Inspection on 24/11/08 for Orchard Street Care Home

This inspection was carried out on 24th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard Street Care Home 19/10/06

Orchard Street Care Home 07/10/05

Orchard Street Care Home 29/03/05

Orchard Street Care Home 21/01/05

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Orchard Street Care Home 2-8 Orchard Street Hucknall Nottingham NG15 7JZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Meryl Bailey     Date: 2 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Orchard Street Care Home 2-8 Orchard Street Hucknall Nottingham NG15 7JZ 01158443675 01159104267 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): NCHA Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 12 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: Service users shall be within category MD Date of last inspection Brief description of the care home 12 The last inspection visit prior to this one took place on 7 November 2007. Orchard Street provides accommodation for up to twelve adults with mental health needs excluding Dementia. There are four bungalows, connected by a covered walkway. People live in three of the bungalows and the fourth is used by staff. Each bungalow has its own kitchen, bathroom and sitting room and each person has a single bedroom. At the rear of the home is an enclosed garden with sheds and seating areas. The home is close to shops, public houses, cafes, a cinema, library, tourist sights and other local amenities in the town centre of Hucknall. The fees for living at this home are £300 per week. More information and copies of the most recent inspection report is available on request at the home. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection is on outcomes for people and their views on the service provided. This process considers the providers capacity to meet regulatory requirements and minimum standards of practice and it focuses on aspects of service provision that need further development. We reviewed all of the information we have received about the home since the last report of our key inspection in November 2007. We have also included information from people who at the home as well as staff. We used questionnaires to allow people to make comments anonymously and six questionnaires have been returned. Managers of homes are now required to complete a document called an Annual Quality Care Homes for Adults (18-65 years) Page 6 of 27 Assurance Assessment (AQAA) to identify from their own quality monitoring what the service does well and what they need to improve. The AQAA was returned before the inspection visit and was used to plan the visit and to support judgements made in this report. We did the inspection visit with one inspector. It was unannounced and took place on one day during the daytime. The main method of inspection we use is called case tracking which involves us choosing a sample of people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We looked at three peoples records. We had discussions with some people living at the home and two support staff working there as well as the acting manager. A partial tour of the premises was made and this included two of the bedrooms as well as communal areas and facilities. We also looked at a large sample of staff records to find out if checks were carried out before they started working at the home and if they were appropriately supervised and supported. What the care home does well: What has improved since the last inspection? What they could do better: Arrange individual nutritional screening and promote healthy eating individually with people living in the home. Review the procedure for monitoring medication for people who look after their own medication so that appropriate records are maintained to ensure it is taken safely. Ensure that all persons working at the home are appropriately supervised. This is so that people receive care from staff who are sufficiently supported, guided and disciplined to meet peoples needs safely. We recommend all staff have individual recorded supervision meetings at least six times a year with their manager. Each member of staff should have a training and development plan, with clear records of training they have completed, so that they receive regular training appropriate to the work they perform in meeting peoples needs safely. The acting manager must make an application to the Commission to be assessed for registration. This is so that the acting manager can demonstrate her fitness to manage the service for the benefit of people that live there. Arrange the annual testing of Portable Electrical Appliances in order to ensure the safety of those people using these appliances. Care Homes for Adults (18-65 years) Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure is established to ensure the service available at the home meets the needs of any new people. Evidence: No new people had moved to the home since the last inspection and there were no vacancies. There were pre-admission assessments and reassessments for each person. People kept a copy of the Service Users Guide in their own bedrooms. This guide gave full information about the home. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual choices are respected and support is planned so that people retain their independence as far as possible. Evidence: There were comprehensive care and support plans that gave details of action staff need to take to support people. Risks had been assessed as part of the planning process. People we spoke with said they knew about their support plans and confirmed they have been involved in the planning process with staff. All care planning was recorded on computer. Plans were printed and kept by people in their own rooms. Each part of the plan indicated when the next review was due and all plans were reviewed at least every 90 days. Where they needed to be updated the new part of the plan was printed and replaced the relevant part of the existing plan. Staff recorded their daily notes on computer and we found information was kept up to date. There were records of meetings and questionnaires that demonstrated that people Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: living at the home made decisions about furnishings in the bungalows and about activities and were generally encouraged to be in control of their lives. People told us they chose what they wanted to do each day. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support in maintaining a positive lifestyle with as much independence as possible, but nutritional needs are not thoroughly assessed and reviewed. Evidence: The ages of the current people living at the home were 45 to 74 years. The younger people attended day centres. There was a pool table in the shared lounge. This lounge was also used for breakfast by everyone. One person had a visitor during this inspection. Relatives were encouraged to continue involvement with organised trips and events involving people living at the home and their relatives. One of the staff informed us of boat trips, pub lunches and trips to Matlock. Other people told us about activities within the home in the evenings that included quiz games and video evenings. Five people had been supported to take Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: holidays to various places, but the manager told us that others had not requested to have a holiday. There have been monthly healthy eating promotion days and the last one was organised by a student nurse. There were records of these sessions. However, the records of food eaten on a daily basis were incomplete and did not indicate whether variety is planned into daily meals. There were more records in one bungalow than in others. There were some menu suggestions in each kitchen, but some people told us they ate whatever one person in their bungalow chose to cook each day. Some others prepared their meals individually with support from staff. On the day of the inspection some people were eating beef burgers, potatoes, cabbage, carrots, brussels and peas. One person had several snacks of chocolate, cake and crisps to eat following the meal. One person had sandwiches for every meal. The acting manager stated on the Annual Quality Assurance Assessment (AQAA) form that nutritional screening had not been carried out. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support with their personal and health care in the way they choose, but medication is not always clearly monitored to ensure it is taken safely. Evidence: People we spoke with told us they were happy with the support they receive with their personal care. One told us they preferred particular staff to assist with showers and staff confirmed they were aware of this and respected the individual choice. Care plans identified the level of support and prompting required with personal hygiene and appropriate dress. There were records of when people had seen doctors and other health professionals. Medicines were stored securely for people who needed full support with their medication. There were completed records where medicines were administered directly by staff. Some people looked after their own medicines and there were risk assessments to determine how this should be managed. New stocks were ordered and delivered to the home for people. These were then passed on to individuals. Records Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: were not clear and we could not determine how medicines were checked into the home. Risk assessments determined that there was a need to monitor if some people were taking their tablets. There were reminders in the general diary for staff to do this, but no clear record that they had monitored people taking tablets appropriately. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their concerns, complaints and allegations are taken seriously and appropriate actions are taken to safeguard people from any abuse. Evidence: People told us in the survey forms they returned to us that they all know how to make a complaint. One person told us there was a clear complaint procedure picture on the main notice board and there were opportunities to make complaints at Residents Meetings and within the womens group. Other people we spoke with during the inspection said they would tell the new manager or another member of staff if there was anything they were not happy about. There had been a recent allegation of verbal abuse and this had been investigated appropriately. There were records to show that staff members had received training in Safeguarding Adults since the last inspection. The recent allegation demonstrated one staff member had understood the need to alert a manager of concerns and to whistleblow about another staff member when appropriate. The acting manager told us that all staff were reminded of the Whistle Blowing policy within staff meetings. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean, comfortable and homely surroundings. Evidence: There were four people living in each of three bungalows. We saw two of the bedrooms and two shared kitchens and lounges. We also saw an additional large shared lounge. All areas were clean and people told us in surveys and at inspection that the home was always clean and fresh. People we spoke with said that they liked their accommodation as they had the choice of small homely environment as well as access to a larger shared lounge. The garden was well kept with areas to sit outside. There was a fountain in the centre of the garden and two sheds. The Acting Manager had already identified some maintenance that was required and was actively pursuing dates for repairs during this inspection. This included a handle on a toilet door in one bungalow. Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff to meet needs. Their fitness to work in the home has been assessed, but training is not all complete and they have not always been appropriately supervised and supported. Evidence: The rota showed that there were always two support staff on duty at the home and the acting manager was in addition to this. We looked at a range of staffing records to include some staff that had worked at the home for several years and the newer staff. There were full recruitment records for the most recently appointed staff including the application form and two references and there was evidence of satisfactory checks carried out by the Criminal Records Bureau (CRB) with respect to all staff. There were no clear individual training records, but some certificates had been placed on staff files. The manager showed us more certificates in a shared file. From this we were able to establish that staff had received training in the following since the last inspection: Fire safety and evacuation procedures, Safeguarding Adults, and Food Hygiene. The acting manager told us that in addition to this 50 per cent of the staff had achieved a National Vocational Qualification (NVQ) in Care at level 2. Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: There were a few records of supervision meetings between individual staff and managers in the past. We found no evidence of such meetings during the last year. Staff confirmed that they had not had supervision meetings or appraisals since the previous deputy manager had left the service. Staff told us they had a regular monthly group supervision meeting with a clinical psychologist and found some support in this way. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are mostly in place to ensure the service is run appropriately. Evidence: The last registered manager left the service at the end of March 2008. There was another acting manager for five months and the current acting manager, Judy Gray, commenced on 8 September 2008. She has not yet applied to be registered with the Commission. There was a systematic procedure used to regularly assess the quality of the service. This included regular audits by managers from other homes owned by Nottingham Community Housing Association (NCHA). Also, questionnaires and self assessments were used and some copies of these were on files of people living at the home. The manager had told us in the Annual Quality Assurance Assessment form (AQAA) that all fire safety equipment, alarms and emergency lighting had been checked and serviced within the last year, but the annual testing of portable electrical appliances was overdue, as they were last tested in August 2007. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: As stated in the Healthcare section of this report, medication was not managed appropriately for people who self medicate, as there were no clear records that staff had monitored whether or not people were taking their tablets. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Review the procedure for monitoring medication for people who look after their own medication This is so that a system is in place for appropriate records to be maintained to ensure all medication is taken safely and as prescribed. 30/01/2009 2 36 18 Ensure that all persons working at the home are appropriately supervised. This is so that people receive care from staff who are sufficiently supported, guided and disciplined to meet peoples needs safely. 31/03/2009 3 37 9 The acting manager must make an application to the Commission to be assessed for registration. This is so that the acting manager can demonstrate 30/01/2009 Care Homes for Adults (18-65 years) Page 25 of 27 her fitness to manage the service for the benefit of people that live there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 17 35 Arrange individual nutritional screening and promote healthy eating individually with people living in the home. Each member of staff should have a training and development plan, with clear records of training they have completed, so that they receive regular training appropriate to the work they perform in meeting peoples needs safely. Arrange for staff to have individual recorded supervision meetings at least six times a year with their manager. Arrange the annual testing of Portable Electrical Appliances in order to ensure the safety of those people using these appliances. 3 4 36 42 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!