Inspection on 29/06/07 for Orchard House

This inspection was carried out on 29th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Orchard House 02/12/05

Orchard House 10/05/05

Orchard House 07/10/04

Orchard House 06/07/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Orchard House Orchard House Maureen Terrace Seaham Durham SR7 7SN Lead Inspector Ms Kathy Bell Unannounced Inspection 29th June 2007 10:30 Orchard House DS0000007494.V342339.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 DS0000007494.V342339.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 DS0000007494.V342339.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address Orchard House Maureen Terrace Seaham Durham SR7 7SN 0191 5817568 0191 5130388 No e-mail 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) European Services for People with Autism Limited Peter Powell Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd December 2005 Brief Description of the Service: Orchard House is registered to provide care (but not nursing care) for 7 people with learning disabilities between the ages of 18 and 65 years. The home provides a specialist service for people with autism spectrum disorders, including challenging behaviour. The home is a large detached building, with seven single bedrooms, two living rooms, kitchen/dining room and a garden area. It was renovated last year so it is closer to meeting the current National Minimum Standards. It is near the town centre of the coastal town of Seaham. Orchard House is managed by the organisation now known as European Services for People with Autism Limited, which was established in 1987 and runs a range of services for younger adults with autism. The yearly fees for this service range from £58,523.98 to £95,176.59. This information was provided to CSCI in February 2007. Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during one day in June 2007. It was the one inspection planned for this year and the home was not told in advance that the Inspector would visit that day. The manager was on holiday at the time so the Inspector was helped by senior staff and the staff in charge at the time she arrived. The Inspector, Kathy Bell, looked at the buildings and some records, met residents and talked to the staff. Residents could not take part in the inspection fully because of their learning and communication difficulties. But four relatives had completed survey forms, giving their opinions about the home. What the service does well: What has improved since the last inspection? The building has been renovated so that each room now has a wash hand basin and four electrical sockets. It was also rewired and has low surface temperature radiators which are safer for residents. An extra bathroom was provided and the rooms used by one resident were altered in a way which staff hope will meet his needs better. A staircase leading down to the basement level has been replaced with new stairs which are easier and safer to use. The manager has achieved half of the recommended qualification for managers of care homes. All the staff have had training in diversity, to increase their understanding that residents may have different needs and choices because of their culture, religion or sexual orientation. Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 6 The home has now achieved the target of having more than half the staff qualified with the National Vocational Qualification in care at level 2. This is the recognised qualification for care staff. 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 DS0000007494.V342339.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 DS0000007494.V342339.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 excellent. This judgement has been made using available evidence including a visit to this service. All the residents were fully assessed before they were admitted to the home, to make sure that it would be able to meet their needs. EVIDENCE: ESPAs admission procedure requires a comprehensive multidisciplinary assessment, including gathering full information from parents and other relevant people. One person is currently being assessed, to decide whether the home is right for her and the staff explained that this persons relative currently has the information on her because she wants to add more detail to it. This shows that the home gets the detailed information it needs and respects the views and knowledge of carers. Care managers who purchase the service also carry out their own assessments. Orchard House DS0000007494.V342339.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 & 9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan which explains the help they need. Staff help residents make decisions, as much as they can. They assess risks so that they can provide the support people need and keep them safe. EVIDENCE: Each resident has a plan which describes the care they need. These are very detailed and include all the information staff need to make sure they respond to needs in the way suitable for each person. They include assessments by specialists such as a speech therapist. They include information about any religious preferences so that staff can respect these. They are kept up-todate, and every six months a meeting is held about each resident to discuss whether the home is meeting all their needs and if they should be doing anything differently. The care plans showed clearly when anything had changed. Staff try and give residents choice in their daily lives, for example, by offering them a choice of meals already on a plate so they can see what is on offer. But they recognise that too much choice and uncertainty can be stressful for Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 10 people with autism and they often offer people a choice of two things, to make it easier for them. The care plans help staff by describing in detail each persons likes and dislikes and what they are sensitive to. Many of the staff have worked in the home for many years and have got to know residents very well. This helps them offer people activities and a way of life which suits them. Records showed how staff think carefully about how someone may be expressing his choices by his behaviour. Staff record when they have tried to find out someones wishes, for example, about whether they were comfortable with trying aromatherapy. There were records which showed that staff had looked at anything which could be dangerous or harmful to residents. These risk assessments considered what staff needed to do to keep each resident safe. They explained, for example, how many staff were needed to support each person to do an activity they enjoyed. These records explained why some people are restricted in some ways and may need supervision for many activities. Staff had looked again at the risk assessments when something had changed for a person and they took into account the benefits the person was gaining from doing that activity. They reviewed the risk assessments at regular intervals to make sure they were still up-to-date. Orchard House DS0000007494.V342339.