Inspection on 09/06/05 for Orchard Lodge

This inspection was carried out on 9th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 06/02/06

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 Annette Turner Announced 9 June 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Orchard Lodge Address Dorking Road, Warnham, Horsham, West Sussex, RH12 3RZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01403 242278 01403 210424 Dr Shafik Hussien Sachedina Mr Shiraz Boghani Mrs Pamela Stuart CRH N - Care Home with nursing 23 Category(ies) of LD(E) Learning disability (over 65) -1 registration, with number LD Learning disability (18 to 65 years) -23 of places Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 24 February 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 H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a morning and an afternoon. There were twenty-three service users living at Orchard Lodge. One person had gone to stay with his parents and two people were at college for the day. A tour of the building took place and the majority of rooms were seen. All the service users were seen taking part in music and other activities. Four members of staff were spoken with and time was spent with the manager. Time was also spent with two service users; care staff assisted with communication. They were both enthusiastic about their home and the staff who provide their care. There was a residents’ meeting during the afternoon that was attended by nine service users. Four relatives returned comment cards about the service; they were very positive about the care provided. Seven health and social care professionals also returned comment cards and made a positive response. What the service does well: Orchard Lodge was designed to provide an environment that would meet the needs of people who have physical disabilities. The environment has been especially adapted to make it comfortable for people who use wheelchairs. There is a strong philosophy of care to help people to develop as much independence as they are able to and to make choices in their lives. There is a wide and stimulating programme of activities. People are encouraged to attend college courses to develop their skills. The manager provides strong leadership and the staff team are motivated and committed to providing a good quality of life for the people who live at Orchard Lodge. There is a commitment to seeking feedback in order to monitor the service. The monthly residents’ meetings are lively and keep people involved in making decisions about the things that affect their daily lives. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 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 H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 4 Service users and their relatives are provided with the information they need to make a choice about moving to Orchard Lodge. People have a thorough pre-assessment before they move to Orchard Lodge so that they can be sure that their needs will be met. The introduction process is well planned so that service users spend time at Orchard Lodge before they move. EVIDENCE: The Statement of Purpose and Service User Guide include information about the services provided at Orchard Lodge. There is also information available on the internet. Some key information is provided in symbol format to assist people who have communication difficulties. There is a comprehensive preassessment process carried out by the manager and other key staff before anyone moves to Orchard Lodge. Information is also gathered from health and social care professionals as well as relatives to ensure that all the person’s needs and aspirations are understood. Case records showed that service users have a planned introduction to Orchard Lodge so that they can make a more informed choice about the move. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9 The care planning and reviewing process is person-centred and comprehensive. Service users are consulted in all aspects of their care and are involved in the six monthly reviews. People are supported to express their changing goals and aspirations. Service users are supported to develop their independence within a risk assessment framework. There is a strong philosophy of service user involvement in making choices about their home and lives. EVIDENCE: People living at Orchard Lodge depend on others for all their care and social needs. The sample of care plans that were seen were thorough and comprehensive. A person-centred care planning programme has been pioneered at Orchard Lodge and is in the process of being developed. The changing needs and personal goals of individuals are reflected in the care plan with clear details of the way that service users require their care to be provided. Care plans are reviewed regularly and any changes noted. Areas of risk are identified and assessed. Information is provided for staff about the way to support service users in being as independent as they are able while minimising the risks. Every service user has a communication passport with them at all times to ensure that staff can understand their needs. The monthly Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 10 residents’ meetings provide an excellent forum for those who attend to be involved in the day-to-day events organised in the home. Key information and notices are provided in symbol format to make them more accessible for service users. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 Service users are provided with opportunities for personal development and are supported to enjoy leisure activities of their choice. A lively activities programme is available to suit everyone’s needs. Service users are supported to attend courses at Crawley College and a college outreach programme. Service users are provided with a healthy and well balanced diet. EVIDENCE: Service users are encouraged to pursue their interests and hobbies, these are recorded and people’s rooms reflect this. Specialist advice and support is available to those who require it. A physiotherapist is employed by Sussex Health Care and provides assessments and treatment programmes to ensure that people are supported to develop their mobility and independence. Five people attend college courses at Crawley College and seven people attend outreach courses in other Sussex Health Care homes. Six people attend a new day service set up by Sussex Health Care and one person attends a social services day centre. Service users are encouraged to take part in a wide range of activities in the home including the sensory room and spa pool. People are supported to access an impressive range of theatre and concert trips Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 12 throughout the year. Several people were very excited about their planned holiday. There is a minibus and adapted car so that several people can be taken out at one time. There is a rolling programme of outings to ensure that everyone has a turn. The staff are clearly committed to providing a range of opportunities for social and leisure activities and service users are involved in choosing these. Family and friends are invited to social activities and there is a flexible approach to service users visiting their families. Mealtimes are social occasions and the five people who have an artificial diet choose to sit with everyone else. The menu is nutritious and balanced with some choice of food. A ‘favourites’ week has been introduced whereby one person chooses their favourite meals for a week. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 19 Staff are provided with the training and guidance they need to provide personal care in the way that people prefer and require. There are policies in place to ensure that physical and emotional needs are met. Service users have access to the healthcare services that they require. EVIDENCE: There are policies regarding the way that personal care should be provided in order to protect the privacy and dignity of service users. Staff said that they receive induction and guidance about the preferences and needs of individuals. There is additional guidance in service users’ rooms where particular risks or wishes are noted. It was clear from case records that people receive the healthcare services that they need; medical appointments and visits had been recorded. Two GPs visit the home each week to ensure that people’s healthcare and medication needs are being met. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 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 standard(s) 22 and 23 The policies and procedures that are in place regarding complaints and adult protection aim to ensure that people feel listened to and that they are protected from abuse, neglect and self-harm. EVIDENCE: The complaints policy is clear and is available in symbol format to assist service users to understand that they have a right to be heard. Complaints are recorded and investigated appropriately. The registered manager has set up a forum for relatives who act as advocates to meet and discuss any issues of concern. There is a proactive approach to dealing with complaints. The service users indicated that they feel listened to. There are monthly service users’ meetings and the activity coordinator holds one-to-one meetings with everyone to encourage them to raise any concerns that would be addressed individually or as a group. There are clear adult protection policies and staff receive training about recognising signs of abuse. Staff were clear about what to do to ensure that people are kept safe. Service users indicated that they feel safe at Orchard Lodge. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28, 29 and 30 Orchard Lodge provides all the facilities required for people who have physical disabilities. The ongoing maintenance programme ensures that people are provided with a homely, comfortable and safe environment. Service users have rooms that meet their needs. EVIDENCE: Orchard Lodge was purpose built. The building and grounds are to a high standard and well maintained. There is an ongoing refurbishment programme. The buildings meet the requirements of the environmental health and fire officers. Service users’ rooms are decorated to their choice and reflect their interests and hobbies and individual taste. The toilets and bathing facilities are adapted to meet individual need. The shared rooms provide opportunities for lively activities or quiet space. The sensory room has recently been refurbished. The physiotherapist provides assessment and reviews to ensure that people have the equipment that they need. The home was clean, bright and welcoming. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34 and 35 Service users are supported by staff who are qualified and competent to provide for their specialist needs. There is a comprehensive training programme to ensure that staff have the knowledge and skills they need. The recruitment records showed that checks are made prior to appointment to ensure the protection of service users. EVIDENCE: The staffing rotas showed that there are sufficient numbers of staff on duty to meet the needs of service users. Most staff work for twelve hour shifts and those spoken with said that this works well for them. There is a comprehensive induction and training programme and there were records to show that staff attendance at training sessions is monitored. Staff spoken with said that they are encouraged to undertake training to make sure that they have the skills to carry out their work. There is a recruitment policy and staff records showed that the required checks and references are obtained before staff begin work. There is an ongoing programme for adaptation nurses from abroad who spend six weeks in placement at Orchard Lodge. Two of the registered nurses provide mentorship for at least four adaptation nurses at any time. The student spoken with said that she had been given a great deal of support and attends regular courses to expand her knowledge to ensure that Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 17 she knows how to carry out nursing tasks for the people living at Orchard Lodge. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 41 and 42 The registered manager is qualified and experienced to ensure that service users benefit from a well run home. There is clear leadership and an open approach within the home. There is an emphasis on review and development of the home through service user and relative’s feedback. The health and safety record keeping systems ensure that the rights and best interests of service users are protected. EVIDENCE: Mrs Stuart is committed to her own development and training to ensure that she provides the leadership required for the efficient running of Orchard Lodge. Mrs Stuart was involved in developing the person-centred care planning system. It was clear from service user and staff comments that people feel able to raise issues of concern and are confident that they will be addressed. The meetings that are held for staff and service users provide a forum for quality monitoring. Sussex Health Care has developed a quality monitoring Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 19 system to gain feedback from relatives and staff. There are efficient record keeping systems that are clear and comprehensive. Risk assessments are carried out to ensure the health and safety of service users is protected. Training is provided for staff in all aspects of health and safety. Accidents are recorded and monitored for the protection of service users. Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 4 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 4 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Orchard Lodge Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x 3 3 x H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 21 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 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 Good Practice Recommendations Orchard Lodge H60-H11 S24192 Orchard Lodge V223087 090605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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. 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