CARE HOME ADULTS 18-65
Orchard View (97) Orchard View 97 Orchard Hill Northampton Northants NN3 9AG Lead Inspector
Stephanie Vaughan Unannounced Inspection 3rd July 2006 13:15p DS0000066794.V302156.R01.S.doc Version 5.2 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 DS0000066794.V302156.R01.S.doc Version 5.2 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. DS0000066794.V302156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Orchard View (97) Address Orchard View 97 Orchard Hill Northampton Northants NN3 9AG 01792 459 571 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) orchard-view@tracscare.co.uk TRACS Mrs Melanie Jane Lennon Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places DS0000066794.V302156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No person falling within the category of MD, Mental Disorder excluding Learning Disability or Dementia, may be admitted to the home unless that person also falls within the category of Learning Disability i.e. Dual Disability (LD) One named person may be admitted to the home with Mental Disorder (MD) and Learning Disability (LD) Date of last inspection None Brief Description of the Service: Orchard View is a new home, recently registered in February this year to provide personal care for 4 residents with Learning Disability and Mental Health needs. It is one of four homes within the County that are owned by Tracscare, a Swansea based company. The home offers spacious and well-maintained living accommodation, with safe and pleasant gardens and is in keeping with the local community. The location offers the residents access to local amenities such as shopping and leisure facilities as well as convenient local transport. The current fees range from £1,800 to £2,330 per week, with additional charges for one to one support, day care, hairdressing, personal toiletries, items and equipment. DS0000066794.V302156.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Orchard View is a new facility having been registered as a care home on by the Commission for Social Care Inspection. As such this is the first statutory inspection to have been conducted there. One hour was spent in preparation, which included a review of the conditions of registration, the registration report, the service history and associated documentation. The Commission have received no concerns or allegations about the service from external sources. However one notification has been received from the Registered Manager; which relates to a Protection Of Vulnerable Adults allegation pertaining to one of the residents and this is currently under investigation and appropriate action is being taken to ensure the protection of residents. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Residents, and upon their views of the service provided The Commission also has a national focus on Equality and Diversity for all within this current year and issues relating to this are included in the main body of the report Two residents were ‘case tracked’ which involved following the care that residents receive through a review of their care plans, other associated documentation such as accident records, observations, and a limited tour of the premises was conducted, which involved a sample of the residents accommodation and communal areas. Two residents were spoken to and discussions held with the care staff This unannounced inspection was conducted in the afternoon and lasted for four and a half hours, during which the Registered Manager, Melanie Lennon was present and was highly cooperative throughout. What the service does well:
Residents said that they had had the right information about the home and that they had been able to visit, meet the staff and other residents before deciding if they would like to live there. The staff had found out what the residents needed before they came to live in the home, to make sure that they were able to look after them properly. DS0000066794.V302156.R01.S.doc Version 5.2 Page 6 Records showed that residents have contracts that tell them what is provided by the home and what it costs to live there. Each resident has a plan of care which tells staff what they need to do to look after them, this includes health care, specialist care such as access to doctors and nurses and plans to manage risks and support behaviour. Residents were dressed well and looked well cared for and said that they were well looked after by the staff. Residents are involved when the care plans are written and also when they are reviewed to make sure that they are happy with he way that they are being cared for. Each resident has their own key worker whose job it is to help them with things that they need to do. Residents said that they were treated well by the staff. Residents are supported to be as independent as possible and risk assessments are in place to make sure that they are as safe as possible. Residents are able to have training in skills that help them to be more independent and help them to stay safe. Regular meetings are held so that residents can say how they would like things to be done in the home and to decide what should be on the menu Residents are able to go to college to learn new things or to develop existing skills. Some residents are able to get jobs and go to day centres. Residents are also able to go to the local swimming pool, cinema and gymnasium as well as to the local shopping centre. The home makes sure that residents are treated fairly and tries hard to make sure that they are able to live happily in the local community and keep in touch with their relatives and friends. The residents said that they were happy in their new home and that the extra space had improved their privacy and freedom. Residents are able to move about the home freely and use the garden areas. Residents said that the food was good and that they were able to choose things that they liked and to have a healthy diet. Staff know how to look after the residents and make sure that they see the doctor or dentist at the right times. Staff also make sure that the residents have the right medicines and that these are given safely. Residents said that they knew how to complain if they were not happy and that they were treated well by the staff. DS0000066794.V302156.R01.S.doc Version 5.2 Page 7 There are enough staff to care for the residents properly and the manager makes sure that staff who work in the home have the right attitude, skills and training to care for residents safely. The manager has the right skills to be in charge of the home 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. DS0000066794.V302156.R01.S.doc Version 5.2 Page 8 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 DS0000066794.V302156.R01.S.doc Version 5.2 Page 9 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): 2,3, 4 & 5 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Appropriate admission processes are in place, which ensure that the home is able to meet the needs and expectations of residents. EVIDENCE: Residents spoken to confirmed satisfaction with the homes admission processes and stated that they had received information about the home. They also confirmed that they had had the opportunity to visit, meet