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): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents take part in a range of activities and go out and about in the local community. Staff help them keep in touch with their families. The home recognises residents rights. Residents are offered healthy, enjoyable meals, suitable for each persons needs. EVIDENCE: Each resident has an individual weekly timetable of activities. Some people go to ESPAs own day centre where they can go to the cafe or take part in art and poetry groups. Some enjoy swimming or trampolining. Staff meet individual interests: one man enjoys gardening so staff take him to work on an allotment. Two of the residents go to visit a farm run by ESPA. Residents regularly go out for walks in the local area. The only difficulty in providing activities is caused because the service has a large bus to meet the particular needs of residents. Only a few of the staff have the necessary experience or qualification to drive this. The staff rota is organised so that these staff are on duty when activities are planned which need the bus, but staff find there are times when they cant go out in the bus Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 12 because they havent got a driver. This could be much more of a problem if any of the drivers stopped working at this service or are off sick. ESPA should consider whether to provide training in driving the bus for more staff. The home supports people to keep in touch with their families and have visits home if possible. Their care plans explain the help they need to send birthday cards etc. Records showed how the home involves relatives in discussions about the care of residents. In the surveys, relatives said that the home always or usually helps their family member keep in touch with them. Relatives had different views about how well the home kept them up-to-date with anything happening, like medical problems. Two felt that this was something they did well but another hadnt received the level of contact they expected. Staff should discuss with relatives how often they expect the home to get in touch with them to avoid misunderstandings. The home recognises residents rights. They try and offer them choices in their daily lives and involve them, as far as they can, in the daily work of looking after their rooms. When they have to restrict people, for their safety, they record why this has been necessary, so they can justify what they have done. The home has a cook who provides choices at every meal. The menu showed a varied diet and the cook aims to provide a diet which is healthy and enjoyable. A dietician who reviewed the menus said that, Meals offered are varied and cater for client choice and most dietary requirements. The home has also recorded that a nurse responsible for one resident who is diabetic has praised how well they have managed her diet. Mealtimes are flexible-one resident was eating her breakfast at 11 am. The kitchen is arranged to make it easier for people to make choices: a variety of cereals are on display for breakfast time and residents can go to the fridge to choose yoghurts. Orchard House DS0000007494.V342339.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 & 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents receive the personal support they need and staff make sure they receive good medical care. They look after and give out medication in a safe way. EVIDENCE: Staff have the information they need to meet each persons personal care needs. The care plans describe the help each person needs and their preferences. Each day, a timetable plans out which staff will be supporting which resident so that enough staff are available to give personal care and support, and provide activities. Three of the relatives said that the home always gives the support or care expected, the other said usually. Discussions with the manager about a resident with complex needs showed that the home has a strong commitment to maintaining peoples dignity. The home has assessed each residents health needs and reviews this every year. Staff work closely with the psychiatrist who is responsible for residents and clear records are kept of referrals to and information from him. Records showed that staff work with GPs to monitor residents physical health, including any long-term conditions. Residents have recently been screened to check if Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 14 they have any eating difficulties. Regular appointments are made for eyesight checks, dental checks and chiropody. ESPA has an established procedure for the storage, administration, recording and disposal of medication. Staff have received training in this. Orchard House DS0000007494.V342339.