Inspection on 27/02/07 for Orchard House

This inspection was carried out on 27th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard House 23/02/06

Orchard House 01/12/05

Orchard House 26/01/05

Orchard House 08/11/04

Orchard House 20/01/04

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Treloar College

Kestrel House, St Anne`s Opportunity Centre,

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Orchard House 31 Hyde End Lane Ryeish Green Reading Berkshire RG7 1EP Lead Inspector Catherine Kane Unannounced Inspection 27th February 2006 1:50 DS0000011365.V328755.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 DS0000011365.V328755.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. DS0000011365.V328755.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address 31 Hyde End Lane Ryeish Green Reading Berkshire RG7 1EP 0118 988 6029 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) orchard.house@atlas.plus.com Atlas Project Team Limited *** Post Vacant *** Care Home 4 Category(ies) of Learning disability (4) registration, with number of places DS0000011365.V328755.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: Atlas Project Team Ltd are the registered provider for Orchard House, and provide care and accommodation for 4 Young Adults aged 18-65, who have a learning disability with associated challenging behaviour. Orchard House is a large detached house within Ryeish Green close to the amenities within the village of Spencers Wood and the town of Reading. The house is owned by Housing Solutions who oversee the maintenance of the home, as reported to them by Atlas Project Team. The home has a large secluded garden with patio and garden furniture, and a large wooden garden swing to be enjoyed by all in the warmer months. The home has the use of its own vehicles’ and public transport is available. Parking spaces are available to the front of the house; off road parking is also available. The fees for this home range from £1661.52 to £2309.09 per week. DS0000011365.V328755.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 1.50pm on Tuesday, 27 February 2007. The inspector was in the service for four and a half hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The manager and three staff members were on duty at time of the inspection visit. The inspector spoke with all four residents. The inpsector saw staff and residents prepare for their evening meal and saw how staff help residents look after and take their medicines. She also looked at residents care plans and other records kept in the home and made a tour of the part of premesis. An area manager was also present during part of the inspectors visit. The inspector would like to thank the manager and his staff team for their assistance with the inspection. She also thanks residents and other visitors who shared their experience of this home. What the service does well: What has improved since the last inspection? The manager stated that the housing provider has completed outstanding fire safety works since the last inspection. The home has been redecorated internally. DS0000011365.V328755.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. The summary of this inspection report can be made available in other formats on request. DS0000011365.V328755.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 DS0000011365.V328755.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good. The admission procedure is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection the home had no vacancies. There has been one new admission to this home since the last inspection. The inspector viewed the pre-admission assessments; these were comprehensive documents and indicated that the home could meet the individual’s needs at the time of admission and a review process was in place. Generally, admissions would not made to the home until a full needs assessment has been undertaken. The home would then be able to confirm that they can meet the needs of the individual through the service they deliver. DS0000011365.V328755.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is good. The care planning system in place to provide staff with the information they need and for assessing risk is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection the inspector viewed two resident’s care plans. These were easy to understand, written in plain language and considered areas of the individual’s life including health, personal and social care needs. The plan is regularly reviewed and includes comprehensive risk assessments. The manager informed the inspector that the home was using a listening monitor to alert staff should one resident require assistance at night. There were no clear guidelines included in the resident’s care plan. The decision to start using this equipment, which could compromise residents’ privacy, dignity or restrict their freedom, had been made by the home following a practice used from this resident’s previous placement. While the inspector understands the decision taken to put limitations may be in the best interest of the resident this DS0000011365.V328755.R01.S.doc Version 5.2 Page 10 must be done only though a full care planning process if the resident is not able to give their consent. This would involve the individuals who would be able to act on the resident’s behalf, for example, their relatives or advocate and other social care or healthcare professionals. Three comment cards were returned from residents’ social care managers. They all indicated that they were satisfied with the overall care provided in this home. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. DS0000011365.V328755.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. Opportunities for people who use this service to take part in a variety of interesting activities are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the inspector was in the home during the afternoon and early evening. She spent this time with all four residents and the staff on duty. Two the four residents had some limited communication skills, with the help of staff were able to tell the inspector about their experiences of the home and some things that were very important to them. Many activities provided in house were based on what residents prefer to do in their leisure time; these included art and craft, cookery, aromatherapy and music. Each resident has a programme of regular activities outside the home that include college courses, sports and leisure centre and shopping. The DS0000011365.V328755.R01.S.doc Version 5.2 Page 12 manager informed the inspector that one resident, who enjoys spending time in the garden, plans to have a summer house built shortly. One resident with the help of the manager told the inspector about how they are supported to maintain their relationships with their friends and family. This was very important for them. The inspector was in the home when the evening meal was being prepared and served. Residents are involved in the planning and preparation of meals and have their meal together with staff in the kitchen/dining area. The meal on the evening of the inspection was freshly cooked savoury pancakes. Regular drinks and snacks are available. A varied menu is provided and residents special dietary needs are catered for. DS0000011365.V328755.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is adequate. The personal and healthcare needs of residents are generally well met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Essential information needed by staff to be able to provide personal and health care support was included in residents’ files. Staff help residents to look after their own medication and see they get to see their local GP and other community healthcare services when needed. However, in the last year six medicines related errors had been noted in records kept in the home. The home did not routinely notify the residents GP, who is responsible for prescribing residents medicines, when an error had been made. The inspector saw how the home helped residents to access specialist healthcare support when this was needed. Residents’ medicines are securely kept in a locked medicines cabinet situated in the home’s office. The home uses a pharmacist produced medication administration record (MAR). Records seen were neat and well maintained. Most residents medicines are supplied in pharmacist produced monitored dose DS0000011365.V328755.R01.S.doc Version 5.2 Page 14 system. Records were kept of staff assessed as competent to administer residents’ medicines. The manager has completed training on medicines through a local adult education college. The inspector recommends that the home checks that any such training is provided by an appropriately qualified person with knowledge of medicines. During the inspection two members of staff confidently demonstrated how a residents’ medicines are looked and how residents are helped to take their medicines. DS0000011365.V328755.