CARE HOME ADULTS 18-65
Orchard Street Care Home 2-8 Orchard Street Hucknall Nottingham NG15 7JZ Lead Inspector
Joanna Carrington Key Unannounced Inspection 19th October 2006 10:00 Orchard Street Care Home DS0000008729.V314785.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 Street Care Home DS0000008729.V314785.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 Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Orchard Street Care Home Address 2-8 Orchard Street Hucknall Nottingham NG15 7JZ 0115 953 4886 0115 910 4267 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) www.ncha.org.uk NCHA Mr Robert Anthony Hill Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users shall be within category MD Date of last inspection 24th February 2006 Brief Description of the Service: Orchard Street provides accommodation for up to twelve adults of both sexes with enduring mental health needs excluding Dementia. The home comprises four small domestic scale bungalows, connected by a covered conservatorystyle walkway. Each bungalow has its own kitchen, bathroom and sitting room; each resident has a single bedroom, which is individually personalised. The accommodation throughout is well maintained and comfortable. Within half a mile of the home are shops, public houses, cafes, a cinema, library, tourist sights and other local amenities in the town centre of Hucknall. Hucknall also has a leisure centre with swimming pool and gym facilities. The home represents a partnership between Nottingham Community Housing Association (NCHA) who own and maintain the building and The Nottinghamshire Healthcare Trust, who employ the staff, some are mental health trained nurses (RMNs). An attractive, small, enclosed garden offers tranquillity and activity to the residents. The fees for living at this home, at the time of inspection are £300 per week. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over six hours on 19th October 2006. This was the home’s key inspection for this year. The main method of inspection was ‘case tracking’ which meant tracking the support received by service users through checking records, discussion with them and with staff and observation of care practices. Altogether four staff members and four service users were spoken with (three service users were spoken with in a group). Staff recruitment records were requested but not available therefore this evidence was supplied to the Commission after the inspection. A partial tour of the premises also took place in order to assess environmental standards. Additional information has been provided from the registered persons, which has also been used to inform the outcome judgements within this report. What the service does well: What has improved since the last inspection?
Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 6 All service users at the home self-medicate and now all have risk assessments in place that identify the need to monitor individuals’ mental health and the taking of their medication. This ensures their safety and promotes good mental health. Service users have been reminded of their right to complain and of the Complaints Procedure, which ensures their complaints are taken seriously and acted on. Complaints are recorded under the Complaints Procedure. 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 Street Care Home DS0000008729.V314785.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 Street Care Home DS0000008729.V314785.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good admissions procedure in place, which ensures the home is suitable in meeting prospective service users’ needs. EVIDENCE: All service users spoken with confirmed that they have a copy of the Service User Guide, which provides information about the home and the services that are provided. This document has recently been updated. There was evidence on the files of all service users case tracked that a multidisciplinary mental health assessment and care plan has been carried out prior to them moving to the home. This ensures that the home is suitable in meeting prospective service users’ needs and also, as a staff member explained, that the new service user is compatible with the people that already live there. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements for planning how needs and choices are met and risk assessments are used effectively for the promotion of residents’ safety, independence and quality of life. EVIDENCE: The support plans seen are comprehensive and provide important information on how staff can support residents in leading their lives. For example, with issues of socialisation such as maintaining relationships, access to the community and recreation as a means to promoting quality of life. Along with care plans, which are reviewed regularly, there are excellent risk assessments in place, for example, budgeting and managing finances, to enable residents to be more independent and to take responsible risks. Residents spoken with confirmed that they are consulted over their support plans, and also on what is going on in the home. This was confirmed in copies of the house meetings minutes. Service users spoken with said they vote if
Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 10 they want to. It is evident from looking at support plans and discussion with both staff and service users that there is a real commitment from the service in enabling service users to be in control and make their own decisions about their lives. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 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): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The rights and responsibilities of service users are respected and upheld, including the right to maintain and form relationships and to be a part of the local community. There is an excellent commitment from the team to provide meaningful and therapeutic activities. EVIDENCE: There is a wide range of organised group activities that service users can access in the home; these include a gardening group, relaxation group, multifaith group, which is for celebrating all cultures and religions, social groups and the ramblers group. Service users spoken with talked about the groups they particularly enjoy. The relaxation group is a favourite on a Sunday evening, when people get the chance to have their hands massaged and to listen to spiritual music. The Breakfast Club is a new club in which service users are invited to each morning to try nutritious healthy breakfasts. A service user spoken with commented that it is nice to be asked. Healthy eating is promoted in the
Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 12 home, with the emphasis on foods that have benefits to mood and mental health. The menu records in one bungalow show a variety of balanced meals including meat, fish and plenty of vegetables. Service users explained that they eat what they want and choose sometimes to eat out. The carers group continues running at the home, which is time for relatives of service users to visit the home and go out socially as a group. Staff spoken with reported that this helps maintain and enhance relationships between service users and their relatives / carers. Staff were observed interacting with service users in a respectful manner. Care plans make reference to ensuring the dignity and privacy of service users when providing personal support. The number and variety of activities supported both in the home and community demonstrate that this service exceeds the National Minimum Standards and is viewed as very good practice. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 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 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. The health and personal care needs of service users are well met and medicine management promotes their safety and welfare. EVIDENCE: There are care plans now in place for service users that require some assistance with their personal care. It was noted in one service users care plan how now that assistance is always offered with showering their personal hygiene has improved. This service user was case tracked and confirmed when spoken with that they are happy with the help they get. Care plans include individuals’ preferences such as “I like my hand nails being groomed by the staff. I like wearing nail varnish” Service users spoken with said that they sometimes visit their GP independently but if they wish to have support from staff with an appointment then this support is available. There was an excellent ‘Physical Health’ questionnaire tool seen on the files of residents’ case tracked, which asks questions about their access to health services and if they prefer staff to accompany them. Care plans seen indicate that service users have regular health care checks including going to the dentist, chiropodist and opticians.
Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 14 All service uses living at the home self-medicate. In response to the requirement made at the last inspection all service users case tracked had risk assessments in place and these are reviewed regularly and show that mental health is monitored closely to ensure the service user is still managing to take their medication correctly. In addition to this the self-assessment form continues which service users fill in on an annual basis. This questionnaire asks service users if they remain happy managing their medication independently and checks on their understanding on how medicines should be stored and the reasons why they take it. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 Complaints Procedure ensures that service users views are listened to and acted on. Service users are not fully protected from abuse unless all staff are aware of their responsibilities in accordance with Safeguarding Adults policies and procedures. EVIDENCE: Minutes of service user meetings show that the Complaints Procedure was recently revisited to ensure that all service users are aware of it and how they use it. Service users spoken with confirmed that they know how to make a complaint. The procedure is displayed in each bungalow also. There have been no disclosures or allegations of abuse in the past year so the Safeguarding Adults Procedure has not had to be used. All staff are in the process of attending Protection of Vulnerable Adults (POVA) training with the Healthcare Trust. A learning need was identified during the inspection. When given a scenario and asked how to respond one staff member did not have an understanding of their responsibility to inform their manager when a service user discloses abuse or when bad practice has been observed, and when confidential information must be shared on a need to know basis. A recommendation to address this is made in the report. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is comfortable and homely. EVIDENCE: Since the last inspection an eco-friendly heating system has been recently installed at the home. There have been some serious problems with this system, with excessive smoke being produced and polluting the air. The manager reported that it was making staff feel ill and neighbours were complaining. At the time of the inspection an engineer had arrived and was in the middle of fixing it. At the inspection registered manager was advised to devise a risk assessment. The inspector notified Environmental Health. The heating system is no longer in use until the problem is fixed. Suitable contingency plans have been instigated until the boiler is fully functional. As this is an event that has the potential to place service users at risk then it needs to be notified in writing to the Commission. New showers have been installed in the bungalows. Service users spoken with confirmed they are happy with the new showers. The bungalows are homely with furnishings domestic in style. One of the bungalows is due to be
Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 17 redecorated and the service users that live there are being consulted over how they would like it. On a tour of the premises the environment appeared clean and hygienic. Service users help out in keeping their bungalows tidy. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from an effective and well-supported staff team, although it cannot be established if they are appropriately trained. It is of serious concern that evidence has not been made available to indicate that recruitment checks protect service users. EVIDENCE: All staff spoken with reported that they get good support from management in carrying out their role. There is individual supervision, where they can talk about their development needs and any personal issues and there is group supervision with a clinical psychologist that visits the service. One staff member explained how this time enabled the staff team to alter the way they worked with one particular service user, which had a very positive effect. All staff spoken with confirmed that they are happy with the level of training they receive, including annual mandatory training such as moving and handling, basic first aid, and food hygiene then there are other courses useful for meeting the needs of service users. There is not sufficient up to date evidence, however of training that has been attended. One staff member is in the process of making a central record but this is not yet complete and only some staff keep copies of certificates on site. This is made a recommendation
Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 19 in the report. All but two of the staff team are qualified to at least National Vocational Qualification Level (NVQ) 2. Evidence of recruitment checks and proof of identity are still not retained at the home but are held centrally with the Trust, despite this being a repeated requirement. In order to satisfy the Commission that the care home regulations are being met three staff members were selected and a request was made for evidence to be supplied to the Commission by a set timescale. The timescale was extended but the information was still not made available. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 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 home is well run, with the views of service users and stakeholders underpinning developments to the service. The health, safety and welfare of service users is promoted and protected. EVIDENCE: The manager is a qualified mental health nurse and has numerous years of experience in supporting adults with mental health difficulties. It is apparent that there is a commitment to an innovative and rights-based approach to the service. Feedback questionnaires are regularly circulated to service users on all aspects of the home and staff, where necessary, support service users to fill in these forms. Self assessments seen on service user files also act as another form of quality assurance, in ensuring that individuals are comfortable with the support, in terms of their own needs and subsequent care plan, that is
Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 21 provided. There are also regular internal quality audits that must be undertaken in accordance with Nottingham Community Housing Association policy and procedures. One is due and emails seen show this is currently being organised. The home has recently had its British Standards Institute (BSI) audit. All the necessary fire safety tests and drills are undertaken and all substances that are hazardous to health are stored securely in accordance with COSHH regulations. The pre-inspection questionnaire indicates that the servicing of equipment and electrical and gas systems are all up to date. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 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 2 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 2 33 x 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 X X 3 X Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 YA34 Regulation 17(3)(b) Requirement All items as specified in Schedule 2 must be kept in the care home otherwise internal arrangements are in place so that staff files are made available for inspection. This is repeated from the previous inspection, initial timescale 30/05/06 not met. Timescale for action 30/01/07 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. 2. Refer to Standard YA23 YA35 Good Practice Recommendations Ensure all staff are aware of their responsibilities in accordance with Safeguarding Adults and Whistleblowing procedures. Ensure there is sufficient evidence at the care home of all training and qualifications of staff. Orchard Street Care Home DS0000008729.V314785.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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