Care Home: Orchard End

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What the care home does well New people are supported to visit and try out the service before moving in. Their needs and wishes are written in their care plans. People are supported to have their health needs met and their physical care needs met in the way they prefer. They can spend time doing things they like at home. People are supported to use communication aids to help them understand things and make choices. They are supported to stay in touch with their families. Their home is comfortable, homely and safe and they have single bedrooms with their own things in them. Their medication is being safely managed. What the care home could do better: Staff must report concerns immediately to help protect people living in the home. Each person should have a health action plan. The house should be adapted to better meet peoples special needs. More of the staff team should be qualified. CARE HOME ADULTS 18-65 Orchard End Auberrow Wellington Herefordshire HR4 8AL Lead Inspector Jean Littler Key Unannounced Inspection 11th January 2008 14:00 Orchard End DS0000031631.V352252.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 Orchard End DS0000031631.V352252.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. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard End Address Auberrow Wellington Herefordshire HR4 8AL 01432 839038 01432 839038 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) Winslow Court Limited Mrs Claire Louise Jones Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care staff to service user ratio must always be in excess of 1 staff to 2 service users. 5th September 2006 Date of last inspection Brief Description of the Service: Orchard End is registered to accommodate five people with learning disabilities and who may display occasional challenging behaviour. It is a five-bedroom bungalow with an additional bedroom that is used as an office and staff sleeping-in room. There are good-sized communal rooms and spacious gardens that allow for a range of activities. The Home is situated on the outskirts of the village of Wellington, which is about 5 miles from Hereford city. Orchard End is owned by Winslow Court Ltd., a company that comes under the umbrella organisation called Senad. The Home retains close links with Winslow Court, which is a larger Care Home in the area where the company training, health and safety, and human resources departments are based. Information about the Home is available from the Home or Winslow Court on request. The fees are currently between £1415 and £2104 per week. On top of the fees the residents are expected to pay for personal items such as toiletries and clothes and personal services such as hairdressing and chiropody. Within the fees costs are included up to £500 a year towards holidays. If a holiday is planned with higher costs these will be agreed with the residents’ representatives. The residents may be asked to contribute to the cost of some leisure activities if these do not form part of their regular activity plan. Orchard End DS0000031631.V352252.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 was carried out over 7 hours on January 11th by two inspectors. The manager and deputy were on duty and helped with the process. We spoke with one member of staff and looked around the house. Two people showed us their bedrooms. Some of the relatives of people who live in the Home and some professionals filled out surveys to give us their views. We looked at some records such as care plans and medication. The manager sent information about the Home to us before the visit. What the service does well: New people are supported to visit and try out the service before moving in. Their needs and wishes are written in their care plans. People are supported to have their health needs met and their physical care needs met in the way they prefer. They can spend time doing things they like at home. People are supported to use communication aids to help them understand things and make choices. They are supported to stay in touch with their families. Their home is comfortable, homely and safe and they have single bedrooms with their own things in them. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 6 Their medication is being safely managed. 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. Orchard End DS0000031631.V352252.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 Orchard End DS0000031631.V352252.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, 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information in a format that will help them make a choice about where to live. Their needs are being assessed, however this process can be improved to ensure all areas of need have been considered. Prospective residents are well supported to visit and trial the Home before moving in permanently. An overnight stay should be offered unless there is clear evidence as to why this is not in the person’s best interest. EVIDENCE: Mrs Jones reported that the Statement of Purpose for the service was currently being revised. The only available copy was the 2006 version. A version of the Service User’s Guide has been developed by the speech therapist that includes photographs and line pictures to support the easy read text. The group of people living at the Home had not changed since 2004, however; recently one resident has been supported to move into a new service opened by the providers. A man living at Winslow Court, which is also operated by the providers, has moved in to take up the vacancy. Mrs Jones had completed an assessment of this person’s needs with input from his mother and senior staff from Winslow Court who know him well. The assessment did not include all