Inspection on 06/02/06 for Orchard Lodge

This inspection was carried out on 6th February 2006.

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

The inspector 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 Lodge 18/03/08

Orchard Lodge 07/03/07

Orchard Lodge 09/06/05

Orchard Lodge 24/02/05

Orchard Lodge 21/09/04

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Thorndene

Insight - Eastchurch

Southfields

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Dovedale Court

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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 Miss Helen Tomlinson Unannounced Inspection 6th February 2006 2.30pm Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 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.V274475.R02.S.doc Version 5.1 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.V274475.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard Lodge Address Dorking Road Warnham Horsham West Sussex RH12 3RZ 01403 242278 01403 210424 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) Dr Shafik Hussien Sachedina Mr Shiraz Boghani Mrs Pamela Stuart Care Home 23 Category(ies) of Learning disability (23), Learning disability over registration, with number 65 years of age (1) of places Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 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 9th June 2005 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.V274475.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 2.30pm and left the home at 7pm. The registered manager was on annual leave, but came into the home for the duration of the inspection. There were twenty two people accommodated at the home at the time of the inspection. During the course of the inspection a tour of the premises took place, with most bedrooms, bathrooms and all communal areas being seen. Discussions took place with staff and the manager regarding aspects of life in the home. Residents were observed taking part in various activities and being given care and support by the staff. General day to day activities and interactions between staff and residents were observed. Various records were examined, as was necessary, throughout the inspection. There were no requirements or recommendations made following the last inspection. At this inspection two good practice recommendations were made. What the service does well: Orchard Lodge was designed to provide an environment that would meet the needs of people who have physical and learning disabilities. The environment has been specially adapted to make it comfortable for people who use wheelchairs and other specialist equipment. Bedrooms and bathrooms are spacious, with wide doorways, overhead hoists and adapted baths, beds and other furniture. The communal areas offer a light and airy place for residents to enjoy activities or have quiet time, in a pleasant environment. There is a strong philosophy of care to encourage and help people make choices in their lives. A wide variety of communication methods were in use and staff interacted well with the residents. A wide and stimulating programme of activities was in place. This included things both inside and out of the home. People were encouraged to attend college courses to develop their skills. The activities which took place in the house were suitable to meet a variety of abilities and included computer work, art work and cooking. The staff assisting with activities used these to stimulate the residents, build on their strengths and improve areas like hand eye co-ordination and communication. Staff spoke highly of the manager and were seen to work well together as a team. They had received training for the work they were doing and suitably qualified staff were on duty to meet the needs of the residents. The health care needs of the residents were met by the qualified staff at the home. There was good communication and consultation with other professionals, should this be needed. Physiotherapy was provided as part of the daily needs of the residents. The health care needs of the residents was assessed and all had detailed plans documented of how these were to be met. The individual choices and preferences of how the residents wished to be cared for were included in the plans. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 6 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 Lodge DS0000024192.V274475.R02.S.doc Version 5.1 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.V274475.R02.S.doc Version 5.1 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): None of these standards were assessed. No new residents had come to live at the home since the last inspection. Standard 2 was assessed and met at the last inspection. EVIDENCE: Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 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 the following standard(s): 6,7 and 9 There were detailed plans of care present in the home. Some of these had not been reviewed as frequently as recommended. Individual choices and preferences of the residents were sought and respected. Specific risks were assessed and measures taken to minimise these, where possible, whilst not restricting the independence of the residents. EVIDENCE: The residents of Orchard Lodge have a high level of dependency on others to meet their physical and social needs. Various communication methods were used, to suit the individual, in order to make sure their needs and choices were understood. The plans of care of how these needs were to be met, were detailed and included the preferences of the individual. The person centred planning meant the plans were developed around each individual, taking into account their abilities, strengths and needs. There was evidence that changes had been made to the plans, to reflect changes in the life of the resident. In some instances a general review of the plan had not been documented for a twelve month period. The manager said the plans had been reviewed in that time, but this had not been documented correctly. A recommendation was made to make sure all care plans were reviewed, at least six monthly, or more frequently should the resident’s needs change. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 10 Risks to the resident’s health or well being were recognised, assessed and a plan of care to minimise them was put into place. These risk assessments were detailed and specific, including environmental and physical risks to the residents. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 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 the following standard(s): 17 Standards 12,13,15 and 16 were assessed and met at the last inspection. Residents were offered a health diet with individual nutritional needs being understood. EVIDENCE: The inspector was present during the supper time in the home. This was a social occasion with all residents eating in the dining room as was their own choice. Assistance was provided on an individual basis and the meal was presented in varied forms to meet the needs and abilities of the residents. Some were cut up by the staff whilst others were changed in consistency to make sure the residents could eat their meal safely. Each resident had their eating and drinking needs documented. This included any aids or adaptations needed, the way assistance should be given and any advice from health professionals such as speech and language therapists. Those residents requiring their nutritional needs to be met through parental feeding had detailed plans in place and the necessary advice and support from health professionals was in place. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 12 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): 18,19 and 20 Resident’s preferences and choices around personal and health care support were understood and respected. The health care needs of the residents were met and advice and support from other professionals was sought as necessary. Staff administered the resident’s medication. EVIDENCE: The individual plans of care contained detailed information about the preferences of the residents of how they would like to be supported and assisted. This information had been obtained from the resident, if they were able, or from a relative or previous carer. It included their daily routine, specific ways of communication, likes and dislikes and detailed ways personal care was to be delivered. Staff said they were guided on the individual manner of delivering care during their induction training and throughout their work at the home. Staff were seen to support and assist the residents in a quiet, calm and patient manner, interacting and communicating well with the residents in a friendly atmosphere. Some residents had been assisted to change into nightwear immediately after supper. They then returned to the communal areas with other residents, staff and visitors. It was discussed that should this be the resident’s individual choice it should be respected, but issues of dignity and necessity for this practice should be considered. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 13 The health needs of the residents were documented in their individual plans of care. These included physical and emotional health needs, specific health professionals involved, with their assessments and plans where appropriate, and details of how health care needs would be met. This information was comprehensive and detailed. Qualified registered nurses were present on each shift. They had received training specific to the needs of the individual residents accommodated including use of suction, oxygen and parental feeding. Advice and support was available from the physiotherapist, employed at the home, who was present three days per week and an assistant five days per week. Equipment and adaptations required to meet the health needs of the residents was present. This included various hoists, mattresses, cushions, chairs and beds. It was seen that staff understood the way residents communicated to indicate their needs, wishes and wants. There were policies and procedures for the management of medication in the home. At the time of this inspection no residents were able to self administer their own medication. All medication was administered by the qualified nurses. Medication was safely stored in the home and administered, as prescribed, and in a way which suited the individual resident’s needs and abilities. All administration of medication was recorded. It was advised that hand written changes to the medication administration sheets should be witnessed, signed and cross referenced to the prescriber’s instructions. Administration of external preparations should be signed by the person administering it. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Standard 22 was assessed and met at the last inspection. Residents were protected from abuse and self harm. EVIDENCE: The person in charge was aware of the procedure to follow should an allegation of abuse be made in the home. Written procedures were in place. Staff had received training regarding protecting vulnerable adults and recognising signs of abuse. It was seen that practices to prevent unintentional self harm where in place such as padding on equipment. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29 and 30 Residents benefit from living in a home which was clean, comfortable and free from hazards. The environment and equipment provided was suitable for the residents accommodated. A large number of specific aids and adaptations were present to maximise the independence, comfort and safety of the residents. EVIDENCE: At the time of this inspection the home was clean, tidy and comfortable. The home was purpose built to accommodate residents with high dependency needs and as such provides a safe and suitable environment. Homely touches were seen to make the home as domestic as possible, within the confines of the large amount of equipment needed. Staff had received fire safety training and fire prevention measures were in place. All areas of the home were clean and hygienic. Appropriate infection control measures were in place and staff had received training in the prevention of spread of infection. At the last inspection it was advised that the system for cleaning wheelchairs was reviewed to make sure they were kept clean. At this inspection the manager stated a rota was in place for the night staff to do this. All wheelchairs seen were clean. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 16 Individual assessments by the physiotherapist or occupational therapist had been carried out to make sure all residents had the appropriate equipment they required. A large amount of equipment and aids and adaptations were present in the home. These included overhead hoists in all rooms and mobile hoists for communal areas, adapted baths, beds and chairs. A spa bath was available which was accessible by a hoist. A sensory room contained specific equipment to stimulate residents. Eating utensils and activity equipment was also adapted. Various communication aids were seen such as signs, pictures and individual communication boards. Risk assessments had been carried out for the use of this equipment by the residents. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 36 Standards 34 and 35 were assessed and met at the last inspection. Residents benefit from being supported and assisted by appropriately trained and qualified staff. Staff receive support and supervision in their work. EVIDENCE: Staff at the home consisted of qualified nurses and care assistants. A system of mentoring and training nurses from overseas on their adaptation training was in place in the home. The staff rota was examined and the number of staff on duty was adequate to meet the needs of the residents accommodated. Staff received induction training which met the current standard. Ongoing training was provided by the organisation which owns the home. Staff said this training was appropriate for the work they were doing and kept them up to date with current guidance. At the time of this inspection staff on duty had the skills and knowledge to meet the needs of the residents and showed an excellent understanding of their individual needs. The registered manager said all staff received formal supervision at least two monthly. This was recorded on the personal files of the staff. Staff said they felt supported by each other, the manager and the larger organisation. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 18 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): 42 Standards 37 and 39 were assessed and met at the last inspection. The health and safety of the residents was protected. EVIDENCE: At the time of this inspection the home was free from hazards to the residents’ safety. Staff received training in health and safety, infection control, fire safety and first aid. Policies and procedures regarding health and safety issues were in place. Accidents were recorded. The storage of accident records did not meet with the data protection guidance and should be reviewed. Risk assessments for the environment and specific activities were carried out and recorded. Staff were seen to understand the risks certain individual residents may be exposed to due to their needs and behaviours. These were minimised as far as possible and management strategies recorded. Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 19 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 X 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 X 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X X X X 3 X Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations The resident’s individual and health care plans should be kept under review and up to date. These reviews should be documented and carried out at least six monthly or more frequently as agreed with the resident or their representative. The accident records should be stored in line with the guidance of data protection. 2 YA42 Orchard Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Lodge DS0000024192.V274475.R02.S.doc Version 5.1 Page 22 - 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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