Inspection on 03/05/07 for Orchard House

This inspection was carried out on 3rd May 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard House 14/04/09

Orchard House 01/05/08

Orchard House 14/03/06

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Orchard House Ashford Road Kingsnorth Ashford Kent TN23 3ED Lead Inspector Mrs Michele Etherton Key Unannounced Inspection 3rd May 2007 09:40 Orchard House DS0000065346.V336725.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 DS0000065346.V336725.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 DS0000065346.V336725.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address Ashford Road Kingsnorth Ashford Kent TN23 3ED 01233 612234 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) CareTech Community Services (No.2) Ltd ****Post Vacant**** Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users who are over 65 years of age to be restricted to one (1) whose DOB is 07/01/1925. Service users who have acquired brain injury to be restricted to one (1) whose DOB is 23/10/1940. 3rd July 2006 Date of last inspection Brief Description of the Service: Orchard House is registered to provide accommodation for up to 9 adults with a learning disability and admits people with medium to high dependency needs. The home caters for 5 service users downstairs that have a sensory impairment as well as a learning disability. The use of the upstairs unit is currently under review with the remaining two people living in the unit moving to other placements. The company CareTech Community Services (No.2) Ltd owns the business. The new manager, who is currently unregistered with the Commission, has day-to-day control of the home. The premise is a detached property with all single bedrooms. The service users have the use of 4 bathrooms. Each unit (upstairs/downstairs) has a kitchen, dining room and lounge. There is no lift access. There is a large garden to the rear and a parking area to the front. The Home is situated in the village of Kingsnorth, which is approximately 2.5miles from Ashford town centre. Within 100yds there is a bus stop and a village pub. The home also has transport, which can be used for service users if they wish. The current fees range from £766.75 to £1846.88 Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of this service has taken account of information received by CSCI since the last inspection in addition to a pre-inspection questionnaire completed by the home manager. Unfortunately no feedback has been received from health and social care professionals to aid the compilation of this report. One survey was received from relatives which indicated they were usually or sometimes satisfied with care provided. All key standards have been inspected in addition to others where previous requirements or recommendations were in place or feedback received has raised issues of concern, the focus of the inspection was to assess progress made by the home towards addressing many of the outstanding shortfalls identified at previous inspections. A site visit of the home was undertaken on 3rd may, 2007. The site visit commenced at 9:40 a.m. and finished at 3.00 p.m. The site visit comprised a tour of the premises; time spent speaking with staff and observation of people who live in the home. A review of documentation including samples of user plans, medication records, staff personnel and training records, accident reports, the fire book, menus and activity information were also viewed. Owing to difficulties in engaging with most of the service users because of their needs and communication issues, judgements as to their quality of life were made from information received about the home prior to the site visit, observations made during the site visit including discussions with staff and a review of some documentation. In Addition to existing shortfalls, four new requirements in respect of management of finances belonging to people living in the home, staff recruitment and training, and the develop of a quality assurance system have been made following this visit, one good practice recommendation in respect of dental care has also been made. What the service does well: What has improved since the last inspection? The home has now recruited a permanent staff team reducing the need for agency staff cover, A new manager has been appointed who is actively Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 6 addressing many of the outstanding required and recommended actions for improvement and there is evidence of progress in many of these, these signs of progress have influenced the overall quality rating for the home. A recommended review of restrictions highlighted previously has been undertaken and restrictions removed. 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 DS0000065346.V336725.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 DS0000065346.V336725.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): 2 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. In view of a lack of admissions since the last inspection, the home is unable to evidence at this time that it is implementing a robust assessment of need for prospective or existing residents. EVIDENCE: No new admissions have been made since the last inspection; consequently the home has not been able to demonstrate that its revised assessment process is sufficiently robust, is being routinely implemented and takes account of the needs and aspirations of prospective residents and how these will be met. Three people living in the upstairs unit are in the process of moving out to another home in the group that is thought to be able to better meet their needs. One person has already transferred and two others are due to leave shortly, discussion with staff indicated that one of those transferring has undertaken a trial visit to the new home although there was no written evidence of how this had gone, documentation viewed failed to give details of reassessment of need and a planned process of moving, staff reported that care managers had been consulted but evidence of this correspondence was not noted. Whilst discussion with staff highlighted some positive outcomes of Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 9 these planned moves for the people concerned, the lack of planning documentation implies the moves have more to do with meeting timescales for refurbishment of the upstairs unit than at a pace best suited to the individuals concerned. The home must ensure that any future transfers are undertaken on a planned basis with clear evidence of prior consultation with interested parties and that moves are in the best interest of the individuals concerned. Orchard House DS0000065346.V336725.