Inspection on 08/03/07 for The Orchards

This inspection was carried out on 8th March 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Orchards 25/01/06

The Orchards 18/10/05

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 Mr Nick Jones Key Unannounced Inspection 8th March 2007 10:00 The Orchards DS0000016522.V329052.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 The Orchards DS0000016522.V329052.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. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchards Address Stowfield Lower Lydbrook Glos GL17 9PD 01594 860493 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 www.orchard-trust.org.uk The Orchard Trust Stephen John Thomas 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.V329052.R01.S.doc Version 5.2 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 25th January 2006 Date of last inspection Brief Description of the Service: The Orchards is part of The Orchard Trust and consists of two sites, about 200 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 service users. 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 service users 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 service users with a learning disability who may have a physical disability and a need for a high degree of personal care. Service users 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.V329052.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on the 8th March at midday for about six and a half hours. A further two visits were made, one the following day in the morning for four hours, and a second the following week to view staff recruitment records at the main office of the Trust. All of the service users were met, along with many of the staff team. The manager was present on both days. One of the deputy managers and the senior line manager were also spoken with. Before the visit a pre-inspection questionnaire was returned. Feedback was also obtained through staff, health care professionals and service user surveys. During the visits to the home various documents were checked including examples of care plans, risk assessments, medication charts, daily records, health and safety records and staffing files. Some general observation of life in the home took place and the premises were inspected. As part of the key inspection a pharmacist inspector carried out a specialist inspection in Offas Dyke of the arrangements for handling medication (Care Homes for Adults 18 - 65 National Minimum Standard 20). The inspection took place over six and a half hours on a Friday and examined some stocks and storage arrangements for medicines, a sample of Medication Administration Record (MAR) charts, other medication records, the medicine policy and procedures. The inspector saw the administration of some medicines to service users at lunchtime in Offas Dyke. There were discussions with a senior manager, the deputy manager and a senior carer. What the service does well: The home is good at providing individualised support to service users with a wide variety and sometimes complex set of support needs. Staff were seen as approachable, attentive and competent. The staff usually work well with other professionals to ensure the personal and healthcare needs of individuals are met. Staff report that they enjoy working at the home and get the support and assistance they require. Service users live in a pleasant well- maintained environment. People have access to activities which they enjoy and which are appropriate to their age and needs. Service users relationships with friends and families are valued and support is provided where necessary for people to see those who are important to them. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 6 Staff receive a comprehensive induction and appropriate on-going training including NVQ qualifications. Medicines are kept safely and records are in place. The medicines needed were all in stock. Staff have training in the safe handling of medicines with policies and procedures in place. 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. The Orchards DS0000016522.V329052.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 The Orchards DS0000016522.V329052.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): 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide give people living at the home and people wishing to live/stay there information about the services provided. Good arrangements are in place around referrals and admissions, increasing the likelihood that appropriate admissions will be made. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. Work has taken place across the Trust to produce an updated format for all of the registered services that will then be adapted for each individual service. It is detailed and comprehensive with all relevant information updated. It will be produced in symbol format in due course. The home has an appropriate admissions procedure. Service users’ files contained copies of needs assessments and care plans by both social services and the home. The most recent admission to the home was in January 2006. This person has had on-going health assessments including a Gloucestershire NHS Trust enhanced assessment and care plan produced in January 2007. The Orchards DS0000016522.V329052.