areas of the man’s needs to ensure the suitability of the placement. For example is the environment at Orchard End suitable to meet his physical Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 9 needs. The care plan being used was the Winslow Court version. This had been reviewed since he had moved in and did contain information that had changed such as the man’s activity timetable. The man had been supported by staff from Winslow Court to visit the Home several times. Those involved decided it was not in his best interest for him to stay overnight before moving in. The assessment did not explain the basis for this decision. His place at Winslow Court had not been reallocated for ten days in case he wished to return promptly. Daily records and monthly keyworker reports showed he had settled well. His family had visited three times and Mrs Jones said they were very positive. A review meeting was planned where the placement was likely to be confirmed as permanent. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ needs and development goals are included in their care plans and these are being kept under review with the support of professionals. The residents are being supported to make decisions about their own lives and to take reasonable risks. They may benefit from being enabled to become more involved in planning and reviewing process. EVIDENCE: A sample of two peoples care plans were viewed. These contain detailed information about their support needs, risk assessments and personal development goals. The risk assessments seemed appropriately balanced between enabling people to enjoy a good quality of life by partaking in activities and being supported to stay safe. For example people enjoy swimming and horse riding but safety measures are in place. The format for this important information should be changed as the font is so small it is hardly legible. Some people’s opportunities for independence have increased now a resident who needed certain restrictions in place has left. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 11 Each person has an intervention plan to guide staff about how to support them consistently. The professionals based at Winslow Court assist the team to develop these strategies and help them monitor the outcomes for the residents. Good evidence of planning was seen to support one person following his return Home after staying in an assessment centre. Incidents are recorded and analysed and staff are debriefed after ones where physical intervention has been used. Monthly staff meetings are used to discuss peoples support needs and progress. The plans and incidents are monitored during the provider’s monthly visits. The daily record forms contain many sections to help ensure staff record relevant information e.g. general wellbeing, meals, activities, personal care, family contact etc. The information recorded each day is collated by the keyworkers into monthly summaries. This system seems effective in enabling Mrs Jones and others to monitor peoples changing needs. More formal six monthly review reports are written and meetings arranged with relatives and other representatives and professionals. One of these two care plans had been fully reviewed in November 07 and the other just prior to the person starting their transition into the Home in October Person Centred Planning could be further developed. Mrs Jones reported that only one person has a life book which is being added to and he keeps in his room. None have care plans in an accessible format. Staff now have a digital and video camera and are hoping to use these to increase the involvement people can have in the planning and reviewing of their support. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The residents are being offered opportunities to take part in appropriate activities both outside and inside the Home. Their rights are being respected. They are being well supported to maintain personal relationships with friends and family. A good variety of meals are being provided and the residents’ food preferences are being taken into account. EVIDENCE: The people currently living in the Home prefer a quiet enviorment. They are not young and a more sedate lifestyle suits them. There is a relaxed atmosphere and daily routine exist but are unrushed. People are encouraged to make choices about where to spend time in the house, what indoor activities to do and what food to eat. Some restrictions have recently been lifted as the person who needed these has moved out. For example the kitchen is now unlocked and more of the food supplies can be in unlocked cupboards. Mrs Jones hopes the laundry door can also be left unlocked in the near future. People are encouraged to carry out daily living tasks for example one man clears the plates and puts any waste on the compost. The staff member Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 13 spoken with said one person always prepares his own cereal and can make a hot drink with support. This potential could be developed with possible involvement in making snacks or baking. People have enjoyed growing flowers and vegetables and pickles and jams have been made as a result. Each person has development goals such as learning new personal care skills. Mrs Jones is aware that the development of goals and longer-term aims and ambitions could be better linked to the person centred planning process. Efforts are made to find activities that people want to engage in, for example one person has shown he enjoys gardening so a place has been arranged and he now attends the Holm Lacey horticulture project. This man’s activities timetable also included car boot sales, riding, pottery, DVD and curry nights, recycling and pub trips. The new person is being supported to follow a similar