Inspection on 04/01/06 for Orchard (The) - Leonard Cheshire Disability

This inspection was carried out on 4th January 2006.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

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

Orchard (The) - Leonard Cheshire... 27/04/05

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 Orchard (The) Woolton Road Liverpool Merseyside L257UL Lead Inspector Peter Cresswell Unannounced Inspection 4th January 2006 8:25 Orchard (The) DS0000025360.V261767.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 (The) DS0000025360.V261767.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 (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Orchard (The) Address Woolton Road Liverpool Merseyside L257UL 0151 428 8671 0151 421 1356 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.leonard-cheshire.org.uk Leonard Cheshire Michelle Maxwell Care Home 26 Category(ies) of Physical disability (20), Physical disability over registration, with number 65 years of age (6) of places Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th April 2005 Brief Description of the Service: The Orchard is a care home for 26 disabled adults, owned by the Leonard Cheshire Foundation, a charity that 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 from Woolton Village, where there is a range of shops, pubs, a post office, banks and many 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 one bedroom can be for shared if required. Four bedrooms have en-suite facilities. There are three lounges, one of which has a wide range of games, activities, and a personal computer with internet access. The breakfast/coffee bar, where service users can make drinks and snacks, is linked to the dining room. The home employs a full time activities co-ordinator who - with the support of service users, volunteers and staff - plans and supports a varied range of activities and entertainment within and outside The Orchard. Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the inspector spoke to a number of residents and staff, including the manager, Care Supervisor and Activities Coordinator. He toured the building, including a number of bedrooms and the kitchen. The inspector checked the home’s medication procedures and examined a number of records, including care plans for three residents. 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) DS0000025360.V261767.R01.S.doc Version 5.0 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) DS0000025360.V261767.R01.S.doc Version 5.0 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): 1. The service user guide provides prospective service users with information about the home. EVIDENCE: No new service users have been admitted since the last inspection so it was not possible to look at any new assessments. The Leonard Cheshire Foundation has well-established procedures for the assessment and integration of new service users. The service user guide was prominently displayed near the main entrance to the home. Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 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, 9, 10. Service users make decisions about their own lives as far as possible and are fully involved in the running of the home. Care planning is not totally consistent and in one case examined staff did not have the information available on which to base their daily care of the service user. EVIDENCE: Individual files contain an enormous amount of information on service users but one of the files examined did not have a clear, concise and up to date account of the care to be provided. Indeed some of the information in the care plan, particularly in relation to skin integrity, was plainly out of date. The service user in question was being seen regularly by the District Nurse and there was other information available (such as a turning chart) to indicate that appropriate care was being given. However, unless this is properly documented, updated and recorded there is always a risk that staff will not have the appropriate information to hand and care standards could suffer. The other two files examined were up to date though it was not always easy to identify the most up to date information. The daily reports file is kept separately and it may be helpful to prepare care plan summaries to be filed with the daily reports, so that staff have immediate access to the fundamentals Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 9 of the care plan. The existing systems seem to place a high premium on staff’s ability to remember detailed information without recourse to written plans. As part of the next inspection the inspector will check a larger sample of care plans. One of the files did not contain a photograph of the service user but photographs were available in the home and the Registered Manager said that she has obtained a digital camera to enable staff to readily take and store photographs. The service users who spoke to the inspector took a full part in the life of the home and were able to make decisions about their own welfare. Service users’ own views on their care are included in their files. Files are stored securely. Orchard (The) DS0000025360.V261767.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): 11, 12, 13, 14, 15, 16 and 17. The home has good links with the community and staff encourage and support service users to pursue activities and pastimes of their choice. Service users enjoy the meals provided in the home, 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 he and two volunteers were redecorating the rooms used by resident volunteers from abroad who were due to arrive the following day. Activities are recorded on service users files but the recording was not up to date. Two service users had visited Buckingham Palace for a garden party in the summer. The Registered Manager has arranged for teaching and support staff from Hugh Baird Further Education College to provide courses on the premises. The courses are for IT, arts and crafts, local history and drama. On the day of the inspection four service users were taking part in a class on ‘Creative use of IT’ and clearly enjoyed the session. All of the courses lead to recognised qualifications. Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 11 Those service users who had stayed in the home over Christmas said that they had enjoyed the festivities and spoke especially highly of the Christmas dinner. The main meal is usually served at lunchtime and a choice of some sort is always available. As well as the set choice, service users can have sandwiches or baked potatoes. 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. There is a breakfast/coffee bar next to the dining room in which those service users who can do so can prepare their own breakfast and hot drinks. Service users who need assistance with eating are supported discreetly by staff. Orchard (The) DS0000025360.V261767.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): 18, 19, 20. Medication is efficiently organised, ensuring the safety and well being of the service users. EVIDENCE: Care plans set out service users’ views on how they wish to be supported, including whether they have a preference for male or female staff to provide personal care. Staff were seen to respond promptly to requests for assistance. Visits by health care professionals are recorded on the files and a district nurse attended first thing in the morning on the day of the inspection to administer insulin injections. Concerns about skin integrity are reported promptly to the district nurse. Medication is stored in a locked facility in service users’ own bedrooms, but the service users do not have access to them. One service user who retains control of her own medication kept the medication in a locked drawer in her room. Medication was in order and its administration was properly recorded on the Medication Administration Record sheets. Medication requiring refrigeration is kept in a lockable, dedicated fridge in the staff office. The fridge temperature is checked each day and recorded. The Orchard uses a Monitored Dosage System and is in the process of changing its pharmacist, as part of a national policy being pursued by the Leonard Cheshire Foundation. Staff who Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 13 administer medication receive proper training, and further, certificated training is to be provided by the new pharmacy company. Orchard (The) DS0000025360.V261767.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, 23. The home has clear policies for dealing with complaints and allegations of abuse. EVIDENCE: The organisation has clear procedures for dealing with allegations of abuse. Only one complaint had been received since the last inspection. It had been investigated thoroughly by the Registered Manager and details of the response issued by the regional manager were on file. Staff receive training in adult abuse procedures. Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 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, 30. The home is purpose built to meet the needs of disabled people and provides a comfortable, spacious 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 has recently been refurbished with the support of some external sponsors. 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 veneer to the bed frame in one room is still damaged. Door surrounds receive very heavy wear from the wheelchairs and improved protective measures have not yet been fitted. This makes the doors and corridors unsightly and the frame to room 11 is splintered and needs to be repaired. The organisation has a redecoration programme and some rooms have been recently decorated and carpets steam cleaned. Some bedrooms could still do with redecoration and the hall and dining room carpets need to be thorough cleaned or, if necessary, replaced. The Orchard has sufficient baths and toilets, though some of the toilets in particular are now looking rather old fashioned and would benefit from Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 16 modernisation. The Registered Manager said that she has requested that they are modernised by the Foundation. The locks on toilet H and the bathroom opposite room 18 cannot be opened from the outside. The Registered Manager said that they were repaired following the last inspection and have been damaged by a service user. They must therefore be replaced by more robust locks that can cope with rough treatment. The bathroom opposite room 18 needs a toilet roll holder. One service user has a freestanding electrical heater in her room, provided by the family. The Registered Manager said that this has been risk assessed and does not get sufficiently hot to present a risk. The home was clean and odour free. Orchard (The) DS0000025360.V261767.