Care Home: Orchard Leigh

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What the care home does well Each person has a care plan that is person centred, provides clear guidelines for staff and is reviewed every five/six months. A range of activities are provided which some people choose not to participate in. People said they like going shopping, to the pub, to clubs and to day centres. One person has a work placement in an old people`s home that they enjoy. Good systems are in place to enable people without speech to express their needs. Good use is made of symbol, pictures and photographs both in documents and around the home. People are provided with accommodation of a high standard. Their rooms are personalised reflecting their interests and lifestyles. What has improved since the last inspection? Arrangements have been made to make sure that safe systems for the administration of medication are in place. Secondary dispensing of medication no longer takes place. A quality assurance system is in place that involves people living at the home and their relatives. What the care home could do better: Confidential information about people living at the home must not be displayed in communal areas. All staff must have access to accredited training in the safe handling of medication to make sure that systems continue to protect people from harm. Staff should have access to information about the mental capacity act and the impact this may have on people they support. Some carpets in the home were becoming threadbare in places and need to be replaced. Staff need access to training in areas relating to the needs of people living at the home such as dementia, mental health and autistic spectrum disorder. CARE HOME ADULTS 18-65 Orchard Leigh Hayden Road Cheltenham Gloucestershire GL51 0SN Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 10th December 2007 10:00 Orchard Leigh DS0000062769.V343234.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 Leigh DS0000062769.V343234.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 Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Leigh Address Hayden Road Cheltenham Gloucestershire GL51 0SN 01242 523848 01242 524536 orchardleigh@hotmail.co.uk www.milburycare.com Milbury Care Services 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) David John Everson Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1), Mental disorder, excluding of places learning disability or dementia (3) Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide care and accommodation for up to eight service users with a learning disability, but may also accommodate service users with associated physical disabilities and sensory impairments provided that their primary needs relate to learning disability. One named service user accommodated who is over the age of 65 years. May accommodate no more than three service users (within the home’s registered maximum numbers) with a mental health need whose primary needs relate to their learning disabilities. 22nd November 2006 2. 3. Date of last inspection Brief Description of the Service: Orchard Leigh is a care home for up to eight adults with learning disabilities who may also have mental health problems. Each person has a single room with en-suite facilities. Two people have self-contained flats with kitchen/dining/lounge facilities in addition to their bedroom with en suite. The home is situated on the edge of Cheltenham with easy access to local shops and facilities. Orchard Leigh is one of several homes in Gloucestershire owned by Voyage/Milbury Care Services. The Statement of Purpose is displayed in the home and each person living there has a personal copy. The current charges are £985 to £1279 per week. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in December 2007 and involved a site visit to the home on 10th December. The registered manager was present throughout. The care of people living at the home was observed and three people were spoken to about the care they receive. Staff were also spoken with. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. Surveys were returned from four people who live at the home, six of their relatives, five staff and two healthcare professionals. A sample of records were examined including care plans, staff files, health and safety systems and quality assurance audits. What the service does well: Each person has a care plan that is person centred, provides clear guidelines for staff and is reviewed every five/six months. A range of activities are provided which some people choose not to participate in. People said they like going shopping, to the pub, to clubs and to day centres. One person has a work placement in an old people’s home that they enjoy. Good systems are in place to enable people without speech to express their needs. Good use is made of symbol, pictures and photographs both in documents and around the home. People are provided with accommodation of a high standard. Their rooms are personalised reflecting their interests and lifestyles. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 6 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 Leigh DS0000062769.V343234.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 Leigh DS0000062769.V343234.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 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. A comprehensive assessment of the person’s wishes and needs are taken into consideration before offering them a place. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 9 EVIDENCE: Two people had been admitted to the home since the last inspection. Admission information was examined for both people. Each had a copy of the Statement of Purpose and Service User Guide in their personal files as well as a statement of terms and conditions. There was evidence that the home had received copies of an assessment of need and care plan from their placing authorities. A representative of Voyage and the registered manager had also completed comprehensive assessments for one person including separate assessments for mental health, every day living skills and challenging behaviour. For the other person an initial assessment only had been completed because they had been admitted to the home sooner than was originally planned. There was evidence that people had been invited for visits including for oneperson tea and overnight stays prior to moving in. The registered manager confirmed that one person had a planned transition into the home but the other person due to their circumstances had moved in very quickly. The person had since asked to return home and he thought they would not be returning to Orchard Leigh. Placement reviews had either been held or were scheduled to take place. Orchard Leigh DS0000062769.V343234.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): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A person centred approach to care planning provides the opportunity for people to take control of their lives. People’s needs are being assessed and they are being supported to makes decisions about their lifestyles. Risks are being managed safeguarding them from possible harm. EVIDENCE: The care of three people was case tracked; this involved reading their care plans, examining financial and medical records, observing the care they were receiving and talking to staff about the support they were providing. Each person had a care plan that was being reviewed every five/six months. The process appeared to be person centred with people or their relatives being involved in developing pen pictures, individual support requirements and goals. Each person had an assessment and care plan provided from their placing authority that formed the basis of their individual support requirements. These documents provided staff with clear guidelines about the support people would Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 11 like to have also indicating “what not to do”. Observations and conversations with staff confirmed their understanding of these records. Assessments, individual support requirements and goals could be crossreferenced and where necessary the relevant risk assessments were in place minimising any hazards identified. For instance a person assessed as having dementia had clear guidelines in place for additional support in the mornings, staff were advised, “not to rush” and a corresponding risk assessment was in place for showering. Risk assessments like care plans were being reviewed every six months. Communication needs were identified in the individual support requirements and these in turn were explored further in communication profiles. This provided staff with clear guidance about the verbal and non-verbal skills of the people they support. Staff were observed using Makaton sign language with one person. There was good use of symbol, picture and photographs around the home and in documentation creating an environment that promotes total communication with the individual. Any restrictions that were in place were recorded in care plans and the rationale for these explained. It was evident that they were in place to safeguard people or to promote their health and well-being. The registered manager stated that Voyage was in the process of introducing a new person centred plan that would replace the current system. The registered manager confirmed that pen pictures, which included a current, photograph also double up as missing person’s information. Orchard Leigh DS0000062769.V343234.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): 12,13,14,15,16 and 17. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. EVIDENCE: Each person living at the home has an activity timetable that provides a pictorial schedule of activities for the week. Staff confirmed that these were being followed. People were observed going out to local shops and for walks around the vicinity of the home. They said they enjoy going to day centres on a regular basis but were not attending college courses at present. One person had a work placement at a local old people’s home and said they looked forward to going there each week. Some people appeared to have the opportunity to go out with the support of staff but others spend time at home. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 13 Staff were observed providing arts and crafts activities during the visit and one person said they also enjoy baking. A number of staff commented in their surveys that they felt there should be additional funding for activities. Staff spoken with during the visit said that they were able to support people on activities and that transport had been an issue but a replacement bus with access for wheelchair users had resolved this. A healthcare professional also commented “staff sometimes find it difficult to help residents access leisure activities they enjoy because of staff resource problems.” The registered manager confirmed that due to the changing needs of one person who no longer wishes to go out of the home for activities, there had been an impact on other people living there. He was confident that this would soon be resolved. People said that they had enjoyed holidays earlier in the year and were looking forward to planning this year’s holiday. Minutes from house meetings that had been held every two or three months indicated that people discuss holidays and what they would like to do. A member of staff had attended training in activity programming and would be taking responsibility for this within the home. People’s daily diaries and timetables showed that they were being involved in activities of daily living such as helping prepare meals, wash up, help with the laundry and cleaning the house. During the visit people were involved in helping with the household shop. People were observed choosing how to spend their time and with whom. People have regular contact with family and friends. Dairies confirmed that they often visit their family or they come to the home to