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. Care plans mostly reflect and inform how needs are to be supported, opportunities for decision-making need strengthening, with relevant risks assessed on an individual basis. EVIDENCE: The new manager and staff have worked hard to improve the level of detail within Care plans, these are person centred and reflect more accurately how support is to be provided to individuals and the preferred manner. Staff spoken with commented that they found care plans more informative and this gave them confidence in providing the appropriate support to people living in the home. Samples of care plans viewed highlighted some confusing language used in describing causes of behaviour and omissions of information in respect of Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 11 communication, these shortfalls have direct impact on how people living in the service may be perceived or are effectively supported, and were discussed with senior staff present at the site visit, these need to be fully addressed in order to meet the outstanding requirement. Although the majority of staff are relatively new those spoken with and observed demonstrated patience and kindness in their support of and interactions with people living in the home, if this was more reactive than spontaneous this may reflect their lack of knowledge and skills in working confidently with visually impaired people in particular, and this will be helped once specific training is provided. The practices of locking the upstairs kitchen to prevent access by service users, and the provision on alternate days only of a pudding after the main meal have been reviewed and rescinded; ongoing shortfalls in a number of standards continue to limit opportunities for choice and decision making. The home has made some progress in addressing a previous requirement to review risk assessments. Samples viewed provided evidence of some individualisation and updating, however, discussion with key workers in respect of individual case tracked residents highlighted that some generic risk assessments present in care files are irrelevant but remain in place. Some risk assessments that no longer reflect the current situation e.g. resident smoking also need to be removed. Orchard House DS0000065346.V336725.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 adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Opportunities for increased activities, access to the community and the promotion of individual independence need further development. The home is supportive of existing relationships and friendships. A nutritious and balanced diet is offered, how this is developed and promoted to people living in the home needs strengthening EVIDENCE: Some progress has been made in the development of an activities programme for people living in the home and all now have an opportunity at least once per week to attend a day centre. Relatives feel there needs to be more varied and frequent interaction with the local community. Whilst there are occasional trips to places of interest little thought is given to the benefits of such trips to the majority of the residents who are visually impaired, and there is still an over reliance on the need to have a driver for external activities rather than initiate stimulating activities in house. Observations made on the day Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 13 indicated no structured in house activity, with a one to one resident receiving no specific input other than time spent with an assessment worker from “Arcadia” who are currently assessing some of the people with visual impairment and their activity needs. Staff were observed undertaking a number of domestic roles around the house that clearly impact on their ability to provide quality time with residents and this should be reviewed within the current staffing arrangements, a previous recommendation to review staffing is therefore repeated. Only a few of the existing residents retain contact with their families, these contacts are supported by the home. Feedback from relatives indicated that they were usually or sometimes satisfied with the care provided and felt that communication could be improved. At present existing shortfalls in the environment, and the awareness and training of staff inhibits the promotion of independence for the majority of people living in the home. Menu planning is done on a one to one basis with users, daily menus are presented in picture form and placed on a notice board, whilst for some residents this is of great benefit, for the downstairs unit where the majority of residents are severely visually impaired this arrangement will need reviewing. Staff confirmed that a pudding is now offered everyday with the main meal, Menus viewed provided variety and were well balanced but offered little choice on a day to day basis. Orchard House DS0000065346.V336725.