CARE HOME ADULTS 18-65
The Orchards Stowfield Lower Lydbrook Glos GL17 9PD Lead Inspector
Kath Houson Unannounced Inspection 25th January 2006 10:00a The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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.V279034.R01.S.doc Version 5.1 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.V279034.R01.S.doc Version 5.1 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.V279034.R01.S.doc Version 5.1 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 18th October 2005 Date of last inspection Brief Description of the Service: The Orchards is part of The Orchard Trust and consists of two sites, about 300 yards apart. The main unit is known as Offas Dyke and consists of three interlinked four-bedroom bungalows 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 small holding 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.V279034.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place one morning in January 2006. The acting manager was available throughout the inspection and able to assist and provide all relevant documentation on request. Twenty-four of the standards were assessed which were a mixture of core and non-core standards. Three residents’ records were case tracked, a short and informal discussion was conducted with residents’ and staff team, a tour of the environment and a short succinct feedback was given to conclude the inspection visit. The inspector would like to extend her thanks to the service users, staff team and management for their assistance in the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The storage issue was highlighted at the previous inspection and was discussed at the current inspection. Consideration is required to be given to how the current storage space can double up to provide wardrobe space in order to solve the problem with storage. The hand sinks were additional a cause for concern as there was no hot water which prompted another discussion as to how improvements can be made to provide better utilities to give residents more privacy to their personal care. There were environmental issues that will require attention such as damaged bath units and kitchen units that were highlighted in a previous inspection. The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 Page 6 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.V279034.R01.S.doc Version 5.1 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.V279034.R01.S.doc Version 5.1 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): 1 and 5 Residents’ benefit from information being provided to make an informed choice about their place of residence. EVIDENCE: The home has an admissions process for potential service users that complies with the regulations. The statement of purpose contains the relevant information to assist service users in making an informed choice about their place of residence. Evidence taken from service user guide outlines the purpose of the home and additionally includes input from other agencies. The acting manager discussed the admissions procedure and was able to supply the documentation on request. The admissions procedure additionally includes other agencies working in partnership to achieve the best outcome for potential service users. Each client has their own version of the service user guide complete with the terms and conditions that are based on an individualised needs assessment and outlines the service of the home. For example non-verbal clients would be offered visits with speech therapist, visual therapy specialist, in order to ensure that information was shared. This was evident as a non-verbal client has a symbolic version in their care plan. The manager said that a new version of the statement of purpose would be updated in a more simplistic version specifically for non-verbal clients. Additionally, the acting manger said that the person centred planning would change shortly to provide a more detailed model of care.
The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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 and 8 Clients benefit from having their needs assessed and any change in their needs is reflected in their care plans’. EVIDENCE: Residents’ are supported to make decisions within the home and participate in household chores with support from key workers and the staff team. Documentation seen such as college reports and activities has been satisfactorily recorded. Care plans are reviewed every six months and discussed with other agencies. Clients’ have an assigned key worker who are additionally aware of their needs and discuss changes and document those changes. Daily accounts of the service users activities were seen in the form of college reports. The recordings of information in relation to the service users demonstrate consistency of care between the college and the home. For example, the college regularly reported to the home that a client had problems with time keeping. The staff team were able to support the client in making adjustments to improve client’s college attendance. The regular recordings between the home and college result in monitored progression of the service users that can be seen as beneficial for the clients of The Orchards.
