CARE HOME ADULTS 18-65
Scotch Orchard 55 Scotch Orchard Lichfield Staffordshire WS13 6DE Lead Inspector
Ms Wendy Jones Unannounced Inspection 1 September 2005 9:30 Scotch Orchard DS0000034865.V260726.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 Scotch Orchard DS0000034865.V260726.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. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Scotch Orchard Address 55 Scotch Orchard Lichfield Staffordshire WS13 6DE 01543 264755 01543 268970 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) Staffordshire County Council, Social Care and Health Directorate Miss Kelsay Suzanne Johns Care Home 13 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (2), Learning disability (13), Learning disability of places over 65 years of age (2), Mental disorder, excluding learning disability or dementia (4), Mental Disorder, excluding learning disability or dementia - over 65 years of age (2), Physical disability (5) Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th October 2004 Brief Description of the Service: Fifty-Five Scotch Orchard is a Local Authority Home that can accommodate thirteen younger adults with learning disabilities; two beds are to provide respite care. There are ten service users who currently live at Scotch Orchard. The home has undergone major refurbishment work to ensure the home meets the new environmental standards. The home is located within private grounds in a residential area in Lichfield. Local shops are within walking distance, and the town centre is accessible by public transport. Service users have the use of a minibus. At the time of the inspection, the accommodation comprised of ten single bedrooms on the first floor and three bedrooms on the ground floor. There are four bathrooms, two of which have an assisted bath. The ground floor consists of a lounge/dining room, a patio lounge, and a hallway with a seating area, two large toilets, large industrial kitchen, laundry room, staff room and two offices. There is a separate respite area on the ground floor incorporating a kitchen/diner and a lounge and two of the ground floor bedrooms. There is a patio area to the rear leading to a large grassed garden. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out in the evening on 31st August 2005. Occupancy was 12 of whom two were receiving respite care. Information for this inspection visit was provided from discussion with management, staff ion and service users; from inspection of the environment, care records and other documentation relevant to the inspection process; from observation of service user and staff interactions. What the service does well:
The service had a Statement of Purpose and Service user Guide, providing information for prospective service users, existing service users, social workers families and friends with the information they need regarding the service provided, the aims and objectives of the service, the philosophy of care, the staffing arrangements and staff qualifications and other information. Care plans were in place and were reflective of the assessed needs of service users. Regular reviews of care plans were recorded, and all service users had been involved in Person Centred Planning. Individual and general risk assessments were in place and gain subject to review. New risk assessments were included in the service handover information to ensure that all staff were familiar with them. All service users had regular access to local authority day services from Monday to Friday. Three service users had a holiday planned for this year. Menu plans provided a picture of a balanced and nutritious diet, service users confirmed satisfaction with the food and choice offered. The systems for the safe administration and storage of medication were satisfactory. All staff were enrolled on a certificated medication training course. A complaints policy and procedure was included in the service user guide and displayed in the home. Records indicated that no complaints had been received by the service since the last inspection. No complaints had been received by the Commission for Social Care Inspection. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 6 The service provides single bedrooms for all service users. The general environment is of a good standard of décor and maintenance. Further plans for upgrading and redecorating some areas of the home were identified for the benefit of service users. Staffing levels were maintained through the use of casual staff and the use of flexible hours. A recent recruitment drive has been successful with four new staff to start, two part time vacancies have yet to be filled. The manager had completed NVQ level in care and management and had been approved as the registered manager by the Commission for Social Care Inspection. Fire safety records were appropriately maintained, fire drills recorded and undertaken weekly. Gas soundness checks had been completed. Risk assessments were in place to safe guard service users and staff. What has improved since the last inspection? What they could do better:
The service must ensure that service users bedrooms are maintained in a satisfactory state of repair and maintenance and have lockable facilities. All service users should be offered an annual holiday. The opportunities to regularly access community facilities and for community presences should be facilitated. Service users receiving respite care must have access to the service user guide and should be provided with a menu to ensure that they are aware of the food choices available to them. The storage temperatures for medication should be monitored closely. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 7 The organisation must make arrangements for monthly, unannounced monitoring visits to be undertaken to assess the progress of the service. A copy of the report of the visit must be provided to the Commission for Social Care Inspection. The free standing wardrobe identified must be secured to prevent the risk of injury to the service user. 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. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The homes Statement of Purpose and Service User Guide provided service users and prospective service users with details of the services the home provides enabling an informed decision about admission to be made. EVIDENCE: A statement of Purpose and Service User Guide had been produced by the service. A copy of a service user guide was included in the care records of permanent service users seen during this visit. There was no evidence that one service users receiving respite care had access to this information, this must be addressed. The service must also ensure that any review of the Statement of Purpose is also copied to the Commission for Social Care Inspection. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9. There was a clear care planning system in place which provided staff with the information they need to satisfactorily meet service users needs. EVIDENCE: A sample of care records were inspected, the service has a detailed assessment process and has adopted a Person Centred Planning model to support service users to plan their care and make real choices and decisions regarding their lifestyle. A sample of one permanent service user file and one receiving respite care were seen during this visit. The records shown showed that reviews of care had been undertaken, risk assessments were in place and had also been subject to review in the main. In one example however a service users risk assessments had not be reviewed, and one risk assessment had not been dated. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 11 The assessment information of one service user indicated that a health condition had been suspected, there was no further information or care plan in the file to indicate how this had been investigated or how the service intended to care for the specific needs of the individual. This was discussed with the manager for action. The records of a second service user showed that care plans were up to date had been subject to monthly reviews, and were reflective of the assessment That had been undertaken. Risk assessments were included in the services handover file” New information file” which was used to handover information to staff at each change of shift this method ensured that all staff were up to date with changes to care and new developments included new or changed policies and procedures. One service user was being supported by the service to move to more independent living in co-operation with the allocated social worker. Some concerns were expressed about the future service by the manager. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 16 and 17. Links with the community were limited with little evidence of community presence or participation. Dietary needs of service users were well catered for with a balanced and varied selection of food available that met service users tastes and choices. EVIDENCE: A sample of service users activity participation records were seen, there was some concern regarding the limited community presence and participation of the two service user records sampled. For example in one record it indicated that one service user had participated in one activity outside of the home in June 2005, and another on just one occasion in August 2005. There was evidence of staff shortage, as discussed in the staffing section of this report, and it is also accepted that all service users attend day services Monday – Friday. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 13 It was reported that three service users were going on holiday for five day’s this year. A service user interviewed stated that she would have liked a holiday this year. The service offers a four week menu, that offers a good range of meal choices from the records seen. Service users confirmed satisfaction with the meals provided. A recommendation of this visit was, that the menu’s are made available to service users in both the main communal area and in the respite care area. It was also suggested that the service should consider the use of pictorial menus to assist service users who were not literate, and had limited ability to make an informed decision about their choice of meals. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Personal support in this home is offered in such a way as to promote and protect service users’ privacy dignity and independence. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure service users medication needs are met. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 15 EVIDENCE: From discussion with service users and staff, and from observations made, there was evidence that the service appropriately and sensitively met the personal and healthcare needs of service users. The service uses a monitored dosage system called “NOMAD”, the medication is stored in a locked cupboard in line with the guidance on the safe storage of medication. All medication cassettes included a photograph of the service user and records of administration were accurately maintained. Protocols were in place for the administration of ‘as required’ medication. The manager reported that all staff who had responsibility to administer “as required medication” have received training. They have also received in house training in the “safe administration of medication”. This training was not certificated. A number of staff had begun a modular medication course for which they will receive a certificate. An up to date medication reference book was available to staff. The storage temperature of medication stored in a fridge was recorded and signed by staff. It was suggested that the temperature records are monitored to ensure that they are within the recommended range. There are were no service users who administered their own medication at the time of this visit, although one service user was being supported to start to self medicate. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 16 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 and 23. The home has a satisfactory complaints system with some evidence that service users feel that their views are listened to and acted upon. Staff understanding of Adult Protection issues provides a safe environment to protect service users from abuse. EVIDENCE: The service had a Vulnerable Adults and complaints policy and procedure in place. A requirement of the inspection was for the complaints procedure available in the home must be updated to reflect the contact details of the Commission for Social Care Inspection. The manager provided an updated copy of the procedure within the given timescale for compliance. The records showed that the service had not received any complaints since the last inspection, but had received some positive comments from two relatives. There had not been any Vulnerable Adults investigations or issues identified in the same period. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 17 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, 25,27,28 and 30. Recent investment has improved the appearance of this home creating a comfortable and safe environment for those living there and visiting. EVIDENCE: The home is located within private grounds in a residential area in Lichfield. Local shops are within walking distance, and the town centre is accessible by public transport. Service users have the use of a car, which was purchased through the Home’s league of friends. Communal space was provided on the ground floor in a lounge/dining room a second lounge or activity room, and a lounge and dining room in the respite flat. There was ramped access to the front and rear of the home, and adequate car parking space. There were four bathrooms, two of which had assisted bathing facilities and there were also two large toilets on the ground floor. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 18 The home had ten single bedrooms on the first floor and three bedrooms on the ground floor. A sample of bedrooms were seen during this visit, one was quite a small bedroom being used for respite care, the service user said that he didn’t have a key to his bedroom or to a lockable facility in his room. In addition the free standing wardrobe had not been fixed to a secure surface and there were some black plastic bags stored in the room which were not his. All of these matters were discussed with the manager for action. In another bedroom ceiling paper was coming off the ceiling in part of the room Generally bedrooms were furnished and decorated to a good standard. Individuals had been able to personalise their room to reflect their individual interests and contained personal possession and items you would expect to find such as their own television, videos or DVD players and radios. Each bedroom door had a lock fitted, one of the service users spoken to had their own key to the their bedroom door. The service had an emergency call system fitted in some areas of the home and staff had a pager system to summon support if required. The home was clean and hygienic on the day of inspection. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 19 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): 33 After a period of considerable instability in staffing there is now evidence that the staffing arrangements are improving for the benefit of service users. EVIDENCE: The staffing arrangements on the day if the inspection were as follows: The manager 8am-4pm One x 7.15am-3.30pm One x 9am-3.30pm Three x 7.15am-3.30pm One x 7.15am-9.45am, One x 9.30am-3.30pm One x 3pm-9.30pm One x 4.30pm-10pm One x 10pm-8am Two x 3pm-10pm Two x 3.30pm-10pm Onex 9.45pm-7.45am Handyman 8am-12.30pm Cook 9am-2.30pm Domestic staff Two x 7.30am-12.30pm, One x 8am-12.30pm. The manager reported that the aim was to have at least four care staff plus a manager on duty through out the waking day. The service had undergone some staffing difficulties since the last inspection, with two part time and four
Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 20 full time vacancies although a recent recruitment drive had proven to be successful with five staff employed, interviews were taking place for the other vacancies during this visit. The manager stated that adequate staffing levels had been maintained through the use of casual staff, and the flexible use of permanent hours. No agency staff were being used during the week of this inspection. The significant staffing difficulties over some months had appeared to have had some effect on service users community presence and participation, from the sample of records seen. The manager expressed a view that now the recruitment drive had been successful, service users opportunities to access local community facilities would be increased. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 21 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): 38 and 42 The manager was supported well by her senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The health and safety of service users was assured by good risk assessment. EVIDENCE: The manager has been approved as the registered manager by the CSCI since the last inspection, and had achieved NVQ level 4, she also has several years management experience in Learning Disability services. A requirement of this inspection included the need for the organisation to carry out monthly, unannounced visits to the home and to produce a report on the conduct of the home for inspection purposes. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 22 As identified at previous inspections, the Local Authority currently carries out five yearly gas inspections and record of testing is held with Property services. It was a previous requirement that this testing is carried out yearly and a copy of testing is maintained in the home for inspection. The records showed that the last test for gas soundness had been undertaken on 04/06/2003. The gas boilers had been checked on 20/04/05. The records of weekly fire drills were recorded with names of attendees, times the drill had taken place, details of the type of evacuation were also recorded. There were also records maintained of fire training, a requirement of this report was that the individual records of fire training must be kept up to date. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 23 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 3 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 1 x 3 3 x 3 LIFESTYLES Standard No Score 11 X 12 X 13 1 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X X x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Scotch Orchard Score 3 X 3 x Standard No 37 38 39 40 41 42 43 Score X 2 X X X 3 X DS0000034865.V260726.R01.S.doc Version 5.0 Page 24 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 2 Standard YA9 YA25 Regulation 12 12 Requirement Timescale for action 30/11/05 3 4 YA25 YA39 23 26 Risk assessments must be dated and reviewed on a regular basis. The service must ensure that 01/09/05 service users are safeguarded, by securing free standing wardrobes. Ensure that the décor in 30/11/05 bedrooms in a good state of repair. Monthly unannounced visits to 30/11/05 the home, must take place, by a representative of the provider, to assess the performance of the service. A copy of the report must be provided to the Commission for Social Care Inspection. 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 YA13 Good Practice Recommendations Service users should have the opportunity to access community facilities on a more regular basis.
DS0000034865.V260726.R01.S.doc Version 5.0 Page 25 Scotch Orchard 2 3 4 5 YA17 YA13 YA25 YA20 The service should provide menu’s to enable service users to make informed choices. Service users should be offered an annual holiday. Lockable facilities should be provided in service user bedrooms. The temperature of the storage facility used for medication should be closely monitor to ensure they remain within the current guidance. Scotch Orchard DS0000034865.V260726.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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