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 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. Staff mostly has sufficient information to appropriately support the needs of people living in the home in their preferred manner, People living in the home have access to routine healthcare. Improvements to current medication arrangements promote the safety of people living in the home in receipt of medication. EVIDENCE: Improvements in the level of detail within care plans has meant that staff now have a clearer and more consistent understanding of how support is to be delivered to people living in the home. Staff reported that they feel they have a better understanding of individual preferred routines; improvements in this area are ongoing, including a need to ensure that the communication needs of people living in the home are clearly understood and supported consistently by staff. A review of files of people living in the home provided evidence of attendance at a range of routine health appointments, previous concerns that some people Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 15 in the home were not accessing a dentist has been addressed, only five out of seven residents have their own teeth and are now offered regular 6 monthly checks, a previous requirement has been addressed although the home must now consider how it will address refusals to allow examination and should consult with relevant parties as to how to address this problem, it is recommended this is evidenced clearly within resident files and this is a recommendation. The new manager has implemented a number of good practice improvements to the current medication arrangements and met an outstanding requirement. Senior care workers are responsible for administration and have received basic medication training, consideration should be given to administering staff undertaking a more in depth course, in view of the complexity of some clients medication regimes. MAR sheets viewed were completed satisfactorily. No controlled drugs are in use currently. Receipt of medication is recorded appropriately. Orchard House DS0000065346.V336725.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 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. People living in the home are provided with opportunities to express their views; there is a lack of clarity as to how these are acted upon. The training of all staff in adult protection and the management of challenging behaviour should be progressed to ensure that the safety and welfare of people in the home is not compromised EVIDENCE: Pre – inspection information supplied by the home indicates that no complaints have been received. Service users are provided with opportunities to express their views and concerns in 1-1 sessions with staff, although it is unclear how this information is acted upon. Relatives confirmed that any concerns that have been raised have always been dealt with appropriately. A programme of core skills and specialist training is now underway that will also provide opportunities for all staff eventually to receive training in adult protection and management of challenging behaviour, the home is some way from achieving this at present, and this remains an outstanding requirement. Sample files of some case tracked people living in the home provided records of interventions approved for use with them, and these are reviewed, not all staff have achieved this training. Discussion with a senior staff member indicated that the home operates a cross gender care policy. Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 17 Recruitment of staff is generally robust although some shortfalls have been identified (see standard 34) that will need to be addressed to ensure people in the home are protected. Finances of two case tracked people who live in the home were checked. Records and cash balances were found to be accurate. The home discusses with appropriate care managers withdrawal of funds for clothes etc from resident savings accounts. It was noted that a cash withdrawal from one resident t savings had been used to purchase new clothes and replace a worn armchair in their bedroom, the home are reminded that residents are not financially responsible for funding the replacement of furniture unless they have specifically requested something which is above and beyond the normal standard of furnishings. A requirement has been issued in respect of this. Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28,30 People who use 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. A programme of improvement is needed to ensure people live in a safe, hygienic, and suitable environment to meet their needs. EVIDENCE: No progress has been made on addressing most of the outstanding requirements and recommendations issued previously in respect of the environment some of which impact on the health and safety of people living in the home. Relatives feel that the home is in need of refurbishment and that the garden should be developed so it can be practically used. There is a clear distinction between the quality and appearance of those bedrooms of people in the home who still have contact with their families, bedrooms of those without external family contact lack personalisation with Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 19 some appearing quite stark, with greater need of upgrade, consideration should be given to ensuring support is provided to service users equally to personalise their own space. New settees have been purchased for the lounge, however, these fail to provide sufficient seating for all the downstairs residents and at least one staff member. Clearly at one time the home was decorated to a high standard and pleasant colour schemes and good quality furnishings would have given a more homely appearance, this has deteriorated over time and whilst there remains a welcoming atmosphere, this is not supported by the overall quality of the accommodation. A previous issue with staff disposing of cigarette butts responsibly has been addressed, as there were no sign of these during the tour of the premises. Observations made of bathrooms, toilets and the laundry area highlighted a broken pedal bin and lack of liquid hand wash in the laundry area, one toilet viewed also had no hand wash for staff or residents to use, these shortfalls fail to promote good hand washing and infection control and need to be addressed within outstanding current requirement for improvements. Staff spoken with confirmed they had access to gloves for handling soiled laundry and undertaking personal care. The home was generally clean and tidy, domestic chores are undertaken by care staff, this impacts on their ability to spend time with people living in the home who need 1-1 support or to initiate activities or provide stimulation. The provision of a domestic post to provide both cooking and cleaning