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 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. ESPA has a satisfactory complaints procedure. This means that staff know how to respond to complaints and any relative or resident who wants to complain knows how to do this, and how ESPA should respond. The home takes all reasonable steps to protect residents from abuse. EVIDENCE: The home has a satisfactory complaints procedure and this has been produced in a form which could be easier for some residents to understand. Staff have recorded when they have tried to explain this to residents. The four relatives who completed a survey form all said that they knew how to complain and that the home had responded appropriately if they had raised concerns. Staff have received training on preventing abuse and the organisation has satisfactory policies and procedures to protect residents. New staff do not begin work until the home has made sure that there is nothing in the background of the new employee which would mean they were unsuitable to work with vulnerable people. Care plans include detailed guidelines on how staff can respond to any challenging behaviour, including the use of restraint. Senior staff check the records of any incidents involving restraint to make sure that staff are following these guidelines and residents are kept safe from harm. A sample of these records showed that staff always tried to distract people if they were beginning to become upset about something and restraint was only used as a last resort and as gently as possible. Records are kept of money handled for residents and these are checked by ESPAs finance department. Orchard House DS0000007494.V342339.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 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, safe place to live, which meets residents needs. The home seemed clean on the day of inspection. EVIDENCE: The home provides domestic style accommodation in a large, detached house. There are two living rooms and a kitchen/dining room. All the bedrooms are single. The whole building was renovated in 2006 and each bedroom now has a wash hand basin and four electrical sockets. The building was rewired to meet current standards and the layout changed so that a staircase to the rooms used by one resident and staff is now easy to use and safe. A third bathroom was also provided and the building completely redecorated. The building was free from unpleasant smells and appeared clean throughout. Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 17 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 to 32, 33, 34 & 35. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staffing levels seen satisfactory to meet the needs of residents. Staff seem to have the personal qualities, skills and training needed for this home. Comprehensive training is provided, including good support for new staff. Proper checks are carried out on new staff to make sure that only suitable people begin work in the home. EVIDENCE: There are usually four or five care staff on duty during the day. During the evenings this sometimes reduces to three when there are no activities planned outside the home. Another member of staff also works 10 hours a week for the home, helping with activities. Records in the home show that staff are able to provide an active lifestyle for residents, including individual attention. 61 of the staff now have the National Vocational Qualification in care at level 2, which is the recognised qualification for care staff. This is more than the 50 recommended in the National Minimum Standards. Staff seem to have the personal qualities necessary for their jobs, showing enthusiasm and patience. Relatives who commented in the surveys said that staff always or usually have the right skills and experience to look after people properly. Relatives also praised the way staff created a comfortable, family atmosphere in the home, and treated residents with the consistency they needed. Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 18 It was not possible to look at the records of recruitment of any new staff because the manager was not to work on the day of inspection. However ESPA has an established system for safe recruitment which includes obtaining three references and carrying out Criminal Records Bureau/Protection of Vulnerable Adults list checks. The home provides comprehensive training for new and existing staff. As well as essential training such as food safety, safe handling of medicines and prevention of abuse, staff receive training specific to the needs of residents. This includes restraint, the use of language and the use of emergency medication. Staff have had training in diversity, to increase their understanding that residents may have different needs and choices because of their culture, religion or sexual orientation. Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 19 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 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and provides a safe place to live and work. ESPA has good systems to check how successful the home is in meeting the needs of residents. EVIDENCE: The manager has worked at the home for a number of years and knows the current residents well. He has already achieved part of the recommended qualification for care home managers and is working towards the second part. Each of the senior staff takes responsibility for particular areas of work, such as health and safety or medication, to make sure the home runs smoothly. ESPA has a number of systems to make sure that the home provides a good service. There is an annual development plan which is linked to individual goals for each resident. Each year residents and their relatives complete a survey so that ESPA knows what they think of the service. A senior member of the staff of ESPA visits the home once a month to check how it is running. Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 20 As part of the renovation last year, low surface temperature radiators were fitted to make the home safe. A rather steep staircase was replaced . The building was rewired to meet current standards. Regular checks of the fire safety system, fire drills and maintenance are carried out. Portable electrical appliances are also checked each year to make sure they are safe Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 21 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 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 2 X 4 X X 3 X Orchard House DS0000007494.V342339.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA37 YA15 Good Practice Recommendations The manager should achieve NVQ 4 in care. Key workers should discuss with relatives how much contact and communication with the home they expect. 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