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Inspection on 19/09/05 for Pages Orchard, 4

Also see our care home review for Pages Orchard, 4 for more information

This inspection was carried out on 19th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff provide individual care in a homely comfortable environment. Residents lead active social lives. There is good communication between residents and staff, and between staff and families and health professionals. Meal planning at the home is integrated with the residents` college cookery course. The registered manager works hard to improve the lives of the residents.

What has improved since the last inspection?

The registered manager has gained the NVQ Level 4 award. All staff have received update training on managing medication, on food hygiene, fire training and on health and safety issues in the home. New blinds have been fitted in the conservatory. Staff have attended training on autistic spectrum disorder.

What the care home could do better:

The complaints procedure needs to be improved, and advice from the pharmacist is needed regarding the recording of medication. One more full time member of staff is needed, although recruiting is difficult.

CARE HOME ADULTS 18-65 4 Pages Orchard Sonning Common Reading Berkshire RG4 9LW Lead Inspector Kate Harrison Unannounced Inspection 4 Pages Orchard DS0000013221.V252460.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 4 Pages Orchard DS0000013221.V252460.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. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 4 Pages Orchard Address Sonning Common Reading Berkshire RG4 9LW 01734 722928 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) Dysons Wood Trust Lise Thorngate Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 3 12th October 2004 Date of last inspection Brief Description of the Service: 4 Pages Orchard is a care home registered for three adults with learning difficulties, and is situated in a residential area of Sonning Common, South Oxfordshire. The home is managed by The Disabilities Trust, an organisation with experience in supporting service users with autistic spectrum disorders. The manager and staff support the three individuals to access the local and wider community and to maintain and develop independence skills. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection against the National Minimum Standards took place over one morning, when the inspector met the residents and some of the staff at the home. The inspector saw accommodation and facilities, and the files of the residents. The inspector also saw other records and discussed with the registered manager the daily management of the residents’ care and the running of the home. During the morning the registered manager was engaged in negotiating with the local college to improve the college provision for the residents. One resident returned from holiday, and after lunch one resident went out to an activity. What the service does well: What has improved since the last inspection? The registered manager has gained the NVQ Level 4 award. All staff have received update training on managing medication, on food hygiene, fire training and on health and safety issues in the home. New blinds have been fitted in the conservatory. Staff have attended training on autistic spectrum disorder. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 6 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. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 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 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective residents’ needs can be assessed. EVIDENCE: There has been no admission to the home for several years as a place has not been available, but the registered manager would work with the prospective resident and care management to ensure that all the individual’s needs were appropriately assessed. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 The individual care plans contain all the necessary detail, and residents are consulted on and participate in all aspects of daily life in the home. Residents are supported to make decisions and take assessed risks about their lives. EVIDENCE: The inspector saw the files of the three residents who have lived together since 1997. Each had individual care plans reflecting their needs, and it was clear that a review of care needs had taken place for the three individuals this year. The individual care plans contained all the necessary information, including therapeutic treatments and behaviour support plans. Information regarding communication with each resident was clear and concise, and included clear instructions on how to address inappropriate behaviour. All the residents have support from their parents with decision making, and staff support the individual when necessary. The registered manager is registered with the bank to withdraw cash for personal items and records are kept of all transactions. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 10 On the day of inspection the inspector saw one resident participate in the household cleaning, and each resident is responsible for weekly cleaning of their rooms. Weekly residents’ meetings are held, where details and preferences for the forthcoming week are discussed. Residents are supported to take responsible risks, such as in personal relationships, through discussion and implementation of the necessary actions to ensure safety. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 All the residents take part in educational and leisure activities, and are part of the local community. Residents are offered a healthy diet, and can plan meals and mealtimes. EVIDENCE: The registered manager has had difficulty in accessing all the appropriate college courses for the residents, due to difficulties experienced by the college, but all are enrolled on some activities. Residents take part in local activities such as horse riding, swimming, bowling and joining the local health walks. Residents have annual holidays and choose group outings regularly. Recent trips have been to London and to the Rain Forest. The inspector saw interaction between one family and the registered manager, and it was clear that the family was comfortable visiting the home. Risk assessments are in place regarding intimate relationships to protect the residents. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 12 All the residents have keys to their home, and staff treat residents with respect by addressing individuals by their chosen name and by deferring to individuals appropriately, to make sure that the individual’s wishes are known and respected. The home keeps a Menu Book, with recipes from the college cookery course, and residents can choose what to eat and where to eat in the home. Residents can participate in shopping, preparing and cooking the food. Nutritional needs are monitored and residents are regularly weighed to assess weight gain or loss. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Residents receive personal support in the way they prefer, and their health requirements are well managed. The system for managing medication at the home is good. EVIDENCE: All the residents have a document ‘About Me’ detailing their personal preferences on all aspects of their lives, and personal support is provided in accordance with this document. The small staff team provides continuity and consistency for the residents, and the registered manager makes sure that, if agency staff are required, the same staff come regularly. The inspector saw information in the individual files showing that health needs are assessed individually and that action is taken to meet those needs. All the residents are registered with a local GP. All the staff have received update medication training from the pharmacist this year. Medications are appropriately stored at the home, and the MDS system is used. One resident occasionally manages his own medication, and appropriate records are kept. The inspector noted that one topical application was not recorded on the MAR in the usual way, and recommends that the pharmacy should be consulted on the best way to manage medications prescribed during the ordering cycle. 4 Pages Orchard DS0000013221.V252460.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 The complaints procedure for residents needs to be improved, and an appropriate procedure needs to be developed for others acting on the residents’ behalf. EVIDENCE: There are weekly meetings when issues can be discussed, and residents can also discuss issues at any time with a member of staff. The home’s staff have worked with the residents for a long time and understand when an individual is upset. The inspector saw the home’s complaints procedure, which uses symbols to help residents understand their right to complain. The procedure must be expanded to include the timescale of 28 days and to include the resident’s right to complain to CSCI at any time. There also needs to be a procedure for relatives, and others acting on behalf of the resident, to use if they want to complain about the home, as detailed in Regulation 22. 4 Pages Orchard DS0000013221.V252460.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 The residents live in a safe, comfortable and homely environment. EVIDENCE: The home, a four bed-roomed semi-detached house, is situated on a residential road with parking to the front. There is a secluded garden and conservatory to the back. The accommodation is decorated in a homely way, and has easy access to public transport. Staff have received update fire training recently. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 16 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): None of these standards were assessed. EVIDENCE: 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 17 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): None of these standards were assessed. EVIDENCE: 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 18 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 X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 4 Pages Orchard Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000013221.V252460.R01.S.doc Version 5.0 Page 19 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 YA22 Regulation 22 Requirement The complaints procedure for residents must be expanded to include the timescale of 28 days and to include the resident’s right to complain to CSCI at any time. An appropriate complaints procedure for relatives and others acting on behalf of the resident must be developed. Timescale for action 30/11/05 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 YA20 Good Practice Recommendations The pharmacist should be consulted on the best way to record medications prescribed during the ordering cycle. 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 4 Pages Orchard DS0000013221.V252460.R01.S.doc Version 5.0 Page 21 - 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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