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): 32, 33, 34, 35, 36. All but two of the care staff have NVQ2 and the home has an active training programme, ensuring that service users are in safe hands at all times. Staff and service users get on well together, giving the home the sense of being a community. EVIDENCE: The home takes up Criminal Records Bureau checks, POVA checks and references on staff 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. Decisions on negative CRB checks (i.e. those listing offences) are made at national level. Checks are also made on volunteers before they are allowed to work at the home. Overseas volunteers are checked in their own country and complete CRB/POVA checks when they arrive in the UK. It would be good practice for the organisation to obtain ‘POVA First’ clearance (urgent checks) in these cases. Files for volunteers are extremely well organised and contain the same checks as are made for paid staff. Volunteers are supervised by the Activities Co-ordinator, who was preparing for the arrival of two gap year volunteers from Australia the following day. These volunteers live at the home and the Co-ordinator said that nearly all of the past overseas volunteers have been hugely successful. A number of other volunteers work at the home including two who are full time. Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 18 The Registered Manager is in the process of recruiting new staff following some recent departures. As a result the current staff rota was incomplete and agency staff are being deployed to cover the gaps in the meantime. The Registered Manager said that when agency staff are used she insists on seeing their up to date CRB checks before they are allowed to start work. As far as possible the same agency staff are used in order to provide continuity for service users. All but three of the care staff now have at least NVQ2 and those remaining three are studying for the qualification. Staff said that NVQ training has improved enormously since the introduction of the in-house Leonard Cheshire NVQ assessor. Staff who want to move on to NVQ3 are currently having to wait until the NVQ2 programme is completed but the Registered Manager said that once that has happened places will be available for NVQ3. Staff said that if they request specific training it is normally arranged. Recent training had included Pressure Care, Protection of Vulnerable Adults, ISPs and Key Working and Moving and Handling. Most training is provided by Leonard Cheshire’s own training section but the next training courses on medication are to be provided by the home’s new pharmacist. Staff receive regular supervision, with the Care Supervisor supervising senior carers (team leaders) who in turn supervise care staff. Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 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 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, 41, 42, 43. The Orchard is well managed, helping to ensure that the home meets the often complex needs of the service users. Fire and health and safety procedures are up to date, ensuring a safe environment for the service users. Standards are checked regularly, ensuring consistency of care for the service users. EVIDENCE: The Registered Manager has been confirmed as a permanent appointment since the last inspection and the post of Care Supervisor has been filled by an experienced member of staff. This postholder is in effect a deputy manager and it is anticipated that the appointment will help to spread the load of management and the maintenance of care plans. The Orchard is regularly visited by other service managers and volunteers as part of the Foundation’s quality assurance policy. They inspect the home and complete reports (in accordance with Regulation 26 of the Care Homes Regulations) which are also forwarded to the Commission for Social Care Inspection. 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 although the situation at weekends has improved Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 20 since the last inspection there will still a number of gaps in the recording at weekends, when the full time staff are not always on duty. The cook said that she had asked agency and weekend staff to do this. The Registered Manager must ensure that fridge and freezer temperatures are checked and recorded daily. Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 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 3 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Orchard (The) Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 DS0000025360.V261767.R01.S.doc Version 5.0 Page 22 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 YA6 Regulation 15 Requirement The Registered Person must ensure that all service users have care plans which are readily available to all staff and are regularly reviewed and updated. (Originally required by 01/06/05) The Registered Person must arrange for suitable furniture and decoration in service users bedrooms by: * Repairing the veneer to the bedframe identified bedroom * Repairing and repainting those door surrounds badly marked from wheelchair use. (Originally required by 01/07/05) The Registered Person must ensure the safety of service users by replacing the locks on bathroom H and the bathroom opposite room 18 with locks which are durable and openable in an emergency from the outside. The Registered Person must clean or replace the carpets in the hallway and the dining area. The Registered Person must DS0000025360.V261767.R01.S.doc Timescale for action 01/03/06 2. YA24 16 01/03/06 3. YA24 16 01/03/06 4. 4. YA30 YA42 16(j) 16(j) 01/03/06 04/01/06 Page 23 Orchard (The) Version 5.0 ensure that fridge and freezer temperatures are checked and recorded each day. (Originally required by 27/04.05) 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. Refer to Standard YA26 Good Practice Recommendations Some toilets are rather old fashioned and institutional in appearance and it is suggested that the Registered Person considers a programme of replacement. Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 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 Orchard (The) DS0000025360.V261767.R01.S.doc Version 5.0 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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