Care Home: Orchard House

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What the care home does well Residents benefit from living in a safe, clean and homely environment and where they are supported in making choices about their lifestyle including taking appropriate risks. Prospective residents have a comprehensive assessment of their needs and the homes capacity to meet the identified needs prior to a permanent placement being offered. Aids and equipment are provided to encourage maximum independence for people using services. People living in the home have the opportunity to participate in a range of activities and are encouraged to be fully involved in decisions that affect the day to day running of the service and their lifestyles. Residents are supported by a knowledgeable and skilled staff team who are supervised and appraised on a regular basis. The service seeks to improve outcomes for people living in the home through regular consultation with individuals and quality checks and surveys by management. What has improved since the last inspection? The home was de-commissioned in 2007 and has since undergone extension and major refurbishment. This was the first inspection since reopening. What the care home could do better: There are no requirements arising from this inspection and we are of the opinion that the service provides good quality outcomes for people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Orchard House Ashford Road Kingsnorth Ashford Kent TN23 3ED     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Paul Stibbons     Date: 2 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Orchard House Ashford Road Kingsnorth Ashford Kent TN23 3ED 01233612234 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: CareTech Community Services (No.2) Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of dservice users who can be accommodated is: 10 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Orchard House is a detached two-storey property that has been extended and refurbished to a high standard, providing two separate, adjoining units, each suitable to accommodate wheelchair users, as follows: Unit one consists of six single private bedrooms on two floors, all with en-suite wet rooms, and having both passenger lift and two stairways; unit two provides four single residents rooms, all at ground floor level, with en suite wet rooms. All residents Care Homes for Adults (18-65 years) Page 4 of 26 1 4 0 4 2 0 0 9 10 10 Over 65 0 0 Brief description of the care home private rooms meet or exceed the NMS for wheelchair users and communal space is more than double that which is required, at over 90 sq m, comprising lounges and dining rooms. Each unit has an office/ staff room, a laundry, with sluice, kitchen suitable for wheelchair access, assisted bathroom, assisted toilet, lounge areas and dinning room. The home has been decorated and furnished to a high standard, which includes the fitting and supply of mobility aids and equipment, with ceiling hoists and tracks, fitted where these are required. The large outside area has been discretely divided into two separated, wheelchair accessible and landscaped gardens. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was conducted over a period of 2.5 hours from 1315 to 1545 on the 26th November 2009. A completed AQAA (Annual Quality Assurance Assessment) was submitted to the commission when we asked for it and it contained good information supported by a variety of evidence. The Area manager and two members of staff were present during the inspection. Discussions were held with those present and a variety of documents and records that included Statement of purpose, Service user guide, care plans, health action plans, risk assessments, activity records, staff training records, medication records and health and safety records were examined. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have sufficient information on which to base an informed decision as to whether the home can meet their needs. A comprehensive assessment of needs is carried out prior to admission to ensure the home can meet prospective residents needs. People living in the home have the security of an individual written contract of terms and conditions attached to the placement. Evidence: We wanted to look at the information available to people who may be considering using the service and whether it was sufficient and detailed enough to be able to make an informed decision as to whether the home would meet their needs. The home has developed a comprehensive statement of purpose and service users guide, which is very specific to the resident group and can be provided in a suitable format to give the individual all the information about the home that a prospective Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: resident would want to know. The AQAA indicates that prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make and there is a high value on responding to individual needs for information, reassurance and support. Only one resident is currently living at the home and the care plan viewed evidences that significant time and effort was spent planning a transition period to make admission to the home personal and well managed. The sole resident living at the home was transferred from another Caretech home and the AQAA states that all new residents will receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity and focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home meet the diverse needs of the individual. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Prospective residents will be given the opportunity to spend time in the home. All residents will have the security of a written contract to which they have agreed. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from having an individual plan of care that reflects their assessed and changing needs. People living in the home are consulted and supported in taking risks as part of an independent lifestyle. People living in the home can be confident that information held about them is handled appropriately and their right to confidentiality is upheld. Evidence: We looked at one care plan because we wanted to know whether residents personal and health care needs are being met and that people using the service make their own informed decisions and have the right to take risks in their daily lives. The home has developed communication aids to enable people to make choices using pictures, signs, and symbols. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: The Care plan viewed is written ensuring that all aspects of support are implemented using a person centred approach. Support plans included guidelines for physical, emotional, health needs and strategies for appropriate ways to support management of behaviours. Because of the short time the service user has been in residence the home is still developing the new Caretech My Plan format. The care plan included comprehensive risk assessments which are regularly reviewed. The service has a can do attitude and risks are managed positively to help people using the service lead the life they want. The service works creatively and actively with other services and organisations to ensure that the persons whole life needs are met, and goals addressed. Residents are continually consulted on how the service runs and are able to influence key decisions in the home whatever their communication style. The privacy of people living in the home is safeguarded through a confidentiality policy that staff and other health care professionals adhere to. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have a range of opportunities that will meet their social and leisure needs and their own personal development. People living in the home are supported in maintaining appropriate relationships with friends and family. People living in the home enjoy a healthy and varied diet that is of their choosing. Evidence: We wanted to know if people living in the home were supported to lead a lifestyle according to their individual preferences. We looked at the care plan and activity records of the sole resident and it was evident that central to the homes aims and objectives is the promotion of the individuals right to live an ordinary and meaningful life in both the home and the community in a way that is directed by the person using Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: the service. People living in the home have access to the day services provided by the company and have opportunities to enhance their daily living skills and access the local community. On the day of this visit the resident went out with a member of staff. The service actively encourages people living in the home to maintain contact with family and friends. People living in the home are involved in meal choices and menus viewed indicated a balanced and nutritious diet. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive personal support in the manner they prefer and require and their physical and emotional needs are met. People living in the home are protected by the homes policies and procedures for dealing with medication. Evidence: We wanted to see if peoples physical and emotional health needs were being met safely and in a manner acceptable to them. We looked at one care plan and the homes procedures for dealing with medication. The records viewed indicated that staff and management are highly aware that the way in which support is given is a key issue for people living in the home and individual support plans clearly record peoples personal and health care needs and detail how they will be delivered to the individuals wishes. Residents have the opportunity to choose their own GP and have access to all NHS health care facilities in the local community. There is evidence that regular appointments are seen as important and there are records of attendances to GP and other health care professionals. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Staff members are very alert to changes in mood, behaviour and general wellbeing and are fully trained in how they should respond and take action. The home consults with other health care professionals and their input is used to improve outcomes for people living in the home. The home has developed efficient medication policy, procedure and practice guidance. Staff all have access to this written information and understand their role and responsibilities. We examined the procedures for managing medication and the storage and administration is in accordance with current guidelines and legislation. Medication records are seen as key to the efficient management of health care matters and the home consistently keeps them up to date. Only authorised trained staff members undertake the administration of medication in the home and their skills are monitored to ensure competency. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their views will be listened to and acted on and they are protected from abuse and neglect. Evidence: We wanted to know whether residents were enabled to raise concerns they may have about their treatment and whether they felt at ease in doing so. The service has a complaints procedure that is clearly written and is accessible in differing communication formats. Residents have various forums to raise any concerns, for example, individual Talk times, resident meetings and Key workers. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff members have been selected from other homes within the company, are experienced and know when incidents need external input and who to refer the incident to. Records viewed evidenced that the training of staff in safeguarding is regularly arranged by the Home and other training around dealing with physical and verbal aggression is also made available to staff as needed. Care Homes for Adults (18-65 years) Page 17 of 26 Evidence: The manager has attended Deprivation of liberty safeguards training and they have assessed relevant needs and discussed with the team. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely, safe and comfortable environment with sufficient personal and communal space to meet their needs. Evidence: The home has been extended and refurbished to a high standard, providing two separate, adjoining units, each suitable to accommodate wheelchair users. Unit one consists of six single bedrooms on two floors, all with en-suite wet rooms, and having both passenger lift and two stairways. Unit two provides four single bedrooms, all at ground level with en-suite wet rooms. All resident rooms meet or exceed the National minimum standards and communal space comprises lounges, dining rooms that are double the space that standards require. Each unit has an office, staff room, laundry and sluice, kitchen that is wheelchair accessible, assisted bathroom and toilets. Mobility aids and equipment include ceiling hoists and tracks and specialised baths. There is a large garden area divided into two separated wheelchair accessible landscaped gardens. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a competent and qualified staff team in sufficient numbers to meet their needs. People living in the home are protected by the services robust recruitment procedures for new employees. Residents individual and joint needs are met by an appropriately trained and supervised staff team. Evidence: The service has a highly developed recruitment procedure that has the needs of people who use the service at its core. and the recruitment of good quality carers is seen as integral to the delivery of an excellent service. Provider relationship managers confirm appropriate pre-employment checks are carried out by the service. Training records were viewed and they evidence that the service ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for residents. The content of the induction and probationary periods are seen to be very robust, Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: detailed and service specific. Induction training exceeds Skills for Care requirements and includes person centred planning and thinking. Evidence was seen that staff meetings and Supervision sessions are regular and staff find them helpful with a focus on improving outcomes for people using the service. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed. Staff rosters viewed indicated that staffing levels are set for times that accommodate the needs and lifestyles of the residents. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home that is run by a competent and qualified manager and where their rights and best interests are safeguarded. Residents benefit from living in a home where their views underpin all self-monitoring and development of the home and their health, safety and welfare is promoted and protected. Evidence: The registration certificate for the service is displayed and correct in its detail. A current certificate of insurance for employer liability and business loss was also displayed. The manager has the required qualifications and experience to run the service and has sound knowledge of both strategic and financial planning and review of service delivery systems and structures. The manager states in the AQAA that they receive supervision and good support from Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: the Area manager and work together with staff and residents to develop the service. The manager of the home has a clear understanding of the key principles and focus of the service, based on organisational values and priorities and they are working to continuously improve services. There is a focus on person centred thinking, with residents shaping service delivery. The AQAA was returned to the commission when we asked for it and contains clear, relevant information that is supported by a range of evidence. The AQAA lets us know about changes they have made, the structures they have in place and where they plan to make improvements. The service has sound policies and procedures that are reviewed and updated in line with current thinking and practice. The home works to a clear health and safety policy and all staff are fully aware of the policy and are trained to put theory into practice. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The home seeks to monitor quality of the service provided through feedback from service users, relatives and internal Regulation 26 visits by senior management. Caretech have a quality and performance team who conduct annual audits of the service and produce a report and development plan. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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