Care Home: Orchard House

What the care home does well Over the past year the management of Orchard House has improved, so that people who stay here are now offered a much better service. Whilst we were at Orchard House we saw that staff and the people who were staying here had very good, warm, caring relationships. One person in particular seemed very happy to be here. She was having a great time with the staff and there was a lot of laughter. In our survey, when we asked `what does the home do well?` one person wrote "Looks after me very well.....nice food - helpful staff - look after everyone at Orchard House", and "Lovely staff members, always helpful and lovely place to stay in". This person said there was nothing the home could do better. Staff we spoke with and who wrote to us said: "I love it here, it`s nice to have different clients coming in and I really enjoy working with them"; "The staff work well as a team"; "Respond positively to individual needs and offer positive opportunities"; "We consult both the service users and their parents/carers in developing and updating care plans"; "The staff manages to work as a team"; and "provides friendliness to the clients so clients feel comfortable when they stay". Good information about the home is available for people thinking of staying here, written in a way which most people using the service can understand. Good assessments of people`s needs are carried out before people are offered a stay at the home, and people can visit as many times as they want to until they feel comfortable to stay. A lot of work has been done with people to involve them in making their care plans person-centred, and to include people`s goals for independence. Personal care is given in the way people choose, medication is dealt with well and safely and people are supported to see a doctor or other medical professional if they need to during their stay. Over the past year people have had more opportunities for outings and activities, and more thought is going into the activities that are provided at the home. Healthy, nutritious meals are served well. People can see a simple copy of how to complain if they want to, staff are recruited well and trained so that they know how to keep people safe, and staff receive regular supervision so that they can do their job properly. The whole building has been redecorated, some carpets and floorings have been replaced, lighting has been improved and pictures have been put up. The home has a quality assurance system that includes asking people who stay here and their families about their views, carrying out regular monitoring audits, and the provider visiting the home. Generally, records are kept as required, the manager told us in the AQAA that all policies and procedures are in place. Tests of the fire alarm system, tests of the emergency lighting, and fire drills are done regularly. What has improved since the last inspection? Just about everything about Orchard House has improved. The improvement in the environment has helped greatly with making the home feel welcoming, and a pleasant place to stay. We made 14 requirements following our last inspection and all of them had been met, or almost met. This means that the management of the home has improved, and the manager and staff team have worked hard to make sure that the service offered to people is much better. They know there is still some work to do, but the manager has shown by her responses in the AQAA that she knows how things can be improved even further. What the care home could do better: One person who responded to our survey said more staff are needed to make sure personal care is done adequately, and staff wrote that they want to improve outings and independence skills for people. The work on care plans, risk assessments and evaluating independence skills has made a good start but needs to continue. We have only made one requirement: staff must receive training at least in all the topics related to health and safety (such as first aid, infection control and food hygiene). We continue to urge the council to find different premises for the respite service, because the Orchard House building is not suitable for offering current good practice in supporting people to lead independent lives. We have repeated the recommendation we made last year about this. We would also ask the provider to reconsider providing an office within the respite unit. Key inspection report Care homes for adults (18-65 years) Name: Address: Orchard House 92 Brookfield Road Bedford Beds MK41 9LJ     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: Nicky Hone     Date: 2 2 1 0 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 27 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 27 Information about the care home Name of care home: Address: Orchard House 92 Brookfield Road Bedford Beds MK41 9LJ 01234363222 01234344448 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bedford Borough Council Name of registered manager (if applicable) Mrs Angela Bradley Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Age range: 18-65 Years Category: Learning Disability (LD) Gender: Male & Female Maximum number of service users: 4 Period of stay: Respite only - up to a maximum of 6 weeks until reprovision of this service takes place, the premises must be safe, and meet service users individual and collective needs Date of last inspection Brief description of the care home Orchard House is a respite service located in Bedford. It is a small bungalow at the back of a larger building which used to be a care home but which has been shut for some time. The buildings and grounds are owned by Aldwyck Housing Association, with Bedford Borough Council providing the staffing and care support. The building does not Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 4 Brief description of the care home meet the environmental requirements of the National Minimum Standards for Younger Adults and should have been replaced some years ago by Bedfordshire County Council. This did not happen, so Bedford Borough Council now has the responsibility to update this service . The accommodation consists of 4 small single bedrooms, a lounge/dining area and very small kitchen. There is a bathroom and a separate toilet, and a laundry room. People with physical disabilities cannot be accommodated here. There is now an office, in the attached building. There are community facilities and shops within walking distance, and a public transport route is close by. Care Homes for Adults (18-65 years) Page 5 of 27 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: For this inspection we (the Care Quality Commission) looked at all the information that we have received, or asked for, since the last key inspection of Orchard House. This included: - The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in August 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who stay here. The AQAA also gives us some numerical information about the service; - Surveys which we sent to the home to give to people who stay here, their relatives/carers and to staff. We received 7 replies: 1 from a service user; 1 from a relative; and 5 from staff; Care Homes for Adults (18-65 years) Page 6 of 27 - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues that have arisen; and - Information we asked the home to send us following our visit. This inspection of Orchard House also included two visits to the home, on 19th and 22nd October 2009. No-one who was staying or working at the home knew we were going to visit on those days. We spent time talking with people who were staying at Orchard House, the staff and the manager. We looked round the bungalow and observed what was happening. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? Just about everything about Orchard House has improved. The improvement in the environment has helped greatly with making the home feel welcoming, and a pleasant place to stay. We made 14 requirements following our last inspection and all of them had been met, or almost met. This means that the management of the home has improved, and the manager and staff team have worked hard to make sure that the Care Homes for Adults (18-65 years) Page 8 of 27 service offered to people is much better. They know there is still some work to do, but the manager has shown by her responses in the AQAA that she knows how things can be improved even further. 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 9 of 27 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 10 of 27 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. Information is available so that people know what to expect from the home, and people who stay here can be confident that their support is based on a full assessment of their needs. Evidence: Orchard House has a Statement of Purpose and Service User Guide. The Service User Guide includes pictures and symbols, is written in large print, and uses easy language, so is suitable for most of the people who use the respite service. It gives good information about what people can expect from this service. The manager has put together a useful pack of information for new people, which includes the Statement of Purpose and Service User Guide, information on how to comment or complain, a contract, a medication consent form and so on. The home is also working on producing a CD of the service user guide so that people will be able to listen to the information. Bedford Borough Council has produced a leaflet about Orchard House. Rather surprisingly, it has a picture of a park with a pagoda on the front, rather than a picture of the home. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: The manager explained that when a referral from social services is received, it includes a full assessment of the persons needs, so the home can decide whether they can offer the person a place. We looked at the documents the home keeps about one person who is new to the service. We found a detailed assessment from the persons social worker. The staff had completed the homes own assessment by visiting the person in their own home, and then the staff had added more assessment information each time the person visited Orchard House. Each person who is starting to use the service goes through a transition period which suits them. This can include short visits with or without their main carers, staying for tea, and overnight stays. The transitions are worked out for each person at their own pace. About a week before the person is booked in to stay at Orchard House, staff ring the person (or their family/carers) and find out if there have been any changes. All changes are recorded and any updates which are needed to the care plans are done. People agree a contract with Orchard House: this has pictures and symbols and includes a section on I will not so people are clear about what is expected of them. Care Homes for Adults (18-65 years) Page 12 of 27 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. Support plans have improved, and show that people have been involved in telling staff how they want their needs to be met. Some risk assessments have been done, and people are encouraged to make decisions about their stay. Evidence: The manager explained that a lot of hard work has been done on the care plans in recent months. The service supports over 50 people, some of whom visit only occasionally. Some of the care plans for these people would not be quite as up to date, if the person had not visited recently, as the plans for people who visit more often. We looked at the support/care plans for 4 of the people who stay here: they were very much improved from some that we saw last year. They were person-centred, and had good details and guidance about the way each person wants to be supported. The assessment information had been transferred to the support plan. The plans included a clear pen-picture of the person, written using I; an alert page if there were any Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: serious issues staff need to know about quickly (such as if the person is diabetic or has epilepsy); an important things about me page; and the persons communication skills. The plans also included good information about the persons daily routines and personal care, and how each person wanted each task to be accomplished. There was a range of other information such as what the person likes and does not like, their independence skills (what the person wants to achieve and by when), and consent forms for medication and emergency medical treatment. The plans we looked at showed that the person (or their representative) had agreed with the plan, and there was evidence that any changing needs are added in. For one person we saw that strategies to support the person with their behaviour had been written, but not moved to the current folder. The manager explained that there is now a keyworker system in place and it is the keyworkers who are responsible for making sure the plans are kept updated in between stays, so that the plan is ready when the person next arrives. A making me safe document had good information about how each individual could be kept safe with reference to a number of risks. While we were there, one of the people staying at the home returned from her day service and decided she was going to have fun with staff and refuse to come in. Staff showed how well they know this person as they knew how to respond to this, so that the person was able to have fun but wasnt running around outside in the cold for too long, and after a short time was happy to come in. Confidential information about people is now handled better. The manager and staff are more careful about making sure that telephone calls they make are private, and all care plans are kept in a cupboard in the hall. Care Homes for Adults (18-65 years) Page 14 of 27 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 are being offered more opportunities to increase their independence skills, and to do a wider range