support should be considered. Although a development plan has not been formalised staff were generally aware that a programme of refurbishment is imminent commencing with the windows and kitchen, this was confirmed in conversation with the area manager although firm timescales are still not in place. The environment does not lend itself to a home for visually impaired people and their needs should be fully taken account of in any planned upgrade. The home has failed to address an outstanding requirement in respect of fire safety arrangements and this matter has been referred onto the fire safety officer for the area. The home is not complying with their fire risk assessment in maintaining equipment. Fire points are being tested regularly as is emergency lighting, only one fire drill was recorded and there were no details as to who had attended this. Fire training was not featured on the training programme viewed and the home has failed to address the outstanding requirement. Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 20 Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 21 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): 32,33,34,35,36 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. People living at the home are benefiting from some improvement in the stability and competency of the staff team. The robustness of the recruitment procedure needs strengthening. Staff consider themselves well supported and informed. EVIDENCE: The manager was absent during the site visit. Staff’ are welcoming and cooperative with the inspection process. They demonstrate a willingness to learn and make improvements to the service for the benefit of people living there. Pre inspection information indicates that the home has made good progress in the number of staff qualified to NVQ2 and above this being currently 60 . Discussion with staff indicated that there are signs of improvement in the establishment of a permanent team, turnover of staff has slowed and use of agency is now limited to some evening shifts only. The staff ratio at the time Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 22 of the visit was 1 senior and 4 carers to 7 residents. Two staff had to leave to take clients to day care. Staff are responsible for undertaking domestic chores in addition to their care tasks and were unable to provide 1-1 time to a resident who is funded for this. Staff felt that care staff numbers were now at maximum, however, consideration should be given either to the planning of care staff work or the provision of domestic support that frees up care staff time for work with people living in the home. A sample of staff recruitment files viewed indicated that there is generally a robust vetting and recruitment procedure, however, only one written reference was noted for one newer staff member, items of ID and a current photo were missing from another file, and details of a valid driving licence were not in evidence for a staff member who is a driver for the home and conveys residents routinely, these shortfalls undermine the recruitment procedure and could compromise the safety of those living in the home, it is a requirement that the home ensures all necessary documentation relating to the recruitment of staff and supporting documentation for their role is in place. The new manager has been proactive in identifying staff training shortfalls and has initiated a staff training programme, this indicates that only one or two staff are being trained at a time, discussions with staff indicated that they have all been selected for attendance at training courses but it will take some time for the whole staff team to achieve all core and specialist skills and for people living in the home to benefit from a more knowledgeable and aware staff team. The manager must be supported and resourced to provide all necessary training in a timely manner to ensure progress in quality of life is consistently offered by all staff to people living in the home. Proposals to make changes to the upstairs to offer support to people with different specific needs to those in the downstairs unit, will require the home to actively plan to meet the training needs of staff prior to admissions taking place. A requirement has been issued to address these shortfalls. The majority of the permanent staff team have been in post less that one year. Those spoken with felt that the new manager had made significant improvements to the home already, and that the staff team was now settling down. Staff reported that they enjoyed being part of a permanent team and felt they understood what they were doing better. The manager has devised a supervision structure and staff indicated that they felt well supported by the manager, and confirmed receipt of regular supervision in which they felt able to express their views. Senior staff’ spoken with are well informed about proposed changes to the service and were looking forward to the upgrading of the property and the ability to use the garden with users. Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 23 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. Service users are continuing to benefit from the slow implementation of some improvements in service. Procedures are not in place to ensure and evidence that service users, staff and other stakeholders influence service development. The health and safety of people living in the home is not suitably protected or promoted EVIDENCE: The manager was absent on the day of the visit; she is newly appointed and is still to be registered by the Commission. It is too early at this stage to assess how influential or effective she is in moving the service forward, however, Staff spoke positively of her hard work in trying to address existing shortfalls, and felt she had been instrumental in ensuring that a stable staff team had been Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 24 established and that a training programme was now in place as well as a supervision rota. Staff felt enthused and motivated by the manager’s hard work and the improvements to the home. There was no specific evidence of quality audit of the service or the seeking of other