Inspection on 31/05/05 for Orchard Leigh

This inspection was carried out on 31st May 2005.

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

Other inspections for this house

Orchard Leigh 22/11/06

Orchard Leigh 02/11/05

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 Glos GL51 0SN Lead Inspector Richard Leech Announced Tuesday 31 May 2005 09:30 st 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 Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Orchard Leigh Address Hayden Road Cheltenham Glos GL51 0SN 01452 - 525553 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) Graeme Barnell, Milbury Care Services Louise Ellis Care Home - Personal Care 8 Category(ies) of Learning Disability (8) registration, with number Learning Disability - over 65 (1) of places Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The manager must complete the Registered Manager`s Award by 31/12/05, or as soon as possible thereafter if there is an unavoidable delay. 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 is over the age of 65 years. Date of last inspection N/A Brief Description of the Service: Orchard Leigh was first registered in February 2005 as a care home for up to eight adults with learning disabilities. At the time of writing there were five residents, all of whom had transferred from a closing home in Tewkesbury run by the same organisation. The home provides eight spacious single rooms, each with en-suite facilities. Two of these are in self-contained flats, one of which is accessed by going outside of the main building. There is a kitchen-diner, a lounge, and a garden with some decking and seating. The home is situated on the edge of Cheltenham, and is close to shops, a supermarket, a pub and bus routes. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began at 09.30 and lasted until 18.15. During this time the inspector met all of the service users and talked with several of the staff. The manager and deputy manager were present throughout the inspection. Most of the building was toured and a variety of records checked including care plans, risk assessments and health notes. Comment cards were received from three service users, four family members and two health & social care professionals. The pharmacist inspector visited from 10.00 to 13.00 to look at medication storage and handling. Their findings are summarised in this report, and a more detailed letter was written to the manager of the home. What the service does well: The home has a good system for assessing the needs of people who might be moving in, and for making sure that the placement would be right for them. Care plans are well written. They include service users’ goals and promote people’s independence. Risk assessments are also clearly written and support service users to take part in activities and to develop their independence. Service users are able to make choices about their day-to-day lives. One person said, ‘it’s my choice when I go to bed’. Staff use pictures and symbols to communicate with service users who do not use the spoken word. There are opportunities for people to air their views, as well as any concerns and complaints they might have. Service users to take part in a variety of activities that they enjoy, and use facilities in the community such as a church. Service users also have opportunities to stay in close contact with family and friends. The food provided in the home is healthy and balanced. One person said, ‘the food is better than at Walnut [House]’. Service users have the help that they need with personal care and to stay in good health. Health and safety in the home is well organised. The building has been refurbished and redecorated to a high standard. All bedrooms are attractively decorated and have en-suite bathrooms and toilets. One person living in a flat said, ‘it’s better in my own flat…it’s nice’. Another service user who has a flat said it was more private. One person living in the main house described their bedroom as ‘nice’. Service users praised the staff. Comments included that they were ‘nice’, ‘very good’, ‘polite’ and that ‘they treat me just like an adult’. One person said that Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 6 it was a friendly home. Staff training and recruitment is well managed, helping to make sure that the team has the skills and qualities that they need. There are some good arrangements in place to help ensure service users always receive the medicines prescribed for them by their doctor and that these are stored safely. Staff have received some training to help them understand about medicines. Through comment cards three service users indicated that they liked living at Orchard Leigh, felt safe there and that the staff treated them well. Family members indicated that they were happy with the care provided. Comments included, ‘the house is so much brighter than the last’, ‘the accommodation is excellent’ and, ‘staff have been very helpful and friendly’. 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 Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 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 Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 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 Prospective service users and others involved in their care are provided with information they need about the home before making a decision to move in. The staged admissions process is thorough, helping to ensure that the home can meet a person’s needs and that the admission is appropriate. EVIDENCE: At the time the home was registered the Service Users Guide and Statement of Purpose were assessed as meeting the requirements of the Care Homes Regulations. Since then the manager has adapted the Service Users Guide to make it more accessible and personalised to each service user, including photographs and symbols. The manager described how service users were consulted about what should be in the Guide at a residents’ meeting. The manager talked through the admissions procedure. This includes filtering out inappropriate referrals at an early stage, gathering background material, conducting a needs assessment and offering visits and overnight stays to prospective residents. One person was coming to visit the home in July. The admissions procedure and criteria for admission are summarised in the Statement of Purpose. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, & 9 The standard of care planning is good, with service users’ goals, preferences and needs clearly reflected. Service users are supported to make appropriate decisions about their lives with support and encouragement from staff. Some issues around recording and administration of service users’ finances need resolving since clarity and accountability is compromised. Risk assessments are used to support service users to become more independent and to take up opportunities whilst remaining as safe as possible. EVIDENCE: Care planning files included personal details, background information and assessments. These were full, up to date and informative. Staff had signed to say that they had read and understood the care plans. ‘Individual support requirements’ provided guidance for staff about service users’ preferences for how they are supported, as well as notes on things to avoid. Files also included agreed goals and plans for how these would be reached. There was evidence of service users’ involvement in the care planning process, a person-centred approach and of regular review. Care plans placed a clear, individualised emphasis on promoting independent living skills and choices. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 10 Discussion with staff and service users, as well as the manager, indicated that there were areas where the team was respecting people’s choices whilst considering best interests and identified risks, particularly in respect of healthy eating, personal hygiene and independent living skills. There was evidence of consultation and agreement with service users and others involved in their care. These are issues which will require particular attention in reviews, but it appeared that an appropriate balance was being struck. Staff spoken with were able to talk through how choices were offered and made in everyday life, including with non-verbal service users. One person uses a communication book. This is gradually being expanded. There was evidence that service users are supported to access advocacy when necessary. Three service users’ financial records were checked. It was agreed that in two cases service users had been charged for things which the home should have paid for. They were refunded on the day of the inspection. The following recommendations are made regarding service users’ finances: • • • Ensure that staff members sign the records when making a transaction. Consider whether service users could be getting higher rates on interest on their savings, whilst bearing in mind the complexities involved in changing accounts. Verify with head office that service users are receiving their statutory personal expenses allowances (as well as any DLA mobility payments which they are entitled to keep), rather than assuming this to be the case. Keep separate records of DLA payments taken as a contribution towards transport (currently 50 ) of DLA in order to provide a clear audit trail of what this money is spent on. Ensure that the Service Users Guide and Statement of Purpose make it clear that 50 of DLA is expected as a contribution towards transport costs, and state what is provided for this charge. • • There was evidence that service users are being supported to take more control over their finances as far as possible. The manager said that the team was in the process of setting up a bank account for one service user whose money is currently administered through a complex arrangement with head office. This is welcomed since the current situation is unsatisfactory. There is no indication in the home of how much money the person has saved, and the manager understands that the person is not receiving interest on their money. Individual risk assessments appeared to cover appropriate areas in sufficient depth. There was evidence on file of regularly review. Risk management included staged approaches to becoming more independent. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 & 17. Activity programmes are individual and varied, and reflect people’s needs and interests. Service users are enabled to become part of the community and to maintain contact with family and friends. Service users’ rights are respected and support provided to help them meet their day to day responsibilities. Varied and balanced food is provided and service users enjoy their mealtimes. EVIDENCE: Service users spoken with expressed satisfaction with their activities. Some talked through their programmes displayed in symbol form in their rooms. These included a variety of college courses. Residents are also taking advantage of local facilities and services such as nearby shops, a church and public transport links. Care plans provided evidence of the team supporting people to access facilities more independently where possible. On the day of the inspection three service users went on a trip to the Forest of Dean. In the evening there was a visit to a local pub. The manager described how, as much Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 12 as possible, service users were being supported and encouraged to go to banks and post offices to take more control over their financial affairs. One person described