Inspection on 07/12/06 for Orchard House

This inspection was carried out on 7th December 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard House 22/10/08

Orchard House 28/09/07

Orchard House 10/02/06

Orchard House 04/11/05

Orchard House 10/02/05

Orchard House 04/06/04

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

CARE HOME ADULTS 18-65 Orchard House 92 Brookfield Road Bedford MK41 9LJ Lead Inspector Pursotamraj Hirekar Unannounced Inspection 7th December 2006 13:00 Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address 92 Brookfield Road Bedford MK41 9LJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 363222 Bedfordshire County Council Mrs Angela Bradley Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Maximum number of service users: 4 Gender: Male & Female Age range: 18 - 65 years Category: Learning Disability (LD) Period of stay: Respite only - up to a maximum of 6 weeks Until reprovision of this service takes place, the premises must be safe, and meet service users` individual and collective needs 10th February 2006 Date of last inspection Brief Description of the Service: Orchard House is a respite service located in Bedford. The accommodation and grounds are owned and maintained by Aldwyck Housing Association, with Bedfordshire County Council providing the staffing and care support. It is a condition of registration that the service will have moved and been rebuilt by November 2005, as it does not currently meet the environmental requirements of the National Minimum Standards for Younger Adults. It is hoped that the service will remain in the local area, but at the time of this inspection, there were still no definite timescales for this to take place. The accommodation comprises of a bungalow, which is intended to provide respite care for up to 4 adults with learning disabilities at any one time. Stays are limited to a maximum of six weeks. There are four single bedrooms, a shared kitchen, bathroom (with shower facility only), separate toilet, laundry area, and a living/dining area. The accommodation would not meet the needs of all individuals with a physical disability. Community facilities and shops are a short distance from the home, which is also in easy access of local transport routes. There is parking to the front of the property, and there is also a small garden area. Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced key inspection carried out on 07/12/06 over 4 ½ hours by pursotamraj hirekar. The method of inspection included review of outstanding requirements and recommendations, study of care plans, risk assessments, staffs’ files, and other relevant care delivery documents, discussion with the service users’, staff on duty and the manager, partial tour of the premises and observations. The manager had coordinated the entire inspection. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that all service users’ contracts are concluded without further delay. The home must ensure to keep all the information of all the staffs with regard to their statutory checks and are available for inspection. The home must ensure that care plans for all the service users’ are completed. The home must ensure that there is a training and development programme, (for all staff) which incorporates induction, mandatory, specialist-training, and NVQ courses/qualifications for all the staffs. The home must ensure to cover all elements of a business and financial plan for the home and the service. Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 6 The home must ensure that monthly-unannounced visits are carried out and are on regular basis in accordance with regulation 26 of the Care Homes Regulations 2001. The home should complete the consultations and finalise the medication policy, which would ensure that service users retain, administer and control their own medication where appropriate, and are protected by the homes policies and procedures for dealing with medicines. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide enabled potential service users to make informed decisions. EVIDENCE: Service users guide was revised and updated in April 2006. The service users guide presented was in a user-friendly format with pictures where relevant. Most of the services uses’ now have written contracts and some of them were in the process of completion. The statement of purpose has been reviewed and updated in the June 2006. Currently the home had around 15 new referrals, and the initial assessment to find out whether the home can meet the assessed needs of the potential service users’ was in the process. The manager for 3-service users carried out health and social care assessments and tea visits were being arranged for 2 potential service users’. Assessments were carried out in the presence of the service users’ and their family members. The visit assessment tools were designed in a user-friendly manner using pictorial format. Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 9 The managers had said that all the 42 service users’ contracts were prepared and send across to their family members. However, the manager has received only 50 of them and the rest were still with the family members of the service users’. The manager had planned to chase. On this inspection 2 service users’ completed contracts were seen as a sample. Orchard House DS0000033039.V323073.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had reviewed the risk assessments and updated the careplans to incorporate the changing needs and aspirations of the service users’. However, the home must complete care plans for the rest of the 10 service users’. EVIDENCE: The manager had informed on this inspection that of the 42 service users’ only 32 service users’ care plans have been completed and the rest 10 service users’ care plans were in the progress. On a random basis, 2 service users’ care plans were seen on this inspection. Service user –1 currently, staying at the home since 05/12/06. The care plan had detailed information with regard to the areas of communication, mobility, morning & evening routine, night time needs, personal care, medication to be administered by staff, diet, behaviour and intervention, autonomy of skills was incomplete, family & social Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 11 contacts, leisure activities & support, TV, music, cinema, shopping, trips out, sparkle club. The photograph and the medical consent form from the mother were outstanding. The service user and the manager signed the care plan. Service user –2-care plan was reviewed on the 02/02/06. The details included; mobility, morning & evening routines, personal care, medication administration by staff, diet, allergies, behaviour and interventions, autonomy of skills, domestic tasks, day care, leisure activity and support that included music cooking swimming walking group activities and TV. Diet was reviewed on 15/11/06. Risk assessment of staff lone working was assessed in March 2006 and was reviewed on 17/11/06. The service user and the carer signed the care plan. The home had a practice of carrying out generic risk assessments across all service users, which included using community resources, unsupervised travel and community access, medication, staff lone working, kitchen and kitchen equipment, laundry room, living room equipment, emergency evacuation, money and shopping. 