Inspection on 15/08/05 for Orford House

This inspection was carried out on 15th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orford House 29/05/07

Orford House 21/06/06

Orford House 13/02/06

Orford House 15/07/04

Orford House 15/01/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Orford House Ugley Bishops Stortford Essex CM22 6HP Lead Inspector Sharon Thomas Unannounced 15 August 2005 th 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. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Orford House Address Ugley, Bishops Stortford, Essex, CM22 6HP 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) 01279 816165 01279 816858 Home Farm Trust Ms Sandra Forsyth Care Home 26 Category(ies) of Learning disability 26 Both registration, with number of places Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 26 persons) Date of last inspection 14th March 2005 Brief Description of the Service: Orford House is located in a rural location close to Stanstead Mountfitchet and is registered to provide accommodation for 26 residenst with varying degrees of learning disabilities. Accommodation is provided in single rooms at ground and first floor level. The home is located in large accessible, and extensive grounds. All bedrooms in the home are highly personalised. The communal areas are domestic in nature and well used by the residents. Since May 2004 the accommodation in the Orford House site is no longer used and all residents live in the adjacent Dove Cottages. The home aims to provide personal, social and emotional care to the residents living there. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 15th August 2005, and took 6 hours. Two inspectors undertook the inspection (one as part of their induction into the CSCI). Eleven of the thirty-eight National Minimum Standards were inspected: six were met, and five were nearly met. Requirements for these can be found at the end of this report. For the purpose of this report the individuals living in the home spoken with on the day stated that they would prefer to be called residents. The inspection process included: discussions with the deputy manager as the registered manager was on annual leave, three members of staff, and six residents. The tour of the premises included observation of seven bedrooms, all of the bathrooms and toilets, all of the communal areas, the kitchens and the laundries. There was an opportunity to spend a considerable period of time observing the care being provided by the staff. The inspection included the examination of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). The home was warm clean and tidy. The residents spoke highly of the care that they receive in Orford House and spoke highly of the efforts of the staff. What the service does well: The home provides a warm and homely atmosphere for residents. The resident bedrooms are personalised and indicate the personal characteristics of the residents Orford House has a good caring staff team, and has a low staff turnover, staff that have left have done so for genuine reasons. The staff are enthusiastic, and motivated. All of the residents spoken with on the day stated that the manager and staff were ‘kind and caring’ and the home was ‘very nice’. Residents reported that relatives and visitors are welcomed into the home at all times. The home has close links with the health care team in the area, and works with both professionals and residents to promote and maintain the residents health. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 6 The residents interacted comfortably with the staff. The home enables residents to maintain and build their independence and confidence; the residents were supported to make positive choices regarding their care and their future. The staff were committed to the resident group. The current staff team had a wide range of experience, skills and knowledge. Staff aimed to provide the service users with a range of activities and experience in order to maximise their personal experience. Orford House aimed to develop residents skills and experience to enable some individuals to leave Orford House to live in small independent supported living properties in the area. What has improved since the last inspection? What they could do better: The home does not provide residents with up to date relevant contracts of the terms and conditions of residence. The home’s care plans are not up to date and regularly reviewed. One of the residents care files did not contain an operational care plan. The care plans did not contain enough detail with regard to the infringement of residents rights and choices. The home is not maintaining accurate and safe records of the administration of medication. The home is not ensuring that staff receive all of the appropriate training necessary to undertake their roles effectively. The senior staff have not received comprehensive training around Adult Abuse that identifies their Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 7 responsibilities and the procedure to undertake in the event of an allegation of abuse being made. The home is not recording weekly fire alarm tests or hot water temperature checks. The responsible person is not sending monthly Regulation 26 reports to the CSCI. 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. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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 standard(s) 2 & 5. The home has a thorough pre-admission system in operation that ensures that the needs of prospective residents are fully assessed and can be met. Residents do not have a current contract of terms and conditions. EVIDENCE: Orford House has not had any new admissions since the previous inspection. The homes resident care plans sampled contained appropriate pre-admission assessments. The home’s pre-admission document contained all of the information required under the National Minimum Standards. The assistant manager confirmed that all of the pre-admission assessments would be used to generate the individual care plan. The home’s admission procedure included the involvement of relevant professional agencies, and offered the prospective resident/relatives an opportunity to visit and stay at the home prior to admission. The prospective resident would undertake a trial period that would be reviewed with relatives and other professionals prior to the placement be confirmed as permanent. Three residents care plans examined on the day did not contain an up to date contract of terms and conditions of residency. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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 standard(s) 6 & 7. Residents health and personal care needs are well met; overall individual care plans detailed the care and support required. Residents are enabled to make informed choices regarding their care EVIDENCE: The resident care plans are generally well maintained. The care plans are detailed and give clear guidelines to staff as to how to deliver the necessary care. However, one care file did not contain a care plan but contained a summary of a recent healthcare review. The three care plans sampled indicated that these are not reviewed on a regular basis, but when reviewed residents are involved in the care plan and review process. The daily records of care plans are detailed and well-maintained. From discussion with staff and observation of care practices in the home, it was evident that the residents in the home are enabled and supported to make decisions and choices regarding their lives. These issues are not recorded in care plans on a regular basis. Records seen indicated that the home provides the residents with a range of opportunities and experiences that supports their independence. Care plans did not record all aspect of care that reflected infringements on the rights of the individual. Staff confirmed that residents are Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 11 in control of their daily lives and one stated “My job is to support the residents to make decisions about their lives”. One resident reported that “I do what I like to do at home and the staff always help me”. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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 standard(s) 12 15 & 16. Residents have opportunities for personal development and are enabled to participate in appropriate activities. Residents are enabled to build and maintain relationships with families and within the local community. The residents’ rights are upheld and respected. EVIDENCE: The care plans sampled contained evidence that staff support residents to integrate into the community. Information and advice was available regarding local events and activities. Residents have access to a minibus and use public transport and the local taxi service to access the local area. The staff are available to the residents during the evening and at weekends to support leisure pursuits. The staff spoken with confirmed that they supported residents to leave the home. This was observed on the day with one resident leaving the home to do their shopping. Staff and residents confirmed that residents attend college and day centres. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 13 Care plans examined on the day indicated that staff support residents to maintain links with their families. One resident was enabled through the staff to visit their family home. The residents and staff confirmed that relatives are welcomed into the home at any time. Families and friends are invited to yearly events held in the home. The residents are able to meet people in the community through the efforts made by the home for example, visits to the local church for Sunday service. One resident maintained their family relationships with support from staff who shop with the resident to buy birthday cards and presents. From discussion with staff, the residents and the deputy manager and information found in the care plans it was clear that the home promotes independence. Staff and visitors have to request permission to enter both bedrooms and communal areas. Keys have been offered to residents and none of them have accepted. Residents mail is not opened by staff. Staff were observed interacting with residents and it was clear that residents are central to the care service that is provided. One resident stated that “I clean my own room and she (carer) helps me make my dinner” Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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 standard(s) 20. The administration of medication is not satisfactorily recorded, and could have the potential of placing residents at risk. EVIDENCE: The home has a clear and comprehensive medication policy and procedure. The medication administration records of all medication used in the home were not accurate and gaps were found in the recording. The records of the receipt of medication were accurate and up to date. However, the records for the disposal of medication was not well-maintained and the home has a large amount of medication due for disposal still on the premises. The staff spoken with confirmed that they have received appropriate training and support, with regard to medication, and were confident that they ensured the safety of the residents when giving medication. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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 standard(s) The above standards were not inspected. EVIDENCE: Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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 standard(s) The above standards were not inspected. EVIDENCE: Although the above standards were not inspected it was noted by the inspectors that the levels of hygiene could be improved. Overall the home was clean however, the paintwork, door handles and light switches were not clean and the carpets had not been hoovered. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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) 34 & 35. The recruitment procedure in the home was robust and provide the safeguards to ensure that appropriate staff were employed. The home did not provide appropriate training to give staff the skills necessary to do their job. EVIDENCE: The staff personnel file of the latest recruitment to the home was examined. It contained all of the information and checks required by the National Minimum Standards. The recruitment systems in the home had been an issue on the previous inspection and from evidence gathered on the day this issue has been thoroughly addressed by the home. The home provided a full and comprehensive programme of training. However, one member of staff spoken with reported that they had not received the reinduction since their return to work at the home. One staff file sampled indicated that the individual had not received any training since November 2004. One member of staff had had 3 days training in the previous year. When discussing training with a senior on duty, it became clear that although this member of staff had received Adult Abuse training the individual was not aware of the process and procedure to take, should an allegation of abuse be made. Overall staff confirmed that the training provided was relevant to their roles in the home and helped them to do their job better. Two members of Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 18 staff reported that Dementia training would be beneficial to both the staff group and the residents. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 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) 42 Overall the health and safety of both residents and staff are promoted and protected by the home. EVIDENCE: The home provides relevant health and safety training for staff, and this was confirmed by staff when discussing this issue. Hazardous substances are safely stored. The records of hot water temperatures and fire alarm checks are not well-maintained and could potentially put residents and staff at risk. There was not an effective system to ensure that these checks were made on a regular basis. From previous discussion with the manager it was clear that she undertook the appropriate premises and equipment risk checks. The responsible person does not send monthly Regulation 26 reports to the CSCI. Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 1 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 2 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 x x 3 3 x Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Orford House Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 (1) Requirement The registered person must provide each service user with a written statement of terms and conditions. Where the local authority funds service users, a copy of the contract between the local authority and the home must be provided to the service user.This is a repeat requirement. This is a repeat requirement. The registered person must ensure that all resident files contain an up to date and relevant care plan that can be used as a working document. Any infringement of rights and choices must be recorded in care plans. The registered person must ensure that the records of the administration of medication are up to date and accurate. Any gaps in recording must be investigated and recorded. The home must ensure that the records of the disposal of medication are accurate and stocks of mediaction are regularly disposed of. Elements of the above is a repeat Timescale for action 16.06.03 2. YA7 15 (1) 30.09.05 3. YA20 17 (1) (a) Schedule 3 15.08.05 Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 22 requirement. 4. YA35 18 (1) (c ) (i) The registered person must ensure that all staff are provided with a full range of training. The senior staff must be provided with Adult Abuse training that incorporates the appropriate action and procedures for staff and are relevant to this issue. The registered person must ensure that the CSCI receives regular Regulation 26 reports. This is a reapet requirement. The registered person must ensure that the hot water temperatures and fire alarm checks are regularly undertaken and recorded. This is a repeat requirement. 15.08.05 5. YA42 26 14.03.05 6. YA42 15.07.04 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 Good Practice Recommendations Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Fairfax House Causton Road Colchester CO1 1RJ 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 Orford House I56-I05 s17899 Orford House v245764 150805 stage 4.doc Version 1.40 Page 24 - 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. 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