CARE HOME ADULTS 18-65
Orchard House 401 Shoreham Street Sheffield South Yorkshire S2 4FB Lead Inspector
Janis Robinson Unannounced 4 August 2005 09:00 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 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 Stationary 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 J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Orchard House Address 401 Shoreham Street Sheffield S2 4FB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0114 2494255 0114 2494256 Not known Orchard Care Ms Linda Margaret Anne Wake PC Care Home Only 10 Category(ies) of LD Learning disability - 10 registration, with number of places Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 8th March 2005 Brief Description of the Service: Orchard House is a care home providing services for up to ten adults with a learning disability. It is based in an inner city area of Sheffield. The home was originally two terraced houses which have been converted into one dwelling. Accommodation is provided on the ground and first floors. The second floor provides office and sleeping in space for staff. All of the ten bedrooms are single, five have en-suite facilities. A communal bathroom is provided on the ground and first floor. Communal space consists of two lounges, a dining room and kitchen. A small laundry is provided. There is a small garden to the front of the property. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 5 hours from 8.00am to 1:00 pm. An inspection of the environment was undertaken. A proportion of records were checked, including care plans, complaints, menu, rotas, and staff training and recruitment. Interactions between staff and residents were observed. All of the eight residents and the two staff on duty were spoken with. Discussions took place with the homes manager. What the service does well:
The interactions observed between residents and staff appeared respectful and caring. Residents said `The staff are nice’, `I like living here’ and `It’s good’. An updated service user guide (Residents Information Pack) had been provided to each resident to give him or her information about the home. Each resident was provided with a contract, which informed them of their rights and obligations. Trial visits took place, to enable prospective residents and their representatives to make informed choices. Care plans were in place for all residents. These set out in detail the personal, social and health care needs of the individual, and the staff action required to ensure these needs were met. Residents were supported to take risks and make decisions about their lives. A policy on confidentiality was in place, to ensure residents rights were respected. Access to day care and work facilities was available to those residents who wished to access these. Whilst the majority of residents independently accessed facilities in the local community, care staff supported some activities and trips out of the home. There was an open visiting policy, to encourage contact with relatives and friends. The routines at the home were flexible, to enable residents to have some control over their lives. The menu was varied, and individual preferences were respected. Residents health care was monitored and access to relevant professionals was available to ensure health was maintained. There was a complaints procedure and Adult Protection procedure in place, to promote residents safety. On the day of the inspection the environment was clean and fresh smelling. Communal areas contained homely touches to create a comfortable environment. Bedrooms contained personal belongings, which enabled residents to have some control over their personal space. Sufficient bathing facilities were provided to ensure residents personal care needs were met. A rolling programme of redecoration was in place.
Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 6 Agreed levels of staff were being maintained. A staff training record was in place, and individual training records were maintained. There was a quality assurance system, which sought the views of residents. Insurance cover was provided. All records were well organised and up to date. Records were stored securely, to respect confidentiality. Health and safety procedures were identified and carried out, and systems were checked and serviced to maintain a safe environment. Staff undertook mandatory training to ensure their skills were maintained. What has improved since the last inspection? 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.
Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5. A service user guide was available, which provided information about the home to residents. Assessments of needs were undertaken prior to admission to ensure that the needs of prospective residents could be met. Trial visits were encouraged, to enable prospective residents and their relatives to make informed choices. Contracts had been undertaken with each resident, to inform them of their rights and obligations. The information available and actions taken ensured that standards were met. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 9 EVIDENCE: The information packs provided to residents had been updated. Each pack contained a range of information, and included a service user guide. Each resident had been given a copy of the information pack, to give them information about all aspects of the homes procedures, environment and staff. They were well set out and easy to read. Needs assessments were undertaken prior to admission to ensure that the home could meet all identified needs. The information was used to formulate a plan of care to ensure staff knew how to look after the resident. Copies of social workers full needs assessments were obtained prior to admission, if these were available, in order that full information was available. Prospective residents, and their families were encouraged to visit the home to meet staff, residents and have a look around the home before admission to inform their choices. Trial visits to the home were undertaken and planned on an individual basis, according to need, these included staying for meals and overnight stays. Statements of terms and conditions were undertaken with residents to ensure that they were provided with information about their rights. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 and 10. Each resident had a care plan, to ensure his or her opinions had been sought and needs assessed. Residents were supported to make decisions to ensure they had some control of their life. Residents were supported to take risks to ensure they led full lives as safely as possible. There was a policy on confidentiality, to protect residents rights. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 11 EVIDENCE: Care plans were well set out and easy to read. Where they had chosen to do so, residents had signed the plans to evidence that they had been involved in its drawing up. The plans contained a comprehensive range of information covering all aspects of personal, health and social care. The plans identified the staff action required to ensure identified needs were met. Risk assessments were in place, to ensure that all identified risks were well managed whilst providing some independence to residents. Plans were regularly reviewed and updated. Residents were able to make decisions about their lives. Residents were observed making choices about where and how to spend their time, and staff respected these decisions. Two residents decided to have breakfast in their room, and two residents decided to go for a walk to the local church and have lunch out. The policy on confidentiality in place ensured information about residents was kept safe. Residents said they liked living at the home, the staff were `good’ and `nice’. They said that they had everything they needed. Residents confirmed that they could make decisions, and the routines at the home were flexible. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16 and 17. Residents had opportunities to participate in activities. Some residents independently accessed facilities in the local community. Staff supported other residents to access these facilities if required. Trips out of the home were organised. Contact with families and friends were maintained. Residents rights were promoted and responsibilities were identified. A varied diet was provided and preferences respected. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 13 EVIDENCE: Risk assessments had been undertaken and a minority of residents identified as needing staff support to access the local community, to minimise risk and maintain their safety. A range of activities was offered to residents, which included trips out of the home to local shops, clubs and pubs. Care staff also organised activities within the home, which reflected residents’ interests. Residents said that they enjoyed the activities provided, and had been to Butlins for a weeks holiday. Staff confirmed that contact with residents’ families and friends were maintained. The home had an open visiting policy to encourage contact. The majority of residents had frequent contact with their family. All residents contributed to the running of the home. Residents were responsible for their bedrooms, and undertook their own laundry and other chores, as identified within their individual plan. Staff support was provided, according to individual assessed need. Residents helped plan the weekly menu, shop for food and prepare some meals. All of the residents’ said the food was good. The menu was on display in the kitchen. A varied diet was provided. Alternatives to the menu were always available. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 21 Residents personal support needs were assessed and met. Staff monitored residents physical and emotional health, to ensure this was maintained. Residents needs regarding long-term care and death were identified to ensure these would be carried out. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 15 EVIDENCE: Care plans contained information on residents personal care needs in detail. The plans set out the staff action required to ensure all identified needs were carried out. The care plan recordings were specific and comprehensive. Staff had a clear understanding of the individual needs of residents, and the knowledge to ensure personal care needs were met respectfully. All residents were able to independently meet their personal care needs, care plans contained information on encouragement and advice. Care plans contained information on all aspects of health care. Appointments and treatments with health care professionals were recorded to ensure these were monitored and health was maintained. The plans evidenced that residents emotional health was monitored. Access to health care professionals was available. Staff responded to any health concerns promptly. Residents were consulted regarding their wishes in relation to long-term illness and dying. The views of residents had been sought from them or their representatives, to ensure any specific wishes were carried out. Since the last inspection one resident had passed away. A funeral tea was provided at the home, and all of the residents and staff attended the funeral. Staff evidenced that they handled this difficult time sensitively and respectfully. Residents received ongoing support to help them deal with the loss of a friend. Staff displayed a strong sense of commitment to the residents living at the home. Positive, caring and happy interactions were observed between residents and staff. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 A clear and accessible complaints procedure was in place, to ensure residents rights were protected and any concerns listened to and taken seriously. An Adult Protection procedure was in place, to ensure residents safety was promoted. EVIDENCE: The complaints policy was included in the information packs provided to residents. It contained relevant information and informed the reader who to contact external to the home, should the complainant wish to do so. Staff were confident in the homes manager to take any complaints seriously. The homes record of complaints detailed the action taken and the outcomes of the complaint. No complaints had been received by the home since the last inspection. Staff had supported one resident to make a complaint, which did not involve the home. There was an Adult Protection policy in place, which included the Department of Health guidance `No Secrets’ to ensure staff had access to all of the information needed to promote residents safety and well being. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29 and 30. The home was clean and well maintained in parts. Homely touches had been provided to create a comfortable environment. Communal areas were well maintained, and bedrooms were well decorated and personalised. Sufficient bathing facilities were provided. A rolling programme of redecoration and refurbishment was in place. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 18 EVIDENCE: Overall the home was well decorated and maintained. Communal lounges and the dining room were provided with homely touches to create a comfortable environment. All of the bedrooms were highly individual and reflected the personalities and interests of the service users, allowing them some control over their personal space. Sufficient bathing facilities were provided. The kitchen and laundry were clean and well equipped. All of the residents said the home was comfortable and they were happy with their rooms. Refurbishment and redecoration work was ongoing. New flooring had been provided in two bedrooms, and an en-suite facility was being built in one bedroom. Three bedrooms and the staircase had marked and worn carpets. The manager had ordered replacement carpets. The first floor bathroom was worn and required refurbishment. The floor covering required replacing. The exterior paintwork on windowsills and some brickwork required repainting to maintain standards. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35, and 36 Agreed levels of staff were being maintained. Good relationships between staff and residents were observed. The majority of staff undertook NVQ training to improve their skills. Recommended levels of NVQ trained staff were being achieved. Staff undertook periodic training to keep them up to date. A staff training plan and individual training records were maintained. Staff supervision took place at the required frequency. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 20 EVIDENCE: Staff were provided with job descriptions, to inform them of their roles and responsibilities. The staff had a positive attitude to their jobs and displayed high level of commitment to the residents. Friendly and supportive relationships were observed between staff and residents. The homes rota indicated that agreed levels of staff were being maintained. All of the staff reported a good team spirit at the home. Staff undertook periodic training relevant to their job. A training day had been organised for the whole staff team to update and enhance their skills. This was being provided by an external training organisation. A training plan and individual training records were maintained to ensure effective monitoring took place. A new organisation was providing NVQ training to the staff team, to improve the service offered. Of the eight care staff, two staff had achieved NVQ level 2 in care. A further five staff were undertaking the training at level 2 in care. Two staff were near to completing the training. Once this training has been achieved, the home will have met the requirement to have a minimum of 50 of the staff team trained to NVQ level 2 in care. A thorough recruitment procedure was in operation, to ensure appropriate staff were employed at the home. The staff files were well organised, and included references from previous employers and proof of identity. Two files did not contain a copy of the person’s birth certificate. All staff reported that they had regular supervision, to ensure they received sufficient support and guidance. Records checked evidenced that staff received supervision at the required frequency. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41 and 42. The home was well run. Management were approachable and supportive to staff and residents. A quality assurance system was in place to seek residents views and inform practice, this needed to be expanded to include other information. A range of policies and procedures were in place to ensure relevant information was available and safe practices carried out. Health and safety systems were in place. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 22 EVIDENCE: The registered manager was qualified and experienced. Residents and staff benefited from the managements leadership style. Staff said that the manager was approachable and supportive. Residents said the manager was `good’ and `nice’. The home had a quality assurance system, and questionnaires were used to seek the views of residents. The results of questionnaires were collated to inform and improve practice. The questionnaires were in a style suitable for residents. The quality assurance system did not include obtaining the views of residents relatives or professional visitors. It is acknowledged that the manager had identified this gap and was planning relevant questionnaires. A range of appropriate policies and procedures were in place. These were accessible to staff to ensure they had appropriate and up to date information to be able to carry out their duties. They were all well set out and well organised. Health and safety systems were checked and serviced. All staff were up to date with all aspects of mandatory training, to equip them with the skills needed to maintain residents safety. Fire instruction and drills were carried out at the required frequency. One fire extinguishers service date had expired. An audit of all fire equipment must be carried out and relevant servicing take place, to ensure the safety of residents and staff. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 2 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Orchard House Score 3 3 x 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 2 x J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 24 Regulation 23 Requirement The exterior windowledges of the property must be redecorated (Previous timescale of 31.05.05 not met) The exterior brick work must be redecorated (Previous timescale of 31.07.05 not met) The first floor bathroom must be refurbished and the floor covering replaced. (Previous timescale of 31.06.05 not met) Staff recruitment files must contain copies of birth certificates. The quality assurance system must be expanded to include obtaining the views of relatives and professional visitors to the home. All fire extinguishers must be checked and an up to date service carried out. Timescale for action 32.10.05 2. 3. 24 27 23 23 31.10.05 31.10.05 4. 5. 34 39 18 12 30.09.05 30.09.05 6. 42 13 31.09.05 Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 32 Good Practice Recommendations 50 of the care staff must be qualified to NVQ level 2 in care. Orchard House J55 S2995 Orchard Hse V237071 04.08.05 UI Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Ground Floor, Unit 3 Waterside Court Bold Street Sheffield, S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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