the residents and the staff prior to deciding whether they would like to live there. Individual plans of care contained appropriate assessments conducted by the placing authorities and there was evidence that the residents had also been assessed by senior staff employed by the organisation to ensure that the home was able to meet the needs of residents. All of the individual plans of care contained a contract, which included appropriate terms, and conditions and these had been signed by the residents. DS0000066794.V302156.R01.S.doc Version 5.2 Page 10 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 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. Individual needs and choices are generally managed well and although outcomes for residents appear to be good; there is insufficient detailed instruction regarding the residents’ personal care needs and preferences included within the individual plan of care. EVIDENCE: Each resident has an individual plan of care that has been developed from the preadmission assessments. There was evidence that residents health care needs are met, in that they have appropriate access to medical and specialist services. Any restrictions on residents freedoms are supported by thorough risk assessments and agreed with the individual residents and their placing authorities. Individual plans of care contained detailed instruction to staff about the resident’s behaviour, including individual triggers and the appropriate management. Residents appeared well presented and confirmed that they were well supported and cared for. Although outcomes for residents appeared good there
DS0000066794.V302156.R01.S.doc Version 5.2 Page 11 was little information included in the individual plans of care regarding the individualised support that residents required regarding their personal care, for example personal preferences regarding their personal hygiene needs. There was evidence that residents are involved in the care planning and review process and that they have some access to the information that is recorded. However written information would benefit from being developed into formats that are more accessible to residents who have greater communication needs or are unable to read. Residents have access to a key worker system and residents confirmed that this worked well and that they enjoyed good relationships with the staff. Residents are supported to maximise their independence and are involved in making decisions about all aspects of their lives. Any restrictions on their freedoms are based on the resident’s own best interests and are supported by appropriate risk assessments. Residents are supported to manage their own finances and are able to contribute to the running of the home, with participation in regular residents meetings, staff recruitment Residents are supported to take risks in their daily lives and examples of this include training in road safety and cycling proficiency, access to Control of Substances Hazardous to Health Training, to enable them to participate in domestic activities. All of these are supported by appropriate risk assessments. DS0000066794.V302156.R01.S.doc Version 5.2 Page 12 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, 15,16 & 17 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Residents are able to maintain an individualised lifestyle that meets their needs and expectations. EVIDENCE: Residents spoken to confirmed that they had opportunities to pursue employment, education and training activities. Both were able to discuss the arrangements that were currently being made on their behalf to comply with their wishes about their individual interests. The management are supportive to new residents and accommodate their wishes to continue with previously established activities. Residents are supported to integrate with the local community, having access to the local shops and other facilities. Residents confirmed that they were supported to access the local gymnasium and swimming pool as well as other leisure facilities such as the cinema, local pubs and restaurants. DS0000066794.V302156.R01.S.doc Version 5.2 Page 13 At present there are no formal policies relating to Equality and Diversity, however this is intrinsic to the philosophy of the home and the care provided. For example, the existing residents are all of western European origin however one of the residents commented that he had some Polish heritage and that he was pleased that a member of staff had been recruited from Poland which had enabled him to practice the language. In addition staff from other cultures have been encouraged to contribute to recent celebrations by preparing food specific to their own culture. Neighbours, friend and relations have also been invited to attend these events. Residents are supported to maintain family links and are able to receive their chosen visitors in privacy should they wish to do so. Residents have the opportunity to build friendships and relationships within the local community and with other residents from homes within the group. Both residents spoken to confirmed that the environment provided by the new home has enabled them to have greater freedom and increased privacy. Residents are able to choose whether to participate in group activities or are able to chose to be alone if they so wish. Residents rooms are fitted with appropriate privacy locks, however one of the residents stated that he did not have a lockable facility within his bedroom, this was discussed with the registered manager who has agreed to provide this facility. Staff were seen to relate well to residents and to refer to them by their preferred form of address. Residents are able to access the grounds, the communal areas and their personal accommodation without restriction. Residents confirmed satisfaction with the arrangements for meals and meal times. Being involved in the menu planning and food preparation residents are able to enjoy their personal preferences and access a healthy diet. The weekly menu was displayed in the kitchen area and appeared to offer a balanced diet. Food is generally served in the dining room, which offers a very pleasant environment. Residents weight is monitored on a regular basis and appropriate guidance is sought where concern is identified. DS0000066794.V302156.R01.S.doc Version 5.2 Page 14 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 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Personal and healthcare support is managed well and meets with the resident’s needs and expectations. EVIDENCE: Staff were seen to provide sensitive and flexible support to residents. Residents appeared well presented and confirmed their satisfaction with the care that was provided. Staff spoken to were knowledgeable about the residents needs, preferences and individual routines. Residents have access to appropriate medical, dental and specialist services. Health care need are monitored and appropriate referrals are made as required. Medication systems were reviewed and found to be in good order. A spot check was conducted and the medication was fond to correspond with the medication administration records. Medication is appropriately stored and maintained.
