Inspection on 08/01/07 for Pages Orchard, 4

This inspection was carried out on 8th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pages Orchard, 4 17/01/06

Pages Orchard, 4 19/09/05

Pages Orchard, 4 12/10/04

Pages Orchard, 4 05/08/04

Pages Orchard, 4 23/02/04

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

CARE HOME ADULTS 18-65 Pages Orchard, 4 Sonning Common Reading Berkshire RG4 9LW Lead Inspector Kerry Kingston Unannounced Inspection 8th January 2007 15:30 Pages Orchard, 4 DS0000013221.V326243.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 Pages Orchard, 4 DS0000013221.V326243.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. Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pages Orchard, 4 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) dw@disabilities-trust.org.uk Dysons Wood Trust Lise Thorngate Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 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 6th January 2006 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. The fees are £1,154 per week to £1,175 per week. Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on the 8th January 2007, between the hours of 3.30pm and 6.30pm. The purpose of the visit was to collect information to inform the key inspection report. Information for this inspection was collected by means of a Pre-Inspection Questionnaire completed by the manager, service user surveys which were returned (service users were unable to complete them without assistance) and relatives’ comment cards (all three were returned). On the day of the visit the inspector toured the building, observed care practice, spoke with one staff member and the manager and met all three service users. Service users offered only minimal verbal communication. Service user care plans and other records were looked at. Overall the home offers excellent care to the service users. There were no requirements or recommendations made as a result of this key inspection. What the service does well: The home works hard to try to make sure that residents can make as many choices and decisions about their lives for themselves, as possible. The staff use lots of different ways to help residents to say what they want to and to understand as much as they can about what is happening. Residents have lots of things to do so that they can enjoy their life. They are helped to keep in touch with their families and friends. Staff treat residents with great respect and make sure that they feel it is their home. The residents have very good care plans to make sure that staff can give them the best possible care in the way that they like best. Staff make sure that residents are helped to keep healthy so that they feel happy and settled. The home has a good manager who makes sure that the home is run according to what is important to the residents. Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Pages Orchard, 4 DS0000013221.V326243.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 Pages Orchard, 4 DS0000013221.V326243.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 and 5 Quality in this outcome area is good. The home would only offer a placement to a service user whose needs it can meet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no admissions since 1998. Service users had previously been in other placements provided by the same organisation. The admissions procedure and policy would be followed if any admissions were likely. The home has had the same resident group for eight years and this is unlikely to change in the foreseeable future. All service users have a written contract/statement of terms and conditions that has been produced in simple English and a service user-friendly format using photographs, pictures and symbols. Pages Orchard, 4 DS0000013221.V326243.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 and 9. Quality in this outcome area is excellent. Service users know what their changing needs are and they are supported to be as independent as possible. The staff work very hard to ensure that they can make as many decisions and choices for themselves as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three service users’ care plans were seen. They included excellent information about personal care routines/how much support individuals need and how to give it. Parts of the care plans are produced in user-friendly formats to assist service users to understand as much of it as they are able. Individual Lifestyle support plans include a short life history, what is vital for staff to know, likes and dislikes, achievements, level of support required, the best way to get to know me, what I like and don’t like and what worries me. Future needs are noted on reviews which service users are supported and encouraged to attend. Families also attend reviews and sign the review notes. Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 10 There is a description on individual files of the service user’s ability/limitations with regard to decision making and how to ensure that they are given appropriate choices, such as ‘trialling’ different activities before being asked what they want their daytime activities programme to consist of. There are weekly group meetings held at which various subjects are discussed, including activities for the week, the rotas, complaints, health and safety and any other issues arising. Staff use imaginative ways to keep service users interested, including playing communication games to ensure their inclusion and interaction in the meeting. Communication is a priority in the home and it has good support from the speech and language therapy department, which is part of the organisation. The staff and service users use several communication methods and have communication boards displayed in bedrooms and communal areas. Risk assessments seen were detailed and regularly reviewed. All documentation had been signed by all staff to evidence that they had read and understood it. Pages Orchard, 4 DS0000013221.V326243.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 and 17. Quality in this outcome area is excellent. The home supports the service users to lead a fulfilling and very positive lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual’s future needs as identified at reviews are reflected in their care plans and in the home’s annual development plan. Daily activity programmes are noted on communication boards in bedrooms and communal areas. Service users are given ‘trials’ of activities to help them make informed choices about what they want to do. Activities also reflect future needs, as identified in the review process. One relative’s comment card said, ‘Has made remarkable progress since he has been in the home’; another said, ‘Has a full and interesting day.’ Service users’ questionnaires noted that they could do what they wanted at all times of the day. Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 12 To assist service users with development, care plans include detailed information on how to support individuals with specific routines such as drinking water, toilet, tea making, tying shoe laces, rocking in the car, rocking, teeth cleaning, family skills and family contact, ie how to maintain and welcome families into the home. Service users’ activity programmes include the use of the community, such as local colleges, one service user attends church regularly, pub lunches and the use of local facilities. Activities are also done in the house and service users were observed being encouraged to take part in the domestic activities of the afternoon. Service users are supported to participate with daily living tasks as part of the maintenance and development of independence. All service users have family contact and are supported to maintain important relationships - how to assist them with this is noted on care plans. Visits and special family dates are recorded and staff facilitate visits even with those who live long distances away. A minimum number of monthly ‘outings’ are organised. The organisation does not provide annual holidays for service users; the day trips appear to suit the needs of individuals. Most external activities occur during the daytime but other external activities are organised as appropriate. Staff and the manager said that they felt service users had plenty to do. Two service users said ‘yes’ and smiled when asked if they had plenty of things to do. Interactions observed between staff and service users were excellent, service users appearing confident to communicate with and approach staff at all times. Staff spoke respectfully and positively to service users throughout the duration of the visit. Individual care plans addressed any equality or diversity issues for the service users. Menus seen were well balanced and good quality food was offered. There was plenty of fruit available and service users were seen to be involved with meal preparation. Pages Orchard, 4 DS0000013221.V326243.