Inspection on 18/10/05 for The Orchards

This inspection was carried out on 18th October 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 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

The Orchards 08/03/07

The Orchards 25/01/06

The Orchards 07/03/05

The Orchards 23/11/04

The Orchards 08/03/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 The Orchards Stowfield Lower Lydbrook Glos GL17 9PD Lead Inspector Peter Still Unannounced Inspection 18th October 2005 10:00 The Orchards DS0000016522.V250014.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 The Orchards DS0000016522.V250014.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. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Orchards Address Stowfield Lower Lydbrook Glos GL17 9PD 01594 860615 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) lee@orchard-trust.org.uk The Orchard Trust Mrs Leonie Janis Abbott Care Home 17 Category(ies) of Learning disability (17), Learning disability over registration, with number 65 years of age (17), Physical disability (17), of places Physical disability over 65 years of age (17) The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The LD or LD(E) category must apply to all service users in the home, but they may also have needs under PD & PD(E) One place is registered for the category Sensory Impairment with Learning Disability 07/03/05 Date of last inspection Brief Description of the Service: The Orchards is part of the Orchard Trust Group and consists of two sites, about 300 yards apart. The main unit is known as Offas Dyke and consists of three interlinked four-bedroom bungalow, and two single rooms, one with en suite facilities. A little further away is a semi-detached house known as 1, The Orchards, registered for three residents. On the site there is also the main office for the Orchard Trust and a continuing education centre called The Barn, which is run in conjunction with Gloscat. This offers a wide range of activities that residents at The Orchards may attend. A large sensory garden and smallholding with animals provides an important extra dimension for the benefit of residents. Offas Dyke provides accommodation for residents with a learning disability who may have a physical disability and a need for a high degree of personal care. Residents living a 1 The Orchards do not require the same levels of support and are more independent. The site is situated close to the village of Lower Lydbrook, in a beautiful rural setting and on the edge of the Forest of Dean. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours. The provider, registered manager and prospective manager were present during the inspection. Some communication was made with one resident and other residents at the home during the inspection were observed. Three care staff were spoken with and other staff were observed. There is currently one resident vacancy at the home and applications are being considered. Most residents were away from the residential accommodation during the inspection, involved with their day care activities. A brief visit to the Home’s educational day care centre, called The Barn, found some residents happy and relaxed, enjoying activity with other people who attend the centre. A tour of the residential buildings was made and a number of records were inspected and discussions took place with the management team. What the service does well: What has improved since the last inspection? The provision of an extensive sensory garden is a very exciting development. All requirements from the last inspection have been complied with, including complete painting to Bungalow 1 and external painting. New, quality, patio furniture has been purchased. Skirting boards have been fitted to the Atrium. The Orchards DS0000016522.V250014.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. The Orchards DS0000016522.V250014.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 The Orchards DS0000016522.V250014.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 Resident’s benefit from good admission and assessment practice, which ensures that the home is able to meet their needs. EVIDENCE: Care needs are well met through a full assessment process, carried out before a resident decides to live at the home. Detailed Care Plans are completed by the home from this information. Evidence from files demonstrated a commitment to a very thorough pre admission process, which included: meeting with family; a family history; visit to school and previous care provider and documentation from Supporter. Evidence was also seen that following admission further detailed assessment is sought, involving key agencies. The Orchards DS0000016522.V250014.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): 7, 9 Resident’s are supported to ensure they can make decisions and take risks to enhance their lives and promote their independence. EVIDENCE: Residents living in three bungalows are mostly in need of significant support and a total communication approach is used. Staff should be commended for the way they advocate for residents. A resident file showed thorough recording including detail about a specific need to develop independence. Another issue for a resident concerned a high level of risk and staff ensured key professionals gave immediate attention. The videoing of staff providing direct care was considered to be an excellent training initiative, enabling staff to consider their practice, making changes leading to improvement for residents. A member of staff talked about specific activities residents enjoy such as getting a paper each day and paying for items they purchase at shops. The files and care plans seen at 1 The Orchard were well organised and showed clear recording. One care file reviewed showed detail of activity and risk taking where residents are encouraged to make their own choices and lead more independent lifestyles. A magnetic board duty rota, principally for one resident, will be reviewed to ensure it is of value and kept up to date. A The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 10 Home/College diary seen in a resident’s bedroom was last updated in May 2005. It may be that a new diary was at college with the resident on the day of inspection but if so the old diary may need to have been put somewhere else to avoid confusion and this matter should be looked into. The Orchards DS0000016522.V250014.