CARE HOME ADULTS 18-65
Orchid House 42 Spring Street Saint Ann`s Road Rotherham South Yorkshire S65 1HD Lead Inspector
Valerie Hoyle Key Unannounced Inspection 1st May 2007 11:30 DS0000003136.V331772.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 DS0000003136.V331772.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. DS0000003136.V331772.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Orchid House Address 42 Spring Street Saint Ann`s Road Rotherham South Yorkshire S65 1HD 01709 836542 NONE NONE 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) Jacqueline Ann Marshall Mr Andrew Marshall Jacqueline Ann Marshall Care Home 4 Category(ies) of Learning disability (4) registration, with number of places DS0000003136.V331772.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th May 2006 Brief Description of the Service: Orchid House is a four-bedded facility providing a long-term residential service for younger adults with a learning disability. The home is a detached property set in a residential street within walking distance of Rotherham Town Centre. Local pubs, shops, and access to the public transport are close by. Information gained on the 1st May 2007 indicates that the current fees range from £740 to £1280. Additional charges include outings, meals whilst out of the home and personal toiletries. The home provides information to service users and their relatives prior to admission into the home. Service Users Guides are available in all bedrooms or on request from the manager. The last published inspection report is available on request and a copy is available in dining area for visitors to read. DS0000003136.V331772.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4.5 hours where a partial tour of the building was undertaken. The inspector examined four service users care plans and supporting documentation. Three of the four people who use the service and three members of staff were also spoken to during the visit. One relative was contacted by telephone to gain his/her views on the Service. The registered provider was available throughout the visit and assisted with process of examining records and discussing relevant issues about the service provided at Orchid House. What the service does well: What has improved since the last inspection?
People who live at the home have now received annual reviews of the care by the placing authority. Two reviews examined were comprehensive and confirmed their needs were being met by the staff at the home. Risk assessments have been completed to ensure people who choose to administer their own medication, keep their medication safe. One person told the inspector that he/she understood the importance of keeping hi/her medication safely stored. DS0000003136.V331772.R01.S.doc Version 5.2 Page 6 Staff training files examined confirm that staff have now received training to ensure they have the skills and competencies to deliver a good service. They are commended for their ongoing commitment to attaining qualifications to NVQ level 2/3 standard. Recruitment procedures are followed to ensure people who use the service are safe and protected, and staff understands the importance of obtaining references and CRB checks prior to commencing employment. 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 summary of this inspection report can be made available in other formats on request. DS0000003136.V331772.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000003136.V331772.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not admitted into the home without a full needs assessment taking place by the registered manager, to ensure their needs can be met. EVIDENCE: The local authority in Rotherham has placed people who use the service. All four people at the home have had their needs assessed to ensure the home is suitable to meet their needs. All people who use the service have lived at the home for a number of years; their care plans were examined. They contained sufficient information to enable staff to meet their care needs. DS0000003136.V331772.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes philosophies to enable people at the home to meet their full potential, with sufficient care plan instructions and comprehensive risk assessments to maximise their safety and protection. EVIDENCE: People who use the service are involved in the care planning process. There was a clear person centred approach, where monthly targets (goals) were agreed with people. One person was trying to watch what he/she ate, although was finding it really difficult, but had agreed to try. The care plan is written in plain English to ensure new staff working at the home can maintain routines and lifestyles of the people who use the service. Comprehensive reviews had been undertaken by representatives of the placing authority. The reviews involved people who use the service and their
DS0000003136.V331772.R01.S.doc Version 5.2 Page 10 representatives. One relative spoken to said the home always keeps them involved in the care of their relative including attending meetings and reviews. A keyworker system had been introduced to enable people who use the service to develop relationships on a one to one basis. All persons spoken to were aware who their keyworker was and how they contributed to their care. Risk assessments had also been developed since the last inspection ensuring that people who use the service can retain their independence whilst maintaining their safety. DS0000003136.V331772.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make decisions and choices about their lifestyle and are supported by staff to develop new skills. Social educational and recreational activities meet individual needs. EVIDENCE: Staff continue to support people to actively seek employment and one person said he/she wanted to work in a music store putting on record labels, but had not been successful at the moment, but intended to keep trying. One person talked about a passion for fast cars and music. The person had restored a guitar and had purchased another to enable hi/her to continue learning how to play the instrument. People who use the service said they were looking forward to going on holiday to a cottage near Scarborough, where they can enjoy the countryside going for
DS0000003136.V331772.R01.S.doc Version 5.2 Page 12 walks and also enjoy pub lunches and visits to the coast. Staff encourages people to save money towards their holiday and this helps to budget for holidays they would like to make abroad. One person talked about wanting to go to Florida and understood the amount of money needed to go on such a holiday. Discussion with people who use the service said they were able to maintain close links with family and friends, by regular visits and overnight stays. Two people described recent visits to family, where they enjoyed going out for meals. One person shared pictures of a family wedding that they had attended. People who use the service are encouraged and supported to undertake routine tasks around the home including laying the tables for meals and putting their own laundry away, and one service user said he/she had helped to clean their own bedrooms and was happy to show the inspector their bedroom. People have their own door keys to ensure their privacy, and are referred to by their first name and they also refer to staff in the same manner. Mealtimes are organised around the routines of the people who live at the home and the main meal is provided at teatime when it is expected that all the people will be at home. People who live at the home were able to describe the kind of food they enjoyed eating and one person contributed to the meal by making an egg custard for the sweet. One person said he/she was on a diet and was happy that he/she had lost a few pounds. The person said staff encouraged him/her and the goals were clearly recorded in the care plan. DS0000003136.V331772.