The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 Page 10 An inclusive approach exists at The Orchards in which clients’ are able to participate in household chores. Household chores consist of cooking, cleaning ironing, going shopping for personal requirements. On a social level clients’ would pay for their own drinks when an outing takes place to any social event, such as to a bowling alley or visits made to a public house or disco. A rota was seen as evidence to support clients’ participation within the household. Outside activities such as grocery shopping for personalised items and cooking is part of promoting independence for clients’ within the home. At the time of inspection the service users were out shopping for groceries. One service user said “I enjoy the care I receive from the home and happy with my key worker” The service user went on to say “with help I cook what is ever on the rota” The acting manger additionally said that the home assist service users to find paid employment on a very part-time basis. For instance a client wished to work in a local garage the staff team helped to organise the work preparation programme that would assist the service user to participate in employment of their choice. The home has a system that at the end of every shift a staff handover file is shared. The handover document contains service users’ daily activities and choice of educational topics. The educational document is reviewed at the end of the college term in preparation for the new semester. Discussions take place with the clients’ about new educational programmes that are based on a new educational brochure which new choices of topics are made. The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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, 15, 16 and 17 Clients are supported to participate in activities which promote and encourage independence, which include maintaining relationships with their peers. EVIDENCE: The Barn is the educational activities centre where clients are able to use which is based on site and has easy access for wheelchair users. Clients are able to visit the Barn that has Gloscat accreditation. A number of service users participate in activities and educational programmes, such as computers, dance, drama and other subjects to include music. There is a multi-sensory room, which is arranged for service users who have a sensory impairment as well as those service users who participate in the arts and crafts. There are plans to build a training kitchen, with the idea that clients can develop cooking skills under a controlled environment. The plan is to improve facilities for the residents on the site of The Orchards and also to share with people from neighbouring areas. The activities programme show consistent variety and over time an increase in educational programmes will be provided when the building works for the hydro pool and the sensory garden are completed.
The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 Page 12 Clients are able to attend church of their choice within the local community. Support is given to encourage client use of neighbouring facilities such as the local community and local shopping areas. The Forest of Dean has a number of picturesque walks and is close to Cinderford, Coleford and Ross-on-Wye in which clients can enjoy and can participate as part of community links. All choice of meals are offered and based on a two-week menu system that changes throughout the year. Alternative menus are offered and fresh fruit and vegetables are included within the diet and were seen during the inspection. Clients go out for food shopping and are additionally given an alternative menu choice. One service user had said, “The food is good I cook Tuesdays and Saturdays.” The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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): 20 Clients benefit from clear recording of medications into the home that prevents the potential for errors. EVIDENCE: Procedures for the homes medication were examined; two trained members of staff check medication, which is good practice. It was found that a GP error had occurred when the medication was supplied. The error has now been resolved. The medication procedure has since then further improved in which only the senior and deputy members of staff are able to double check medication coming into the home particularly for Offas Dyke due to the complex medication of the service users. Homely remedies, internal and external medication will need to show date of opening. For example the use of eye drops are time sensitive and will need to be discarded within a month of opening. Additionally, all medicine containers must be dated when first opened to allow for correct stock rotation and for audit counts to be regularly made, which would demonstrate that medicines are being given to residents correctly. In addition there ought to be a separation between internal and external medicines, which need to be housed in separate compartments within the medicine cabinet. The individual MAR sheets were consistent, however allergies of service users’ need to be written and ‘none known’ to be entered if nothing else relevant, this would indicate that the matter has been considered.
The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 Page 14 Additionally, the name of the GP for each service user will need to be written on the MAR sheet. On the whole the complexity of medication within Offas Dyke appears adequately managed and the home owned a recent copy of the British National Formulary (BNF). The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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 and 23 Residents’ review records and regular meetings demonstrate progress within the home and service users benefit from issues addressed promptly. EVIDENCE: Residents’ meetings occur on a regular basis to deal with any issue arising within the home. The residents set the agenda such as social evenings, educational courses, and client relationships and discuss any concerns that the staff members address promptly. The home has a good level of recording the wishes of service users and a communication book seen confirms that communication is fluent. The clients have the choice to request a meeting sooner and the staff team will support any issues raised. For instance, clients voiced their satisfaction with the educational choices made and this was written in the notes of the meeting. Clients have copies of the complaints procedure within their file and were seen during the inspection. Residents have the opportunity to file a complaint if they so wish following the procedure of the home. The home however, has received a number of compliments about the service, and that advocates were satisfied with the care given. The evidence was seen in a file that is held at Offas Dyke. Compliments are shared with the staff team. All new staff receive specialist training in regards to abuse training via the LDAF course. The head of care is additionally providing in-house abuse training for all staff members within the residential homes that fall under The Orchard Trust umbrella. The recent change to the protection training was to provide an advanced level of training on the subject of protection issues. Clients benefit from a staff team who are fully trained in protection issues.