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): 13, 14 An extensive and wide range of activity, both in the community and at the home, are well managed and provided interest, independence, choice and enrichment of residents lives. EVIDENCE: Activity plans were seen for residents and showed good variety. The home minibus enables residents to enjoy the beautiful local countryside and many amenities. One resident enjoys spending time with people in her/his local community. Residents visit the local day centre, library, swimming pool, hydrotherapy pool and holidays. A member of staff talked about a resident who had only been able to spend one night away on holiday but it is commendable that a night away was still considered and achieved. The provision of an educational day centre has been a significant achievement and was observed to be much enjoyed by residents and others from the local community. The smallholding is used as a resource by the day centre and also by residents at other times and animals are close to residents. Ponies walk by their bedroom doors in the main building providing stimulation and interest. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 12 The ethos of the home in the use of total communication methods, is clearly valuable to residents and a good example was given of letting residents feel rain and enjoy walking through leaves, which abound due to the number of trees close to the home. The provider should be commended for supporting the provision of an extensive new sensory garden, which includes easy access paths. This is still being developed and is an exciting development. The Orchards DS0000016522.V250014.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, 21 Resident’s health and needs are well met and promoted by good planning arrangements and the homes focus on the individual. Sensitive communication concerning a resident’s final wishes has been helpful. EVIDENCE: The good recording systems in place ensure timely communication with GP’s and other agencies. Three Care plans reviewed reflect resident’s likes, dislikes and preferred choices. A traffic light system is used to highlight issues and ensure priority of need can be met. One reviewed care plan had been discussed with the resident; two others had included family involvement. Whilst the home accommodates 17 residents, the living accommodation is in small units, with their own staff teams and this helps to ensure staff know the residents well and can concentrate on individual needs. One member of staff said that Makaton communication training would be helpful, and the manager said this is being sought and will be provided within the next six months. The prospective manager is working with the Gloucester NHS Trust’s development group concerning best practice, which will provide further help in ensuring this standard is promoted further. Information was provided about an incident where an external professional had been inappropriate concerning a procedure and the home should be The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 14 commended for helping the agency to ensure future good practice to ensure residents required needs are met. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 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 the following standard(s): 22 The homes focus on the resident as an individual ensures their views and understood and acted upon. EVIDENCE: Good levels of recording show that staff know residents well and the key worker system ensures good communication and that residents needs can be understood and met within their small living group. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 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 the following standard(s): 24, 25, 26, 27, 28, 30. Extensive work to the home since the last inspection demonstrates a willingness by the provider to provide a good environment for residents. Items identified in this inspection, currently detract from a fully satisfactory place for residents to live. EVIDENCE: Many parts of the buildings are in good order and no issues were seen in 1 The Orchard. Requirements will be made to address a number of matters, which were seen to need repair, redecoration or replacement. The main residential bungalow complex presents significant maintenance difficulties for the provider to overcome and managers are well aware of the issues and are trying hard to overcome them. A recent consultation with an architect to consider options to improve the buildings and environment is a proactive step. Since the last inspection expensive work has been undertaken to comply with requirements, which had been made and the provider should be commended for this. It is recommended that an audit be undertaken concerning the points listed below to assess where action is necessary. Requirements will be made concerning the kitchen unit doors, carpets and hot water for resident’s sinks. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 17 The following points were noted at this inspection, which require resolution or a programme of works. • Kitchens: One draw was missing in Bungalow 3; a number of unit doors were in need of replacement due to outer surface damage. . • Carpets/floor covering: A number of carpets need cleaning or replacement and paint has dropped onto some vinyl flooring in communal areas. A section of vinyl in Bungalow 3 was badly scuffed. • Walls: A lot of redecoration has taken place since the last inspection and more is due to start soon. Some walls have been filled ready for painting. • Bathrooms and WC’s: The assisted bath in Bungalow 3 has a damaged corner, where the plastic is cracked; The home has a significant problem with storage and the storage areas within bathrooms/WC’s detracts from a homely environment; faeces was seen on a toilet seat, which was dealt with immediately by a member of staff. It is understood that a resident had a bowel difficulty and at that moment there were no staff in the Bungalow. • Beams: The design of these makes them difficult to clean and two very small pieces of wood were seen to be balancing on one beam. The prospective manager immediately took them away. • Hot water: Residents sinks are in what was described as wardrobes. Some sink areas were being used for storage, which would make use difficult and a number did not have hot water. The provider had already sought guidance from a plumber and on the day of inspection arranged for work to be undertaken to remedy this. • Leaves on the patio outside residents bedrooms: Due to the number of trees the manager’s consider it is not possible to keep these areas clear of leaves all the time and the sensory beneficial effects of leaves with their colour, sound and feel is acknowledged. A risk assessment should be made to ensure residents would not slip in these areas. 