Care Home: Home Orchard

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What the care home does well The owners write in the Annual Quality Assurance Assessment (AQAA) that: "Home Orchard provides a comfortable, safe and caring home, where everyone aims to improve their living and work skills. Our aim is to enhance our people who live in the home` feelings of self worth and self esteem leading to a greater independence. We encourage them in a mainstream lifestyle with emphasis on progression." The needs of people who live at the home have been properly assessed. These generate appropriate care plans so that their needs can be met, and enable them to be as independent as possible. A huge range of activities is on offer. People can make choices about all aspects of their lives and are supported to do so. The food in the home is healthy and good. People who live in the home are supported with personal and health care as they prefer. People who live in the home are protected from all forms of abuse and enjoy a homely, clean and safe environment, supported by competent staff, run in their best interests. What has improved since the last inspection? The owners write in the Annual Quality Assurance Assessment (AQAA) that: "We now have a much better qualified staff group, which has broadened Service Users involvement in community based activities/holidays/integration etc. Service Users attend group training in mainstream activities whenever possible." The home has made every effort to provide extra activities, in the house or offsite with extra staffing, and has purchased another vehicle. They take advantage of free or low cost training for staff. They have managed to obtain agreement with one provider to provide extra staffing hours for holidays. Since the last inspection work has taken place to improve a building previously used as a garage. This is now an additional day/activities room / casual lounge, together with a small gym and massage room used by a visiting professional masseuse and enjoyed by many of those who live there. What the care home could do better: The owners write in the Annual Quality Assurance Assessment (AQAA) that: "Make everything more Service User friendly and accessible. Maintain standards through rigorous quality assurance. Regularly discuss and document care plans with Service User involvement. Continue with programme of staff training, and identify needs by appointing a Training Officer, and setting up a database. Promote consistency in approach to clients, through discussion and agreed changes to care plans, life plans timetables, etc." This home provides a high quality service, it needs to ensure through continual quality assessment this remains so. CARE HOME ADULTS 18-65 Home Orchard Palace Farm Rock Road Chudleigh Newton Abbot Devon TQ13 0JJ Lead Inspector Peter J Wood Unannounced Inspection 14 and 17 January 2008 09:30 Home Orchard DS0000003724.V357857.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 Home Orchard DS0000003724.V357857.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. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Home Orchard Address 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) Palace Farm Rock Road Chudleigh Newton Abbot Devon TQ13 0JJ 01626 852254 01626 854787 homeorchard@tiscali.co.uk Mr David John Martin Mrs Annette Martin Mr David John Martin Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2006 Brief Description of the Service: Home Orchard is a care home registered for five younger adults of either gender who have learning disabilities. The Home is owned and managed by David and Annette Martin who also live at the home with some of their grownup children. The home is divided into two properties. Three people who live in the home live on the original premises named Palace Farm. Another property, Sunset Cottage next door to Palace Farm, accommodates two further people who live in the home. The home is registered as one Care Home. Both properties are situated in Chudleigh, which has a variety of shops, medical and dental practices, a library, community centre and public swimming pool. (Open in the Summer months). Chudleigh is just off the A 38, approximately eight miles from Exeter City Centre. The town is on the main line bus routes to Exeter and Newton Abbott, which have main line railway stations. Palace Farm site is a spacious well presented farmhouse, situated on a smallholding in the small historical town of Chudleigh. People who live in the home share the accommodation with the Providers and their family. Each person has free access to the entire property and has their own bedroom with either en suite or designated bathroom. The house has a large farmhouse kitchen where people who live in the home, providers and their family and staff all eat together around the traditional table. Sunset Cottage is a separate detached house next door to Palace Farm. It has three bedrooms. Each person who lives at the home has free access to the entire property and an en suite bedroom. Staff employed by Home Orchard also live within the home and provide 24 hour staff cover. In the event of holidays/sickness cover is provided by existing staff. Home Orchard is a home, which has a working farm and has a variety of animals including: cows, horses, sheep, pigs and bees. Fees are individually negotiated with sponsoring local authorities and vary Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 5 considerably depending on the specific needs of the individual resident. They start from £750 per week, plus staffing costs, plus costs of any specialist input. This basic fee does not cover hairdressing, clothes, toiletries, holidays or activities and outings. Inspection reports can be viewed in the administrative office of the home or via the CSCI website. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This inspection was unannounced and took place over two separate days in January 2007. The focus of this inspection was to inspect all key standards and to seek the views of people who live in the home, staff, relatives and professional visitors to the home, the latter mainly using survey forms. At the time of writing this report, no surveys have, unfortunately, been returned - this may be a result of the new CSCI policy and business model causing delays. However, providers, all staff and all people who live in the home who were there at the time of the inspection were consulted. The parents of a prospective resident who coincidentally were visiting the home during the inspection were also consulted. Considerable time was spent with the home’s administrator examining documentation, particularly that relating to client assessment and care planning, staffing and health and safety. A full tour of the whole home, including both houses, farm and other buildings, was undertaken. The inspection process also includes a review of the Annual Quality Assurance Assessment (AQAA) questionnaire completed by the owners, which is extensively quoted throughout this report. What the service does well: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “Home Orchard provides a comfortable, safe and caring home, where everyone aims to improve their living and work skills. Our aim is to enhance our people who live in the home’ feelings of self worth and self esteem leading to a greater independence. We encourage them in a mainstream lifestyle with emphasis on progression.” The needs of people who live at the home have been properly assessed. These generate appropriate care plans so that their needs can be met, and enable them to be as independent as possible. A huge range of activities is on offer. People can make choices about all aspects of their lives and are supported to do so. The food in the home is healthy and good. People who live in the home are supported with personal and health care as they prefer. People who live in the home are protected from all forms of abuse and enjoy a homely, clean and safe environment, supported by competent staff, run in their best interests. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 7 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. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The needs of people who live at the home have been properly assessed to allow them and their relatives to be confident that their needs can be met. EVIDENCE: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “We provide a small comfortable family environment. All produce is home grown and individual dietary requirements are taken into account. Rooms are en-suite or have a designated bathroom. We specialise in Autism and have high levels of appropriately trained and experienced staff. We offer a wide range of fun and work related activities to suit the individual. Time and care are taken in matching the service provided to the Service User, and decisions are not based purely on financial reasons.” As part of the inspection process we (The Commission for Social Care Inspection, hereafter referred to as ‘we’) examined assessment documentation of four people who live in the home. Examination of this documentation, together with consultations with the owners, staff and people who live in the home substantially evidences the statements as above. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 10 Information from social workers and care managers is obtained prior to any admission to indicate whether Home Orchard would be an appropriate placement. People who may come to live in the home visit the home for an assessment period when their needs are identified and a judgement is made as to whether this is the right home for them. The admission process is gradual and the number of visits made before a decision to stay on a long- term basis is led by the resident. We discussed the assessment process with people who live in the home who confirmed that ‘I visited on several occasions’, I had a day visit with my family then a weekend visit on my own and I was given a booklet about the home’. Home Orchard does not accept short term or respite placements due to the impact on the welfare of existing people who live in the home. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 11 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. Proper assessments generate appropriate care plans for people who live in the home. This enables staff to understand their needs and goals and the action staff need to take to enable people who live in the home to be as independent as possible. EVIDENCE: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “We regularly review care plans, risk assessments, medication, hold daily open meetings with staff, keyworkers and service users. We maintain diaries, open and maintain dialogue with families and Learning Support Teams. Constantly update files following new legislation and discussions at staff meetings. Provide in-house and external staff training. Treat the services users as individual people and develop their own hobbies and interests with positive self-driven attitude. Staffing is tailored to meet their needs and requirements.” Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 12 As part of the inspection process we examined assessment and care planning documentation of four people who live in the home. Examination of this documentation, together with consultations with the owners, staff and people who live in the home substantially evidences the statements as above. We saw that each resident has an A4 lever arch file, a life plan and daily diary. We looked at a sample of the records kept for all people who live in the home. These documents contained a photograph, assessment, care plan, personal information, review sheet by the multi disciplinary team, health care information, prescriptions, risk assessments and contract. We saw evidence of reviews involving health care teams, home staff, people who live in the home, and their representatives. We saw documentation indicating that the home is held in high regard by health professionals. We observed mutual respect shown between people who live in the home and staff members. Activities provided and encouraged by the home have been supported in the light of the resident’s abilities, disabilities and preferences, and also following specific risk assessment. Plans are in place to identify triggers that may affect behaviours and actions taken to minimise escalation. The staff in the home work closely and with guidance from the community specialist support team. We consulted all people who live in the home who were at home at the time. All have a degree of learning disability, some with additional physical disabilities, and most on the autistic spectrum. All were aware of the documentation held in the home about them and agreed that they had been involved in discussions and agreement about their care plans. All agreed they were able to make choices about what to do during the “working” day, evening, weekends and holidays, though most felt comfortable that the owners and staff assisted them making choices. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. A huge range of activities is on offer to meet the needs of those living in the home individually and on a group basis. People can make choices about all aspects of their lives and are supported to do so. The food in the home is specially healthy, of good quality and with plenty of choice. EVIDENCE: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “Home Orchard provides quality care, skills for living and a wide range of age appropriate activities for young adults with a Learning Disability. We provide a safe environment where they receive care and support with appropriate staffing levels, to follow a flexible programme, with a consistent approach, tailored to individual needs. Round the clock care is provided by Dave and Annette Martin, at Palace Farm and [PB and MH] in Sunset Cottage, in a family home atmosphere.” Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 14 We consulted all people who live in the home who were at home at the time of the inspection visit. Evidence from these discussions, and those with the owners and staff, coupled with written evidence such as from care plans and meetings in the home, substantially evidences the statements as above. People who live in the home were involved in lots of activities, including work (and business) experience. We saw during the inspection that people who live in the home were being guided and respected in a sensitive and supported manner. Small prompts were given and people who live in the home were seen to respond. The use of affection, humour, appropriate touch and reassuring conversation was shared between staff and people who live there. Discussion with people who live in the home, staff and examination of records confirmed that people who live there are encouraged and supported to continue education, take up pursuits and find appropriate employment. Some people have been assisted to gain employment within the community in local shops and a nursery. Others have been encouraged and supported to set up a small business selling compost. One person owns his own bee hives which for health and safety reasons have to be kept in a field separate from the home in another part of Chudleigh. One person is an avid horse rider and is employed at a local stable. People who live at the home are so busy with their day opportunities that it was necessary to visit on two occasions to find them at home. Photographs and discussions confirmed that people who live in the home are fully involved in the local community. Examples include: entries at the local County Shows (some of the animals are prize-winning), attendance at the local Lions Club and bee keeping clubs. Home activities include: Farm animal care, horse riding, woodwork and construction, bee keeping, art, and horticulture. Since the last inspection a small but well equipped gymnasium has been created and people who live in the home enjoy this exercise under the watchful eye of a member of care staff who is a fully trained exercise instructor. Other activities include attendance at the local cinema, funfairs, arcades, swimming, horse racing, rock climbing, ten- pin bowling, local night-clubbing and shopping trips. A tour of the buildings showed that people who live in the home have their own entertainment equipment within their private rooms. This includes: TV’s, videos/DVD players and computer games. Care plans and daily diaries confirm that people who live in the home maintain links with their families and that this process is supported by staff at Home Orchard. Menus seen confirm that people who live at Home Orchard have a wide variety of home-cooked, balanced meals. Annette Martin has attended a Safer Food, Better Business Course, which has been rolled-down to other care staff who assist with food preparation. Mrs Martin has also attended a course on Managing Autism through Diet to help her clients as much as possible. Home Orchard DS0000003724.V357857.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 good This judgement has been made using available evidence including a visit to this service. People who live in the home receive support with personal and health care in ways they prefer and require. The home’s policies and practices regarding medication administration protect residents. EVIDENCE: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “Protection of residents in addition to their everyday care with due respect to ensure no-one is denied their rights. The benefit of a small home is that all residents are supported by a key worker who as far as possible, has similar interests and affinity with the client. Our codes of practice, policies and procedures endeavour to maximise support, privacy, dignity with the maximum of choice. Input from other specialist services, such as the Learning Disabilities Support Team, [Dr M (specialist consultant psychiatrist for people with learning disabilities)], [other] Consultant Psychiatrists, and Clinical Psycholgists are a very important part of our service users’ well-being. We seek advocate support and clients visit doctors and dentists regularly (at least 6 monthly).” Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 16 We examined the files of four people who live in the home as part of case tracking. Examination of this documentation, together with consultations with the owners, staff and people who live in the home substantially evidences the statements as above. We saw several examples of how input from doctors, psychiatrists, community nurses and other professionals was appropriately sought. We saw that care plans indicated how personal support was given to those people who needed it. People who live in the home confirmed that staff support was given in ways they prefer. “The staff are very helpful.” Our observation and discussions confirmed that the majority of people who live in the home are independent in performing personal care. We saw that prompts are given to ensure people who live in the home achieve a satisfactory standard of personal care. Records confirmed that health care is provided through a General Practitioner and specialist community and hospital services as well as trips to the dentist being enabled. The registered provider confirmed that he is solely responsible for the medicines and authorises selected staff to administer medicines. Both registered providers have obtained certificates in the safe handling of medicines. The medication chart is properly signed and dated after giving and ensuring the person has taken it. We examined the policy statement and procedure for the safe management of medication which is good. A national formulary of medication was available for staff to use to improve their knowledge and understanding of specific medicines prescribed for the people who live in the home. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 17 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. People who live in the home are protected from all forms of abuse and know that any concerns they may have are listened to and acted on. EVIDENCE: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “We have enhanced CRB checks on all staff including volunteers. Policy statements for the protection of people who live in the home, including whistle-blowing are in place in order to avoid abuse, and so that no-one is denied their rights and staff do not abuse their position in caring for our people who live in the home. We also make sure people who live in the home respect each others rights to privacy, autonomy and integrity. It is very important that clients know and understand how to complain about the service they receive. Their chosen key worker is there to support them, or they can talk to Dave or Annette Martin, contact their families, advocate and Social Worker. All such people have a copy of our complaints procedure.” We consulted all people who live in the home who were at home at the time of the inspection visits. All responses substantially evidence the statements as above. People who live at the home told us that they were clear about whom to go to if they had a concern. They said they would go to either registered provider, or any of the staff: “if I wished to make a complaint staff would assist with appropriate forms and sit with me to help me complete them correctly’. They also said that they were listened to, and were confident that action would Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 18 be taken if they were not happy. The Commission has not received any complaints about this home since the last inspection and information from the provider indicates they haven’t received any complaints either. The complaints procedure has been given to all people who live in the home and sent to all their representatives, and also to social and health care teams. This includes detail and timescales and methods of how people who live in the home and their representatives should contact the Commission for Social Care Inspection. A booklet explaining the process is also available for people who live in the home. The home has appropriate policies for protection and whistle blowing, which contained useful contact numbers. All staff consulted demonstrated that they had received appropriate training in safeguarding (adult protection) and demonstrated that they knew what to do in the event of an allegation or disclosure of abuse. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 19 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, 25, 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the home enjoy a homely, clean and safe environment. EVIDENCE: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “Dave and Annette Martin provide a 24 hour, seven days a week, caring family atmosphere in a warm, comfortable, spacious farmhouse. A similar standard is adopted by [MH and PB] in Sunset Cottage. Most meals are produced using home grown produce, which is wholesome and appetising. Special diets are catered for, and clients likes and dislikes noted. There is a programme for renewal and refurbishment of décor.” We undertook a full tour of the whole site, including both Palace Farm and Sunset Cottage, the whole farm and outbuildings, all the communal rooms, kitchens and laundries and those bedrooms that we were invited into. We also shared several tea breaks and meals with the owners, some of their own Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 20 grown up children, staff and people who live in the home during the two days of the inspection visits. Together, all this substantially evidences the statements as above. Home Orchard is divided into two sites: Palace Farm and the next-door property - Sunset Cottage. Despite being based on a small farm, both properties appeared safe, comfortable, bright, airy, clean and free from offensive odours. Planned and routine renewal and redecoration were evident; since the last inspection work has taken place to improve a building previously used as a garage. This is now an additional day/activities room / casual lounge, together with a small gym and massage room used by a visiting professional masseuse and enjoyed by many of those who live there. The work to improve the environment is very much a team effort between staff and people who live in the home. The involvement of people who live in the home in these projects is documented in the individual care plans and has been individually assessed to minimise risks. Mutual respect between staff and those who live in the home is extended to the farm animals and to the wider environment. The farm and home uses recycled materials wherever possible and appropriate. People who live there have been involved in a small recycling business creating and selling compost. All equipment seen within the home appeared to be in a good state of repair. Records confirmed that they are supported and encouraged to clean and tidy their individual rooms. All people who live in the home have either en suite or access to a private designated bathroom. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 21 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. People who live in the home are cared for and supported by staff in sufficient numbers and with the qualities, skills, and qualifications to meet their needs. The procedures for the recruitment of staff safeguard people living in the home. EVIDENCE: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “We maintain a consistent, reliable and experienced staff group. Our recruitment procedure is thorough.” We examined the personnel files of four staff to ensure that proper recruitment, induction, training and supervision arrangements were in place. We also received the Annual Quality Assurance Assessment (AQAA) from the owners. Discussions with them and their staff complemented this documentary evidence. Staff reported that the correct recruitment procedures were carried out with them, including an application form, POVA First (a check against a list of people considered unsuitable to work in care settings) and CRB (Criminal Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 22 Record Bureau) checks and ID (identity) checks being carried out before employment. Staff told us that the training they received was good and helped them with the people who live in the homes they cared for. A training development plan for the staff team showed that training included: understanding challenging needs, first aid at work, positive values and attitudes, HACCP principles of safer food, understanding and managing stress, safe handling of medicines, health & safety, an induction and foundation course, risk assessment, moving and handling, food hygiene, infection control, POVA, and fire awareness. Staff attended specialist learning disabilities training when it was available. There is a culture of training in this home, not only in care but in diverse areas needed to run the farm and provide occupation for those who live in the home. Of the eight permanent staff, four have achieved National Vocational Qualification (NVQ) at level two or above, meeting the 50 target. A further staff member is undertaking such training. When qualified, the home will have 62.5 trained to NVQ level two. Both owners have NVQ 4 in Care; one staff in Sunset Cottage already has NVQ 4 in Care, the other is currently undertaking the course. Existing staff have experience in care and education of people with learning disabilities, animal care, horticulture and agriculture, primary school education, nursing, administration and outward pursuit training. In addition the home has recruited new specialist staff for beekeeping, art, craft, pottery and aromatherapy. All staff commented on the training they received: “Done NVQ2”. “Give you plenty of training.” “Regular Training.” “Staff are kept up to date with all the training they need to know.” “It makes sure everyone is comfortable and cared for in the way in which they are all entitled to.” “Plenty of training given. Enough staff to provide excellent care for the clients and quality time with them.” “Good quality care for residents in out care. Perfect support for staff. We observed that staff were courteous and respectful when interacting with people who live in the home. They told me that the staff, including the owners, were kind and helpful. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 23 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, 38, 39, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live here benefit from a home which is well run, in their best interests, by competent owners. Their health, safety and welfare are promoted and protected, and they benefit from the open and clear management approach taken in this home. EVIDENCE: The owners write in the Annual Quality Assurance Assessment (AQAA) that: “We operate an open-door policy with all staff, daily informal morning meetings are held, and staff encouraged to discuss any issues surrounding management or working environment. At mealtimes staff and clients sit around the same table and chat, which we feel helps to build a good rapport beween us all.” Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 24 Our own observations, together with consultations with the owners, staff and people who live in the home substantially evidence the statements as above. Staff consulted during this inspection said they felt happy working at the home. Personnel files showed that staff undergo an annual appraisal as well as regular and ongoing supervision and support. People who live in the home told us they feel comfortable discussing any issues or concerns with the staff and providers. Formal reviews are used as an opportunity to formally seek opinions of people who live in the home, care managers and representatives regarding the service provided. Care Plans confirmed this process is recorded. All records seen contained signatories and dates and therefore it was easy for us to track through the documentation and identify who had made and when information had been documented. The records are stored securely and people who live in the home were aware of the information held about them. Health and Safety Executive posters and safety notices were displayed within the home as was a current employers liability insurance certificate. All activities involving people who live in the home, identified as a possible risk have been assessed with a documented plan to minimise the risk, which has been communicated to the carers/enablers. We examined incident reports which were found to be detailed and inclusive of actions taken to prevent reoccurrence. Records seen during the inspection and information given to the commission before the inspection by the provider indicate that all fire safety, gas and electrical equipment is regularly serviced. Health and Safety policies were examined and these had been dated as being reviewed in September 2006. The home has a clear policy on the management of resident’s money, valuables and financial affairs and a secure safe has been fitted in the new office for all items that require safekeeping. Quality assurance systems within the home include regular formal review of care plans with people who live in the home and their representatives, daily discussions, informal and formal staff meetings and communications on a daily basis in people who live in the home ‘day books’. Home Orchard is a unique blend of family home, care home, and working farm where everyone, with whatever ability or disability is accepted and treated with respect as a valuable person. The home is professional yet casual, where people are happy. It is this unique combination which makes this home excellent. Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 25 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 X 2 3 3 X 4 3 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 4 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 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 4 12 3 13 3 14 4 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 4 3 X X 3 X Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Home Orchard DS0000003724.V357857.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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