Inspection on 07/03/07 for Orchard Lodge

This inspection was carried out on 7th March 2007.

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 06/02/06

Orchard Lodge 09/06/05

Orchard Lodge 24/02/05

Orchard Lodge 21/09/04

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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 Peter J McNeillie Unannounced Inspection 7th March 2007 09:00 Orchard Lodge DS0000024192.V327106.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.V327106.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.V327106.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 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.V327106.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 6th February 2006 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.V327106.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was written after taking into consideration a number of sources of information /evidence including a site visit to the premises, previous reports examining residents /staff records, personal observations, talks with staff and management, responses to a results from an in house quality survey and responses by the manager to a pre inspection questionnaire. Following the last two inspections during which the key standards were last inspected no requirements were made a situation that mirrored itself following this visit This key unannounced visit was the first inspection for the year 2006/07 and covered all of the key standards for younger adults. The inspection took place on 07/03/07 between the hours of 09.30 am and 01.30pm. During the inspection the inspector who was assisted by the manager had the opportunity to discuss living and working in the home with a number of staff both individually and in groups but was only able to talk with two residents due to the profound communication difficulties of the remainder. The results and findings contained in this report which looked at all of the key standards for care homes for younger adults will determine the frequency and type of future inspections. Current fees range from £1211 to £2140 per week. What the service does well: The records of the initial admission assessment and the subsequent care planning process is clear, thorough resulting in documentation which is useful and assists in ensuring residents needs will be met in an manner that residents themselves wish. Both these areas have been assessed as excellent. The home provides care in an well-maintained pleasant and welcoming environment parts of which have been assessed as excellent. Care is delivered by a well-managed supported, motivated, well-trained and qualified staff team who work in a manner that recognises resident’s need for personal privacy and dignity. The staff’s attitude and support to the residents has also been assessed as excellent. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 6 Residents were able to participate in a range of social activities. Considerable effort and expertise including the employment of specialist staff has gone into this area of the homes life with a result, compliance with this standard is also assessed as excellent. The quality of the service provided in the home is given a high priority; the systems for ensuring quality and the methods of consultation have been assessed as excellent. 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. The summary of this inspection report can be made available in other formats on request. Orchard Lodge DS0000024192.V327106.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.V327106.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): 2. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met. EVIDENCE: All residents are admitted in accordance with a corporate service user admission procedure that was last reviewed in July 2006. A sample of four residents records selected at random by the inspector were viewed. All of the comprehensive accessible, well-presented and user-friendly records seen indicated that no residents are admitted without a very detailed assessment of needs nutrition and risk being carried out by the manager or another member of senior staff. This assessment would also establish if any special equipment is required. All parts of the assessment seen had been signed and dated. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 9 Information is also gathered from external social and health care professionals as well as the resident’s representative/relatives and where possible the resident themselves. Records viewed also indicated that before a trial period of admission is agreed, a planned programme of visits and if possible overnight stays would be arranged which is followed by a review in which the resident and their representative participate where it is established that all of the potential residents needs and aspirations can be met. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 8. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a well-developed system of planning and reviewing care which is person centred, ensures residents needs are met within a risk management policy and involves residents /residents representatives or relatives in decisions that affect them. EVIDENCE: All of the residents of the home are dependant on others for their physical and social care. All have very high care needs and rely on a range of communication methods. A sample of four residents records selected at random by the inspector were viewed. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 11 These comprehensive plans/night care plans, (which) are based on assessments of need, risk and the particular wishes and aspirations of the residents are reviewed and amended if required monthly to reflect the ever changing high care needs and communication difficulties of the residents. Residents rights to take risks is seen as fundamental, any restrictions placed on individuals due to their high needs or physical abilities are clearly recorded in the care plans and are only taken following a detailed risk assessment which are reviewed on a regular basis to ensure they are still applicable. All assessments of risk are carried out in accordance with a written corporate risk assessment policy and procedure, which was last reviewed in July 2006. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected service users interests and choices. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 13 EVIDENCE: Records viewed, comments from staff and notices seen during the inspection confirmed a very full activities and social opportunities both in house and community based were available organised by a full time specialist activities coordinator. Verbal communication with the majority of residents was almost impossible, however, the inspector did manage to obtain confirmation from two residents that there was always something to do and that if an activity was not available and was requested if possible it would be provided. Examples of activities on offer included swimming, theatre/cinema trips, bowling, crafts, music entainers, araomatherapy, reflexology, computers, sensory room, ice skating, holidays as well as attending an outreach college, Crawley college and a local day centre. This is a small representative sample of opportunities available. Staff and management confirmed that residents could choose whether or not to participate There is no restriction on visitors, family and friends are encouraged to visit often and residents supported if possible to spend time at home. A detailed menu that reflects resident’s choice produced in both written and a large high quality full colour photographic format was available. Assistance in feeding was provided on an individual basis and the meal was presented in varied forms to meet the needs and abilities of the residents. The staff cut some up 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. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place, ensuring the personal emotional, health care and medication needs of residents are met. EVIDENCE: Due to extreme communication difficulties with most residents the inspector was only able to talk to two persons, both of who confirmed they were able to exercise choice in respect of bedtimes, mealtimes, leisure pursuits and where they received personal care. Guidance is available in care plans regarding the wishes of residents; this information is also available in individual rooms. Guidelines in care plans directed staff to assist residents in the choice of clothes they wore. At the time of the inspection all residents were dressed in a manner that was both age and gender appropriate. During the inspection the inspector observed staff interacting with residents. It was clear that staff held residents in high esteem and treated them with Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 15 respect dignity, and affection. All of the residents had very high care needs, staff are to be commended for the manner in which they went about their tasks and it was clear the efforts of the staff had a profound effect on the quality of life of the residents. Records seen indicated that any special medical or health or social care needs would be provided following consultation with the appropriate professional, these might include learning disability, specialists, doctors, district nurses and physiotherapists and care managers. In support of external health care professionals the home /residents receive the services of an in house physiotherapist and two physiotherapy assistants. Two local medical practice where approximately twenty plus doctors are based visit the home. The inspector was informed that residents are able to consult with whatever gender doctor they prefer. All medication, which is securely stored, is dispensed by a local pharmacist and administered by trained staff. The pharmacist also visits the home to give advice if required. Medication records indicated that all drugs and medicines are given and disposed of in accordance with the homes medication policy. No residents are able to administer their own medication following a risk assessment. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear policies and procedures in place which ensures residents are able to complain and are protected from abuse . EVIDENCE: A whistle blowing and Adult Protection Policy and Procedure have been implemented to work in tandem with the procedure produced by West Suss County Council. All management staff spoken to demonstrated they were aware of the procedure to follow should they witness or suspect the abuse of a resident. The complaints procedure, which was also included in the service users guide included information on how to contact The Commission for Social Care Inspection (C.S.C.I), was seen, as was record of complaints, which indicated that any complaints received were dealt with promptly and a written response given. All of the complaints viewed were of a minor nature and had all been dealt with to the satisfaction of the complainant. Due to the problems of verbal communication the inspector was not able to ascertain whether residents felt comfortable in discussing any concerns they Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 17 had with the homes manager but staff did state they felt comfortable in discussing issues with management on behalf of any resident. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 Quality in this outcome area is excellent good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a purpose built home which was clean, homely, free form adverse odours, hazards and equipped with a large number of specific aids and adaptations designed to maximise the independence, comfort and safety of the residents. EVIDENCE: During a tour of the purpose built building no obvious hazards to health and safety were seen and fire safety arrangements were all being observed. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 19 The building, which was, fit for its stated purpose, accessible, safe, well maintained free from adverse odours met residents individual and collective needs. All residents have their own bedrooms, which have been professionally assessed with regard to special equipment, and adaptations such as special beds which ensure assessed needs can be met. All bedrooms are fitted with ceiling hoists, which allow access to personal shower facilities. Appropriate infection control measures were in place and staff had received training in the prevention of spread of infection. Following professional assessments a number of aids and adoptions had been provided including hoists, wheel chairs, special beds and grab rails Furniture was comfortable and homely and in keeping with the décor. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. EVIDENCE: The staff day to day working rota indicated the planned deployment of staff would be a manager, ten nurses/ care staff plus a receptionist/administrator, one activities coordinator, one chef, one domestic cleaner, one driver/maintenance and a physiotherapist and physiotherapist assistant., support staff and a housekeeper/cook per shift. The inspector observed that this deployment of staff met resident’s needs. Care staff were observed to carry out their duties in a calm unhurried manner taking time to talk with and assist individual residents. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 21 It was confirmed by the manager that staffing levels are closely monitored to reflect the changing / assessed needs of residents, residents at home and would be increased /decreased as required. The inspector viewed three staff files, which included evidence that all staff are employed in accordance with a robust recruitment and selection procedure designed to protect residents. This involves the completion of an application form, the signing of a rehabilitation of offenders declaration, an interview, satisfactory Criminal Record Bureau, Protection of Vulnerable Adults and reference checks followed by the satisfactory completion of an in house induction training and probationary period of employment. Files seen also included a copy of a job description, a contract and comprehensive training records covering all aspects of care, including, care and administration of medication, manual handling, basic first aid, health and safety, risk assessment, P.O.V.A. basic food hygiene and fire. A corporate training and development policy requires that on commencement of their employment all staff undergo an in house induction programme. Following induction qualified nurses attend compulsory training update training sessions in wound care, continence, diabetes, and staff supervision every two years. None nursing care staff following induction continues on a foundation course in care followed by National Vocational Training in Care level 2. At he time of the inspection 60 of non-nursing carers were qualified to N.V.Q. level 2. When nurses are included 76.5 of all staff are qualified. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents whose views about living in the home are formally sought through their representatives. EVIDENCE: The service is well managed by the manager who is qualified nurse with additional management qualifications. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 23 Staff who confirmed they were fully aware of their responsibilities and towards residents confirmed management has an open door policy, and encourages them to share any concerns or ideas they have better the service. A number of service external national service quality initiatives have been undertaken. The home has received an Investors in People award, an HQS, Health Quality Systems award as well as ISO 2000. Apart from the above the home conducts monthly audits of 1 of residents/residents representatives as well as visiting health and social care professionals. The results of surveys are discussed at staff meetings where an action plan is developed to overcome ant actual or perceived shortcomings in the service. A health and safety policy and procedure was in place. During the visit no obvious hazards to health and safety were seen. Protective clothing, gloves, control of substances hazardous to health (COSHH) assessments, risk assessments, equipment servicing and accident records were available as were records to confirm all staff have receive training in the techniques of moving and handling first aid health and safety and the procedures to follow in the event of fire, including evacuation. The home has a laundry procedure and a washing machine, which is capable of disinfecting soiled items. All of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees centigrade and all radiators and hot pipes were covered. Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 24 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 4 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 4 26 x 27 x 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 x LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 x 3 3 4 X X 3 x Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 25 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. 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. Refer to Standard Good Practice Recommendations Orchard Lodge DS0000024192.V327106.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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.V327106.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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