of activities. Evidence: A planning your stay document is now being used when people arrive, so that they are able to plan what they want to do during their stay, and make longer term plans for future stays. Staff write to parents if there is a big outing planned, so that parents can send in any extra money, clothing or whatever might be needed. For example, this summer 4 people and 2 staff went to Brighton for the day. The number and range of activities offered to people has improved. We were told that all sorts of things have been happening, such as going to the pantomime, pyjama parties, Xmas dinners, Easter egg hunt, games evenings, and trips out to the pub or local restaurants. One person who stays here is from the Caribbean so he requested Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: chicken with rice and peas on the menu. A member of staff, also Caribbean, cooked the meal and also brought in music and souvenirs, so people enjoyed a Caribbean evening. There are plans to have evenings based on other countries. Staff said there is a family church service once a month, and people have chosen to do things like go shopping, swimming, to the cinema, have a meal out, go to the gym, out for walks, help with gardening and planting pots, and so on. The menus chosen by people who had stayed here during the past few weeks showed that people eat a variety of meals. People choose what they want to eat when they arrive, and help to write the menus for the rest of their stay, but they can change their mind and go out for a meal instead if they want to. We saw that meals are served well now, with the table being set properly. We also saw that people are being encouraged to help in the kitchen to prepare the meal if they want to. Care Homes for Adults (18-65 years) Page 16 of 27 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 are supported with their personal care in the way they prefer, their health needs are met and staff administer medicines correctly and safely. Evidence: The support plans show that people are supported in the way each person prefers. As this is a respite service, peoples main carers are responsible for making sure their health needs are met. Staff will make sure people get medical treatment if they need it while staying at the home. The manager told us that it has been decided that each person should have a health action plan. Whichever service the person uses most will complete the plan (day service, respite and so on). People who have to take medication bring enough with them each time they stay. There is a small lockable cupboard in each persons bedroom for their medication. When the person arrives, staff book the medication in, counting how much there is. When staff give people their medication, they record how much is left. The medication file included clear guidelines for staff, information about each person staying at the home (including a photograph), and the medication charts. Care Homes for Adults (18-65 years) Page 17 of 27 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 know that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. Evidence: We saw a very good complaints procedure on the wall at Orchard House, which had symbols and pictures, was easy to understand and meant that everyone coming in to Orchard House would see it. Also, the manager showed us that Bedford Borough Council had recently produced a new complaints procedure. In the AQAA and in our discussions, the manager said that no complaints had been made about Orchard House. The complaints and compliments folder included a number of written compliments, and a record of verbal compliments that people, especially parents, had made about the service. The manager has developed a safeguarding (SOVA) folder, which has all the information, including the policies and protocols, that staff would need if they had to report anything to the safeguarding team. The manager explained that new staff always shadow other staff, then they have a discussion with the manager, and then go on formal training. Some of the current staff team are waiting to go on the training. Safeguarding is also part of the Learning Disability Qualification (LDQ) award that all staff at Orchard House undertake. Care Homes for Adults (18-65 years) Page 18 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Orchard House has been redecorated and refurbished and now offers a reasonably comfortable, clean place for people to stay. Evidence: In last years report we wrote We have been told for several years now that Orchard House was to be replaced with a more suitable building (part of the Councils programme of re-provision of respite services). However, this has still not taken place. The building does not meet the National Minimum Standards. It is very cramped with only one small lounge/dining room which is just about big enough for two comfortable chairs and a two-seater sofa, and a small dining table which four people can sit at. This area also doubles up as the office, so there is also a cupboard for files, a computer table, and shelves for other office equipment such as the telephone and fax machine/photocopier. A shelf along the wall behind the dining table held several files, communication book, diary and so on. The hallway is very narrow and the bedrooms, which are quite small, do not have ensuite facilities or even a washbasin. Although the same building is being used, since our last inspection the whole home has been decorated, some of the carpets and flooring have been replaced, the lighting has improved, and all the defects have been rectified. Some really nice pictures and other items have been bought and the home looked very much better than it did. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: Orchard House needs an office, so that there is somewhere for all the paperwork, and office equipment such as the telephone which is currently in the already very small lounge/dining room. We discussed this and suggested that perhaps the service should think about reducing the number of service users to 3 and using one of the bedrooms. This reduction in numbers would also make life more comfortable for the people who come to stay, as the home is very small for 4 people. However, following the inspection we spoke with one of the senior managers who said the demand on the service is too great to reduce the places available. The manager has been allocated an office in the attached building, so there is somewhere private for meetings, supervisions and so on to take place and they do not intrude on the people staying here. On the first day we visited, the central heating was causing problems, so individual electric heaters had been brought into the home. These were getting very hot to the touch. The manager had already put instructions in place that these were to be used to warm up the bedrooms before people arrived, but were not to be left in rooms once people were in there. She stated that she would remove them immediately: we suggested she complete