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is adequate. The homes complaints procedure is good. Information about safeguarding vulnerable people was out of date. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager declared that home has received no complaints in the last year. The Commission has received no information relating to complaints in the last year. Training records indicate that most staff have attended specific training on protecting vulnerable people from abuse and about local adult protection procedures. However, the information available in the home about local safeguarding procedures was dated 2000. The inspector recommends that the home obtain more up to date information about local adult protection procedures from all relevant placing authorities and that these are made available to all staff. Staff who spoke with the inspector were clear about their responsibilities and were aware of the homes ‘whistle blowing’ policy. The Commission has received no information relating to adult protection issues since the last inspection. DS0000011365.V328755.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. Quality in this outcome area is good. The home was tidy and generally clean at the time of the inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The furniture and fittings are modern and domestic in style providing a homelike environment. One resident has new bedroom furniture. The home has been redecorated throughout since the last inspection. However, the lounge carpet was badly stained and looked grubby spoiling an otherwise pleasant homely environment . Other carpets throughout the home also would benefit from thorough cleaning. The manager informed the inspector that the home regularly has the carpet professionally cleaned and has bought a carpet shampooing machine. The inspector recommends that carpet cleaning needs to be carried out at more frequent intervals and when it is needed to keep home clean. The home has a programme of repair and renewal. DS0000011365.V328755.R01.S.doc Version 5.2 Page 17 DS0000011365.V328755.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35. Quality in this outcome area is good. This homes recruitment procedures and training for staff to do their jobs well is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection visit the inspector spoke with three members of staff on duty. The home has a core of well-established staff that understand residents’ needs and they relate well to. Three staff members have left or transferred to other homes run by this organisation and one new member of staff has been recruited since the last inspection. Staff commented that morale is high. The inspector viewed two staff files selected at random. These were well organised and contained the necessary documentation. The recruitment process is thorough. The area manager was unable to confirm at the time of the inspection of the organisations intention to renew the Criminal Record Bureau (CRB) disclosures made on staff every three years as recommended. The home keeps a record of training completed by staff; staff spoken with confirmed details of the training they have undertaken. Four staff members have completed a relevant National Vocational Qualification (NVQ). DS0000011365.V328755.R01.S.doc Version 5.2 Page 19 DS0000011365.V328755.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. Quality in this outcome area is adequate. The manager has a good understanding of management areas in which the home needs to improve and has plans in place to address this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post since October 2006 and must make an application to register as manager with CSCI without delay and keep the inspector informed about the progress of his application. It is expected that the manager shall complete the Registered Managers Award at NVQ level 4 that he is currently undertaking. The manager has experience and knowledge about working with people with learning disabilities. Comments received from staff were complimentary about the manager and said they felt they were supported and listened to. DS0000011365.V328755.R01.S.doc Version 5.2 Page 21 During the inspectors visit records were seen about incidents relating to errors in made with residents medicines that had occurred in the home that CSCI should have been notified about. Proprietors’ representatives monthly visit reports have been regularly received. The Commission no longer requires that a copy of this report be sent to CSCI but a copy must be kept in the home and made available for inspection. A development plan for the home is generated from the monthly visit reports with a clear action plan with timescales for the manager. However, other quality assurance, monitoring systems or annual audits that would provide the inspector with information to indicate how the home was performing and providing a good quality service were not available. The area manager informed the inspector that the organisation is a member of an association of care providers who provide support and information about current good practice in the area of learning disability services. The home has sound policies and procedures in line with current thinking and practice. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. The home works to a clear health and safety policy and checks take place to ensure the home meets relevant health and safety requirements and legislation. Records kept were good and are routinely completed. Atlas Team Project Limited, who run this service, has financial and accounting systems subject to internal and external audits DS0000011365.V328755.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 1 X 2 X X 3 X DS0000011365.V328755.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 12 Schedule 3 Requirement The responsible person must ensure that a record is kept of decisions that have been made for residents and the reasons why these decisions have been made. The responsible person must advise the CSCI of what action has been taken to meet this standard The responsible person must ensure that advice and guidance be obtained from the appropriate healthcare professional responsible for prescribing residents medicines when errors have been made. The manager must submit a full application to register with CSCI. The responsible person must ensure that any notifications to CSCI under Care Homes Regulations 2001 Regulation 37 are made without delay. The registered provider must provide CSCI with details of how it plans to establish an annual quality assurance and review system to take into account the DS0000011365.V328755.R01.S.doc Timescale for action 31/05/07 2. YA19 13(1)(b) 31/05/07 3. YA37 4. YA37 Care Standards Act 2000 12(1) 37 30/06/07 31/03/07 5. YA39 24 31/05/07 Version 5.2 Page 24 views of residents, their relatives or advocates and others about the home and make the resulting reports available to interested parties 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 Refer to Standard YA23 Good Practice Recommendations The inspector recommends that the home should obtain more up to date information about local adult protection procedures from all relevant placing authorities and make these available to all staff. The inspector recommends that carpet cleaning should be carried out at more frequent intervals and when it is needed to keep home clean. 2. YA30 DS0000011365.V328755.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000011365.V328755.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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