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, 8 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of the service users are on the whole clearly identified and wherever possible met. The records of care plans and risk assessments of service users must be reviewed and updated to ensure consistency in staff support. Service users have been imaginatively supported to enable them to make decisions and choices about their lives. Service users are consulted about their care needs and are supported in developing and maintaining independence. EVIDENCE: The care plans of six service users were viewed, four in more detail as part of case tracking. The plans were detailed and clearly written. They indicated the The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 10 needs, interventions and desired outcomes for service users. The care plans indicated the relevant issues under each section and included support needs such as personal care, mobility, support routines at different times of day, communication, staff responses to conflict situations, breathing support needs, leisure and daytime pursuits, accessing community facilities, independent living skills, use of money, health support needs and eating and drinking. Some service users’ care plans were very complex and detailed with regard to the number of interventions and support staff needed to offer to a service user. Daily notes and other monitoring sheets viewed showed that staff were carrying out interventions and support appropriately. Care plans showed the service was sensitive to the needs of service users in terms of their ethnic background and range of disabilities. Some guidelines indicating the need for staff to sign when read, were not signed by all staff. Some guidelines were not signed or dated. Personal files also contained assessments and guidelines by CLDT clinicians that included physio postural drainage, use of a standing frame, walker guidelines and hoisting guidelines. Many of these were in written, pictorial and photographic formats. One care plan described supporting a service user to use the bus to college in Gloucester independently. Risk assessments were in place. One of the plans was written up in the form of a ‘Person Centred Plan’. This format includes a section titled ‘What you need to know to successfully support me’ which contained clearly written information for staff to read. One care plan had post-it notes attached describing amendments needed to the care plan. The manager stated this format was in the process of being introduced and was being piloted for three service users. Most of these had been reviewed regularly. One service user had a recent assessment in November and December 2006 by CLDT (Community Learning Disability Team) clinicians that required amendments to the person’s care plans. This had not taken place and other records showed the person was not being appropriately supported with regard to diet and weight monitoring. Viewing care plans and risk assessments and spending time with service users demonstrated they are imaginatively supported to make choices and decisions in their day-to-day lives. Any limitations to choice are documented as to why it is in the best interests of the service user. There was evidence that CLDT clinicians have been involved in the decision making process. Service users were observed to be able to choose where they wished to spend time. Some service users were seen to be reliant on staff to physically move them to a different location or spend time out of their wheelchair. Staff were observed to be sensitive to the different needs of service users in this aspect of their lives. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 11 Service users at the Orchards were supported to be involved in many different aspects of the running of the home. This includes choosing menus, working out domestic rotas, maintaining the gardens and developing independent living skills. Risk assessments are in place identifying hazards and how these are to be minimised. Activities included use of a vehicle, use of a hoist, eating and drinking, various moving and handling situations, personal care, swimming, smoking and the independent use of buses. These records were, in the main, being reviewed and amended in response to changing needs. One service users’ risk assessments had not been reviewed since June 2004. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided for people to take part in activities which reflect their needs and interests both in the home and community. Service users are also supported to maintain and develop contact with important people in their lives. Service users are respected and valued as individuals, promoting their selfesteem and sense of autonomy. A varied and balanced diet is provided, enhancing service users’ health and quality of life. EVIDENCE: People living at the home have a range of educational, social and leisure activities. The programme for each service user was contained in their personal files. Some attend the Barn, which is owned by The Orchard Trust, The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 13 and run in conjunction with Gloscat. Others attend the local College and other day centres. Other activities include shopping, swimming, hydrotherapy, music therapy, attending music and theatre shows, attending the ‘Triangle’ and Ross social club, walking, cycling, fishing, visits to cafes and pubs, and other excursions. Notes from a service user meeting at the Orchards included a request to be able to go bowling at the weekend; daily notes confirmed this took place the following weekend. Some service users attend a local church and some visit the local library. Activities in the home include multi-sensory activities, arts and crafts and domestic activities. Various holidays were undertaken last year including a trip to Butlins and a specialist outward bound centre. A memorandum to staff in July 2006 from one of the deputy managers was read, which reminded the whole staff team to ensure activities both inside and outside of the home were being offered to service users. Viewing daily notes showed that some service users were not being offered many activities outside of attending the Barn and the Triangle club. Social and family relationships are encouraged and supported and most service users have contact with family/friends. One relative’s returned survey stated their relative could phone them whenever they wanted. Relatives and friends are welcomed to visit the home and transport is provided if needed to take service users to visit their relatives. Eleven returned relatives’ surveys expressed satisfaction with communication between them and the home. Two surveys expressed concerns at