1 The Orchard was very clean and tidy with a relaxing and homely feel to the living areas and communal kitchen, where residents take it in turn to prepare food. The Bungalows were clean and tidy and each had been individualised and made to feel homely. Resident’s bedrooms are large and have been personalised and one bedroom had incorporated sensory equipment for the resident. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 Resident’s benefit from competent staff whose practice will continue to develop when more staff achieve their NVQ Level 2 or 3 qualification. EVIDENCE: Staffing on the day of inspection was considered to be satisfactory and was adjusted depending on the numbers of residents as they returned from activity away from the home. Each small living unit has its own staff team and files and documentation for their specific residents. The file system reviewed in 1 The Orchard showed a comprehensive and clear system, where policies and procedures were easily found. One file containing key information was considered to be an excellent tool to enable staff to be confident in their work. The well-organised and detailed documentation helps to ensure staff can be competent in their work. Two Staff were observed to be communicating well as they completed recording from their duty period. One resident was seen to be presenting challenging behaviour towards a member of staff and this may have been difficult for the member of staff in the presence of the inspector. This member of staff was also observed to be working sensitively with a resident. Some qualified staff have moved to other jobs and this has led to a difficulty in the home achieving the necessary 50 of staff who hold an NVQ Level 2 qualification. The manager, who is an assessor, should be commended for being proactive in employing two peripatetic assessors to ensure progress is The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 19 made with this standard. The prospective manager has started the registered managers award manager, which should be completed in June 2006. One staff file contained evidence of good recruitment practice. Where a reference had not provided sufficient detail, a further reference would be sought. Discussions took place about steps to take when the manager had concerns about the way other homes had responded to reference requests and this also emphasised the good practice of this home. A new member of staff was being inducted on the day of inspection. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 20 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 The home benefits from confident leadership, which underpins an ethos of good practice, enabling the home to continue to improve the lives of residents. The Trust demonstrates a willingness to resolve issues and be available ensuring good communication and management. EVIDENCE: The provider was keen to be involved in the inspection and to hear the issues, which need resolution. The manger strongly defended the key principals under which the home operates and it was clear to see the commitment to best practice and reflection on both the past achievements and hopes for the future. The home is complex and unique in many ways and the manager’s confident support will be important in helping the new manager into post. Good policy, procedure and recording provide a good base for staff to work competently. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 2 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 2 2 3 X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Orchards Score 3 3 X 3 Standard No 37 38 39 40 41 42 43 Score X 3 X X X X X DS0000016522.V250014.R01.S.doc Version 5.0 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. 1 2 3 4 Standard 24 24 24 24 Regulation 23 23 23 23 Requirement Replace missing draw in kitchen unit of Bungalow 3. Check all kitchen units and replace badly worn doors or replace units. Stained carpets to be cleaned or replaced. Resident’s washbasins to be supplied with hot water. Timescale for action 06/01/06 06/01/06 28/04/06 06/01/06 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 2 Refer to Standard 42 27 Good Practice Recommendations Risk assess the area outside residents bedrooms so that it can be used safely. This concerns the problem of leaves. Consider how residents can be supported to make use of their sinks to aid privacy/personal care and a level of independence. Also consider how the wardrobes can have better access to the sink units, in relation to some storage difficulties. Risk assess the broken plastic to the corner of the assisted bath in Bungalow 1 to ensue it can not injure residents or staff and remedy as needed. DS0000016522.V250014.R01.S.doc Version 5.0 Page 23 3 29 The Orchards 4 5 6 7 24 35 35 11 Continue to seek guidance, which may help to resolve a difficulty with a lack of storage space. Encourage and support staff to complete their NVQ level 2/3 training. Review support to staff concerning their work with residents who may present a challenging behaviour. Review use of magnetic staff rota board for residents and Home/College diary for another resident. The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 The Orchards DS0000016522.V250014.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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