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, and personal care that people receive is based on their individual needs. However medication procedures need improvement to ensure records are accurate, and people who use the service remain safe. EVIDENCE: People who use the service were encouraged and supported to manage their own healthcare including visits to the doctors, dentist and opticians. Health action plans are now established which provide clear written instructions about what help people may need to attend appointments. People are supported with appointments with consultants to ensure their mental health needs are met and relatives are encouraged to attend the appointments, with the agreement of the individual. One relative spoken to say he/she is fully involved in attending reviews and appointments and felt confident in the care provided at the home. DS0000003136.V331772.R01.S.doc Version 5.2 Page 14 Medication policies are efficient to ensure people who use the service are protected. Two people are supported to administer their own medication. They have responsibility to sign to say they have taken their medication, and have completed a declaration to ensure they keep the medication stored safely. Medication records were examined and were fully completed, however two people had a surplus of medication, making it difficult to audit stock. To ensure stock is accurately recorded, boxes of medication should be dated when opened. The medication administration record should indicate the date when medication is received, and the amount of medication received. DS0000003136.V331772.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can access the complaints procedures and the manager ensures any concerns are recorded and investigated appropriately. Adult protection Policies, procedures and training of staff ensure the protection of service users from abuse. EVIDENCE: There is a robust complaints procedure which is available to people who live at the home that is kept in the home. The procedure is also referred to in the Service Users Guide, identifying the stages to follow; this includes the time scales to respond to complaints. The address and telephone number of the Commission for Social Care Inspection is included in the procedure. There is a comprehensive Adult Abuse and Whistleblowing procedures and staff follow the procedures to those standards. The registered manager would investigate fully any allegations of abuse and would follow the necessary procedures if any were substantiated. The registered manager holds discussions with staff to talk over issues and how to recognise different forms of abuse. DS0000003136.V331772.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with a clean, comfortable environment to live in, which is well-maintained and encourages independence. EVIDENCE: A partial tour of the building found it clean and free from odours. The home provides comfortable communal areas with lounges/dining area and a domestic kitchen. There was a problem with the rear garden where a neighbour’s wall had fallen onto a paved area. The manager said the problem should be resolved quickly, to ensure people who use the service could access the area safely. Individual bedrooms are personalised to people’s own interests and hobbies, and are furnished appropriately including music centres and televisions. One person showed the inspector their bedroom, which was personalised with
DS0000003136.V331772.R01.S.doc Version 5.2 Page 17 posters and pictures of family members. The mattress on the bed was worn and must be replaced, as the person said it caused discomfort and back pain. Communal areas have televisions and the owners had installed Sky TV to give people more choice of channels to watch. There was a domestic kitchen and people are encouraged to help prepare meals and snacks. One person was making drinks for guests and staff encouraged his/her independence. DS0000003136.V331772.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected by robust recruitment procedures. Staff had the skills and knowledge to ensure service users are cared for. EVIDENCE: Staff are organised to ensure there are sufficient to meet the needs of people who spend their time at the home during the day. Staffing is increased when most of the people are at home at weekends and in the evenings. Staff had achieved awards in care and are commended for their efforts. Staff had worked at the home for a good length of time and have good relationships with the people who use the service. Training in a number of areas had been undertaken to ensure staff have the necessary skills and knowledge to meet the needs of people who live at the home. Training has been arranged to ensure staff understand techniques used to safely move and handle people who live at the home, although the manager must still arrange training in the management of people who display challenging behaviour.
DS0000003136.V331772.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and management arrangements are sufficiently robust to ensure the safety and protection of people who live at the home. People’s views are actively sought to improve the service. EVIDENCE: The registered providers play an active part in the running of the home, and they have demonstrated the skills and abilities to deliver a good service to the people who live at the home. However the registered manager no longer is involved in the day-to-day operations at the home. Mr Marshall holds the relevant management qualification and attends the home on a regular basis. DS0000003136.V331772.R01.S.doc Version 5.2 Page 20 The registered providers should consider who is the most suitable person to be the registered manager, and submit an application for registration to CSCI. Quality assurance systems have been developed using a survey to gain the views of people who live at the home. Evidence on peoples files show that views are gained by means of a survey. Surveys are also sent to relatives and to peoples placements to ensure their views are gained. People who use the service are also involved in house meetings where decisions are made about outings and holidays. The registered manager has the required Health and Safety policies and procedures and maintenance and service records examined were up to date and current to the services provided. However there is no evidence to conform portable appliance testing had taken place. The manager said he intends to attend the required training to enable him to carry out the testing of appliances at the home. DS0000003136.V331772.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 X 4 X 5 X 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 2 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 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 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 X 3 X 3 X 3 X X 2 X DS0000003136.V331772.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA24 Regulation 23(2)(c) Requirement A new mattress must be provided for one person who lives at the home to help maintain good posture, as the current mattress is causing some pain and discomfort. Staff must have training in the management of people who display challenging behaviour. (timescale 1 November 2006 not met) Portable appliance testing (PAT)must be undertaken to ensure the safety of people who use the service Timescale for action 01/07/07 2. YA42 18 01/07/07 3. YA42 13 01/07/07 DS0000003136.V331772.R01.S.doc Version 5.2 Page 23 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 YA20 Good Practice Recommendations There should be a clear audit trail to ensure medication is administered as prescribed, and to reduce how much stock is maintained. A manager who is ‘fit to’ be registered should be appointed, to be in charge of day-to-day operations. 2. YA37 DS0000003136.V331772.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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