Care Home: Orby House

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What the care home does well The service provides a small, comfortable environment for people in a house that is unobtrusive and blends in well with the local community. The service is focussed on the needs of people living there and these are identified in consultation with them. Staffing is arranged around peoples needs and the work staff are required to do is made clear and relates to the individual needs of the people living in the home. The privacy, dignity and rights of the people living in the home is emphasised throughout each aspect of the service and people are supported to develop skills. The home is well managed and is continuing to develop in response to the needs and wishes of people living there. What has improved since the last inspection? Since the previous inspection appropriate privacy locks have been fitted to all the bathroom areas and to service users` bedrooms. At the time of the previous inspection there was no one living in the home and two people have moved in since then. The home has been able to demonstrate that the service is appropriate to these people and that the service is organised around addressing their needs. What the care home could do better: The service needs to update the `easy read` version of the complaints procedure so that it includes timescales within which a complaint will be responded to. The quality assurance process needs to be developed further and the Manager needs to make an application to be registered. The Manager also needs toliaise with the Fire Authority about the use of the rail on top floor and to produce risk assessments highlighting the need for this. CARE HOME ADULTS 18-65 Orby House Orby House 85 Station Road Hayling Island Hampshire PO11 0RS Lead Inspector Nick Morrison Unannounced Inspection 12 March 2008 11:30 th Orby House DS0000067113.V359396.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 Orby House DS0000067113.V359396.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. Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orby House Address Orby House 85 Station Road Hayling Island Hampshire PO11 0RS 02392 465 348 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) D & A Rodgers Homes Mrs Julie Denise Champion Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Orby House is a small home that can provide a service for up to three people with a learning disability. The service is located at the end of a small terrace of houses in a busy street on Hayling Island. The home is owned and managed by D and A Rodgers Homes. The provider has three other services. Accommodation is provided over three floors with bedrooms on the first and second floors. One bedroom has an en-suite shower room. The other two bedrooms do not have an en-suite facility however a communal shower room is located on the ground floor and a bathroom on the third floor. The placement fees for this service range form £550 to £950 per week. Orby House DS0000067113.V359396.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 stars. This means the people who use this service experience good quality outcomes. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 12th March 2008 and lasted five hours. During this time the Inspector toured the premises, looked at the files of both service users, spoke with one of them and observed the support they were receiving. We also met the Manager and one member of staff and observed interaction between staff and service users and also spoke with a relative of a service user. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to service’s own self-assessment of the home. What the service does well: What has improved since the last inspection? What they could do better: The service needs to update the ‘easy read’ version of the complaints procedure so that it includes timescales within which a complaint will be responded to. The quality assurance process needs to be developed further and the Manager needs to make an application to be registered. The Manager also needs to Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 6 liaise with the Fire Authority about the use of the rail on top floor and to produce risk assessments highlighting the need for this. 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. Orby House DS0000067113.V359396.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 Orby House DS0000067113.V359396.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): 2 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs and aspirations assessed prior to moving into the home. EVIDENCE: The home requires a full care management assessment for each person before they move into the home. In addition to this, the home does it’s own comprehensive assessment. Records showed that all assessments were in place prior to the person moving in and that service users and their families had been involved in the assessment. This was confirmed in discussion with a service user. Care packages were only agreed and offered once the home was clear it was able to meet the needs of the person moving in. Orby House DS0000067113.V359396.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 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having clear care plans and risk assessments in place and from being supported to make their own decisions. EVIDENCE: Individual care plans were in place for each person living in the home and were clearly related to the initial assessment and the ongoing information the home had gathered on each person over time. The service user spoken with was also clear about her own care plan and said that she was able to contribute to it. Car plans were reviewed initially six weeks after people moved into the home and at six month intervals after that. Each service user’s file contained a review schedule. Service users, their families and care managers were involved in the reviews. One review occurred on the day of the inspection visit. Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 10 In addition, each care plan was reviewed on a monthly basis in the home and records were kept. Service users were fully involved in this process too. Care plans were written from the point of view of each service user and included information about the person’s history and the things that were important to them. Personal preferences were made clear throughout the care plan and the care plan responded to these. Service users spoken with were clear that they were supported to make their own decisions about their lives. This included day-to-day decisions about what they wanted to eat and what activities they took part in as well as being able to make decisions about future plans. They said that staff were available to help with decision-making, but they were clear that their decisions were their own. Staff spoken with demonstrated an understanding of the need to help people make decisions rather than make decisions for them. Care plans were clear about how service users made decisions and about what things were important to them. Risk assessments were clearly written and reviewed on a regular basis. Staff spoken with were clear about risk assessments for each person and the importance of supporting people in line with the risk assessments. Risk assessments were used to promote independence and support people living in the home to be involved safely in the activities they wanted to do. Risk assessments were in place for a variety of general activities as well as specific activities for specific service users. Risk assessments were also in place regarding the privacy and dignity of the people living in the home. Orby House DS0000067113.V359396.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 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their rights respected and from balanced and nutritious meals. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. EVIDENCE: People living in the home told us they organised how they spent their own time and were able to get support from staff with the things they needed help with. Records of activities and discussion with service users and staff showed that service users were supported to make use of a wide variety of local facilities and to be involved in the activities they had chosen. One person living in the home is supported to go to college and the other is supported to be involved in activities by staff at the home during the day. The kinds of activities people Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 12 were involved with related to the preferences stated in their care plans and included local shops, visits to shopping centres, social clubs and visits to places of interest such as the zoo. The home also arranges a holiday for each person each year, which is paid for as part of the fees for the home. People living in the home were supported to maintain contact with their friends and families. Records were kept of visits from families and of people going to stay with families. People were also supported to maintain contact with their families over the telephone and staff assisted them to make telephone calls if necessary. Food in the home was of good quality and people spoken with during the inspection visit said they enjoyed their meals. There was a four weekly menu in place that had taken account of the individual preferences stated by service users on their care plans. Service users were able to change their minds and deviate from the menu if they chose to and were also supported to be involved in the preparation of meals if they chose to. Staff encouraged and supported people to consider healthy eating options relevant to their own particular needs. Where necessary, people living in the home had received some input from the dietician in order to support them in making healthy choices about their diet. Orby House DS0000067113.V359396.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 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their healthcare needs met and are protected by the home’s medication policies and practices. EVIDENCE: Care plans contained information on how people preferred to be supported with their personal care. The files of people living in the home demonstrated that healthcare needs were monitored and that people were supported to use healthcare services as necessary. There were comprehensive records relating to each person’s health. Each person’s healthcare needs were monitored and recorded on a regular basis. Where people had used healthcare services there were records detailing the time and date, the reason why they attended and any outcomes as a result of the consultation. Staff in the home liaised closely with healthcare professionals in the interests of people living in the home. Service users spoken with said staff always supported them to use healthcare services whenever necessary. One person had visited the doctor on the morning of the inspection visit. Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 14 The system for administering medication in the home was clear and was stated in the home’s policies. Staff spoken with who were involved in administering medication said they had received good training and demonstrated that they had a good understanding of medication issues. Medication records were clear and up-to-date and all medication was stored appropriately and safely. There was a comprehensive system in place for monitoring medication with regular checks and crosschecking to minimise the possibility of any errors occurring. Orby House DS0000067113.V359396.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 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their views listened to and are protected by the home’s policies and practices. EVIDENCE: The home has a complaints policy in place and service users spoken with said they were clear about how to complain if they wanted to, but had not felt the need to make formal complaints, as issues were resolved in house meetings or in conversation with the manager or their keyworker. No complaints had been received at the home. The complaints procedure was written in an ‘easy read’ format and service users had their own copy. This version of the complaints procedure lacked timescales and the Manager has undertaken to address this. There were behavioural supports plans in place for people whose behaviour occasionally caused problems for other people in the home. The way the plans were written demonstrated a positive approach to such behaviour and that individual service users were involved in the plans put in place for them. Any incidents were recorded. The home has good policies and procedures in place for dealing with allegations or suspicions of abuse. The service user spoken with had some knowledge of their rights and of abuse issues. Orby House DS0000067113.V359396.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 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a clean, comfortable and safe environment. EVIDENCE: The environment is small and homely and blends in well with the local community. Service users’ bedrooms are well equipped and they have been able to bring their own possessions with them to the home. There is a small lounge on the ground floor and a larger lounge on the top floor. In addition there is a large kitchen/dining room. One room has an en-suite bathroom and there are two further bathrooms. Privacy locks are on each of the bathrooms and the service users’ bedrooms have Yale locks for privacy. Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 17 On the third floor there is a rail across the opening of the stairs. This is used for the safety of service users to prevent people accidentally falling on the stairs. During the previous inspection it was highlighted that the Manager needed to consult with the Fire Authority about the use of this rail. The current Manager told us she thought the previous Manager had done this, but that she could not find any record of it. She has undertaken to consult the Fire Authority again and to discuss the matter and will keep records of their advice. There is also a need to link the use of the rail with a risk assessment for each person living in the home to identify whether or not it is necessary and, if so, how and when it would be used. The home was clean throughout, while remaining comfortable and homely. There were cleaning rotas in place for each day of the week to ensure that cleanliness was maintained and clear records were kept of what cleaning had been done. Service users were supported to be involved in the cleaning of the house if they had identified this as something they had wanted to do. Orby House DS0000067113.V359396.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 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by adequate numbers of welltrained staff and are protected by the home’s recruitment policies and practices. EVIDENCE: Recruitment records in the home demonstrated that all staff were employed within the home’s recruitment policy and that all necessary pre-employment checks had been undertaken prior to them beginning work in the home. Staff spoken with confirmed they had been required to provide all relevant information prior to beginning work in the home. There was one member of staff on duty throughout each part of the day and one member of staff sleeping in during the night. In addition the Manager was available during the daytime. The service user spoken with said there were sufficient staff available in the home to meet the needs of the people living there and to ensure that they could go out and use local facilities when they Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 19 wanted to. Staff spoken with also felt the staffing was sufficient to meet people’s needs. Staff training was well managed and good records were kept of the training that each member of staff had received, what training they still needed to do and when updates were required. Staff spoken with said the training was useful and relevant to their role and that access to training was good. It is the policy of the home that all new staff complete their initial induction programme and then progress on to National Vocational Qualifications at level two as a minimum. Discussion with the member of staff on the day of the inspection visit, as well as reference to staff files, demonstrated that all staff received regular support and supervision sessions with the Manager and that records were kept of these sessions. We were also told that the Manager was always available for advice and support and that staff found her to be very supportive throughout their work. There were clear guidelines in place for staff so that they were aware of what was expected of them. These included Keyworker guidelines and a list of daily jobs that needed to be done. Orby House DS0000067113.V359396.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 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well managed home that is safe and responsive to their needs. EVIDENCE: The current Manager has been in post since October 2007. She is not registered as the manager but has undertaken to complete and submit her application to become registered by the end of April 2008. The service user spoken with on the day of the inspection visit felt that the home was organised around the needs of herself and the other person living in the home. Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 21 The fact that there were only two people living in the home meant that it was easy to focus on their needs and to manage the home around their preferences. They said the Manager and staff listened and responded to them through house meetings, informal discussions and meetings with keyworkers. Staff spoken with said they felt the home was clearly managed around the needs of service users. The quality assurance process in the home is being developed and is focussed on the people living in the home and will use their feedback as the basis for improvements to the service. As the home is still new, there is further work needed to complete the quality assurance process so that it includes analysis of the feedback received and a development plan in response to that which is then shared with people who have an interest in the service. The Manager understands this process and will be continuing to develop the quality assurance process. At present there are questionnaires in place for service users, their families and staff. These are completed twice a year. The questionnaires for service users have been developed in an ‘easy read’ format. So far, all the responses received on the questionnaires have been very positive about the service. Examination of the fire logbook demonstrated that it was kept up-to-date. There were effective systems in place for monitoring and managing health and safety issues in the home. Good records were kept of all health and safety issues including fire, appliance servicing, substances hazardous to health, accidents and electrical testing. All staff received initial training in health and safety as part of their induction as well as regular updates. Regular checks and records were kept relating to health and safety aspects of the home. Fridge and water temperatures were closely monitored and action was taken rapidly to resolve issues where necessary. Orby House DS0000067113.V359396.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 X 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 2 25 X 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 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 3 X 2 X 3 X X 3 X Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 23 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. 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 Orby House DS0000067113.V359396.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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