Inspection on 27/04/05 for Orchard (The) - Leonard Cheshire Disability

This inspection was carried out on 27th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard (The) - Leonard Cheshire... 17/04/07

Orchard (The) - Leonard Cheshire... 17/05/06

Orchard (The) - Leonard Cheshire... 04/01/06

Orchard (The) - Leonard Cheshire... 01/09/04

Orchard (The) - Leonard Cheshire... 12/05/04

Orchard (The) - Leonard Cheshire... 03/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Orchard Woolton Road Liverpool Merseyside L25 7UL Lead Inspector Peter Cresswell Unannounced 27 April 2005 8:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Orchard Address Woolton Road, Liverpool, Merseyside, L25 7UL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 428 8671 0151 421 1356 s.maxwell@nw.leonard-cheshire.org.uk Leonard Cheshire Michelle Maxwell CRH 26 Category(ies) of PD 18 - 65 yrs 20 places registration, with number PD(E) over 65 yrs 6 places of places Both genders The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1st September 2004 Brief Description of the Service: The Orchard is a care home for 26 disabled adults. It is owned by the Leonard Cheshire Foundation, a charity which provides a variety of services for disabled people in the United Kingdom and Europe. The Orchard is in a suburb of south Liverpool, a short drive away from Woolton Village, where there is a range of shops, pubs, a post office, banks and other amenities. The Orchard is purpose built, standing in its own well-maintained and accessible grounds. All service users’ accommodation is on the ground floor. Service users have single bedrooms though there is currently one bedroom available for sharing if required. Four bedrooms have en-suite facilities. There are three lounges, the largest of which has a wide range of games, activities, and a personal computer with internet access. There is a breakfast/coffee bar linked to the dining room where service users can make drinks and snacks. The home has a full time activities co–ordinator who - with support from service users, volunteers and staff - plans and supports a varied range of activities and entertainment within and outside The Orchard. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 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 standard(s) 2, 3 and 5 Service users are properly assessed before they are admitted to The Orchard. EVIDENCE: The manager assesses service users before they are admitted to The Orchard and details of initial assessments were on the service user files examined during the inspection. The home provides specialist services for disabled people and is well equipped to meet their needs. The Leonard Cheshire Foundation is a major national and European charity specialising in the care of disabled people so the management and staff of the home have access to the resources of the organisation. All service users have contracts and copies are kept in their file. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 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 standard(s) 6, 7, 8, 9 and 10 Care planning is not consistent and in some cases staff do not have the information available on which to base their daily care of service users. Service users make decisions about their own lives as far as possible and are fully involved in the running of the home. EVIDENCE: One of the three service user files looked at during the inspection did not contain a care plan of any description. Some documents that set out the service users’ own views about the care they wish to receive were not signed or dated. Undated documents are of limited value as it is not possible to judge whether the information in them is up to date or valid. For example, one unsigned, undated document recorded the view of a service user that she did not object to care being given by male or female staff. In fact the latest position was that she did not want personal care to be provided by male staff, with the exception of one particular member of staff. Thus the case file was not just incomplete, it was actively misleading. Reviews had taken place but the care plans had not always been clearly updated. Care plans are not kept with the daily reports file, which makes it difficult for staff to relate their daily recording to the care plan. The manager said that she was working with staff to develop care planning and was proposing to relocate the daily reports to the The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 9 individual case files. The post of care co-ordinator (in effect a deputy manager) has been vacant since the Registered Manager was promoted from that post. She said that the post was due to be advertised as a priority if and when she was confirmed as the permanent manager, having been appointed initially on a temporary basis to cover for a secondment. This was confirmed by the Regional Service Manager. Service users said that they attend service user meetings and put forward their views on how the home should be run. They feel that their views are taken seriously and are acted on where possible. Service users have differing packages of care, some of which include one to one time for activities. Files are stored securely, though as noted previously, not all were accurate and up to date. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 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 standard(s) 11, 12, 13, 14, 15, 16, and 17 The home has good links with the community and service users are encouraged and supported in pursuing activities and pastimes of their choice. Meals in the home are to the taste of the service users, and choices are available. EVIDENCE: The Orchard has a full time activities organiser who, with the support of other staff, service users and volunteers, arranges a wide range of activities. On the day of the inspection a small group of service users was going to the Ellesmere Port Boat Museum and recent activities included theatre trips, concerts, shopping, airport visits as well as pastimes within the home such as games, computers and gardening. One service user who used to work at airports is supported in going to John Lennon Airport several times a week and said how much he enjoyed these visits, where he meets up with like-minded friends. Activities are recorded on service users files but the recording was not up to date. The home has been selected to send service users and staff to a garden party at Buckingham Palace in the summer and the service users to attend had been chosen by drawing lots, which the service users felt was fair. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 11 The home has a four week menu which is currently being changed, following consultation with service users. The main meal is usually served at lunchtime and a choice is always available. The menu and choices for the day are set out on a blackboard in the dining room. Service users said that they enjoy the food provided and feel that their tastes are reflected in the menu. Mealtimes are flexible. There is a breakfast/coffee bar next to the dining room so that those service users who can do so can prepare their own breakfast and hot drinks. One service user raised the issue of the height of the tables in the dining room. The manager said that individual, adjustable tables had been purchased which she felt might address this concern. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 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 standard(s) 18, 19 and 20 The systems for the administration of medication are good but there are some areas of weakness, especially in relation to recording. EVIDENCE: Service users’ views about how care is to be given are recorded on file but as described earlier not all of these were up to date. Service users said that they were happy with the care provided. One service user who retains her own medication was not storing it securely as the drawer for that purpose was not convenient for her current circumstances (she was confined to bed). The management should investigate if another secure storage facility is possible and if not should carry out an appropriate risk assessment. There was no doubt that the service user did want to administer her own medication and was capable of doing so but the self medication declaration on her file was not signed or dated. The Orchard operates a monitored dosage system and medication is securely stored in individual service users own rooms. Medication records were accurate but some drugs had not been delivered on time by the pharmacist and were therefore not available in the home. The Registered Manager said that she was pursuing this unacceptable level of service with the pharmacist. The application of prescribed creams was not recorded. The administration of all prescribed medication must be recorded on the Medication Administration The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 13 Record sheets. Medication requiring refrigeration is stored in a dedicated fridge but the lock is broken and in the meantime staff were not routinely locking the door of the room in question when it was left empty. Medication must never be left unsecured so until the lock can be repaired or replaced the Registered Manager must ensure that all staff lock the room in question. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The home has clear policies for dealing with complaints and allegations of abuse. EVIDENCE: There have been no complaints since the last inspection. The organisation has clear procedures for dealing with allegations of abuse. One service user had recently developed a very serious pressure sore, partly as a result of inadequate care practice. The Registered Manager had carried out a thorough investigation into the incident and the service user, family and commissioning Social Services Department were satisfied that the serious issues raised had been addressed. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 28, 29, and 30. The home is purpose built to meet the needs of disabled people and provides a comfortable, spacious and homely environment. Some minor repair, redecoration and modernisation work is needed. EVIDENCE: The home is purpose built and has a range of comfortable communal spaces. These include a spacious dining room/coffee bar and a large internal courtyard which was in the process of being refurbished for the summer months. Service users were already using the courtyard and said that they make good use of it in warm weather. A new canopy is being fitted, paid for by donations from a bank and a local charity. Service users have spacious single bedrooms, four of which have en suite facilities. All of them have built in electric ceiling hoists. Bedrooms are on the whole well decorated and furnished, though the chair in room 1 needs to be replaced and the veneer to the bed frame was damaged. The ventilation system cover in room 14 is damaged and the Registered Manager said that she had ordered a replacement. Door surrounds receive very heavy wear from the wheelchairs and improved protective measures have not yet been fitted. This makes the doors and corridors a bit unsightly. The organisation has a cyclical decoration programme and whilst some lounges The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 16 have been recently decorated some bedrooms could do with redecoration. The Orchard has sufficient baths and toilets, though some of the toilets in particular are now looking rather old fashioned and would benefit from modernisation. The locks on toilet H and the bathroom opposite room 18 cannot be opened from the outside and must be adjusted or – even better – replaced. There is a hole in the wall of bathroom H. Mop heads are still being dried in bathroom B, despite a requirement to stop doing this following the last inspection. This limits the use of the bathroom by service users. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 and 36 The home has a full staff team and an active training programme. Staff and service users get on well together and there is a sense of the home being a community. EVIDENCE: Staff have detailed job descriptions which are kept on their files. Criminal Records Bureau checks and references are taken up before employment. CRB records are kept in the regional office but the home retains emails from region as evidence that the checks have been made. Checks are also made on volunteers before they are allowed to work at the home. One volunteer said during the inspection how much he enjoyed working in the home, taking service users out and helping with activities in the home. The Registered Manager said that if agency staff are used she insists on seeing their up to date CRB checks before they are allowed to start work. 15 out of the 21 care staff now have NVQ2 and the remaining 6 are about to begin training. The Leonard Cheshire Foundation employs a regional training officer and a regional NVQ assessor. Both were in the home at the time of this unannounced inspection. The training officer was preparing an up to date training matrix and the NVQ assessor was working with individual members of staff. Two of the Team Leaders have completed the Leonard Cheshire/NEBS Team Leader course. As a result of a service user developing a serious The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 18 pressure sore additional training on moving and handling and pressure sore awareness is being arranged. Normal care staffing during the daytime is a team leader and four care staff. In addition there is a full time activities co-ordinator, the Registered Manager, domestic and catering staff, volunteers and foreign student volunteers (who live on the premises). Service users said that they have good relationships with staff. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 41, 42. Service users play an active part in the running of the home. Standards are checked regularly. EVIDENCE: The newly Registered Manager for the home is still a temporary appointment though this situation is due to be resolved shortly. The Orchard is regularly visited by other service managers and volunteers, who inspect the home and complete reports in accordance with Regulation 26 of the Care Homes Regulations. Fire safety checks and training are carried out regularly and are recorded. The kitchen is clean and well organised. Fridge temperatures are checked and recorded during the normal working week but are not checked at weekends. The cook said that she had asked agency and weekend staff to do this but to no avail. The Registered Manager must ensure that fridge and freezer temperatures are checked and recorded daily. One freezer’s built in thermometer was broken and the cook said that a repair had been ordered. In The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 20 the meantime the manager must arrange for a free standing thermometer to be used in the freezer to ensure that it is safe. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 21 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 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 2 3 2 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Orchard Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x 3 2 x F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 22 Yes 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 6 Regulation 15 Requirement The Registerd Person must ensure that all serive users have care plans which are readily available to all staff and are regularly reviewed and updated. The Registered Person must ensure that all documents relating to the care of individual are signed and dated. The Registered Person must ensure that the administration of all medication is recorded on Medication Administration Record sheets. The Registered Person must ensure that risk assessments and authorisations for service users who administer their own medication are sgned and dated. The Registered Person must arrange for suitable furniture amd in service users bedrooms by: Repairing the veneer to the bedframe and replacing the chair in the identified bedroom· Repairing and repainting those door surrounds badly marked from wheelchair use. The Registered Person must ensure the safety of service Timescale for action 1 June 2005 2. 6 15 1 June 2005 With immediate effect 1 June 2005 3. 20 13(2) 4. 20 13(2) 5. 25 16 1 July 2005 6. 27 16 1 July 2005 Page 23 The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 7. 27 16 8. 42 16(j) 9. 20 13(2) users by: replacing the locks on bathroom H and the bathroom opposite room 18 with locks which work efficiently and are openable in an emergency from the outside; repairing the hole in bathroom H. The Registered Person must arrange a suitable place to dry mop heads which does not impinge on service users; facilities. The Registered Person must ensure that fridge and freezer temperatures are checked and recorded each day. The Registered Person must ensure that medication stored in the refrigerator is stored securely at all times 1 July 2005 With immediate effect With immediate effect 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 20 26 Good Practice Recommendations It is suggested that the Registered Manager makes alternative arrangements to allow the identified service user to store medication securely. Some toilets are rather old fashioned and institutional in appearance and it is suggested that the Registered Person considers a programme of replacement. The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS 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 The Orchard F52_F02_S25360_The Orchard_V223057_270405_Stage 4.doc Version 1.30 Page 25 - 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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