Inspection on 28/09/07 for Orchard House

This inspection was carried out on 28th September 2007.

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

The inspector 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 22/10/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Orchard House 92 Brookfield Road Bedford MK41 9LJ Lead Inspector Katrina Derbyshire Unannounced Inspection 28th September & 9 October 2007 09:50 th Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address 92 Brookfield Road Bedford MK41 9LJ 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) 01234 363222 01234 344448 Bedfordshire County Council Mrs Angela Bradley Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Maximum number of service users: 4 Gender: Male & Female Age range: 18 - 65 years Category: Learning Disablilty (LD) 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 7th December 2006 Date of last inspection Brief Description of the Service: 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 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 (with shower facility only), separate toilet, laundry area, and a living/dining area. The accommodation would not meet the needs of all 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 also a small garden area. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 28th September and 9th October 2007. During the inspection several areas of the home were visited and the inspector spent time with some of the people who were at the home in the sitting area on the second day of the inspection. The care of two people was examined by looking at their records, and speaking to people who had stayed at the home and staff who look after them. Comment cards were also received from 4 people who had also stayed at the home that show their views of the service that they receive. Information from the home, through written evidence in the form of a Annual Quality Assurance Assessment has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: What has improved since the last inspection? One of the areas that has changed is records about when staff have been appointed are now being kept at the home for inspection. These show numbers for example that prove that special safety checks have taken place, before that Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 6 person has been allowed to work at the home. This reduces the risk of someone that is not suitable being employed. 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. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House DS0000033039.V346750.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): 1, 2 & 5 People who use 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. The system in place for staff to assess the needs of prospective people is sufficient to ensure that they would have the information to know if they would be able to meet their needs. EVIDENCE: A copy of the statement of purpose and service user guide was on display on a notice board in the front hall. The service users guide to help in understanding its content used words and pictures. Information included how to complain and about the accommodation available. Information regarding the assessed needs of each person were seen within individual files. In the main information available had been provided by the funding authority as part of their assessment process. People had been given the opportunity to visit prior to making a decision to use the service. The visit assessment tool used by staff at the home was designed in a user-friendly manner using words and pictures. A previous requirement regarding contracts had almost been met. The manager had sent contracts to all those that had been using the service, all but a few had been returned signed. However those people who had recently Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 9 used the service had not been issued with one, therefore the requirement remains with an extended date given for compliance. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use 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. Opportunities for people to make decisions about their lives are satisfactory and make people feel in control of their own lives, however care planning systems are not sufficient to ensure all people receive continuity of care. EVIDENCE: The care plans seen at this inspection showed basic information on the needs of the person. There is still a need for further development to ensure that guidance is sufficient to staff to ensure continuity of care. Generic risk assessments remained in place as reported at the previous inspection as over 40 people had been using the service. These included areas including unsupervised travel, the kitchen area and community access. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 11 In addition other risk assessments were seen relating to individual needs, these included specific information on the assistance someone needed with mobility and another at mealtimes. The manager and documents confirmed that people had a level of choice within those possible at a short stay home. The frequency of people coming to stay and leaving and their individual needs influence this area. However choice of meals, participation in the weekly shopping, choice of where to out in the evening were all supported by staff. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use 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 living at the home have a sufficient level of access to local facilities so benefit from being part of the community and having their social needs met. EVIDENCE: Through speaking with people living at the home and all 4 returned comment cards to the Commission for Social Care Inspection, evidence shows that people are satisfied with the provision of meals at the home. Menus examined showed that a choice is available. Menus had been developed using pictures to assist people in making their choice. The stocks of food kept at the home were examined. A good amount of protein, carbohydrates, fruit, dairy and vegetables were seen to be in place. The service uses a range of transport for the people living at the home including taxi’s. Within the care records examined, entries were seen within Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 13 the daily notes to show that people participated in a variety of activities and occupation, so they could continue these whilst staying at the home. People attended varying day care services where they were able to participate in a curriculum of activity and development. Examples of these included cooking, art, music and social development. In addition information supplied by the manager showed that people attended the local pub, fetes, car boot sales and use the local media to see what is going on in the local area. One person said, “ I had a drink at the pub” and “ I enjoyed watching telly. I bought cds at the car boot sale”. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 14 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): 18, 19 & 20 Quality in this outcome area is good. We have made this judgement using a range of evidence including a visit to this service. Medication systems are sufficient to ensure people receive their prescribed medication. EVIDENCE: Nominated staff are responsible for the administration of medication in the home; staff confirmed that they had also undertaken further training in this area, including staff supplied through an agency. The systems for the ordering of medication showed that the home maintained clear records to ensure that the medicines ordered were received from the pharmacist. Medication administration sheets contained the balance of stock and contained staff signatures to show when medication had been given. The amount of stock kept at the home was at acceptable levels. Observations of the personal support to people by staff were noted to be sensitive and respectful, the guidance of a person at tea time was seen to be explained fully to the person. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 15 Through observation and confirmation by the people who had stayed at the home it was confirmed that clothes, hairstyle and makeup reflected their individual personalities. Guidance and support regarding personal hygiene was offered and the level offered by staff was reflected in the care plans examined on this inspection. All people continue to be registered with their General Practitioner and any needed referral to access other healthcare services would be made through the General Practitioner if the need arose during their stay. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 16 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): 22 & 23 Quality in this outcome area is good. We have made this judgement using a range of evidence including a visit to this service. Managements understanding and the systems in place for safeguarding adults are sufficient to reduce the risk from abuse and for people to receive the multi disciplinary support from a safeguarding team if needed. EVIDENCE: On the notice board in the front entrance the homes complaints procedure was on display. The homes complaints procedure included to whom you could speak to and this included details of how to contact the Commission for Social Care Inspection, and in addition how long the person would have to wait before a response. Peoples feedback through the comment cards sent to the Commission for Social Care Inspection detailed that they were aware of the how they can complain and feel comfortable doing so. The homes protection of vulnerable adults policy alongside local guidance was noted to remain in place, this as previously assessed gives sufficient guidance in this topic. Both give clear guidance on how to report a suspicion of alleged abuse and give details on the types of abuse, including physical, emotional and financial. Training records provided by the home show that staff had attended training workshops on protecting vulnerable adults. On interviewing a staff member, they were able to demonstrate that they knew how to report a suspicion of abuse and confirmed that they had been trained in this area. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 17 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): 24 & 30 People who use 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. The standard of cleanliness in this home is good to provide a pleasant environment for people to live in. EVIDENCE: All areas of the home that were seen were noted to be clean and free of any odours. Domestic style furnishings were in place and bedrooms contained a bed, wardrobe, chair and chest of drawers. There was no designated available space for a staff area/office. A fax machine and folders for example were being kept in the sitting/dining area. As detailed in the introduction there were plans to move the service to another building. However the manager confirmed that no date has been given for this at the time of the inspection. Orchard House DS0000033039.V346750.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): 32, 34 & 35 People who use 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. The systems in place for the recruitment of staff and vetting of prospective employees are robust and of a good standard and protect people. EVIDENCE: Examination of two staff files was undertaken to look at recruitment practices. It was noted that the files contained an agreed format to show the following had been secured, proof of identity; verification of employment history and that Criminal Records Bureau clearance had been obtained. The system that had been followed was extensive when recruiting staff. Responses had been recorded when people had been interviewed and these documents had also been kept. Job descriptions, person specifications and initial enquiry letters were also maintained on the personal file. Information regarding training of staff show that staff had undertaken training in areas including health and safety. Through discussions with the manager it was confirmed that they had undertaken a variety of courses including those specifically to better understand the needs of the people living at the home. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 19 Observation of interaction between staff (agency) and people living at the home showed that a good amount of communication took place between them including the use of non-verbal communication. The use of a high level of agency continues, this was also reported in 2006. The effect of this has been helped by the use of the same staff from the agency. Orchard House DS0000033039.V346750.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): 37, 39 & 42 People who use 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. Systems and staffing levels are not sufficient to enable the manager to have the time needed to fully execute her management role. EVIDENCE: People and their representatives had been asked their opinion on the services offered by the home as part of the quality assurance system. The results and how the home acted upon the views received were available for inspection. Analysis of the survey results had also been undertaken. Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 21 The health and safety policies in the home are detailed and gave clear guidance to staff on how they should manage this area. Staff had all received training in a variety of Health and Safety subjects and these included food hygiene, moving and handling and infection control. Certificates or copies of certificates of attendance are maintained within the training files at the home. Feedback regarding the manager was positive. However the limited amount of staff that had been employed directly by the service had resulted in her having to undertake many tasks. Sufficient time should be given for her to complete the Registered managers’ award that she is currently undertaking. This was discussed with the manager at the time of inspection. Orchard House DS0000033039.V346750.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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 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. Standard YA5 Regulation 5 Requirement The home must ensure that all service users’ contracts are concluded without further delay. (Previous timescale of 30.6.05, 31/01/06 and 30/01/07 partially met). The home must ensure that care plans for all the service users’ are completed that contain sufficient guidance to ensure continuity of care. (Previous timescales of 30/11/04, 30/6/05, 31/01/06 and 30/01/07 partially met). The home must ensure that there is a training and development programme, (for all staff) which incorporates induction, mandatory, specialisttraining, and NVQ courses/qualifications. (Previous timescale of 30/4/05, 31/12/05 and 30/01/07 partially met). Staffing, support and systems must be sufficient to enable the manager to have sufficient time to carry out her manager role. DS0000033039.V346750.R01.S.doc Timescale for action 30/11/07 2. YA6 15 31/12/07 3. YA35 18 31/12/07 4. YA37 12 31/01/08 Orchard House Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orchard House DS0000033039.V346750.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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. 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