individual risk assessments and management plans for each person so that people did not get cold. On the second day all the heaters had been replaced with fan heaters which would be far less risky, and the central heating was working again. The home was clean throughout, but there was a slight smell of stale urine in 2 of the bedrooms and in the entrance hall. Care Homes for Adults (18-65 years) Page 20 of 27 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. The number of staff on duty to support people has improved, and staff are recruited and supported well. The provider has produced a learning and development programme, so the amount and range of training staff can do is improving. Evidence: The rota showed that there are usually 2 staff on duty each evening and at weekends, and one member of staff who stays awake during the night, when people are staying here. The night staff stays on in the mornings to assist people to get up and get ready for whatever they will be doing during the day. Extra staff are put on the rota if specific activities are planned. On the day we visited, one person was being supported on a one-to-one basis, so there were 3 staff, and 2 night staff. The manager told us that 3 new staff have recently been recruited, which only leaves one vacancy. Regular agency staff who know the people who stay here are used to cover any gaps. We looked at the records the home keeps about three of the staff. There was a proforma in place, showing that all the necessary documentation is in place in their personnel files, which are held centrally at Borough Hall. We spent a morning in June 2008 checking a random selection of files of staff who work across the Councils registered services. Generally all the required information was available on the files we looked at. Some staff have been employed for many years, and started long before Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: the current requirements were in place. The Council has worked hard to get as much information as possible, and has ensured, for example, that Criminal Record Bureau (CRB) checks have been done, and are renewed every three years. The manager and staff told us that training is much improved. There was a bit of a gap when the new authority came into being, but a training needs analysis was completed by all services and the training department has now arranged a wide range of training. Bedford Borough Council has a learning and development programme. The manager said that all 5 of the new staff at Orchard House have already done the first part of the Learning Disability Qualification (LDQ), and new staff had been booked onto a medication course later in the month. Although training was becoming available, training records showed that a number of staff still needed to do some of the mandatory training topics to bring them up to date. For example, only 4 of the 9 staff had done food hygiene, 3 had done first aid, and 5 had done infection control. The deputy manager has been trained as a fire warden so she trains the staff. She teaches staff during staff meetings, and during their induction, and makes sure that all staff are involved in a fire drill regularly. The manager is a key assessor for moving and handling so she teaches new staff about moving and handling during their induction and then they go on a more in-depth course. The manager explained that there is little moving and handling at Orchard House as the building can only support people who are mobile. Other courses that staff can do include autism, deaf awareness, Mental Capacity Act, Deprivation of Liberty safeguarding (DOLs), race and culture, and advocacy. The manager told us that she tries to have a one-to-one supervision session with each member of staff, every month. Records showed that all staff have at least 6 supervision sessions a year. One member of staff told us that her supervision is regular and she finds the sessions helpful. Care Homes for Adults (18-65 years) Page 22 of 27 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. This home is managed much better than it was, so that the quality of service offered to the people who come to stay here is improving. Evidence: The manager, Angela Bradley, has been at Orchard House a number of years. She has completed her NVQ level 4 and Registered Manager Award. Staff told us that they feel comfortable saying things to Angela, and that she is very approachable and supportive. The manager told us that Bedford Borough Council is aiming for excellence in all its services. The director has required all services to produce an excellence plan: the manager said the plan is evolving. It is discussed at staff meetings and everyones ideas taken into account. During our second visit, the manager told us the plan was re-written after the most recent staff meeting. The excellence plan is part of the homes quality assurance system. We looked at the quality assurance folder the manager keeps. This showed that a range of monitoring Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: audits are done regularly to make sure standards are maintained, or improved. The system also includes sending out surveys to people. Surveys had been sent out to all parents a few weeks before our inspection. The manager had collected all the responses and the member of night staff was going to put them anonymously into a report. The week after the inspection an evening meeting with parents/carers and people who stay at Orchard House had been arranged in a local day centre. A representative of Bedford Borough Council (the provider) visits the home every month, as required by the regulations, and writes a detailed report of the visit. We looked at the records the home keeps about checking the fire alarms and emergency lighting. These had been checked weekly/monthly as required. Health and safety is given reasonably high priority: risk assessments are being developed around a range of risks that people who stay here might face; staff are being booked onto training in topics relating to health and safety; and the management of risk (such as the hot heaters) is improving. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 1 35 18 All staff must be up to date with the training they receive, particularly in relation to topics related to health and safety (such as first aid, infection control and food safety). So that staff can support people safely 31/01/2010 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 1 24 We strongly recommend that this service is moved to a premises which will better suit the needs of the people using the service, so they have a more comfortable place to stay, and so that current good practice in supporting people to lead independent lives can be put in place. Care Homes for Adults (18-65 years) Page 26 of 27 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). 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. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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