Care Home: Apple Orchard

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What the care home does well The home provides spacious and comfortable accommodation within large grounds. The home has its own activity centre. The home has an established staff team that relate well to the service users and work effectively as a team. The home has detailed person centred care plans in place that provide good guidance for staff on the delivery of care. Staff are supported to complete NVQ training. What has improved since the last inspection? Staff have been receiving regular supervision and have had annual appraisals completed. Parts of the home have been decorated and more bedrooms have had ensuites fitted. CARE HOME ADULTS 18-65 Apple Orchard The Green Dean Road Newnham-on-severn Glos GL14 1AQ Lead Inspector Mr Simon Massey Key Unannounced Inspection 19th & 24th June 2008 09:00 Apple Orchard DS0000016365.V362216.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 Apple Orchard DS0000016365.V362216.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. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apple Orchard Address The Green Dean Road Newnham-on-severn Glos GL14 1AQ 01594 516582 F/P 01594 516582 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) Mr Thomas Alfred Mills Mrs Beverley Mills Mrs Elaine Elizabeth Watkins Care Home 10 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (2), Physical disability (1), of places Sensory impairment (2) Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The LD(E) category refers to two named service users. The home will revert to the original category (LD) when these service users no longer reside at the home. 22nd June 2007 Date of last inspection Brief Description of the Service: Apple Orchard is in the village of Newnham-on-Severn, Gloucestershire. It is a large detached property on three floors and provides care and accommodation for 10 adults with learning disabilities. All residents are accommodated in single rooms. The home is staffed at all times. Adjacent to the home is a two-storey building that is used for activities, training, meetings and social groups. This also incorporates a sensory room and leisure facilities. The home’s Statement of Purpose and Service User Guide provide information as to the services that the home provides. The current fee range for the home is between £307.50 and £859.34 per week. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place over two days. The Inspector met with the Deputy Manager, the Provider and all of the service users. The Registered Manager was on leave at the time of this visit. Care staff were also spoken with during the inspection. Records relating to care planning, staff recruitment, health and safety and staff training were examined. An inspection of the environment was also carried out. What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure that correct pre-employments checks are completed on all newly recruited staff. The home needs to ensure that the fire risk assessment is adequate to the needs of the building and that regular checks are completed to ensure all fire doors are operating correctly. The home could improve its quality assurance procedures to ensure that any required improvements are identified and implemented more formally. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 6 Greater structure and organisation could be provided around the planning and developing of independence skills. More choice and variety could be provided around menus and more guidance provided in the area of healthy eating. 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. Apple Orchard DS0000016365.V362216.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 Apple Orchard DS0000016365.V362216.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 adequate. This judgement has been made using available evidence including a visit to this service. Service users would benefit from information in the Statement of Purpose and Service User Guide being reviewed and updated and presented in formats that some people would find easier to understand. EVIDENCE: There have been no admissions to the home since the previous inspection and the home is currently fully occupied. The home has an admissions policy that complies with the regulations. The home has a Statement of Purpose and Service User Guide in place but these documents have not been reviewed since 2006 and this needs to be done. Improvements could also be made to how the information is presented and structured, with consideration given to the use of more pictures and symbols and the production of the documents in formats that would make the information more accessible to the present service users, and also any future admissions. These could also provide more of a flavour of what life was like in the home. Apple Orchard DS0000016365.V362216.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision of person centred plans has improved the quality of care and support provided. Service users are encouraged and supported to make decisions about their daily lives and activities. EVIDENCE: All service users have care plans in place that have been developed using a “person centred” format. These plans are detailed and cover a wide range of needs and provide guidance for staff. The process and procedure for reviewing these plans needs to be better documented and include evidence of the involvement of the service users in drawing up the plans. The plans also need to include proposed review dates. The plans could also provide clearer information around short and medium term goals and objectives. Some service users were able to demonstrate an understanding of the content and purpose of their care plans but there is scope for them to take further ownership of this aspect of their care planning Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 10 People have a document in place called a “communication passport” which provided information on how to communicate with people who may have difficulties in this area. Individual files have risk assessments in place which cover a variety of activities and issues and these were correctly dated and reviewed. There was evidence of regular recording and good detail in the personal files and of staff understanding the individual needs of service users. Service users gave various examples of how they have made choices about the activities and interests they follow and how they are supported to make these decisions by the care staff. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A more structured and planned approach to day care activities is providing the service users with more organised day care arrangements. Service users are being supported to use the kitchen facilities and maintain and develop their living skills but more structure and organisation could improve this aspect of the provision. EVIDENCE: On the first day of the visit all the service users were at home for the majority of the day, except for two people who attended a college course later in the day. The home supports the service users to participate in various day care activities according to their personal preferences, with many activities taking place within the home and the adjacent activity centre that is part of the home. There appeared to be a relaxed atmosphere around the home and all service users said they were satisfied with their current activity arrangements. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 12 A sample of the daily and weekly routines being followed were examined, as well as a sample of trips into the community over the previous few months. This showed that people are offered individual and group activities that generally meet their needs, and also that people can choose to participate or not if they wish. The home has regular service user meetings which are recorded and these show people being asked about activities or things they would like to do, and also if they have any concerns about any issues within the home. Service users expressed satisfaction with the food provided and confirmed that they now have more opportunities to be involved in menu preparation and cooking. However some service users said that the staff still did most of the cooking and shopping and that they could not help themselves to drinks whenever they wished and had to ask staff permission first. They understood that some people required more supervision than others in the kitchen and this was the reason for this. Some service users said they could help themselves but understood that this was not the same for everyone. At the time of the first visit the inspector found that the kitchen had been blocked off with a barrier to prevent one person entering the kitchen. This was a concern that had been raised at a previous inspection and it was believed that this practice had ceased. If these limitations are to be place they must be recorded and the reasons explained. The deputy manager stated that the practice would be stopped again. It is evident that the home has made progress in terms of greater involvement in domestic chores and tasks but greater structure and planning could still be provided in these areas to maximise people’s interests and abilities. This could help ensure that people have opportunities they wish to develop cooking skills and be more independent in this area. The menus showed that variety and choice is provided but there is scope for greater imagination, less use of processed foods and more choice for vegetarians. At the time of the visit there was no fresh fruit and no fresh vegetables in stock, though it was stated that shopping was due to be done later that day. There is scope for the greater promotion of healthy eating. People are provided with keys for their rooms if they choose and several service users said that their privacy was respected by staff and other service users. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to access the healthcare professionals they require to ensure that their physical and emotional health needs are met. Service users are protected by the homes medication and administration procedures, though one error was identified. EVIDENCE: Monitoring sheets in the personal files record health appointments and a recommendation has been implemented that individual sheets are used for different health professionals. These record that regular checks are maintained and that peoples health needs are monitored by the staff team. The individual files contain the details of the personal care and support that is required. Service users spoken to expressed satisfaction with the personal care they receive. The medication system for administration and storage was examined and found to be order with the exception of two omissions on the medication charts were medication was not signed for. This was followed up by the deputy manager, who explained how the error had occurred. There needs to be a Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 14 system for regularly auditing the charts to ensure that mistakes are easily identified if they occur. All staff have completed medication training. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to approach care staff and the Providers to raise concerns, and feel confident that they will be listened to. Training undertaken in Adult Protection by the staff team provides further protection for the service users. EVIDENCE: The home has a complaints procedure in place but has had no formal complaints to respond to over the past twelve months. Service users spoken with said they were happy to approach staff with concerns or issues they wished to discuss. Staff spoken with said that the managers and the Provider were approachable and they felt confident about raising concerns or complaints. Service users also have regular meetings in which they can also raise issues that concern them. People were observed interacting in a relaxed and confident manner with the staff on duty. Staff and managers have completed training in Adult Protection. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides spacious and homely accommodation but this is compromised by a fault in the heating system on the top floor and the odour on the first floor of the building. Regular checks on the effectiveness of the fire doors will ensure service users safety is not compromised. EVIDENCE: The home was generally clean, and well maintained throughout. The dining room has been decorated and furniture replaced and is a much improved environment for people to use. All the bedrooms were seen and these were personalised according to taste and interests and all service users said, or indicated, they were pleased with their personal accommodation. On the first floor of the building there was a strong odour. This was reported to the deputy manager who said they would investigate. This needs to be addressed. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 17 On the day of the inspection it was a fairly warm day in June, but on the top floor of the building the central heating was on, which made the rooms and landing area uncomfortably hot. One service user said they liked to have their room warm, but the situation appeared to be as result of a fault in the heating system. This needs to be remedied. In one of the bedrooms a service user was using a wedge to prop open their door, which is s fire door. An alternative device which complies with fire safety must be investigated and used. In one other room a large number of clothes were hung on the back of the fire closure device, which made the door difficult to shut, and this needs to be addressed and monitored. The inspector also found that several of the fire doors did not close as effectively as they should. This needs to be more routinely checked and adjustments made to the doors when required. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by an established and motivated staff team that relate well and have a good understanding of the individual needs. Failure to follow recruitment procedures could compromise the safety of service users. EVIDENCE: The home is currently fully staffed and has had regular staff meetings which are recorded. Service users were very positive about the staff team and the management. People said they got on well with staff and were able to talk to them about concerns if they wished. Staff were observed communicating and interacting appropriately and positively with service users. All statutory training relating to health and safety, food handling, first aid and fire safety was up to date and the majority of the staff have now completed NVQ 2 in care. Staff have also completed training in medication administration, which they must do before they can undertake this task. Staff have received regular supervision meetings which are recorded. Annual appraisals on all staff have also been completed. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 19 Examination of the staff files found that the most recently recruited staff member only had one reference in place. All staff should have two references including one from their last employer in care. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team provide direction and leadership for the staff team and are also approachable to the service users. The provision of more formal support and supervision for the manager, and more formal structured quality assurance systems, would be of benefit to the quality of care provided. EVIDENCE: At the time of this inspection the registered manager was on leave and the deputy manager was in charge of the home. The Commission had been informed of these arrangements. Staff and service users were positive about the management of the home and said they found them approachable and responsive to any issues they raised. Staff said they felt well supported and were clear about the direction and ethos of care in the home. In general records and administration, except were identified elsewhere in the report, were well organised and up to date. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 21 The home has used questionnaires as a form of quality assurance but this had not been done for over a year and is not incorporated into a formal system for ongoing review and development of the service. The provider has regular, often daily, contact with the home, staff and service users, but the quality assurance process would be further improved with the provision of more formal supervision of the registered manager. The home has a fire risk assessment in place but this is not a very detailed document, especially considering the large size of the home and the slightly complicated layout of the home in terms of bedrooms and stairs. This needs to be reviewed and advice taken as to whether a more comprehensive fire risk assessment is necessary. All fire safety checks and servicing had been completed and recorded. All other health and safety monitoring checks had been completed. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 22 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 2 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 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 X 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA20 YA42 Regulation 13(2) 23(4) Requirement The home must ensure that medication is correctly administered and signed for. The home must ensure that it has a fire risk assessment in place that complies with the regulations. The home must ensure that fire doors are not wedged open. The home must ensure that all fire doors are regularly checked and maintained. The home must ensure that any limitations or restrictions on service users are correctly documented. The home must investigate and eliminate the odour identified on the first floor of the building. The home must review and update its Statement of Purpose and Service User Guide Timescale for action 30/07/08 30/08/08 3. 4. 5. YA42 YA42 YA16 23(4)(a) 23(4)(a) 17(2) Sch 3.3(q) 13(3) & 23(2)(d) 6 30/08/08 30/08/08 30/08/08 6. 7. YA30 YA1 30/07/08 30/08/08 Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 24 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. 4. Refer to Standard YA39 YA1 YA6 YA6 Good Practice Recommendations The home could improve its quality assurance processes. The home should produce its Statement of Purpose and Service User Guide in formats that are more easily understood by some service users. Person centred plans could clearly record the involvement of the service user in the process Care plans could identify more short and medium terms goals for service users. Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Apple Orchard DS0000016365.V362216.R01.S.doc Version 5.2 Page 26 - 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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