DS0000066794.V302156.R01.S.doc Version 5.2 Page 15 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): The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Concerns, complaints and protection are managed well and residents are protected from abuse. EVIDENCE: The Commission have received no concerns or complaints about this service since it was registered. Residents confirmed that they knew how to complain and that they would feel confident to do so in the knowledge that their concerns would be handled appropriately. The complaints policy is included within the individual plans of care and the service users guide, to which residents and their representatives have access. The home has appropriate procedures in place for the Protection Of Vulnerable Adults and management and staff take appropriate action when concerns are raised. Systems are in place for the safe storage and management of residents’ money and these are audited on a regular basis. However one of the individual plans of care contained personal financial information, such as building society statements, which should be stored in a more secure environment to protect the residents against the potential for identity theft. This was discussed with the Registered Manager, who confirmed that this was an oversight and that the documentation had been removed from safe storage to organise the change of address, the information has now been removed for safe storage. DS0000066794.V302156.R01.S.doc Version 5.2 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 & 30 The quality in this outcome area is excellent, this judgement has been made using available evidence including a visit to the service. The standard of the environment is excellent which has a positive impact of the residents’ quality of life. EVIDENCE: The premises are suitable for their stated purpose and exceed the National Minimum Standards for communal space and some of the individual accommodation. The premises are safe, clean and comfortable with appropriate heating, lighting and ventilation. All areas are very well furnished and maintained. Residents confirmed a high level of satisfaction with the location; environment and facilities provided by the home and stated that as a consequence their quality of life has been much improved. There is a separate utility room and working practices in place, which facilitate the management of infection control. DS0000066794.V302156.R01.S.doc Version 5.2 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, 24 & 35 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Staffing, recruitment and training are managed to ensure that residents are in safe hands at all times. EVIDENCE: Residents spoken to confirmed that they had good relationships with staff and that the staff were sensitive to their needs and had the skills to care for them. Residents and staff spoken to confirmed that the staffing levels were adequate and enabled residents needs to be met. Discussions with management indicated that emphasis is placed on recruiting individuals with the right personal characteristics to work with residents. Staff have access to appropriate mandatory training including induction training. Currently approximately 50 of staff have at least a national Vocational Qualification level 2 in Care, whilst others continue to work towards the NVQ level 3 and 4. The management is mindful of the need to maintain NVQ levels at around 50 , which may be affected by some internal reorganisation. Recruitment is managed well, staff confirmed that they had completed application forms, attended interviews and had the right clearances conducted. A sample of staff files were viewed which confirmed that appropriate
DS0000066794.V302156.R01.S.doc Version 5.2 Page 18 references and Criminal Records Bureau Clearances were obtained prior to employment. Training and development is managed well, the Registered Manager having organisational responsibility for training throughout the group. Staff spoken to confirmed that the had access to appropriate and timely mandatory training, such as Fire Safety, Food Hygiene, First Aid, Movement and Handling, Health and Safety, Control of Substances Hazardous to Health and the Safe Administration of Medication. In addition staff are trained in subjects necessary to meet the residents needs such as the management of challenging behaviours. DS0000066794.V302156.R01.S.doc Version 5.2 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, 39, 40 & 42 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service The Conduct and Management of the home is good which ensures that residents are cared for in a safe environment. EVIDENCE: The Registered Manager is qualified, experienced and competent to manage the home. Staff and residents confirmed that she provided good leadership and was both knowledgeable and approachable. The Registered Manager is known to the Commission, having been the Registered Manager for another home within the group. As such she is known to be knowledgeable about the work of the Commission and compliant with the Legislation and Regulations. Currently informal systems are in place to monitor Quality Assurance and these involve regular residents meetings, internal audits of individual plans of care,
DS0000066794.V302156.R01.S.doc Version 5.2 Page 20 medication systems and residents money. However these would benefit from being formalised within the organisation in order that benchmarking and good practice can be identified. In addition systems should be developed to enable residents to comment individually on a regular basis as to their views about the quality of service provided. Safe working practices are managed well. Staff have access to appropriate mandatory training, appropriate risk assessments are in place for the environment and residents individual needs. No hazards were identified and appropriate safety equipment is available. Accidents and incidents are appropriately recorded and reported. DS0000066794.V302156.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 3 4 3 5 3 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X DS0000066794.V302156.R01.S.doc Version 5.2 Page 22 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. 1 2 3 Refer to Standard YA6 YA6 YA39 Good Practice Recommendations Individual plans of care should be developed to contain detailed instruction to staff as to how the residents’ personal care needs and preferences are to be met. Individual plans of care and associated documentation should be reviewed to ensure that they are in appropriate formats that enable residents to access the information Quality assurance systems should be formalised to enable residents to provide individualised and regular feedback on their experience of the quality of service provided. DS0000066794.V302156.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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