Inspection on 18/03/08 for Orchard Lodge

This inspection was carried out on 18th March 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard Lodge 07/03/07

Orchard Lodge 06/02/06

Orchard Lodge 09/06/05

Orchard Lodge 24/02/05

Orchard Lodge 21/09/04

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

CARE HOME ADULTS 18-65 Orchard Lodge Dorking Road Warnham Horsham West Sussex RH12 3RZ Lead Inspector Mark Sims Key Unannounced Inspection 18th March 2008 09:30 18/03/08 Orchard Lodge DS0000024192.V359397.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 Lodge DS0000024192.V359397.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 Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Lodge Address Dorking Road Warnham Horsham West Sussex RH12 3RZ 01403 242278 01403 754392 orchardlodge@sussexhealthcare.org sussexhealthcare.org Dr Shafik Hussien Sachedina Mr Shiraz Boghani Mrs Pamela Stuart Care Home 23 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) Category(ies) of Learning disability (23), Learning disability over registration, with number 65 years of age (1) of places Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One person over the age of 65 years may be accommodated Only persons under the age of 65 years may be admitted. Date of last inspection Brief Description of the Service: Orchard Lodge is a care home registered to accommodate twenty-three service users between the ages of eighteen and sixty-five and one person over sixtyfive years of age. The category of registration is learning disability (LD) to include nursing care. Orchard Lodge is in a rural setting near the village of Warnham. The establishment is part of the Sussex Health Care Group and is situated adjacent to the building occupied by the main administrative offices. The care home was purpose built and is on the ground floor of a two-storey building. There are two separate units connected by a covered walkway. The first floor is used for staff accommodation and has a separate entrance. There are twenty-three single rooms with en-suite facilities. There is a communal lounge and dining room in each part of the building. The dining room in the east wing is also used as an activities room. There is a kitchen in both buildings; all meals are prepared and cooked in the east wing. There is a spa pool and sensory room available to service users. The registered proprietors are Dr S Sachedina and Mr S Boghani. Mrs P Stuart is the registered manager responsible for the day-to-day running of the home. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over six hours, where, in addition to any paperwork that required reviewing, we (the Commission for Social Care Inspection) met staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment information provided by the service provider/manager. The response to the Commission’s surveys was good, with two service user, five relative or carer and three professional surveys returned, prior to the report being written. What the service does well: What has improved since the last inspection? No requirements or recommendations were made as a result of the last inspection. The service, however, inform us, via their AQAA that they have made improvements to the service provided by: ‘ Introducing Health Assessments, Health Action Plans, Person Centred Care Plans, Gold Standard Framework Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 6 Advanced Care Plans, Sussex Health Care – Care Governance Incident Auditing System: won a Hospitality Awards and purchased a new vehicle’. New brochure documentation has been produced and provided to the service, this was seen during the fieldwork visit. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard Lodge DS0000024192.V359397.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 Lodge DS0000024192.V359397.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 2: People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: The service tell us, via their AQAA, that ‘Prospective service users will be assessed using the corporate pre-admission assessment forms. A meeting is arranged with the service user’s keyworker, care manager or relative, by the registered manager of the home to establish and document the care needs of the service user. A visit to the home is encouraged and a DVD, on the service is offered, transition visits are then arranged to trail the home’. During the fieldwork visit the manager produced a copy of a recently completed pre-admission assessment, the tool used was based on a modified ‘Activities of Daily Living’ (ADL) model and contained input from the manager and a Physiotherapist employed by ‘Sussex Health Care’. The information contained within the assessment document was detailed and summarised the input of the ward staff, Speech and Language Therapist (SALT) and a hospital based Physiotherapist. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 9 Prior to this assessment the last person admitted to the home had arrived in the February of 2007, details of their assessment remains on their ‘service user plan’. Information taken from the service user and relative surveys indicate that people were consulted about moving into the home prior to accepting the offer of accommodation and that ‘usually’ people are provided with sufficient information when making decisions about the care home. The service provider has produced a series of brochure style documents, which are made available to people when visiting the home, which are accessible within the main reception hallway. A number of these documents were read during the fieldwork visit and found to provide an overview of the company and the home. The manager stated during conversation that she always takes copies of the services brochure and/or ‘service users guide’, when she visits people preadmission and that she also provides them with a copy of a DVD, which tells them about the service and facilities provided, copies of the DVD were seen in the manager’s office. The company also has a website, which people can visit for further information about the service’s offered by Sussex Health Care, details of the web address are contained on the back page of the brochure documents. Orchard Lodge DS0000024192.V359397.