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 and 20. Quality in this outcome area is excellent. The home offers excellent personal and healthcare support to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users’ care plans are very detailed and include all the necessary information to ensure that staff can meet their individual personal support needs. How they prefer to be supported is clearly noted in the plans. The home focuses on communication and there are communication boards in bedrooms which describe daily personal care routines as well as activities. The home has immediate access to a psychology department, which is part of the organisation. It supports the home to respond quickly to any evidence that a service user is having difficulties. One service user who was exhibiting some disturbed behaviours was very quickly referred to a psychologist and immediate, positive action was taken. This involved the service user, the family and the home working together to resolve the issues. Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 14 There is also a ‘Gateways Pro-Active plan’ which includes communication, environment, physical needs, interactions, therapeutic activities, relaxation, calming techniques, listening techniques and sensitivities. This describes how to support the service users in those areas. Health records are well kept and accurate, service users are supported to have regular health checks and attend the GP/specialists as necessary. The home is also working sensitively with a service user to prepare for bereavement. There are few incidents recorded and immediate action is taken if necessary and appropriate. The medication administration system is robust and all staff receive training to administer the Boots monitored dosage system - the manager ensures that they are competent in this area. Records showed that one staff member had failed to sign the chart on one occasion. The manager was able to check that medication had been given correctly. Pages Orchard, 4 DS0000013221.V326243.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 and 23. Quality in this outcome area is good. The home ensures that service users’ views are listened to and protects them from all forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is produced in service user-friendly format and is up-to-date. The home has a complaints book, but has had no complaints since the last inspection. Complaints is a topic discussed at the service user group meetings. The Commission for Social Care Inspection has received no information about complaints or safeguarding adults issues. All staff have received Protection of Vulnerable Adults Training and one staff member fully described the action she would take if she had any concerns about the safety or well being of service users. Service users’ appointees are their parents and they have their own bank accounts so that they are able to access money. Service users’ financial records were not examined. The manager advised that appointees audit their accounts at regular intervals. Incident reports are detailed and timely and appropriate action is taken if necessary as a result of any incidents arising from challenging behaviours. Pages Orchard, 4 DS0000013221.V326243.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 and 30. Quality in this outcome area is good. The home offers service users a very comfortable environment, maintained to a high standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is very homely, with good quality furniture and fittings. Bedrooms are individualised and reflect the service users’ tastes and personalities. The kitchen has been retiled and a new cooker has been installed. All areas of the house were very clean and hygienic. Decorating and maintenance are included in the annual development plan. The external appearance of the house is tidy and welcoming, ie plants in pots and a neat and tidy garden. Pages Orchard, 4 DS0000013221.V326243.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35. Quality in this outcome area is good. The home has an effective and competent staff team that is able to offer high standards of care to service users. Recruitment practices ensure that staff are recruited safely and are suitable to carry out their duties. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has four permanent staff, two have NVQ qualifications and the other two have completed an approved induction programme. Staff rotas showed that generally there are two staff in the daytime (until approximately 4.00pm) and one staff in the evening and at weekends. Additional staff are provided if there are any specific activities occurring. The manager and a staff member felt that staffing levels were adequate. Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 18 The manager shares responsibilities between and with the staff team. The staff member spoken to was knowledgeable and efficient. Staff morale appeared to be high and staff took an equal share in the running of the home. Records and written documents were of a high quality. Recruitment records for two staff showed that all the necessary information is kept and staff recruitment processes are safe. A staff member confirmed that there are good training opportunities and demonstrated her knowledge and understanding of the residents and their needs. Training records showed good opportunities for training, which staff ‘take up’. Pages Orchard, 4 DS0000013221.V326243.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 and 42. Quality in this outcome area is good. The home is very well managed in the interests of the service users, who are kept as safe as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is experienced and qualified. She has an in-depth knowledge of the needs of the service users. The management systems are effective and efficient. The organisation has a senior manager responsible for quality assurance. The quality assurance system consists of regular Regulation 26 visits, an annual audit by managers on each other’s homes, a weekly service user group meeting and formal annual reviews of service user care plans. Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 20 The information collected at the different forums is developed into an annual development plan, which includes aims and goals for the home. Most of the goals are service user focused, such as developing a total communication approach, monthly day trips, decorating of the home, using visual strategies to provide service users with more information and staff training to support service users’ developments. There was evidence that some of the aims and objectives had been achieved, eg communication training and communication boards in the home. All health and safety records and checks were up-to-date. Staff have updated health and safety training. Few accidents and incidents occur but those that do are properly recorded and any remedial action necessary is taken promptly. The home has smoke alarms, which are checked weekly. Pages Orchard, 4 DS0000013221.V326243.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 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 3 X Pages Orchard, 4 DS0000013221.V326243.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. Refer to Standard Good Practice Recommendations Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 © 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 Pages Orchard, 4 DS0000013221.V326243.R01.S.doc Version 5.2 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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