a recent holiday to Dublin. This year the service users are going to in two groups to Spain. The manager said that they had agreed this in a residents’ meeting. One person who does not communicate verbally smiled broadly when the manager talked about holiday plans with them. One person said that they were getting bored with going bowling every week, though expressed general satisfaction with their activities. The home has one seven-seater vehicle. The manager described how it was unsuitable since some service users find it quite difficult to get in and out. She, along with staff spoken with, had understood that the home would be provided with a second vehicle or, preferably, two smaller vehicles instead of the sevenseater. To date this has not happened. This should be addressed, particularly given that the home is likely to fill vacancies in the near future. Discussion with service users and the manager, along with records, provided evidence of the team supporting residents to have regular contact with family and friends. Where more difficult situations had arisen there was evidence that appropriate measures had been taken and advice sought. Care plans included people’s preferred form of address. There was evidence that people are supported to use keys to their rooms and the front door. Service users described their involvement in household tasks and expressed general satisfaction with the arrangements. Staff talked through how they supported service users and promoted independence in these areas whilst taking into account people’s wishes around the nature of support. For example, one person has asked that staff do not ‘nag’. Clearly there are complex and subtle balances to be struck in this area which need to be regularly reviewed. External reviews led by placing authorities made reference to the progress that some people had made in developing their independent living skills. Service users spoken with made generally positive comments about the food served in the home. Menus provided evidence of variety and balance and some staff commented that service users’ diets were more healthy than in the past. The manager described the balance between encouraging healthy eating whilst respecting people’s rights to make less healthy choices. Staff and service users confirmed that alternatives are offered to accommodate individual preferences. There are regular opportunities built into activity programmes for service users to cook meals and/or go out for lunch and choose what they like. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Personal care is provided in a way which respects service users’ preferences and promotes their independence. Service users are supported to access the healthcare services that they need. Medicines are generally safely managed in the home with procedures and staff training in place. Some more attention to detail is needed to ensure the systems and records necessary to demonstrate the correct use of medicines are available. EVIDENCE: Service users’ care plans included information about the way each person preferred to be supported, as well as promoting their independence. One person has a particular condition which makes them prone to feeling very tired. The manager explained how regular breaks and sleeps are built into their programme. One person prefers female support for personal care. The manager said that this was consistently achieved. Healthcare records provided evidence that service users were being supported to access relevant routine and specialist services according to their needs. Notes of appointments and outcomes were detailed and well organised. A comment card from a GP indicated that service users were regularly late for Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 14 appointments. The manager agreed that this was the case and said that she was reminding staff to leave for appointments earlier. Staff have undertaken some external training about the medicine administration system used and in-house assessments are undertaken. Additional accredited training in the Safe Handling of Medicines would benefit staff by provision of greater understanding about the medicines handled and all the issues to consider that help ensure the wellbeing of service users. Storage for external medicines needs reviewing for security and to ensure segregation from internal medicines. Receipt records for some medicines in the home had not been completed thus there is not always a complete audit trail. Regular audits need to be conducted to show correct use of medicines and staff competence in administration and recording of medicines. Dating all medicine containers (except the monitored dose system (MDS) blister packs) assists in this simple process. The Medication Administration Record (MAR) charts in use did not always contain details of any currently prescribed and stocked medicine that may be administered to service users. Handwritten changes must be signed and countersigned for accuracy. The boxes to record allergies and doctor need completion. Plans must be recorded for any ‘as required’ medicine to ensure consistent use for the benefit of the service user as intended by the doctor. A record of service users’ consent to medication should be made in the care plans. A comprehensive medicine policy is in place but must contain specific local information and procedures for this home. The manager must be aware of the guidelines from the Royal Pharmaceutical Society of Great Britain and use these to inform safe practice in the home. An up to date edition of the British National Formulary is recommended as an authoritative medicine reference source. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users have opportunities to raise concerns and complaints and are confident that they will be listened to. EVIDENCE: The home a complaints procedure which includes reference to CSCI. Service users spoken with indicated that they would feel comfortable raising something that they were not happy with through their key worker, other staff or the manager. They expressed confidence that they would be listened to and that action would be taken to resolve the issue. Further evidence of this came from service users’ comment cards. Staff spoken with described how service users communicated dissatisfaction and unhappiness. There are regular residents’ meetings which provide people with the opportunity to raise and discuss issues and concerns if they wish. These are written up with pictures and symbols as part of the minutes. A letter was received by the manager which was interpreted as a complaint. This has been passed to head office. The inspector has written for information about the outcome of this. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 28 & 30 Orchard Leigh is spacious, comfortable and homely. Renovation has been completed to a high standard, although some further adaptations and modifications are needed. Service users are happy with their rooms and are able to personalise them as they wish. The home is clean, fresh and hygienic. EVIDENCE: Communal areas of the home were bright, comfortable and attractively decorated. Service users’ artwork was on display. There is a garden with an area of decking and seating. Service users were seen using this and talking/relaxing with staff. Bedrooms are all en-suite and are clean, well decorated and personalised. Service users spoken with indicated that they were happy with their bedrooms or flats. The manager said that an Occupational Therapist was working with the team to establish what further aids and adaptations needed to be fitted around the home. This will include dong some work to adapt individual en-suites to people’s needs, and making the front door more easily accessible. This work will need to be completed at the earliest opportunity in order to make the environment as safe as possible for each service user. It is accepted that there are inevitably some teething problems with a new environment. However, the Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 17 overall quality of the building and décor is very high and the team has been proactive in taking steps to address any work identified as necessary. The home appeared to be clean and hygienic throughout. There is a daily tasks sheet which includes cleaning. The fridge was clean and a record of kept of temperatures for this unit and the freezer. There are soap dispensers and paper towels in appropriate locations. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 18 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) 33, 34 & 35. Staffing levels are good, enabling the team to meet people’s needs in an individual way. Recruitment procedures are thorough, reducing the likelihood of unsuitable workers being taken on. There is a commitment to training, helping to ensure that staff are skilled and competent, and that they feel valued. EVIDENCE: A photo rota was on display to help service users to know who would be on duty. The manager, along with carers spoken with, felt that staffing levels were sufficient to meet current service users’ needs. Two people are on shift at night. Before the inspection the manager had contacted CSCI to check whether they could revert to just having one person at night as had been the case in the previous home. On the basis of the manager’s proposal this was agreed as reasonable, on condition of regular review, particularly when new service users moved in or an existing resident’s needs changed. Three staff files were sampled. These included all required documentation. A risk assessment had been used for a staff member taken on with a PoVA-First check and with a CRB pending. This referred to the person not doing personal care. It was suggested that it could also specify other areas of work which the person would not undertake until they had full clearance, such as dealing with medication and money. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 19 Selected training records provided evidence that staff were up to date with core training, or that this was booked for the near future. Staff are undertaking LDAF accredited induction training through distance learning with in-house mentor support. Staff receive training in non-violent crisis intervention, which is a form of challenging behaviour training which the Commission understands to be BILD accredited. Some training has been provided in areas such as communication, mental health, health & safety, adult protection, continence management and risk assessment. Staff spoken with felt that their induction programmes had been thorough. According to the pre-inspection questionnaire 3 staff are working towards NVQ level 2 in care and 40 of care staff are qualified to this level. The manager said that senior staff have received training in conducting supervision and appraisal and that they would now take on the role of supervising care workers. Service users spoken with were positive about the staff team. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 20 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 & 42 Orchard Leigh is well run in all areas, promoting service users’ happiness and wellbeing. The home is a safe place to live and work. EVIDENCE: The manager is a qualified nurse with around 20 years’ experience of working with people with learning disabilities, and has a BA in health and social studies. She has begun the Registered Manager’s Award but is in the process of transferring training provider. There is a condition of registration about this being completed by 31/12/05. Once completed it is anticipated that this standard will be met. Staff spoken with indicated that the home was well run. There was evidence of this throughout the inspection. Records of monthly Regulation 26 visits by representatives of the provider are being forwarded to CSCI. These are thorough and informative. In the action plan following the inspection it was confirmed that service users are asked if they are happy for their name to be on the report or if they would rather supply feedback anonymously. The format could be extended to include an Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 21 ‘actions agreed’ section to provide a mechanism for issues to taken forward and revisited. Records provided evidence that routine health and safety checks were being undertaken, including testing fire alarms and emergency lighting at suitable intervals. Hazardous chemicals were locked away. The manager said that, unknown to the team, the sprinkler system in one service user’s flat had not been rendered operational. She said that this had now been done. The manager said that in the same flat the lock has been changed so that staff can gain access even if the person has left their key in the other side. One service user living in a flat described what they would do if they heard the fire alarm and pointed out the fire procedure on their wall. They said they might tackle a fire with an extinguisher if it were small. This point may need further exploration, perhaps through their keyworker. Not all staff were aware of an incident when a service user had been physically aggressive towards a team member, suggesting that there might have been an oversight with communication in this instance. The records of this incident could not be located on the day of the inspection. Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 22 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 x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Orchard Leigh Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 3 x D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 23 N/A 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 7 Regulation 17 (2). Sch. 4 (9). 20 (1). Requirement Make appropriate arrangements for one service user whose finances are held and administered through head office to have a clear record of all of their money in the home, access at all times required and to be given any interest due to them. All external medicines to be stored securely and segregated from those for internal use. Records to be kept for receipt and disposal of all medicines received into the home. Full directions and administration records to be documented on the MAR chart for any prescribed medicine. Written plans to be in place for 01/07/05 the use of any medicine prescribed ‘as required’. Handwritten changes on the MAR charts to be signed by authorised staff and countersigned as a check for correct transcription. Regular audits to be conducted 01/08/05 to demonstrate correct use of Version 1.30 Page 24 Timescale for action 31/07/05 2. 20 13 (2). 17 (1). 20/06/05 3. 20 13 (2). 17 (1). 4. 20 13 (2) Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc medicines and staff competence in administration and recording of medicines. The medication policy and procedures to be reviewed so as to include specific local information and procedures. All staff handling and administering medication to receive additional accredited training in the safe handling of medicines. Fit all necesssary aids and adaptations and undertake all necessary modifications to the building in order to make the environment as safe as possible, continuing to consult with external professionals as required. 5. 20 18 (1) 01/09/05 6. 24 13 (4). 23 (2) a & n. 30/09/05 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 7 Good Practice Recommendations Implement the recommendations made about service users financies as listed in the bullet points in Individual Needs and Choices section. Ensure that all staff are clear about which items are paid for by service users and which come from the homes budget. Proceed with opening bank accounts for service users currently without them. Once achieved, provide support for them to manage their accounts locally rather than through head office. 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. Check that service users are happy to go bowling each Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 25 2. 12 3. 4. 19 20 week or whether there are other leisure activities that they would rather do regularly or occasionally. Take steps to ensure that service users arrive for their appointments with the GP on time. All containers of medicines (other than those supplied in the MDS blisters) to be dated on opening. The GP name and allergy boxes on the MAR charts to be completed. Service users consent to medication to be obtained and recorded in the individual plan. An up to date edition of the British National Formulary to be kept in the home. In risk assessments for staff working with just PoVA First clearance specify all broad areas of work which the person would not undertake until full clearance is received. The format of Regulation 26 reports could be extended to include an actions agreed section to provide a mechanism for issues to taken forward and revisited. Clarify service users understanding of the fire procedure and the use of fire extinguishers, particularly for people living in the flats. Review communication systems to ensure that staff will always be made aware of relevant information as early as possible, such as about incidents of agression. 5. 6. 7. 34 39 42 Orchard Leigh D51_D03_S62769_OrchardLeigh_V222358_310505_Stage4.doc Version 1.30 Page 26 Commission for Social Care Inspection 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. 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