activities plan to the one he had at his previous placement. Sensible changes had been made such as he was now going to a local pool to swim instead of driving to Droitwich brine baths. He was continuing to attend the same riding session and go to Winslow Court for pottery so he was still seeing people he had lived with for many years. Mrs Jones reported that each resident has a personalised activity plan designed around their needs and preferences, and that usually two trips out are arranged a day so all have an opportunity to go out at least daily. One person had been out that morning to buy his weekly magazine which he looks forward to. Several staff drive the Home’s vehicle to facilitate outings and day trips of interest and holidays are arranged. Mrs Jones reported in the AQAA that contact is actively promoted between people and their relatives. Keyworkers are responsible for communicating with relatives. Feedback from relatives was very positive, for example one said she could not fault the service, they do everything well. Some people go to stay with their relatives and others have visits in the Home. In some cases staff drive people to enable them to visits their family. Communication aides are used including symbol systems, signing and specific verbal prompts. The organisation’s speech therapist has been involved in the development of these. A personal communication system was seen on one person’s bedroom wall. This contained the information for that day. Information has been developed in a visual form to help understanding and choice making e.g. photographs of meals to enable involvement in menu planning. Some specific arrangements are in place to try to meet one resident’s sensory needs. The staff are familiar with how he communicates and were seen to respond promptly to his vocal sounds. Menus are in place and the sample seen in the kitchen showed a good variety of healthy meals are being offered. A vegetarian option is offered or another alternative if requested. Meals from different cultures are tried and fresh fruit and vegetables are being provided daily. The meals are flexible depending on the plans for the day. They are eaten in the conservatory and one person chooses to eat alone in the dining room. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 14 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. The residents are having their personal care and health needs met in a sensitive manner. There are safe arrangements for the management of medicines in this home. EVIDENCE: Care records showed that residents were bathing or showering daily and their other personal care needs are being met. Mrs Jones reported in the AQAA that people are supported with their personal care needs with respect, dignity and confidentiality, for example appropriate gender care is offered and their personal wishes are aways respected. Staff were observed to respect the residents’ privacy e.g. one man would not like to be asked to show the inspector his bedroom. The member of staff spoken with said this was his first care role and he had been impressed by how staff support the residents. Feedback in the surveys was also positive in relation to personal care and health care. The Home has a good record of providing very personalised support to help people access and cope with medical treatment. One person was supported to have an operation and another went into an assessment hospital for serveral Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 15 weeks this year. Care records showed that the new man had been registered with a local GP and dentist. He had not been weighed on admission or for the first two months but this was now being monitored. His medication had been reviewed and staff had been trained to administer the emergency medication he is prescribed. Mrs Jones reported in the AQAA that they have excellent links with the local GP and dentist. The supporting dental nurse is one of the bank staff, which helps the residents be able to accept treatment. The GP offers a well man clinic which all service users have attended, and the nurse at Winslow Court offers flu jabs and general check ups when required. Additional information that contains pictures is available to assist people to understand hospital visits and check ups. External links with health professionals are in place e.g. the consultant psychiatrist. Records showed health concern are recorded and monitored through the monthly care summaries and the six monthly review reports. Health Action Plans have been developed but not yet fully completed for each person. The staff are supported to meet the residents’ needs by a team of professionals who give advice. These include the nurse, a speech and language therapist, a psychologist and her assistant. These professionals contribute to the staff training programme e.g. the nurse trains staff in epilepsy and diabetes. Mrs Jones needs to ensure that written evidence is provided demonstrating that the GP has delegated responsibility to the site nurse if any treatment is given. The Home is not registered as a nursing home and therefore nursing care should not normally be provided directly. A recent review of the way the psychology team develop behaviour intervention strategies highlighted the need to modernise their methods. The organisation is taking positive action to address the shortfalls. As mentioned under choice of home and environment a specialist assessment was not arranged as part of the assessment process for the man with mobility needs who has recently moved in. Good efforts are being made to ensure he has the correct specialised boots. The evidence below was gathered by Mr David Jones a pharmacy inspector who spent three hours with the manager, deputy and nurse from Winslow Court looking