Inspection on 02/11/05 for Orchard Leigh

This inspection was carried out on 2nd November 2005.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard Leigh 22/11/06

Orchard Leigh 31/05/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Orchard Leigh Hayden Road Cheltenham Gloucestershire GL51 0SN Lead Inspector Kath Houson Unannounced Inspection 2nd November 2005 10:30 Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Orchard Leigh Address Hayden Road Cheltenham Gloucestershire GL51 0SN 01242 523848 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) Milbury Care Services To be Appointed Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1) of places Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide care and accommodation for up to eight service users with a learning disability, but may also accommodate service users with associated physical disabilities and sensory impairments provided that their primary needs relate to learning disability. One named service user accommodated who is over the age of 65 years. 31st May 2005 2. Date of last inspection Brief Description of the Service: Orchard Leigh is a care home for up to eight adults with learning disabilities. The home provides eight spacious single rooms, each with en-suite facilities. The house is detached with two floors; there is no lift available as the staircase is too narrow. The home is situated on the edge of Cheltenham, with easy access and is close to shops, to a supermarket, a pub and bus routes. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place one morning in November 2005. The acting manager was available throughout the inspection and able to assist and provide all relevant documentation on request. Twenty-four of the core standards were assessed and included an examination of documentation; three residents’ records were case tracked, a short and informal discussion was conducted with residents’ and staff team, a tour of the environment and a short succinct feedback was given to conclude the inspection visit. What the service does well: What has improved since the last inspection? Many issues were addressed since the last inspection: • The storage and administration of medication has improved • Appropriate arrangements has now been made for one service user to have a bank account in which clear record of all transaction is documented. • Staff are clear about which items are paid for by service users and which come from the home’s budget • The range of activities has become more creative to include, aromatherapy, college courses, pantomimes, water sports to name a few. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 6 • Steps have now been taken to ensure that service users arrive on time for GP appointments by arriving a few minuets earlier than set appointment. 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 Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 the following standard(s): 3,4,and 5 Service users benefit from updated information that reflect the home EVIDENCE: The acting manager is aware that all admissions into the home must comply with the category that the home is registered. A request for a minor variation category will need to be submitted for the named service user. The home has a good admissions procedure to ensure that residents sample Orchard Leigh and what the home has to offer prior to permanent residency. Information gathering, needs assessments and offering overnight visits are part of the admissions procedure, and are coordinated by the acting manager. The home has a good working partnership with families’ representatives, advocates and other professionals to ensure that all service users are supported. The service user guide is currently being updated to reflect staff changes and to incorporate the requirements set out in the regulations. Each SU guide will need to include terms and conditions. Service users currently have terms and conditions but these are being updated and will be included in the revised service guides. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 9 Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 the following standard(s): 7, 8,and 9 Residents’ were supported to take risks as part of living an independent lifestyle. EVIDENCE: All residents’ are given the opportunity to choose their key worker and are encouraged to participate in exercising their independent life skills. Photographs of the staff team are openly displayed on the wall close to the entrance door service users can see who is on duty and the care plans are discussed with the manager, staff member and service user. Two of the service users were encouraged to cook their own meals and do their own shopping with assistance. The staff team are available and provide support when required promoting independent living and facilitate confidence security for residents living in the flats. The residents’ were additionally encouraged to participate in all aspects of the home and was evident in the documentation of the residents’ meeting. The minutes were made available on request. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 11 A wide variety of activities are made available to all service users, and are appropriate to individual need such as the snoozelum sessions of benefit to non-verbal sensory challenged resident. Other activities are culturally and peer appropriate. Service user said, “I go to the gym, and go to the nursing home and talk to the old ladies” this encourages socialisation and the making of new friends outside the home thus promoting independence. A member of staff also added “ I take note of the body language of the service user.” This is a good indicator that the care team take note of the service users’ who are non-verbal. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 the following standard(s): 12, and 14, Residents’ are encouraged to lead full and independent lifestyle and have the opportunity for personal development. EVIDENCE: Residents’ participate in a variety of cultural and peer activities that consist of a mixture of educational and leisure programs, such as aromatherapy, pantomimes water sports and college courses. The care staff assist residents’ with finance and budget planning to ensure that independent living runs smoothly. One service user’s documentation for her finance was recorded clearly to show income and expenditure. Two of the service users’ live and function independently within their own flats with support from the care staff. Each is encouraged to attend day centres and join in the wide range of activities and fully engage in social integration of community life. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 13 One service user stated that “I like my flat very much I enjoy living here, I have good support ” Another service user said, “I like my room” Consideration is to be given to seek an alternative to the 7- seater vehicle and replace with two smaller accessible vehicles this item is under discussion and will be monitored at the next inspection. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 the following standard(s): 20 Residents’ benefit from an improving organised system for medication. EVIDENCE: Although some requirements from the last inspection were met there remain some minor shortfalls. The immediate requirements from the last inspection conducted by the pharmacist were met. However there are still some improvements to be made in order to fully reach the standard. All staff members are trained to administer medication. The acting manager has tightened up the medication procedure to include a new plan for when residents’ are on weekend stays to show that medication was administered whilst at home. Documentation demonstrated that records kept for receipt for the arrival and return of medication into the home reflects good practice. Additionally internal and external medication was stored separately. Written plans were in place for the use of PRN medication. Medication, other than those supplied in blister packs now show date of opening. The name of the General Practitioner is now on all residents’ MAR sheets with evidence of any allergies known. A recent copy of the British National Formulary has been purchased. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 15 Evidence of any handwritten changes to the MAR sheets was signed, with regular audit trial to demonstrate correct use of medicines and staff competences. The minor shortfalls outstanding from the previous pharmacy inspection are as follows and will be made a recommendation: The medication policy and procedure is to be reviewed to include specific local information and procedures. The service users’ consent to medication to be obtained and recorded in individual care plans. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 the following standard(s): 22 and 23 There is a complaints procedure that meets the National Minimum Standard and Regulations. EVIDENCE: The home has received a number of compliments that would reflect the standard of care that is being maintained. The home received its last complaint in December 2004 would reflect that good standard of care the service users receive on a daily basis. There are regular residents meetings that provide the opportunity to raise any concerns. The minutes are written with pictures and symbols format for those who are non-verbal. All staff members are trained in whistle blowing procedures and were able to share information during an informal discussion. Service users, benefit from a concerns and complaints procedure, in which the care staff was aware and able to access information. The care staff is responsive of the needs of the service users and were able to provide care at a satisfactory standard. This was evident in the manner in which staff addressed the service users with respect, the working knowledge the staff have of the service users and the commitment from the staff that was displayed as an inclusive approach an example was during meal times lunch was very informal and relaxed. In addition a staff member said “ I enjoy working and very much part of the family as well as being a key worker I am aware of needs and the progression of the service user” Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 the following standard(s): 24; 25,26,27,28,29,30. The residents live in a homely comfortable and safe environment that maximises their independence. EVIDENCE: The home has two flats that from part of the home but the residents live separately from the home. The flats have been risked assessed and smoke alarms fitted with sprinkler system installed. The communal areas of the home are homely comfortable and attractively decorated. Cleaning and maintenance programme insitu to ensure general upkeep of the home is maintained. All bedrooms were decorated with service users work on display; rooms were additionally personalised to reflect individuality and personal taste. The home is clean and hygienic throughout. Daily task sheets were signed and the fridge/freezer contents were clean with records kept of temperature gauges. There are still some environmental requirements yet to complete such as an adaptations at the front door making it more accessible to all service users. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 18 The hot water tap in the little sink in the kitchen becomes very hot. A safety sign will need to be put in place to ensure protection for both staff and service users. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 and 36 Service users benefit from competent qualified skilled staff. EVIDENCE: The staff have in care some specialist training in Mental Health and all the staff team have completed their basic mandatory training. The staff are currently undertaking LDAF accredited training via distance learning and mentor support in which regular supervision sessions are arranged. The care provider is additionally developing and organising a new training programme and will arrange a training matrix that will update and identify those staff members that require refresher courses. All staff handling medications are now trained with an accredited trainer to administer medications this training was completed in October 2005. The staff numbers have decreased due to staff changes occurring at a rapid rate. Procedures for recruitment are in place and will be increasing staff numbers to fall in line with new admissions into the home. Comments from residents are that they “like the staff very much and that they are good” Service users were addressed with respect by staff members. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 20 The staff commented that they “enjoyed working at the home supporting the service users” The acting manager operates a thorough recruitment procedure based on equal opportunities to ensure the protection of service users. Newly recruited staff files were examined; references, CRBs and full employment histories were discussed. The staff went onto say “like working with Service Users (SU’s) very much, it’s a nice place to work” Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 40,41 and 42 The home has its policies and procedures in place to safeguard the service users rights and protection within a safe environment. EVIDENCE: The current acting manager is an experienced care manager with a keen interest in providing a good standard of care for service users. He has begun the Registered Managers Award (RMA) that he aims to complete next April 2006 once this is completed he will study for the NVQ level 4. The acting manager has been in post a short while and is seeking to become the registered manager for the home. He is presently putting his systems in place such as improving channels of communication within the home and amongst the staff. It is apparent from discussion with staff members and with the acting manager the team is aware of the service users needs and seem committed to providing good standard of care. The home has a range of policies and procedures, which were easily accessible. Documentation of health and safety to ensure that home continues to be a safe Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 22 environment. Regular fire and safety checks were documented. Health and safety issues were dealt with in particular to a service user was risk assessed to have a sprinkler system put in place, this task has been completed. Regular monthly recording of Regulation 26 visits have been forwarded to the Commission of Social Care Inspection (CSCI) these are thorough and informative. The acting manager said that he intends to resume senior staff meeting to ensure that information is shared with all staff members. The manger is aware that communication systems between staff is poor and aims to ensure that relevant information such as aggression from service users is shared in the first instance. Supervision arrangements for all staff members occur two supervision sessions every eight weeks. There was an established schedule for the acting manager which is another example of implementing a new system to brief staff on issues that relate to the home, this would link with the development of stronger communication methods between service users and staff team and the development of good practice. Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 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 X X 3 3 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Orchard Leigh Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X X 2 3 3 X DS0000062769.V260075.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? Yes YA24-13 (4) 23 (2) a & n. 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 YA24YA7 Regulation 13 (4) 23 (2) a & n Requirement Fit all necessary aids and adaptations and undertake all necessary modifications to building in order to make the environment as safe as possible continuing to consult with external professionals as required (Previous timescale of 30/09/05 not met) Timescale for action 01/03/06 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 YA12 Good Practice Recommendations Provide a second vehicle. Consideration should also be given to whether it would be appropriate to replace the seven-seater with a smaller, more accessible vehicle. (Highlighted from previous inspection) The format of Regulation 26 reports could be extended to include actions agreed section to provide a mechanism for issues to be taken forward and revisited. Review communication systems to ensure that staff will always be made aware of relevant information as early as possible, such as about incidents of aggression. DS0000062769.V260075.R01.S.doc Version 5.0 Page 25 2. 3. YA39 YA42 Orchard Leigh YA20 4. Two examples were found from the last pharmaceutical inspection of incorrect dosage directions on the medication regimes pages written by the home, this will need to be rewritten to read the correct dosage for prescribed medication Service user’s consent to medication to be obtained and recorded in the individual plan. The medication policy and procedure is to be reviewed to include specific local information and procedures (highlighted from the previous pharmacy inspection which has not been met procedure be forwarded to CSCI) 5. 6. YA20 YA20 Orchard Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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 Leigh DS0000062769.V260075.R01.S.doc Version 5.0 Page 27 - 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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