The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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, 29 and 30 Residents’ benefit from living in a comfortable homely and safe environment where all aspects of the home are maintained in good order at an adequate standard. EVIDENCE: The environment of The Orchards and Offas Dyke provide a safe and comfortable place for residents to live. Many sections of the buildings are in good order particularly at The Orchards. However, there were a number of issues that were highlighted from the previous inspection which were discussed on the day of the current inspection. Many of the issues will be resolved in March 2006 and will be monitored at the next inspection, specifically the main building at Offas Dyke. It would appear that there is a lack in consistency between the buildings. For instance, the fridge and freezers temperatures and date of opening for all foodstuffs between the bungalows ought to be noted in a consistent manner between the bungalows. The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 Page 17 The damaged bath panel is in need of repair and will be monitored at the next inspection. The issue of storage and the use of the hand sinks are to be resolved in order for service users to be supported with their personal care. This was also highlighted at the previous inspection and was discussed during the current inspection. Some of the other requirements from the last inspection have been met, that is the two new carpets have been replaced and another is on order, with cleaning to take place for the remaining carpets. However there are other issues in relation to the environment which is will need to be addressed and will be monitored at the next inspection. The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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): 31, 32 and 35 Residents’ benefit from consistent recruitment procedures and are supported by competent and qualified staff. EVIDENCE: The staff team appear competent and qualified within their roles and support service users to promote their independence. The staff had completed their mandatory training. New staff members are introduced to an induction programme which would be beneficial to service users and plans for additional training will begin towards the end of probationary period. A new staff member said “ its good here different” “I am sure of my role and responsibilities, and I feel that the clients’ are listened to.” Staff training is ongoing as many of the staff team are pursuing the next NVQ level. The central office checks all CRBs and POVAs of newly recruited staff and performs recruitment of potential staff. Residents each have a key worker who works along side the client to ensure and maintain quality of care. The staff team demonstrates a good working knowledge of client needs. Staff expressed satisfaction with working in the home with the clients this was observed during the inspection, in which interaction between clients and the staff was respectful. The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42 Residents’ benefit from a home that is well managed with appropriate systems in place to ensure that the home functions smoothly. EVIDENCE: Comments from a nurse who works in Gloucester Hospital commented on how well the clients’ are cared for within the home. Relatives and advocates have written expressing their satisfaction with the service. It would appear that The Orchards has a regular procedure for monthly monitoring for particular areas within the home. For instance, the communication book is organised with clear indication to whom the message is intended and signed and dated. This can be seen as good practice as it would keep all staff members in the loop of activity in and around the home. The internal audit schedule is broken down into three areas - care plans monitoring, monthly monitoring and audit visit. This would indicate regular The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 Page 20 observation of how the home is managed and ensures good standards in the home are consistently maintained. The acting manager who has strong support from other members within the team at The Orchard Trust is currently managing the home. The service users appear content and safe with support given from all staff members who address the residents with respect and consideration to their needs. The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 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 3 2 X 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 2 25 2 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 3 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 X 3 X X 3 X The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 Page 22 Yes 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 YA20 Regulation 13 (2) Requirement The registered manager shall make arrangements for the safe handling, recording safekeeping safe administration and disposal of medicines received into the home, particularly regarding the date of opening of medication. Kitchen units in bungalows 1 & 2 will be replaced in their entirety Remedial work will be completed on units in bungalows 3 Timescale for action 25/01/06 2 3 YA24 YA24 23 23 31/03/06 31/03/06 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 Refer to Standard 29 Good Practice Recommendations Bathroom panel to be replaced in the main bathroom in bungalow 1 The Orchards DS0000016522.V279034.R01.S.doc Version 5.1 Page 23 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
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