stakeholders views, some opportunities exist for people living in the home and staff to express their views, but no analysis of this feedback or how it has influenced service development and fed into the annual development plan has been undertaken. Staff are aware of plans to upgrade the home but these have not been formalised within a development plan and made available to the Commission. Plans for upgrading have been underway for some time with proposed timescales repeatedly slipping. A previous recommendation to develop quality monitoring within the home has not been implemented and the home is now required in line with changes to legislation to provide evidence of self audit and assessment of the service and how consultation with residents and other stakeholders influences changes to the service and how this feeds into a development plan. The home has initiated a training programme for staff, but fire training is not part of that programme, testing and servicing of equipment has been undertaken, however, a gas safety certificate has not been obtained since 2005 and a certificate confirming the electrical installation has been checked was not in evidence. The home has failed to address requirements relating to the health and safety of service users over several inspections. Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 25 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 2 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 2 25 2 26 X 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 X X 1 X Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 15(1) Requirement Care plans must contain sufficient detail to enable staff to meet service users assessed needs and aspirations and evidence these needs are being met (previous timescale 30/09/05 & 14/05/06 not met) timescale of 31/10/06 partially met Risk assessments must be specific to the individual service users and reviewed regularly (Partially met) Service users must have increased opportunities to access appropriate leisure activities (previous timescale 30/08/05 & 14/06/06 not met)partially met Service users must have increased opportunities to access the community (previous timescale 30/08/05 & 14/06/06 not met) Partially met Residents finances are not to be used to fund replacement furniture within the home without consultation and written approval from DS0000065346.V336725.R01.S.doc Timescale for action 31/10/07 2. YA9 13 (4) 03/07/07 3. YA12 16 (2) m 31/07/07 4. YA13 16(2) m 31/07/07 5 YA23 16(2) l 30/05/07 Orchard House Version 5.2 Page 27 6. YA23 13 (6) relevanindependent representatives All staff must be trained in adult protection and NVCI (partially met) Take adequate fire safety measures for training, door closures (previous timescale 14/04/06 not met) and tumble dryer outlet) not met within timescale of 31/07/06 not met Service users must be provided with a suitable and safe garden area which they can access (Not met within timescale of 31/8/06) Not met within timescale of 31/8/06 There must be sufficient and suitable furniture (lounge seating) for service users to use Partially met The home is required to submit to the commission their plans for the kitchen refurbishment together with timescales Not met within previous timescale of 31/7/06 The new laundry must be signed off by the EHO and any requirements implemented and the tumble dryer outlet comply to the FO instructions Not met within previous timescale of 31/7/06 The home must be kept clean and hygienic with reference to the kitchen worktop (previous timescales of 30/08/05 & 14/04/06 not met)Not met within previous timescale 31/10/06 Sufficient, suitably qualified, competent and experienced staff DS0000065346.V336725.R01.S.doc 31/07/07 7 YA24 23(4) 30/06/07 8 YA28 23(2)o 30/06/07 9 YA28 23(2)g 30/06/07 10. YA30 16 (2) 30/06/07 11 YA30 23 30/06/07 12 YA30 13 & 16 30/06/07 13 YA33 18 31/07/07 Page 28 Orchard House Version 5.2 are working at the home to ensure the needs of the service users are met (previous timescale 31/3/05 and 30/10/05 not met) Partially met 14 YA34 19 The home must ensure that a 30/06/07 robust recruitment and vetting procedure is in place and that all supporting documentation is evidenced A training matrix to be 30/06/07 developed. A programme of training to ensure all staff to receive specialist training specific to the service users needs/disabilities i.e. sensory impairment, Makaton, epilepsy and physical intervention in a timely manner Home to provide evidence of: self audit and assessment of the service, how consultation with residents and other stakeholders influences changes to the service and how this feeds into a service development plan. Comply with Health & Safety legislation by maintaining the electrical installation equipment (previous timescale of 30/08/05 & 21/03/06 not met) Not met within previous timescales of 31/7/06 All staff to be trained in fire safety, moving and handling and food hygiene (previous timescale of 14/09/06) Not met within previous timescales of 14/9/06 30/06/07 15 YA35 18 16 YA39 24 17 YA42 13, 23 30/06/07 18 YA42 23 4d 13 (5) 16 2j 31/07/07 Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 29 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 3 Refer to Standard YA19 YA28 YA28 Good Practice Recommendations The home to consult with relevant parties as to how to address refusals for dental examination and to evidence outcomes Repair/replace exposed plasterwork and rear window sills The cooker is replaced with one that is large enough to cook for the numbers required (brought forward from 3 previous inspections) Provide hand drying facilities in the laundry areas, suitable arrangements which are managed for the disposal of cigarette butts and the cooker cleaned adequately A formal assessment tool is used to identify staffing levels based on residents needs (brought forward from previous inspection) Check out information on highlighted references and record findings 4 YA30 5. YA33 6. YA34 Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Orchard House DS0000065346.V336725.R01.S.doc Version 5.2 Page 31 - 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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