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 6,7 & 9: Individuals are involved in making decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: The service tells us, via their AQAA, that they: ‘have a well-developed system of planning and reviewing care. We have developed our own person centred plans for each service user, ensuring that each need is met within a risk management policy; and involves the service users, their relatives/representatives and the multidisciplinary team in decisions that affect their daily lives’. Three ‘person centred plans’ were reviewed during the fieldwork visit. The plans were based on a modified ADL model and each section required the view of the person being assessed to be clearly documented. ‘Makaton’ picture grams having been included alongside the written text to improve the service users’ involvement with the process. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 11 The ‘person centred plans’ and the pre-admission assessment tool are designed to dovetail, ensuring easy transference of information from the assessment into the plan of care/support. It was evident on reading through the ‘person centred plans’ that the often complex and challenging needs of the service users are identified and documented and that reviews are regularly undertaken. The reviews including, general reviews, keyworker reviews, Physiotherapy and Occupational Therapy reviews and activities reviews. Information taken from the service user and relative surveys indicate that people feel they are supported to live the lifestyle they choose and that the home provide the support and/or care expected or agreed upon. Observations established that the information contained within the ‘person centred plans’ and the daily activities people undertake and/or are involved with correspond, with one person’s plan indicating that they went riding on the day of the visit and that person was observed returning to the home following their riding lesson/session. The indication from those service users to have completed and returned surveys is that they are enabled and encouraged to make decisions for themselves, where and when possible. This was best illustrated whilst observing people participating in activities, with people involved in a number of different projects, including colouring or art work, using the computer to send and receive emails, using the sensory room to relax and rest or percussion instruments to create audio sounds that stimulated. People were also involved in making meal choices, both at breakfast and lunchtime, with details of the daily menu on display outside the kitchen; the menu is in a picture format. The service states, via their AQAA, that: ‘our service users are involved with the service users meetings, bringing choice to their care plans and opportunities to discuss and involve them in the daily running of the home and any changes’. In discussion with a service user the role of the keyworker was explored, with the person saying that their keyworker supports them in undertaking activities both internally and externally, the external support including shopping for clothes and going on outings, the shopping apparently a popular option as the person spoken with likes clothes. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 12 Service users are also involved in the development of their ‘person centred plans’, as mentioned above, this providing further evidence of the service’s wish to promote independence and independent decision making were possible. Risks are present in the day-to-day lives and activities that people opt to become involved in, however, these are considered as part of the ‘person centred planning’ process, with risk assessments and plans to manage risks seen during the fieldwork visit, although some assessments required reviewing. The majority of the risk assessments focused on the physical health care needs of the service users and the use of aids to prevent or reduce the potential for injury, bedrails, lap-straps (in wheelchairs), etc. The service was noticed to employ or use listening device’s, which are used to monitor people in their bedrooms, the manager stating that this is primarily used to monitor clients known to suffer from seizures, as it alerts the staff to changes in their condition. However, these devises also pick up every other sound produced by the service user, which impacts on their right to privacy and the promotion of dignity. Also the use and/or purpose of the device was not documented with the risk assessments and so staff had not been prompted towards considering alternative monitoring devises, such as seizure alarms, this was discussed with the manager. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16 & 17: People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: The service tell us, via their AQAA, that: ‘our activities co-ordinator plans the in-house activities for each day: arts and crafts, computer work, cooking and the organisation of the entertainers who come to the home. He also plans the community outings such as: swimming, theatre, riding for the disabled, cinema, bowling, ice skating, pub & restaurant visits, shopping trips, holidays, ice-shows, pantomimes, College outreach classes and Day Centre visits, our service users can choose whether they wish to participate or not’. The AQAA also states that: ‘Aromatherapy, reflexology, support to visit the gateway club and local churches is provided’. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 14 During the fieldwork visit time was spent talking to the activities co-ordinator who produced a range of records to support the work undertaken with the service users, these including pictorial records in the form of photo albums, collages and computerised displays, as mentioned earlier. The co-ordinator, also maintains written accounts of the activities undertaken and has placed a map on the wall of the activities room/lounge, which documents the places people have visited. The co-ordinator is also keen on involving the service users in celebrating special occasions and on arriving at the home we (the Commission), found the activities room/lounge decorated for ‘St Patrick’s Day’, photo’s of the day’s events were also seen on the computerised display. The activities room is well appointed and the home provides people with access to a wide range of entertainment tools, games, computer (which is linked to the internet, each service user has a unique email address), sensory room, percussion equipment, televisions, music systems, etc. Around the activities room/lounge, were billing posters for the acts or entertainers that visit the home and again there are photos to document the performances and the service users’ involvement in these events, at the recent ‘St Patrick’s Day’ event an Irish group provided the evenings entertainment. In discussion with one service user it was ascertained that they enjoyed the opportunity to keep busy and appreciated the range of activities available. People were also observed participating in a variety of activities during the visit, as well as being seen returning from their ‘riding for the disabled’ event. The indication from the service users surveys is that both parties feel they have choice over their day-to-day activities, although one person did state that ‘sometimes I want to go out more at weekends but I have to share outings with my friends’. The service does provide transport for the service users, with two vehicles currently owned by the home, although the manager stated she is hoping to increase this to three vehicles shortly, as she is in negotiations to purchase another car. A small fee is charged to cover petrol costs, which is documented and charged according to usage, i.e. the more miles travelled the higher the cost, although this only covers social events and not visits to health care appointments, etc. The photographs maintained by the activities co-ordinator provide a good indication and/or record of the involvement of families, friends and representatives in the lives of the service users, with people captured on camera at a number of annual events arranged by the home. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 15 The service users also receive regular visits from family and friends, as evidenced by the visitor’s book, which people were seen signing during the visit and which provided a record of the number of people to have visit the home recently. As mentioned above, the service users are provided with an individual email address, which they can use or be supported to use to keep in touch with family and friends. The service user spoken with at length during the fieldwork visit showed us (the Commission) a copy of an email they had received from a relative, which related to photos they had shared following a recent outing. The indication from the relatives to return surveys is that generally the home supports service users to keep in touch with them, three people ticking ‘always’, one usually and one person not addressing the question, ‘does the care home help your friend or relative to keep in touch with you’. The service also state, via their AQAA, that: ‘visitors, friends and relatives are encouraged to visit often, we support those people wishing to visit and spend time at home’. People are, where, possible supported to exercise their rights to selfdetermination, independence, dignity and privacy, although due to the often complex nature of their health care/support needs, their ability to influence these decisions, etc can be limited. However, people are involved in making a range of choices, activities, menus, holiday destinations, room décor and layout, rising and retiring times, people they wish to socialise with, etc. Where limitations are placed on peoples right to free movement, etc, these are largely addressed via the services risk management process, although as mentioned above the use of the listening devises for people with epilepsy needs reviewing. Privacy, especially during the delivery of personal care/support, within the home is assured, as all bedrooms are single rooms, the majority offering ensuite facilities. Communal bathing or toileting amenities are spacious and each is fitted with an appropriate lock, which can be opened from outside in the case of emergencies. All records, as mentioned, involve input from the service user or their next-ofkin/representative and residents meetings provide people with an opportunity to discuss issues that concern them. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 16 The service’s brochure or ‘service user guide’ documentation also states that: ‘service users have the right to live as normal a life as possible and to have the respect of those who support them’. The service tells us, via their AQAA that: ‘Menu’s are produced in both a picture format and written format’, a statement verified during the fieldwork visit. During the visit the manager accompanied us on a tour around the premise, which included a visit to the kitchen. The manager stated during this time that the home had been awarded a hospitality award in 2007 for their catering arrangements, a statement support via the company’s brochure documentation, which advertises the home’s achievement in gaining the award. Whilst visiting the kitchen the chef on duty discussed how the menus are generated and that presently the menus are being revised and revamped to reflect seasonal changes in produce. Whilst the food provided did indeed look appetising, it was disappointing to discover that the service users have no direct input into the menu production and that the manager and the catering staff are the primary people involved in determining the foods to be included, although the chef did confirm that people’s known preference and/or dislikes were considered. Observations during breakfast and lunchtime, establish that mealtimes are social occasions and that sufficient staff are around to support the service users eat their meals. The catering staff were also aware of how meals should be served and presented and soft/liquidised meals looked appealing and were well presented. The observations also suggested that the people eating the meals were enjoying what they were served, as people required little or no prompting to eat their food. Food stores and records seen during the visit were good and/or appropriately maintained, with records of the food served available for review. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 & 20: The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The service users are provided with ‘person centred plans’, which as discussed earlier within the report, require the service user to provide input, where possible. The three ‘person centred plans’ seen during the fieldwork visit provided staff with good levels of information, which did indeed include details of how the service user wished to be supported. Each service user is allocated a keyworker and it is understood from discussions with the manager that it is the keyworker’s responsibility to ensure the service users plans are reviewed and updated; and that the service user has been consulted as part of the process, the plans reviewed did contained entries verifying that the plans had been reviewed. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 18 The plans also contained input from professional sources, such as ‘Occupational Therapist and Physiotherapist’, professionals employed by the company, who also produce monthly reviews and/or assessment statements. The brochure documentation makes reference to: ‘Our aim is to provide a care home that offers a safe comfortable environment with support and stimulation to help service users maximise their potential physical, intellectual, emotional and social capacity within an individual person centred plan. Service users have the right to live as normal a life as possible and to have the respect of those who support them’. Information taken from the surveys indicate that the service users’ relatives are generally happy with the care and/or support provided to their next-of-kin with one person ticking ‘always’ and four ‘usually’, in response to the question: ‘do you feel that the care service meets the needs of your friend/relative’. Whilst the service users indicated that: ‘I like living at Orchard Lodge, I am very happy’ and ‘I like living at Orchard Lodge, the staff who look after me are nice’. People’s health care needs appear well catered for at Orchard Lodge, with each service user plan containing a written account of their health care needs, set out within a ‘health action plan’ and identified during an initial and ongoing health assessment process, which takes a multidisciplinary approach and involves a variety of health professionals. Information taken from the services brochure indicates that the service users have access to: Physiotherapist, Dieticians and weekly General Practitioner visits, whilst Occupational Therapy input was discussed with the manager during the visit. The evidence obtained, via the relative surveys, is that all five relatives feel they: ‘are kept up to date with important issues affecting their friend/relatives (for example if they have been admitted to hospital or had an accident, etc)’. Information taken from a professional survey indicates that: ‘individuals health care needs are met by the care service’ and ‘ staff are very caring, able and motivated, they work well as a team and are very organised’. Training and development records indicate that staff are provided with access to a variety of health related courses and that recently they have completed training around palliative care and the use of the Gold Standard Framework, an advanced life plan that aims to supporting people in the final stages of their lives. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 19 In discussion with staff it was apparent that training and development opportunities at the home are very good and that staff recalled having completed the above courses. Whilst talking to a staff member, the use of PRN (as and when required) diazepam, with service users who suffer with epilepsy was discussed. The staff member confirmed the findings of the review of the ‘person centred plan’, which identified that several people required monitoring and on occasions the administration of rectal diazepam to manage their seizures. The staff member also confirmed that currently there was no protocol to guide the use of this invasive procedure and that one of the local doctors was writing up the protocol for the home, a statement confirmed by the manager when discussed, however, this must be followed up. Generally the home’s management of the service users’ medications was considered safe and appropriate, with the home providing safe storage facilities, records generally well maintained, although the odd gap should be addressed. Staff observed administering medicines did so safely and appropriately, taking the medication to the service user, administering the medicine and then returning to sign the medication record. No service users self-medicate, as a result of their physical health and learning disabilities according to the manager and staff. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 22 & 23: People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The dataset, which forms part of the AQAA documentation, establishes the existence of the home’s complaints and concerns procedure and that this was last reviewed in the July of 2007. The dataset also contains information about the home’s complaints activity over the last twelve months: No of complaints: 10. No of complaints upheld 0. Percentage of complaints responded to within 28 days: 100 . No of complaints pending an outcome: 0. The evidence indicates that people’s complaints are being appropriately handled, with written responses, where appropriate, being dispatched by the manager, a complaints logging system documents all activities associated with a complaint. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 21 The indication, from the survey respondent is that people are generally aware of the home’s complaints process and when service users have raised concerns these have been appropriately handled. During the visit the manager produced copies of the home’s training matrix, which indicates that all staff have completed ‘safeguarding adults’ training, this corroborated the information contained within the AQAA, which states that staff have undertaken ‘adult protection training’. The homes tells us, via their AQAA and dataset, that policies on the protection of service users are in place, ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, both policies updated/reviewed in the December of 2007. The dataset also establishes that over the last twelve months no safeguarding referrals have been made to the Local Authority, a statement supported by a review of our database, which established that no alerts had been brought to the Commission’s attention during this period. In discussion with staff members it was established that training opportunities are good and that they are aware of their roles in supporting service users make and/or raise concerns and in protecting them from poor practice. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 24 & 30: The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The service tells us, via their AQAA that: ‘our home is purpose built building on the ground floor only. The house is homely, clean and free from adverse odours. The home is equipped with overhead tracking hoists throughout the home, in each bedroom, bathrooms, spa room, sensory room and specialised equipment, shower trolleys and chairs are available for personal care. The bedrooms have en-suite showers or wash areas to promote dignity and respect. All equipment is maintained throughout the year by a maintenance contractor, which ensures the safety of the equipment used. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 23 Bedrooms are spacious for wheelchair access and throughout the home. High / low profiling beds provide comfort and safety. Pressure relieving mattresses are provided for those at risk pressure sore development. Lounge and garden areas compliment and supplement the service users’ bedrooms and the furnishings in the home are bright and flame retardant. Bedrooms are decorated to the service users specification/wishes’. The tour of the premise substantiated much of the information provided via the AQAA, with the exception of the maintenance contractor, who was not seen during the visit, although records of the work completed and/or logged by the staff was available. Several service users bedrooms were visited during the fieldwork visit and found to be well maintained and furnished and to be individually set out and personalised. In conversation with a service user it was clear that they enjoyed living at Orchard Lodge, a view shared by the people who completed surveys, with both commenting:’ I like living at Orchard Lodge’. A comment made via a relative survey suggest that the service users next-ofkin are also satisfied with the environment: ‘they try and keep a family atmosphere and a happy environment’. The home employs domestic staff; who were observed during the visit undertaking their duties. The home was also noted to be free from odours and very clean and tidy throughout. The AQAA also tells us that staff receive access to training on the management and control of infections and that policies and procedures are available, these were last reviewed and updated in the November and December of 2006. Communal toilets and bathrooms were noted to contain liquid soaps; paper towels and bins for the disposal of waste and all chemicals were stored in accordance with the ‘Control Of Substances Hazardous to Health’ (COSHH) regulations. The laundry, which is located within the main building but away from areas of the home used by the service users, is the responsible of the staff who laundering residents clothing and returning this to the client room. Clothes are labelled to reduce the possibility of lose or the item being returned to the wrong person, although the manager admitted that from time to time items/ errors can occur. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 32, 34 & 35: Staff in the home are trained, skilled and provided in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: The home’s brochure documentation states: ‘all staff undertake an induction programme of instruction when joining Sussex Health care (SHC). In addition a system of supervision and support for care staff enables them to gain experience and increase their skills. Extensive in-house training is provided by ‘Sussex Health Care’s’ training team and National Vocational Qualifications (NVQ) courses are undertaken in conjunction with the local colleges’. The manager provided us with sight of the training matrix, which evidenced the training completed by staff over the last twelve months, including: moving and handling, fire and fire marshal training, adult protection, epilepsy, food hygiene, first aid training, health and safety, risk assessment, continence awareness, Diabetes, Palliative and end of life care, Gold Standard Framework, Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 25 eating and swallowing, medication administration, venepuncture and wound care. A large number of the training sessions organised / provided in house utilising training videos and distance learning packs, however, additional courses are provided by the company’s training and development team, as mentioned above. Information taken from the professional survey indicates that the: ‘staff are very caring, able