at how the residents’ medication is being managed. Staff who administer medicines have undertaken a formal training process according to the extent that they will be involved with handling medication. A medication policy is available so that the staff also have written direction as to how the provider and manager expect them to handle medicines safely. The home receives support from a pharmacy in Hereford and a pharmacist also visits to advise. There are recent reference books about medication available. For each person living in the home there are arrangements to make records of medicines received, administered and leaving the home or disposed of. Complete and accurate records about medication are important so that all medicines can be accounted for and residents are not at risk from mistakes Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 16 and receiving their medicines incorrectly. Our inspection found that these records were being properly kept and indicated that all the medicines residents needed were being kept safely in the home. Two members of staff are involved when residents take their medicines. We discussed safer practices to follow when administering medicines so that a check of the medicine record and the label on the medicine packs can be made in the presence of the person who is to receive the medication. The home has improved their systems for dealing with medicines taken out on trips. We discussed with the manager other ways to improve this and make procedures easier as well as still being safe. We saw written guidelines about administering some medicines prescribed to use only ‘as required’. This information was not available for a few other medicines (such as laxatives) with this sort of direction. In some cases there were additional directions on the medicine charts. It is important that for any medicines with an instruction to use ‘as required’ there are clear written guidelines in place describing to staff how this medication is used for the benefit of that particular person. For residents who may lack capacity to consent to treatment, more consideration about the provisions of the Mental Capacity Act 2005 must be taken into account. We saw there were generalised protocols for using ‘as required’ medicines but these were more like risk assessments about these medicines rather than specific information on how to use them. Care plans also now need to reflect what choices residents have made and are given about how their medicines are administered and their consent to the way in which staff handle and administer their medicines. Where consent is not possible because of lack of capacity consideration must be given to the provisions of the Mental Capacity Act 2005 and records made of the agreement that the way in which medicines are administered is in the best interests of that particular person. Since the last inspection a new medicine cupboard has been installed so that there is enough space to store all medication safely. Opening dates were written on medicine containers. This provides a method to rotate stocks properly and see that residents receive medicines that are of the correct quality. We asked one resident if we could see the arrangements for keeping an ointment in his room. He was happy about this and we found the ointment kept safely. This person told us he was enjoying his lunch. A medication audit system is in place with specific weekly and monthly checks as well as stock balances of medicines confirmed. Orchard End DS0000031631.V352252.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. The views of the residents and their representatives are listened to and acted on. The residents have not reliably been protected from abuse despite suitable management arrangements being in place. EVIDENCE: Policies and procedures are in place for the management of complaints and any adult protection concerns. None of the people in the Home have external advocates but all have keyworkers and family members who can raise concerns on their behalf. Mrs Jones reported that no complaints have been received since the last inspection and none have been received by the Commission. She had made good efforts to ensure the mother of the man who had recently moved in felt able to inform her of any concerns. She had not provided her with a copy of the Home’s complaints procedure and agreed to do this promptly. All new staff attend training about protecting vulnerable adults as part of their induction programme. Refresher courses are also provided and the subject is covered in the LDAF foundation course and in the NVQ Care awards that are promoted. The providers plan to arrange more in depth adult protection training for the manager and other senior staff in the organisation. Mrs Jones has taken appropriate action to report issues promptly to Social Services and us. She has co-operated fully with the local multi-agency procedure for the referrals made since the last inspection and informed relatives appropriately. One related to an incident between two people living in the Home. The other, which is still being investigated, related to a worker’s conduct towards a resident. The worker who witnessed the incident did not report it for some Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 18 weeks. This has highlighted the need for further training for staff and Mrs Jones reported that she has learnt from the situation in relation to staff team management matters. When the investigations are concluded the providers should ensure a review is carried out and any relevant changes are made to personnel and protection procedures. Guidance is in place for staff about how to support people with challenging behaviours and Mrs Jones reported that physical intervention is used as a last resort. Appropriate recruitment procedures are being followed to help provide protection. Orchard End DS0000031631.V352252.