10 service users’ had additional risk assessments including the above, which were specific to their individual needs; they were predominantly in the area of guided walking, being left alone and lone working. The home was planning to develop picture based care plans for service users’ by the middle of 2007. The home now had photographs displayed of staffs on the notice board, lounge cum dinning area, and sometimes some agency staffs’ photographs were not available. However, the manager had planned to take the photographs her and display where necessary. The fire board had photographs displayed of service users’ currently staying at the home with their individual room numbers including any visitors’ to the home. Orchard House DS0000033039.V323073.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): 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had consultations with all service users’ and developed activites that meet the individual service users’ needs and aspirations to achieve quality of life goals. EVIDENCE: The home had developed a picture bank to facilitate the service users’ in making choice of food and assist them in planning and preparation for shopping. The home had continued to engage service users’ in providing opportunities for various kitchen tasks and family interactions. Service users’ were provided with the freedom of choice to decide what they would like to do and when during their stay at the home. Service users were also encouraged to attend college and work placements in line with their assessed needs and abilities. At the time of this inspection, one service user had arrived from his work placement; upon his arrival at the home the manager had meaningful conversation regarding his day’s work and had provided support in the kitchen whilst the tea was being prepared. Orchard House DS0000033039.V323073.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): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessed personal and health care needs of the service users’ were met as per their care plan. However, the home must conclude the medication policy and procedures to enable service users’ lead independent life. EVIDENCE: The home’s medication policy was under review and wide consultations were in progress with family members of the service users and the community nurses, which was likely to be completed by the end of December 2006. The home now had placed a medicine cabinet in all the rooms of the service users and the plan to encourage service users’ those who have the capacity to self medicate was put on hold for completion of the medication policy. Currently, the home staffs administer the medication. All the 4 staffs working at the home had received medication training in October 2006. On this inspection, 2service users medication record was seen and found that the medication records and the medicines were in order. It was observed, on this inspection that the manager, staffs and service users’ had good working relations, that was in the interest of the service users’. Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 14 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had made appropriate arrangements with regard the complaints policy and procedures. EVIDENCE: The home had appropriate policy and procedures to deal with any complaints, concerns, and allegation. There was no complaint recorded since the previous inspection. Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 15 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had provided relevant documentary evidence with regard to health and safety checks carried out by the professionals. EVIDENCE: The home had systems and procedures to carry out various check that included water, fridge & freezer. Water checks were carried out daily and records were maintained, which included sink, bathroom, and shower. The fridge & freezer checks were also carried out daily. The home is part of a larger campus. The electrical, environmental health, and the fire checks that were carried out for the entire premises of which, this home is a part. The manager informed on this inspection that, the various checks certificates were in the other office for supported living on the campus. However, the manager had arranged a photocopy of the Kidde fire protection services certificate of service and inspection dated 22/11/06 which, included include information Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 16 about quarterly service of fire alarm inspection and half yearly inspection and testing of emergency lighting system. The home was maintained clean and hygienic and there were no offensive odours. Orchard House DS0000033039.V323073.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): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must have staffs training plan in place and ensure that all the staffs have received all the mandatory training. Continuing inconsistencies in the information held on staff files calls into question the homes commitment to providing suitable staff to meet the needs of service users. EVIDENCE: Currently, the home had 1 fulltime community support worker, 2 part time night staff, 2 agency staff and for any additional staffing needs the home would seek agency staff. The manager had said that the home was in the process of recruiting new full time, part time and night staff and the human resources personnel may send out adverts by end of January 2007. On this inspection 5 staffs’ records were seen, of which 2 were agency staffs. Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 18 Staff – 1 was working as night care assistant since February 2006 and had received training in adult abuse & protection, first aid, medical awareness, autism awareness, food hygiene, basic fire awareness and had staff induction. Her supervision was carried out monthly dated 28/7/6, 31/8/6, 28/9/6, and 23/11/6. The other details maintained on her file included a photograph, employment history, CRB checks. The manager had informed that the references were kept at the head office. Staff-2 was working as a support worker joined in August 2006 as a fulltime staff and had received training in equality and cultural diversity, medical awareness, autism awareness, food hygiene awareness and staff induction. Supervision was carried out monthly on 30/8/6, 12/9/6, 3/10/6, 18/10/6 and 10/11/6. CRB and the 2 references were on the file. However, the manager said the staff contract was at the head office. Staff –3 was working as a part time staff and had received training in adult abuse and protection, epilepsy awareness, first aid, manual handling, medical awareness, equality and cultural diversity, health and safety and staff induction. Supervision was carried out on 24/6/6, 24/7/6, 27/8/06, 16/10/6 and the next one was scheduled for 11/12/6. The manager had said that the CRB, references, and staff contract documents were at the head office. Agency staff –1 the manager had said that the entire mandatory checks prior to employment were with the agency. Supervision was carried out on 01/09/06, 16/10/06, 09/11/06, and 07/12/06. Training received included first aid, moving and handling, medical awareness, and staff induction. Agency staff –2 was working 2 nights a week completed induction and the manager had said that all the records were at the agency office. The manager was told keep at least photocopies of staffs record at the home. The home must have staffs training plan in place and ensure that all the staffs have received all the mandatory training. Orchard House DS0000033039.V323073.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): 37, 39, 42 and 43 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. The home had made significant progress with regard the outstanding requirements and appears that it continued to make further progress. The manager and the staffs work as a team in the interest of service users’. EVIDENCE: The home had 16 various written policies and procedures. However, the policy on medication was under review and expected to be completed by the end of December 2006, the manager informed. The other policies and procedures were about anti bullying, medication awareness, POVA, on call protocol, staff dealing with inspection, missing person, sudden death, behaviour policy, local admission and discharge, comments complaints and compliments, managing absences, health and safety- injuries, diseases, dangerous assurance, near Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 20 miss accidents, property damage, loss and theft, using physical interventions, quality assurance and racial harassment. As part of the home’s quality assurance mechanism and process, the home had carried out an evaluation of the service; the respondents to the evaluation were service users’ who completed 99 forms’. The operations manager had summarised the analysis of feedback under general comments about what service users said they liked about the service, general comments about things service users didn’t like about their visit, general comments about how the home can make things better, evaluation and future course of action. This exercise was found to be useful, which not only appreciated the efforts and the good work being done by the home but also had some meaningful suggestions for further improvements in care delivery. Business and financial plan produced in may 2006 and that was expected to be reviewed in may 2007 was presented on this inspection. The plan needed to fill in gaps primarily in the area of performance indicators, budget spread and time line for implementations of specifics to achieve the overall aims and objectives of the home. Provider visit report of 10/04/06 was made available on this inspection. However, the visit report of 04/12/06 was yet to reach the manager of the home. The home must ensure that monthly-unannounced visits are carried out and are regular in accordance with regulation 26 of the Care Homes Regulations 2001. Orchard House DS0000033039.V323073.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 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 2 Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 Requirement The home must ensure that all service users’ contracts are concluded without further delay. (Previous timescale of 30.6.05 and 31/01/06 partially met). The home must ensure to keep all the information of all the staffs with regard to statutory checks and make available for inspection. (Previous timescale of 30.4.05 and 31/12/05 partially met). The home must ensure that care plans for all the service users’ are completed. (Previous timescales of 30/11/04, 30/6/05, and 31/01/06 partially met). The home must ensure that there is a training and development programme, (for all staff) which incorporates induction, mandatory, specialisttraining, and NVQ courses/qualifications. (Previous timescale of 30.4.05 and 31/12/05 partially met). The home must ensure to cover all elements of a business and DS0000033039.V323073.R01.S.doc Timescale for action 30/01/07 2. YA34 17 30/01/07 3. YA6 15 30/01/07 4. YA35 18 30/01/07 5. YA43 25 30/01/07 Orchard House Version 5.2 Page 23 6. YA39 26 financial plan for the home and the service. (Previous timescale of 30/4/05 and 31/01/06 partially met). The home must ensure that 30/01/07 monthly-unannounced visits are carried out and are on regular basis in accordance with regulation 26 of the Care Homes Regulations 2001. (Previous time scale 31/12/05 partially met). 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 YA20 Good Practice Recommendations The home should complete the consultations and finalise the medication policy, which would ensure that service users retain, administer and control their own medication where appropriate, and are protected by the homes policies and procedures for dealing with medicines. (Previous timescale 15/12/06) Orchard House DS0000033039.V323073.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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