CARE HOME ADULTS 18-65
Orchard,The 20 Church Road Wootton Isle Of Wight PO33 4PX Lead Inspector
Janet Ktomi Unannounced Inspection 21st February 2006 16:00 Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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,The DS0000012593.V252255.R01.S.doc Version 5.1 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,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Orchard,The Address 20 Church Road Wootton Isle Of Wight PO33 4PX 01983 884092 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) Mrs Barbara Winifred Anne Bailey Mrs Barbara Winifred Anne Bailey Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: The Orchard is a residential care home providing care and accommodation to one service user with a learning disability. The home is a chalet bungalow situated in a quiet residential area of Wootton, a short walk from local shops and amenities. The property is domestic in every respect with the service user’s bedroom on the first floor. There is space for off road parking to the front and a large garden to the rear that is available for use by the service user. The home is owned by Mr and Mrs Bailey and managed by Mrs Barbara Bailey. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second inspection of this inspection year; core and additional standards were assessed. Core standards not assessed during this inspection were assessed during the previous inspection undertaken in August 2005. The service was provided with limited notice of the inspection to ensure that the one service user and the manager were at home. The inspection was undertaken on a weekday late afternoon and lasted two hours. Discussions were held with the manager, her husband and the service user. The service user stated that he is very happy and has no worries or concerns. Records and documentation identified in the report were viewed. What the service does well: 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,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 6 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,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 7 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): None The service does not intend to admit any people to the home. EVIDENCE: The manager confirmed that the home does not intend to admit any new service users. The service exists solely to continue to provide a home for the one service user and would cease to exist as a registered home should the service user move to alternative accommodation. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 8 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, 8, 9 and 10. The service user’s physical, social and emotional needs are fully met at the home. EVIDENCE: The service user has been supported to write his own care plan identifying the areas he needs support with. This covers all the necessary areas and states clearly how the service user would like support to be provided. The manager informed the inspector that the care manager had recently undertaken a placement review and the notes from this were not yet available. The care plan was viewed during the inspection and is appropriately stored within the home. The service user confirmed that he had been involved in the writing of his care plan and was fully aware of the information contained within it. The manager encourages the service user to make choices and take responsibility for his own decisions. The manager spoke knowledgably of the ways this can be done and the progress that has been made in this area such as writing his own plan of care. Discussions with the service user confirmed that he is able to make decisions for himself and is aware of the consequences of these decisions. The home does not restrict the service user’s rights and the manager confirmed she would discuss any concerns with the service user’s
Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 9 care manager. The manager is appointee for the service user and there was evidence seen during the inspection that the service user makes decisions as to how his personal money will be spent. The service user confirmed that he is able to make his preferences known and that he is involved in decisions about the home. During the inspection it was evident that the service user felt comfortable with the manager and her husband and able to make any suggestions or requests as they occur. The policies and procedures within the home are specific to the needs of the service user. The service user had been involved in the writing of the fire risk assessment, which states the action the service user would take should a fire occur in the home as well as the actions taken by the home to minimise the risks. The manager clearly understands the service user, his needs and capabilities. He is encouraged to consider the implications of his actions and to understand any risks involved. The service user attends day services and college. The home has an appropriate procedure in place should the service user have any unexplained absences or not return home at the time expected. The manager and her family are well used to working with the rules for confidentiality having worked as a foster carer and in a school for many years. The manager was clear about the service user’s right to confidentiality and would not share information inappropriately. The service user attends social services review meetings. Information held within the home is appropriately stored. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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): 11, 12, 13, 14, 15, 16 and 17. The service user has chosen an active lifestyle appropriate for his age. EVIDENCE: Care plans, along with discussions with Mr and Mrs Bailey and the service user, indicated that he is able to maintain and develop social and leisure skills and activities with disabled and non-disabled people. This increases his selfconfidence, self-esteem, independence and communication skills. The service user is supported to develop practical life skills within and outside the home in both formal (college and day services) and informal (social activities) settings. During the inspection the service user talked about external activities he enjoys and about a holiday he had undertaken with Mr Bailey in October 2005. It was clear during discussions that the service user is able to make decisions and is supported appropriately to do this. The service user discussed his day services and leisure activities with the inspector and is supported when necessary. It was clear that the service user has control over what he does and how he spends his time. The service user is very much part of the local community and previously informed the inspector that he knows and likes the people who live in
Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 11 neighbouring houses. The service user is involved in local activities, church events, the PHAB club held in Wootton Youth Centre and he attends local pubs frequently, where he especially enjoys playing pool with the other regulars. The service user is supported to attend activities in other parts of the Island and transport is available via the car owned by Mr and Mrs Bailey. The service user is registered to vote and would be supported to exercise his rights if he wanted to. It was clear during the inspection that the service user is able to choose what he does and how he spends his time. The service user has his own television, video player, DVD player and music centre in his bedroom. The service user also spends time in craft activities. The service user enjoyed a holiday in October with Mr Bailey and discussed plans for holidays for this year. The service user confirmed that he is fully involved in decisions about holidays and where he would like to go. The service user has no contact with his birth family and regards Mr and Mrs Bailey as his family as he has lived with them since the age of 14 months. During the inspection the service user talked about visits from Mr and Mrs Bailey’s daughter and grandchildren that he has clearly enjoyed. Mr and Mrs Bailey’s other daughter is a regular visitor to the home and the service user clearly enjoys her company and social activities with her. The service user is able to invite friends to visit him and is supported by Mr and Mrs Bailey to maintain contact with friends. The service user has many friends, both disabled and non-disabled within the local community. Mrs Bailey confirmed, and the service user agreed, that he has a lot of choice in his daily life. The service user clearly felt able to express his opinions and thoughts to Mr and Mrs Bailey. The service user enjoys the pets (two dogs and two cats) that live at the home and is involved as appropriate in their care. The service user does not smoke and the home has a non-smoking policy. The service user was very complimentary about the food provided at the home and stated that he is involved in family meal choices. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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): 18,19 and 20. The service user’s personal and healthcare needs are met. EVIDENCE: The service user is virtually independent in all areas of personal care requiring only occasional physical support. The service user’s care plan identifies how he would like support to be provided. The service user has a daily routine for getting up, baths, mealtimes and bedtimes. Verbal support is provided tactfully by the manager and she reported that the service user accepts suggestions appropriately. The service user has his own bathroom adjacent to his bedroom and his privacy is respected. The service user does not require any aids or equipment to maximise independence. The service user is registered with a local GP in East Cowes. The service user is happy for one of the proprietors to accompany him for medical appointments and will tell them if he has any health concerns. The service user is generally fit and healthy. The service user has regular health checks, chiropody, dental and optician appointments. The manager maintains a record of all visits to health professionals and advice/action taken. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 13 The service user has been assessed as being able to self medicate and does this as part of his daily routine. The service user will request Paracetamol from Mrs Bailey should he have a headache or pain. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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. The service user is able to complain and he is protected from abuse. EVIDENCE: There have been no complaints about this service. The service user was clear that he had no complaints and confirmed that he was aware of how to make one. The service user could also make a complaint via his care manager or his day services that would ensure that appropriate action was taken to resolve any complaints. The manager was aware of the need for the service user to feel he could make complaints and would pass on complaints either to his care manager or to the Commission. The home has a copy of the Isle of Wight adult protection policy. The manager was clear about her responsibilities in connection with adult protection and the action she would take should she have any concerns. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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 the following standard(s): 24, 25, 26, 27, 28, 29 and 30. The accommodation provided is to a high standard and meets the service user’s needs appropriately. EVIDENCE: The premises is domestic in nature, very clean and comfortable with a homely atmosphere. There is a very good standard of decoration throughout and the service user has access to all parts of the building and the garden to the rear. The home is within easy walking distance of the shops and amenities and close to a bus route that provides services to other parts of the Island. Mr and Mrs Bailey have a car that is used for the service user when required. The service user was happy to show the inspector his bedroom and bathroom that are decorated and personalised to a high standard. There is central heating and natural ventilation, and the room contains all required furniture, fixtures and fittings. The adjacent bathroom has a Whirlpool bath, WC and washbasin. The service user also has access to the ground floor shower/bath room that has non-slip tiles on the floor. The home has accessible indoor and outdoor communal space that exceeds the standards required. There is a large kitchen/dining room, separate dining room, lounge, conservatory and a sitting area on the landing close to the
Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 16 service user’s bedroom. All areas of the home are decorated to a high standard, well maintained, clean and tidy. The service user is fully mobile and does not require any aids or equipment. There is a separate utility room with tiled floor, sink, washing machine and tumble dryer. Mrs Bailey confirmed that the washing is done to the recommended temperatures. No sluicing facility is required. At the time of this inspection the home was found to be clean, tidy and free from offensive odours. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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): 33 The service user is appropriately supported at all times. EVIDENCE: The home does not employ staff and therefore the standards within this section are not applicable. The service user does not require physical care, his needs relate to emotional and organisational support. He is quite independent and does not need constant supervision. The family is aware of the service user’s needs and ensure these are met. The extended family provide care and support if the proprietors are unavailable and are appropriately trained via their care related employment. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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): 37, 38, 39, 40, 41, and 42. The management arrangements of the home are appropriate to ensure the service user’s needs are met. EVIDENCE: The manager, Mrs Bailey, has no formal care qualification, but does have in excess of 35 years practical experience of working with learning disabilities. Mrs Bailey has an NNEB certificate and Mr Bailey is a retired teacher with remedial expertise. Mrs Bailey is the chairperson of Friends of Medina Centre and leader of the Isle of Wight PHAB club. Mrs Bailey was recently presented with an award at the House of Lords in recognition of her work for PHAB. Mrs Bailey has been involved in Person Centred Planning training and regulation related workshops. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 19 The home is a family home and the atmosphere is one of warmth and caring with each member sharing views and desires. The manager shares her role with her husband, but takes most of the responsibility for the paperwork. During the inspection the interaction between the service user and the manager was positive and he clearly felt able to state his views and opinions. Although there are no formal quality assurance processes in place there are regular reviews of the placement by Social Services. This gives everyone an opportunity to voice their views. There is a range of policies and procedures in place. These are appropriately stored together with other paperwork relating to the placement. The family is aware of the information kept and how to access it. The care is tailored to the one well-known service user and therefore the policies/procedures are relevant, simple and straightforward. The service user has been involved in the formation of some of the policies such as the fire risk assessment and action plan in which he states what he will do if there is a fire in the home and he is in his bedroom. The records kept by the manager are sufficient to cover the nature of the service offered. As previously stated, records are held in a lockable facility. Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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 Standard No Score 1 N/A 2 N/A 3 N/A 4 N/A 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 N/A 30 4 STAFFING Standard No Score 31 N/A 32 N/A 33 3 34 N/A 35 N/A 36 N/A CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 X Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orchard,The DS0000012593.V252255.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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