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, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents have a comfortable, clean and attractive home that is being well maintained. Some adaptations are needed to meet some special needs. EVIDENCE: The house is a detached bungalow with a large attractive garden. It is situated in a very rural location, which is beneficial to the residents in terms of quietness and access to beautiful countryside. The location does not easily facilitate the residents becoming part of a local community, however links have been made through staffs’ ongoing efforts. The exterior of the home is in good condition and the interior continues to be well maintained. The kitchen is in need of replacement but this is due to take place very soon. The organisation has a repairs and maintenance department, however a slow response time has been noted in the providers monthly visit reports. There are five bedrooms, two of which have en-suite facilities. The bedrooms sampled were clean and comfortable. The man who had recently moved in had been supported to personalise his room and he brought his Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 20 double bed with him. He has some mobility difficulties and Mrs Jones has arranged for some wall bars to be fitted to assist him using the bath and toilet. She has realised that the input of an occupational therapist would be beneficial to get a full assessment of his needs and how the environment needs to be adapted. Currently he cannot easily access the conservatory and garden because of step. The lounge, dining/art room and large conservatory are attractive and appropriately furnished. The conservatory has additional dining and seating areas that allows the men a choice of where to spend time. Art the men have made is displayed on the walls. Some residents choose to spend time in their bedrooms and often some are out for part of the day which helps prevent the communal space becoming crowded. There is a communal bathroom, a shower facility, toilets, a laundry and a kitchen. Two residents have visual impairments. Mrs Jones did not explain in the AQAA how the environment has been adapted to support these men. Consideration should be given to seeking a review by a specialist. Mrs Jones reported that there are plans in place for the coming year that include updating areas of the bungalow which are tired, or in need of modernisation, opening up the garden so it is more accessable to people with mobility problems and making the facilities in the laundry room more functional so this can be more easily used by the people who live in the Home. The care staff do the cleaning and Mrs Jones reported that laundry and cleaning schedules are in place. Staff try to engage the residents in helping e.g. tidying their bedrooms and ironing. Suitable infection control arrangements are in place. Orchard End DS0000031631.V352252.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, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are being supported by a competent staff team in sufficient numbers to meet their needs. They are being protected by the homes recruitment practices. Effective training and support systems are in place for staff, however more staff need to become qualified. EVIDENCE: A minimum of three staff are on duty during the day. This is often increased if the manager or senior are working in the Home. The minimum level has been increased to four recently to provide additional support to one resident. This is being slowly withdrawn in line with an agreed multi-agency strategy. Care records showed that the staffing levels enable people to be well supported with their personal care and to access appropriate activities. There are currently twelve staff. Since the last inspection four staff have left and unfortunately four more are leaving in the near future. One of those living is the deputy. Most staff have left for positive reasons for example to become a nurse. Mrs Jones was positive that the impact of the staff changes would be reduced as two agency staff who work regularly in the Home are applying for the posts. As detailed earlier the main staff team is supported by a team of specialised staff based at Winslow Court. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 22 Feedback from surveys was positive about the staff team. They were described as committed and positive in their role. Mrs Jones reported that the team has worked well together through a very difficult year where two residents have needed a lot of support. One worker was spoken with in private. He was positive about the service provided and the quality of life of the men. He had found the training provided appropriate and felt the manager and his colleagues were supportive and approachable. He reported having supervision sessions every two to three months and found the shift handovers and staff meetings useful. Recruitment is managed centrally from Winslow Court where a personnel (HR) officer is based. The main files are held at this office and copies are sent to the Home. The file of the newest worker was sampled. This contained all the required information and demonstrated that the robust organisational policies had been fully implemented. Mrs Jones reported in the AQAA that new staff shadow their trained collegues for seven shifts to help them understand the residents routines and behaviours. A training plan for the year ahead is in place, and clear training records for each worker are in place. Training is managed centrally at Winslow Court where a rolling programme of core and basic training is provided. Existing staff who need refreshers are called to attend