information not being passed on. The manager stated the home always welcome comments and aims to keep all relatives informed about their relative. Discussions with staff, service users and observation of practice showed service users are well supported to participate and make decisions about their lives in the home. Staff were observed taking a keen interest in pottery work brought back by one service user from their day care. Staff were observed treating people living at the home respectfully, knocking on bedroom doors and spending time with them. One service user has signed an agreement that restricts their access to tobacco to avoid them running out of tobacco and money for other activities. Discussions with staff and service users showed they were being supported as much as possible to be involved in menu planning. Preferences of service users were noted for those not able to express direct choices. Menus are planned in the different bungalows and the Orchards. Meal times were observed in two The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 14 locations and were found to be a relaxed, sociable time. One service user was supported to eat a little later than others, as they prefer to eat alone. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 15 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 & 20 Quality in this outcome area is adequate with some aspects being considered good. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area regarding medication is adequate. This judgment has been made using available evidence including a visit to this service by a pharmacist inspector. The support and guidance offered to service users by staff and health professionals ensure, in the main, personal care and health care is adequately provided. The home generally manages medicines safely for service users but some issues are identified to make sure safe procedures are always followed and some records improved by including more detail. EVIDENCE: Care plans provided guidance about the personal care support each person required, including reference to people’s preferred routines and to respecting their choices. Files contained details about moving and handling procedures that contained protocols produced by health clinicians that were in written, The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 16 pictorial and photographic forms. Staff spoken with demonstrated awareness of people’s needs and wishes in this area, and of issues around people’s privacy and dignity. A comment card from a relative described how their family member was always treated with respect and their right to privacy was respected. Healthcare notes for three people were looked at in more detail. These included evidence that people were accessing a wide variety of routine and specialist services according to their individual needs. The notes for one person contained details of a Gloucestershire NHS Trust enhanced assessment and care plan produced in January 2007. This was produced following a meeting chaired by a CLDT community nurse where a large number of health clinicians, staff from the home and relatives met to discuss the complex health needs of the person. Care plans and protocols were seen to have been amended appropriately. Health professionals produced several of the guidelines. They included details about sleep patterns, food supplement guidelines, mealtime guidelines, diet, management of a specific syndrome, physio exercises and positioning, fluid recording charts, weighing exact amounts of food eaten, bed time positioning, standing frame guidelines, seizure recording sheets, ‘toileting’ chair guidelines, and continence monitoring. Staff were observed to follow these guidelines and keep extensive records of work and interventions undertaken. The notes for another person contained details of assessments by a dietician and Speech and Language Therapist in December 2006 that contained clear statements about changes needed to health and personal care plans. This had not taken place and other records showed the person was not being appropriately supported with regard to diet and weight monitoring. The notes for another person contained details of recent appointments to visit a dentist and optician. Medication – pharmacist inspector – There is a policy and procedures about how medicines are handled in the home. This is available to staff and the Head of Care is reviewing this at the moment. Staff who administer medication to service users receive accredited training about the safe handling of medicines. Additional training is provided when medicines are given in a more specialist way. In the bungalows at lunch time the pharmacist inspector watched medicines given to residents following safe procedures. Staff treated service users kindly and with dignity. Records are kept for the receipt, administration and disposal of medicines. There are safe arrangements for storing medicines. The following issues were noted - The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 17 • • • • • • • • • • • • The pharmacy provides printed Medication Administration Record (MAR) charts each month. Some information on the charts was not up to date so senior staff had made changes. Where staff make handwritten entries or changes a second member of staff must check and sign that all the information is correct. Every effort is necessary to make sure printed dose directions are the latest by liaison with the doctor and the pharmacy. The records used when medicines are taken out of the home during periods of leave must fully describe the medicine (name, dose form and strength) and in situations when packs of medicines are taken out, record the amount returned to the home so that there is a full audit trail. When a senior carer prepares single doses of medication for another carer to give to a service user when away from the home, records must indicate who has prepared the dose and then who subsequently gives the dose. There is potentially more risk of mistakes in this situation