Inspection on 07/10/05 for Orchard Street Care Home

This inspection was carried out on 7th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard Street Care Home 24/11/08

Orchard Street Care Home 19/10/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Orchard Street Care Home 2-8 Orchard Street Hucknall Nottingham NG15 7JZ Lead Inspector Joanna Carrington Unannounced Inspection 7th October 2005 10:00 Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 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.V253210.R01.S.doc Version 5.0 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.V253210.R01.S.doc Version 5.0 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) 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.V253210.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29/03/05 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 of whom are mental health trained nurses (RMNs). An attractive, small, enclosed garden offers tranquillity and activity to the residents. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four and a half hours on the 7th October 2005. This was the home’s first inspection for this inspection / financial year. The main method of inspection was called ‘case tracking’ which involved selecting three service users and tracking the care and support they receive through the checking of their records, discussion with them, the care staff and observation of care practices. In total, four service users and two members of staff were spoken with and the manager was available for discussion and feedback throughout the majority of the inspection. What the service does well: What has improved since the last inspection? What they could do better: As well as the self assessment service users fill in there also needs to be a formal risk assessment carried out by staff for service users self medicating. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 6 Service users self-medicating need to be aware of the importance of secure and safe storage otherwise the risk to other service users is not being managed appropriately. When Medication Administration Records (MAR) are being used then clear and accurate instructions on these charts is required. Complaints Procedure needs to be updated so that both service users and their representatives know that they can take their complaints to the Commission and that complaints should be responded to within 28 days. So that the Commission can effectively regulate care services then the home needs to improve on its legal responsibility of notifying the Commission of certain events, as specified under Regulation 37 of the Care Home Regulations. Staff files are not kept at the home but are held centrally with the Nottinghamshire Healthcare Trust. Therefore, there need to be internal arrangements in place to ensure that these files are made available for inspection. 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.V253210.R01.S.doc Version 5.0 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.V253210.R01.S.doc Version 5.0 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): 2 Prospective service users do not move to the home until their needs are assessed, although residents falling out of category should not be admitted to the home until a variation of registration is applied for. EVIDENCE: For the three service users that were case tracked all of them had a copy of their Health and Community Care Assessment on file. This assessment helps to determine whether the home is appropriate to meeting individual service users’ needs. One of the service users case tracked is over 65 years of age and was so on admission. The home is not registered to offer accommodation and support to adults over 65. Through both talking with this service user and looking at their support plans and file it is already evident that the home is appropriate to meeting this person’s needs. However, as this service user is not within the home’s category of registration an application for variation should have been received by the Commission prior to their admission. This application is still required. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 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): 7 Service users take control of their lives and are supported to make their own decisions. EVIDENCE: This was evident from talking with service users, who confirmed that they are encouraged by staff to be independent and take control of their everyday lives. Staff spoken with demonstrated a commitment to promoting service users’ self-empowerment. Information about advocacy services is displayed on bungalow notice boards. Staff gave examples of when service users have chosen to participate in local community activities and support plans show that service users are encouraged to manage their finances themselves, within a risk management framework. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 10 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 and 17 Service users are able to participate in appropriate activities, maintain friendships and relationships and be a part of the local community. Service users have a varied and healthy diet and are supported to be involved with menu-planning and meal preparation. EVIDENCE: There is only very limited day service provision for adults with mental health difficulties in Nottinghamshire. Some service users at Orchard Street attend what is available while others are supported to take part in other communitybased activities such as going to college, into town or out for a drink and lunch. It is up to service users what they want to do. The home has excellent links with the local neighbourhood. Service users are involved in the development of a regular newsletter, which is circulated to the local community. There has recently been a summer fete held at the home, with a report and photo about the fete in the local newspaper. These events also help service users to maintain relationships with family and friends. There is also a ‘Carers Group’ run for informal carers. Informal carers spoken with at the last inspection reported that this is an invaluable resource. Staff that run it were spoken with during this inspection and confirmed that the group is still Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 11 running successfully and service users who have little family also enjoy and benefit from being involved with the sessions. Each bungalow is provided weekly with a sum of money specifically for food. Service users are supported (where necessary) to plan their weekly shop and to plan and prepare meals. Service users in one bungalow spoken with explained how they do this independently and the menu diary showed that they enjoy various nutritious and balanced meals. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Service users’ right to self-medicate is promoted within a risk-management framework, however, a formal risk assessment including responsibilities for storage of medication is also required. EVIDENCE: The majority of service users at Orchard Street take responsibility for their own medication. Every six months service users fill in a self-assessment questionnaire, to ensure that they continue to be comfortable with this arrangement. This in itself acts as a risk assessment and is good practice, however, in addition to this a formal risk assessment is also required. This was not seen for the three service users that were case tracked. This risk assessment needs to include individual service users understanding of the importance of storing their medication securely. It was discovered during the inspection that one service user keeps theirs in an unlocked kitchen cupboard, where other service users and anyone using the kitchen has access. To ensure the safety of others if service users choose not to keep their medication in their lockable facility then to minimise risk service users should be responsible for at least keeping medication in locked bedrooms. For one of the service users case tracked there was a Medication Administration Record (MAR) being filled in by staff and a member of staff spoken with reported that staff are responsible for giving this service user their medication. There were no instructions included on the form and a member of Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 13 staff spoken with reported that a tablet is given at night whereas on the actual dosette box the GP instructions states one to be taken in the morning. According to staff this service user is on ‘stage 2’ which means they have some responsibility for self-administration and this was recorded in their care plan. However, there was no recorded definition on the support plan of what ‘stage 2’ actually means and while staff provide some support and subsequently fill in a MAR chart then there must be accurate instructions on the chart that reflect the GP instructions. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users views are listened to, however, increasing use of the complaints procedure will ensure that there is a record of issues being acted on. Staff are aware of their role and responsibilities in accordance with local adult protection procedures, which assures residents that they will be protected from abuse. EVIDENCE: There are regular bungalow meetings where service users can air their views and service users spoken with confirmed that they feel listened to and comfortable enough to raise concerns and complaints. However, the complaint procedure needs updating to include the Commission for Social Care Inspection (CSCI) and that complaints will be responded to within twenty-eight days. Since the last inspection a complaint was received by the Commission and the provider, Nottingham Community Housing Association (NCHA) were requested to investigate this complaint, which they are currently in the process of. The complainant claimed to have raised issues with the Acting Manager prior to raising the complaint to CSCI. This situation identifies why if any issue, regardless of its seriousness, it is important that it is addressed using the complaints procedure, for the purposes of an appropriate response and clear records etc. There have not been any recent adult protection notifications. Nevertheless, staff spoken with demonstrated that they are confident with their role and responsibilities in accordance with the Nottinghamshire Policy and Procedures. Staff receive Protection of Vulnerable Adults training from the Nottinghamshire Healthcare Trust and also training from the Nottinghamshire Committee for Protection of Vulnerable Adults (NCPVA) is accessed. The November amendments to the Policy, (which state that any allegations involving staff members must be notified to Social Services in order to negotiate who Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 15 conducts investigation) was discussed, as this could not be found in the Policy folder. It is recommended that the amendments are downloaded from the website and added to the policy folder, to ensure that the Procedures are followed correctly. The manager reported during the inspection that a considerable sum of money raised at the summer fete has recently been stolen from their Safe. The police were immediately informed of this crime and subsequent measures have been implemented. In accordance with Regulation 37 of the Care Home Regulations any theft at the home must be notified to the Commission without delay. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 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 Service users live in a homely, comfortable and safe environment. EVIDENCE: It was evident from touring the premises that the home is well maintained. Each bungalow has its own communal living space that is homely and pleasantly decorated. In addition to this there is the main communal area for all four bungalows where service users can meet up. Service users spoken with confirmed that they are involved in the decoration process, selecting colours and items of furniture etc. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 Staff files in future need to be made available for inspection. Staff have good opportunities to training, which ensures that the needs of service users can be met. Although some progress has been made service users will ultimately benefit once all staff are formally supervised. EVIDENCE: Staff files containing copies of references and Criminal Record Bureau disclosure are held centrally with the Nottinghamshire Healthcare Trust therefore at the time of the inspection it was not possible to access these files, which is necessary for checking that safe recruitment practices are being followed. If this information is not available at the home then there needs to be internal arrangements in place to ensure that these files can be made available for inspection. Staff spoken with confirmed that the training with both Nottinghamshire Healthcare Trust and Nottingham Community Housing Association is very good, with plenty of mandatory training updates and other courses useful for effectively carrying out their support role. As recommended at the previous inspection, it was reported that formal supervision sessions have now commenced for care staff and staff spoken with feel that they are valuable. Supervision needs to take place for all staff and it is important that any senior staff supervising other staff are trained before doing so. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X None of these standards were assessed on this occasion. EVIDENCE: Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 4 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Orchard Street Care Home Score X X 2 x Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000008729.V253210.R01.S.doc Version 5.0 Page 20 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 YA2 Regulation 14 Requirement Admissions of people that do not fall within the category of registration must not be made (Unless an application for variation is approved.) Ensure there are adequate arrangements for the recording, safekeeping and safe administration of medicines received in the home. This includes doing detailed risk assessments for service users that self-medicate. The copy of the Complaints Procedure shall include the name, Commission for Social Care Inspection and that a complainant is responded to within 28 days. Ensure that any theft is notified in writing to the Commission without delay. Ensure that there are internal arrangements in place so that staff files are made available for inspection. Ensure that staff receive training on giving supervision before carrying out this role. Timescale for action 11/11/05 2 YA20 13(2) 11/11/05 3 YA22 22 30/11/05 4 5 YA23 YA34 37 17(3)(b) 07/10/05 30/11/05 6 YA36 18(1)(c) 30/11/05 Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 21 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 3 Refer to Standard YA22 YA23 YA36 Good Practice Recommendations A record is kept of all issues raised, details of any response to complainant, investigation, action taken and outcomes. Ensure that the November amendments to the NCPVA Policy and Procedures are included in the Policy File. All staff receive at least six supervision sessions per year. Orchard Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 22 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 © 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 Street Care Home DS0000008729.V253210.R01.S.doc Version 5.0 Page 23 - 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. 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