these sessions as required. New staff attend an induction and then go on core training during a foundation programme over the first three to six months. This has led to them gaining their Learning Disability Award Framework. The organisation is aware that they need to introduce the new Learning Disability Qualification that is replacing this. Staff then go on to gain NVQ awards. At the time of the inspection 50 of staff were qualified and two others were working towards an award. Some specialised training is routinely provided for staff e.g. Autism Awareness, Adult Protection, Epilepsy, Positive Approaches to Challenging Behaviour and Physical Intervention training. Annual refreshers are provided appropriately to help ensure good practice is maintained. It is positive that cconsideration is being given to arranging sensory impairment training. All staff should attend training in the Mental Capacity Act. Mrs Jones reported in the AQAA that health and safety training has greatly improved in the last year, however she did not give any examples of this. Orchard End DS0000031631.V352252.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, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home are benefiting from a well run service. EVIDENCE: Mrs Jones was registered with the Commission in November 2005. She has relevant experience and qualifications including the Registered Manager’s Award. She is currently working towards the NVQ 4 in Care and plans to complete this by June 08. The manager’s hours are not usually included in the care element of the Home’s rota, however she often works at weekends to ensure she maintains a good knowledge of the residents’ needs. She is directly supported by a deputy, by the manager of Winslow Court who provides supervision and by her line manager. Staff and residents’ relatives continue to report that Mrs Jones is approachable and committed. She communicates well with the Commission, has shown leadership during a challenging year and seems to prioritise the residents’ best interests. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 24 Quality assurance systems are in place e.g. monthly provider monitoring visits and health and safety checks. Mrs Jones has taken action to address the recommendations made at the last inspection. She continues to be proactive in seeking feedback from stakeholder surveys and plans to issue these more frequently. The findings from the quality assurance systems and consultation should be linked more closely to the AQAA next year. It was positive that some development aims for the service are planned for the coming year and the worker spoken with was aware of these. Company policies and procedures are in place. An external company has recently been engaged to keep these up to date and in line with changes in legislation. Records are being stored securely and the information is being kept up to date. Records relating to one resident’s finances was sampled. The receipts showed money was being spent on appropriate things and the records were clear and up to date. £800 had recently been spent on a double bed. This item had not been added to the person’s inventory. Mrs Jones said she did intend to do this, however it would be good practice if inventories were updated at the time valuable purchases are made. Mrs Jones agreed to review if anyone could be supported to keep some of their money in their bedrooms rather than it all being held in the office. Mrs Jones is supported to manage health and safety matters by the training co-ordinator also leads on health and safety. Mrs Jones reported in the AQAA that essential equipment servicing and safety checks are being carried out routinely e.g. fire alarm tests and hot water temperatures checks. Risk assessments are in place relating to the environment, work tasks and the residents’ care needs and these have been kept under review. A recent fire inspection had not raised any issues and records showed that the new man had been involved in several fire drills to help him become familiar with the evacuation process. Accidents and incidents are being recorded and monitored through the monthly provider’s visits. Orchard End DS0000031631.V352252.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 3 2 2 3 2 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 4 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 3 3 3 x Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NA 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. 1 2 Refer to Standard YA22 Good Practice Recommendations Provide all representatives of the people who live in the Home with a copy of the current complaints procedure. Ensure staff to report adult protection concerns immediately to help protect the people who live in the Home. Complete a Health Action Plan for each person to demonstrate their current and future health needs are being looked at in a holistic way. Ensure there is evidence that the GP has given delegated responsibility to the Winslow Court site nurse if she provides any direct nursing treatment to the residents. 4 YA20 Include more consideration about the provisions of the Mental Capacity Act 2005 when writing care plans about medication choices and handling for people who may lack DS0000031631.V352252.R01.S.doc Version 5.2 Page 27 YA23 3 YA19 Orchard End capacity to consent to treatment. Make sure that there is clear written guidance to staff on how to reach decisions to use any medicines prescribed to be administered “when require”. Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park Droitwich Road WORCESTER WR3 7NW 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 Orchard End DS0000031631.V352252.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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