31/12/2008 3 10 12 Confidential information about people, both written and spoken, must be dealt with properly. So that peoples privacy and dignity are respected. 31/12/2008 Care Homes for Adults (18-65 years) Page 30 of 35 4 14 16 People staying at Orchard House must be given opportunities to engage in activities of their choice, both in the home and in the community. So that people lead stimulating and fulfilling lives. 31/12/2008 5 17 16 People must be offered 31/12/2008 healthy, nutritious, balanced meals and meals must be served properly. So that people have a good, healthy diet and mealtimes are enjoyable. Records must be available to 31/12/2008 show that staff have received training in safeguarding (SOVA). So that we are sure staff have received current training in how to keep people safe. Any defects in decoration 31/01/2009 and maintenance identified must be rectified. For example, areas that need decorating must be decorated; carpets and flooring must be cleaned or replaced; items such as the freezer and bathroom mirror must be replaced. So that people have a comfortable place to stay. Bedrooms must be as comfortable as possible: defects identified must be 31/01/2009 6 23 13 7 24 23 8 26 23 Care Homes for Adults (18-65 years) Page 31 of 35 addressed. For example, curtains must be hung properly; any necessary decorating must be done; carpets and flooring must be cleaned or replaced. So that people have a comfortable bedroom. 9 28 23 The lounge/dining room must be made as comfortable and homely as possible: any defects identified must be rectified. So that people have a comfortable lounge/dining room. The home must be kept clean throughout and must smell fresh. So that people have a pleasant, clean and fresh place to stay in. 31/01/2009 10 30 16 31/12/2008 11 33 18 There must be a sufficient 31/12/2008 number of staff on duty to make sure the needs of each person who stays here are met, including their needs for activities and stimulation. So that each person staying at Orchard House is able to lead the life they choose. All staff must receive training in a range of topics relevant to the care of the people who stay here. So that staff can do their job in the best way possible. 31/01/2009 12 35 18 Care Homes for Adults (18-65 years) Page 32 of 35 This requirement is repeated. 13 37 12 Management of this home must improve. The manager must be given sufficient time to carry out her management duties. 31/12/2008 So that the quality of service offered to the people who stay here improves. This requirement is repeated. 14 42 13 All staff must receive 31/01/2009 training in the five topics relating to health and safety, that is moving/handling; first aid; fire safety; food hygiene; and infection control. So that staff know how to keep the people who stay at Orchard House as safe as possible. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 20 22 Staff should sign the MAR charts so that it is clear which staff member has recorded receipt of the medication. The complaints procedure should be more accessible for people staying at Orchard House so that they know how to complain if they want to. We strongly recommend that this service is moved to a premises which will better suit the needs of the people using the service, so that they have a more comfortable place to stay and so that current good practice in 3 24 Care Homes for Adults (18-65 years) Page 33 of 35 supporting people to lead independent lives can be put in place. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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