and motivated, they work well as a team and are very organised’. The relative surveys indicate that generally the staff are thought to possess the skills required to look after people properly, two people ticking ‘always’ and three usually’ in response to a question about the skills and experience of the carers, one person adding: ‘the permanent staff are very good, obviously new and agency staff do not have the same knowledge of the residents’. Information provided via the dataset was a little confusing, as the manager indicated that there were either 29, 27, or 26 care staff, for the purposes of the calculations below the median number has been used, which indicates that currently the home employs twenty-seven care staff. Ten of the twenty-seven staff have completed a National Vocational Qualification (NVQ) at level 2 or above and this gives the home a percentage of 37 of its care staff possessing an NVQ at level 2 or above. The dataset also indicates that four people are completing their NVQ, which would increase the percentage of staff holding an NVQ level 2 or equivalent to 52 . Information contained within the dataset establishes that a recruitment and selection strategy/procedure exists to support the management staff when employing new staff. It also indicates that all of the people who worked in the home over the last twelve months had undergone satisfactory pre-employment checks. On reviewing the files of three newly recruited staff all of the required checks were in place, Criminal Records Bureau (CRB) checks, Protection Of Vulnerable Adults (POVA) checks and two references, although the home had trouble in gaining one reference request, which was discussed with the manager. The files also contained completed application forms, health declarations, photographs of the employee, interview summaries, personal information and information used to support the CRB application process. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 37, 39 & 42: The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: The service tells us, via the AQAA, that the manager is a Qualified Nurse who has completed additional management training, foundation management and the Registered Managers Award (RMA). The fieldwork visit established that the manager has introduced a number of management tools into the home to ensure the day-to-day operation of the home runs smoothly, these including many of the tools referred to during the report, training matrix, staffing files, service user meetings, complaints process, visitor records, ‘person centred plans’, etc. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 27 Information taken from both the service user and their relatives surveys indicate that people are happy with the day-to-day operation of the home, people commenting: ‘high levels of care, lost of activities, lovely atmosphere, dedicated and friendly staff, I do not think they can improve on any think, I have a nice bedroom and the staff who look after me are nice and I like living at Orchard Lodge’. Whilst the professional considers the service to be: ‘caring, organised, meeting patients individual wishes and already of a high quality’. The service’s approach to quality assurance is good with service users meetings or one-to-one sessions used to identify people’s satisfaction with the service. The involvement of the service users in the development of their ‘person centred plans’, allows them to influence the care service being delivered and reviews enable them or their representatives to changing things that are no longer applicable or they wish changed. Staff meetings also occur at regular intervals, with minutes of the meetings maintained for reference purposes, copies of visits undertaken in accordance with Regulation 26 of the Care Homes Regulations are also retained for reference purposes. The service tells us, via their AQAA, that: ‘as a corporation the service has achieved and/or completed national service quality initiatives audits and been awarded an ‘Investors in People’ and achieved a hospitality award, both or which are assessed by independent bodies. The service tells us, via the AQAA and dataset that health and safety policies and procedures are made available to the staff and that domestic appliances and personal equipment is regularly maintained and serviced, two staff within the home are designated as ‘Health and Safety Representatives’. The AQAA is also used to inform us that: ‘Personal protective clothing (uniforms, aprons and gloves), are provided to staff and that COSHH materials are appropriately stored’. Health and safety training is being made available to staff, with the training matrix and plan providing evidence of the courses attended and those to be attended by staff, including: health and safety, infection control and moving and handling, etc. The tour of the premise identified no immediate health and safety issues, and the environmental risk assessments do consider both potential areas of harm and how these can be managed. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 28 Generally the service users and their relatives are satisfied with the service being provided at the home and raised no concerns in relation to either Health or Safety. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 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 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 30 No 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 YA20 Regulation Requirement Timescale for action 14/06/08 Regulation The service must ensure that 13 protocol for the administration of medications, i.e. rectal diazepam are in place. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard YA16 Good Practice Recommendations The home should review the use of the listening devises in people’s bedrooms. Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard Lodge DS0000024192.V359397.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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