so staff must work to a protocol with proper checks in place Emergency medicines are kept for several service users and records are kept about these. It is strongly advised that these are extended with stock balances and routine checks to monitor correct use. A protocol is needed for one person where staff prepare an oral rehydration solution in the home so that there are double checks that the right quantities are measured. A care plan for using this solution is needed following discussion with the doctor. Information about the use of an antibiotic course for a particular service user needs to include the strength of the medicine and the how long the treatment is taken. The procedure followed to take the medication for one person in The Barn at lunchtime had the potential for error and must be reviewed to follow accepted safe practice. Some audits of medicines carried out agreed with the records indicating that service users were having their medicines correctly. There were two medicines (a liquid and capsules) where a discrepancy was noted and the deputy manager was to look into this. Writing the dates of opening on container labels makes this type of check possible as well as allowing stock to be used within the recommended shelf life. Many medicines had an opening date but not all. Potassium bicarbonate solution has a seven-day shelf life but the container in the fridge had no opening date. The deputy manager keeps monthly stock balance checks on some tablets and this could usefully be extended as random checks on the whole range of medicines. Medicines applied externally need storing separately from medication that is swallowed, to prevent cross contamination. There were some medicines on the open lower shelf of the trolley so these are not secure when the trolley is taken around the home. Some care plans were looked at. Some had good information about how service users take their medicines and their consent but this was missing in others. Information about medication was sometimes included in other DS0000016522.V329052.R01.S.doc Version 5.2 Page 18 The Orchards • parts of different plans. There was a detailed plan for giving medication to one person with complex health needs. In other cases the information was not up to date and did not include medicines currently used. When medicines are prescribed to use ‘as required’ it is important that all staff understand what this means for each person. Some care plans contained some of this information but this was missing in other cases. Each medicine prescribed in this way needs a protocol so that all staff understand how they should be using this for the benefit of the service user. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 19 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 & 23 Quality in this outcome area is good with some aspects being considered adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for managing complaints that have been used appropriately that ensures service users and relatives have an active voice. Systems are in place which help to protect service users from harm and abuse. The use and recording of service users’ monies should be reviewed and improved to ensure appropriate purchases were recorded. EVIDENCE: The Trust has an appropriate complaints procedure dates from 2003 and consists of a text and symbol version. This has been recently reviewed as part of a review of all of the Trusts’ policies and procedures. There has been one complaint received by the home since the previous inspection. The head of Care described the investigation and actions taken by the home and provided documents recording the complaint and how the home responded. The responses were appropriate and resolved issues, as much as was possible, raised in the complaint. Conversations with the service users and staff, as well as observations made during the visit provided evidence that people’s needs are closely monitored. This ensures that those who cannot communicate their dissatisfaction or changing needs in a conventional way are supported correctly and any concerns are identified and responded to quickly. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 20 There was also evidence that communication is promoted with each individual and people have opportunities to voice their views in a group forum or one to one as appropriate. There was evidence that the management of the home and the staff team have a good knowledge of adult protection procedures. Service users’ finances were reviewed which included checking two money tin balances and accompanying paper records. Post office savings account books were also checked. People’s finances were seen to be in good order. These were generally in order and the balance of cash was exact. However the records revealed two aspects of service users’ finances that require improvement. One entry showed a cash withdrawal for over £700 pounds that had no details about what the money was spent on. The manager stated he thought this was for a specialist chair bought via an OT. Records checked at the main office showed this was actually a part payment for a funeral plan being purchased by the service user. Appropriate records must be maintained in the home for all monies spent on behalf of service users. Some entries of personal spending also showed service users were paying for some staff drinks and food on trips out. The manager stated this practice varied amongst the bungalows and the Orchards. A discussion took place with the manager and senior managers about service users’ personal finances. Some service users are currently paying a third of their disability living allowance as a contribution for transport costs. Budgets for staff to accompany service users on trips to cafes, restaurants etc are limited, and hence the practice of some service users paying for staff costs. The home could review how much transport costs actually amount to and amend the contribution accordingly. The practice of service users paying for staff costs should cease. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, homely and comfortable environment is provided, promoting service users’ quality of life. EVIDENCE: All communal areas of the home were viewed including the Orchards. A number of bedrooms were also viewed. Décor and furnishings are of a good quality with bedrooms personalised to the tastes and preferences of service users. Some bedrooms have been extended in size by building an extension around the doors that open out to the garden/patio areas. This has given wheelchair users considerably more space in their bedrooms. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 22 An extension has been recently completed to one of the bungalows creating a large sitting/sensory room. This will benefit the service users group who spend considerable amounts of time in wheelchairs. Fixtures and fittings were well maintained and appropriate to the needs of service users. All of the bungalows had new kitchens fitted in March 2006. Various on-going decoration has taken place including one of the bungalows being redecorated. The manager stated an order would soon be made to install overhead tracking in all bedrooms and bathrooms for people who require support with hoisting. This will make a significant improvement to the facilities for people with physical support needs. The paving in the communal entrance hall and lobby area had paint stains and other marks. The manager stated he would investigate methods to clean this area. The home was found to be clean and hygienic. Staff have access to disposable gloves, aprons and laundry bags. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 23 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, 35 & 36 Quality in this outcome area is adequate with some aspects being considered good. This judgement has been made using available evidence including a visit to this service. Support is provided by a skilled, well-trained and, in the main, well supervised staff team, helping to ensure that service users’ needs are met. The manager has a sound understanding of recruitment and selection ensuring service users are protected. EVIDENCE: One service user stated “ I like it here, staff are always happy to talk to me”. One relatives comment card stated “ We are very impressed the way a member of staff will spend time with him if he needs a stay in hospital” and another stated, “ All residents are treated as individuals and with great affection and respect”. Returned health professionals’ surveys returned were positive about the service provided by staff. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 24 The inspector was able to watch many interactions between staff and service users, and the view was that staff were attentive, competent and caring and placed the needs of the service users as paramount. Service user files viewed showed the home is well supported by outside professionals such as clinicians from the CLDT. Six staff have completed their NVQ 2 in health and social care and a further 15 are registered and in the process of working towards their NVQ. Duty rotas showed that eight or nine staff work each shift to cover the main house and one or two staff at the Orchards. Three waking night staff work at the main site with a member of staff sleeping-in at the Orchards. Discussions with staff and viewing relatives’ comment cards indicated there are usually sufficient staff numbers to meet the needs of service users. The home has just advertised for two new senior support workers; vacancies were being covered by staff from the home and locum workers. Minutes of staff meetings were viewed. A wide range of topics were discussed including service users, rotas and the building. The manager meets with the two deputy managers with minutes being taken. Staff meetings take place for the individual bungalows and the Orchards. The manager or a deputy was not always present at the meetings. Two of the bungalows have not had a staff meeting since November 2006. This includes the bungalow where the care plans for one resident have not been amended following CLDT assessments in November/December 2006. The manager described the steps that he takes when recruiting staff, demonstrating a sound awareness of the relevant National Minimum Standards and Care Homes Regulations. Four files of newly recruited staff were viewed. They contained most of the details as required under Schedule 2. The human resources employees are based the Trust’s office and keep copies of both the PoVA First e-mail print out and the CRB clearance document. The files in the home usually contain details of the CRB clearance number and the date of the PoVA First check. The manager and human resources staff agreed that the PoVA e-mail received by the human resources staff would be forwarded to the manager to be printed off at the home. Discussions with staff and the manager, and viewing staff records showed new staff were being provided with comprehensive induction and training. Staff receive both the in-house induction as well as undertaking the LDAF (Learning Disability Award Framework) induction. Staff described being provided with supervision during the induction by both senior staff from the Trust as well as managers at the home. They also described reading care plans and working along side experienced staff as part of their induction. One new member of staff said the work could be rewarding. Another member of staff said it was a good place to work and that management listened. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 25 A detailed training matrix was being maintained to enable the manager to know the training staff have undertaken or booked to do. This showed that ‘mandatory’ training was generally either booked or had taken place. Staff described attending course that addressed the needs of people living at the home. Training in specific procedures such as PEG feeding and supporting service users with epilepsy was being provided. Discussions with staff and viewing staff supervision records demonstrated that they were being offered good support that included recorded supervision sessions. However some staff records showed that the frequency of these sessions was less than the six times a year, as outlined in Standard 36.4. Some staff had not received recorded supervision for over 6 months. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 26 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 & 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is, in the main, well run, promoting positive outcomes for service users. Systems are in place which help to monitor and improve the quality of the service provided. Health and safety in the home is promoted that safeguard people’s wellbeing. EVIDENCE: The acting manager has become the Registered Manager since the previous inspection. The manager is an experienced manager and has an NVQ Registered Managers Award at Level 4 and has nearly completed the NVQ 4. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 27 The manager will be attending, with other managers from the trust, a course on Equality and Diversity that may be provided for other staff at the home. Discussions with staff and returned comments cards showed the management of the home is open and inclusive. A discussion took place as to how systems could be put in place to ensure team meetings and supervision sessions take place to ensure information is communicated about the changing needs of service users. Regulation 26 reports were available at the home following monthly visits by representatives in the Trust. Minutes from staff meetings provided evidence of wide ranging discussions taking place regularly. It was agreed that one aspect of quality assurance which should be considered was about widening the sources of feedback and, in particular, considering other ways to seek relatives’ and service users’ views. Health and safety aspects of service provision were being maintained and monitored. Comprehensive records viewed included fire safety checks, water temperatures, various health and safety checks/assessments and servicing of equipment. A Fire Safety risk assessment has been produced. It was recommended that the home contact the Gloucestershire Fire and Rescue Service to confirm arrangements for evacuation in the event of a fire to meet the requirements of the new Evacuation Strategy. The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 28 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 3 3 X 4 X 5 X 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 2 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 3 X X 3 X The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The procedure for administering medicines to people who use the service in The Barn must make sure the medicines are conveyed safely and are prepared adjacent to the person so that direct checks are made with the labelled medicine container and record chart and so reduce the risk of administering the wrong medication. Keep up to date written protocols for any medicine prescribed ‘as required’ and for any medicine with a more complex dosage pattern or method of preparation so that clear information is readily available to staff about how service users are to receive their medication correctly. Timescale for action 30/04/07 2. YA20 13(2) 31/05/07 3. YA6 15(2) 4. YA33 12(1) (a) 13(4)(c ) 5. YA34 19(1)Sch 2.7 Care plans must be amended to 30/04/07 put into practice recommendations from health care clinicians’ assessments. Team meetings or other forms of 30/04/07 communication must take place regularly to ensure information about the changing needs of service users is communicated to all staff. When PoVA First information 31/05/07 comes through on the email it must always be printed off as evidence and put on the DS0000016522.V329052.R01.S.doc Version 5.2 Page 30 The Orchards 5. 6. YA9 YA36 12(1)(a) 18(2) individual personnel file in the home. Risk assessments must be reviewed regularly and amended when necessary. Recorded supervision sessions must be provided regularly as part of the supervision of the staff team to ensure information about changes to the needs of service users is clearly communicated. 31/05/07 31/07/07 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. 3. Refer to Standard YA20 YA20 YA1 Good Practice Recommendations A second member of staff to sign handwritten entries on medicine charts as a check that the information is copied correctly. Keep medicines that are swallowed stored segregated from those applied externally to prevent cross contamination. The Statement of Purpose and Service User Guide should describe details of any communal areas of the home that are kept locked, such as the kitchen and laundry, are detailed and the reasons why it is necessary. Care plan amendments should be completed, signed and dated. Old information should be archived and new entries/protocols signed and dated. All staff should sign a care plan when it is indicated that this is required. Reviews should take place as to the frequency and variety of activities offered to service users. The paving stones in the lobby/hall way areas should be cleaned. The home should consider how to survey the views of service users and relatives. Accurate records should be maintained in the home identifying the items purchased when withdrawals of money occur. Service users’ finances should be reviewed to ensure DS0000016522.V329052.R01.S.doc Version 5.2 Page 31 4. 5. 6. 7. 8. 9. 10. 11. YA6 YA6 YA6 YA14 YA24 YA39 YA23 YA23 The Orchards 12. YA42 contributions to transport and activities are clearly set out in the Service user Guide. The home should contact the Gloucestershire Fire and Rescue Service to confirm arrangements for evacuation in the event of a fire to meet the requirements of the new Evacuation Strategy The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 The Orchards DS0000016522.V329052.R01.S.doc Version 5.2 Page 33 - 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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