see them. Relatives commented “I speak to carers once a week”, “my son is non verbal so can’t phone us, but the care home send us newsletters and house magazines.” One person has a cat which lives with them in their self contained flat. A menu was displayed in the kitchen. This was produced in a mixture of text and picture. The registered manager said that each meal had been produced in photograph or picture to provide people with a visual prompt. People had two choices for each meal. Staff were advocating a healthy and nutritional diet for people providing fresh vegetables and freshly produced meals. Fresh fruit was available and people were observed helping themselves to drinks and snacks throughout the day. Some people choose not to eat a healthy diet and this was being monitored. People’s choice of meal was recorded in their daily notes. Monitoring forms were in place for people checking their fluid intake. At the time of the visit these along with guidelines for support provided to people whilst eating were displayed in the kitchen. Care needs to be taken with confidential information about people living at the home. Orchard Leigh DS0000062769.V343234.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 and 21. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are being met helping them to stay well. Their health and wellbeing are promoted by satisfactory arrangements for the handling of medication. Training for all staff in the safe handling of medication will ensure that systems remain robust. EVIDENCE: The AQAA states that “we provide service users with the personal support they require in their preferred way, meet the physical and health needs of the service user, the ageing, illness and death of any service user is handled with respect and as the individual would wish.” People’s individual support requirements were clearly detailed providing staff with guidance about how people would like to be supported. Their likes and dislikes were noted alongside “What to do” and “What not to do”. The pen picture supported these records and also provided peoples’ wishes in relation to dying. There was evidence that relatives had been involved in these discussions. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 15 Comprehensive records were in place providing evidence of appointments with a range of healthcare professionals including Doctor, Dentist, Optician, Chiropodist and the local Community Learning Disability Team (CLDT). Outcomes of each visit were recorded. This is good practice. Guidelines provided by the CLDT were in place with evidence that staff were monitoring people as had been requested. Comments from health care professionals indicated that whilst the “home is good at seeking advice. They need continual support to act upon advice given”. Another comment noted, “They work together as a team to give consistent care”. One person had been diagnosed with Alzheimer’s disease. Their care plan had been adjusted accordingly and the relevant professionals involved in their care. The home were committed to supporting this person as long as they were able but had acknowledged that long terms plans needed to be agreed with the placing authority. Medication administration systems were examined and found to be satisfactory. Consent to having medication administered by staff was recorded in care plans. Medication was being supplied in a monitored dosage system that could be taken away from the home when needed to ensure the safety of each person. Relatives were signing records to confirm receipt of medication. The registered manager stated that some staff had attended accredited training provided by a local pharmacy. In addition to this all staff were audited on a regular basis by the home to check their competency. All staff administering medication must complete accredited training in the safe handling of medication. The temperature of the medication cabinet was not being monitored. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are confident in the knowledge that any concerns they may express will be listened to and acted upon. Systems are in place that safeguard people from possible harm or abuse. EVIDENCE: The home has a complaints policy and procedure which was accessible to people living at the home. Voyage had provided a leaflet “Letting us know what you think” giving information in text and picture for people and their relatives. One relative indicated that they were not aware of the complaints procedure but others were. The home had received two complaints over the past twelve months and full documentation was available. People living at the home also had the opportunity to express any concerns at house meetings. The AQAA indicated that staff have access to training in safeguarding adults and to copies of the local procedures. Staff were also completing training in non violent crisis intervention. Discussions with staff confirmed their understanding of abuse and how to safeguard people. They also confirmed that physical intervention was not used in the home. Behaviour guidelines were in place, which had been agreed with a Behaviour Specialist employed by Voyage. Healthcare professionals raised concerns that there were no processes in place for the Behaviour Specialist to liaise with the local Community Learning Disability Team. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 17 There was no evidence that staff had received any information or training in relation to the Mental Capacity Act. Staff support people to manage their personal finances and this was noted in their care plans. Financial records were examined and daily checks were observed to be taking place. Numbered receipts were kept for all purchases and debits on the financial records could be cross-referenced with these. . Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 18 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, 29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: People living at Orchard Leigh have access to accommodation of a high standard. Two people have self-contained flats and others have double rooms which they have furnished and decorated to reflect their interests and lifestyles. A maintenance programme was in place for day-to-day repairs and long term redecoration as and when needed. Carpets in parts of the home were in need of attention before they become a hazard to people living there, several were threadbare in parts. Communal areas were pleasantly decorated with good use made of personal photographs and framed paintings produced by people living at the home. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 19 People were observed choosing where to spend their time whether in their room, the lounge or dining room. The grounds around the home were well maintained providing decking with a seated area. Where needed specialist adaptations or equipment have been provided after consultation with the Physiotherapist and Occupational Therapist. These included a hospital bed, bath/shower seat and cutlery/crockery. Paths and ramps outside the home were wheelchair accessible. At the time of the visit the home was clean and tidy. Communal toilets and hand washbasins were provided with liquid soap and paper towels. Hazardous products were locked securely and data information sheets were in place. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 20 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): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staff team need to have access to a satisfactory training programme that provides them with knowledge and skills about the diverse needs of people living at the home. Improvements in recruitment and selection procedures will ensure that people are being safeguarded from possible harm. EVIDENCE: The staff team have had some changes over the past twelve months with new staff joining the existing team. They have a range of skills and experiences with some staff having considerable experience in this area of care and others being new to the profession. Conversations and observation of staff indicated that they were developing an understanding of the needs of the people they support. However some additional specialist training in Autistic Spectrum Disorder and Dementia appeared to be required. Comments from healthcare professionals also verified training in these areas was needed. The registered manager confirmed that a healthcare professional had provided some training in dementia care. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 21 Comments received from relatives indicated, “we are happy with the high standard of care provided”, and “we are very happy with the carers”. A person living at the home also stated, “all the staff are nice to me”. The NVQ programme was not fully operational. The registered manager said that he and the deputy manager were planning to become assessors and would then share responsibility for those staff waiting to register for their awards. The AQAA indicated that 33 of staff had a NVQ Award. Recruitment and selection files were examined for three new members of staff. A copy of the agreement between Voyage and us about the storage of this information was in place. A summary sheet was being used for each person providing information when records had been received. Each person had an application form, two of which had gaps in their employment history. Two written references from previous employers had been provided for each person although these were not seen. They were stored at head office. Likewise Criminal Records Bureau checks were not seen but records confirmed that staff had not been appointed until after these had been received. Proof of identity and a current photograph had been obtained. The registered manager was keeping a training matrix providing confirmation of staff training over the past year. Staff verified that they had an induction booklet to complete which follows the Skills for Care Foundation Programme and that they also had access to the Learning Disability Award Framework. Copies of certificates were being forwarded to Voyage to keep centrally. The AQAA confirmed staff have access to this training as well as mandatory training but also identified increasing the range of training courses available. The training matrix indicated that two staff had completed training in epilepsy and that mental health and equal opportunities training were still to be provided. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 22 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): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from a well run home. Effective quality assurance systems are in place involving people who live there. Satisfactory health and safety systems are in place providing a safe environment. EVIDENCE: The registered manager has a Registered Managers Award and NVQ in Health and Social Care at Level 4. Staff said he was approachable and supportive providing hands on care when needed. He said that he was aware that communication with the staff team was important and that team meetings could be held more frequently. One survey from a member of staff indicated that communication between management and staff could be improved but others were satisfied with the flow of information within the home. The AQAA stated that people are provided with “ a well run clean and safe environment Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 23 with an effective manager who respects the individual’s rights and ensures their best interests are safeguarded”. Voyage have a robust quality assurance system in place which includes regular unannounced visits to the home by a representative of the organisation. Written reports were being produced. Regular quality audits were being conducted and an annual quality assurance report was being produced which included views from people living at the home. The manager was also sending out comment forms to relatives on a regular basis to ask for feedback about the service provided. A newsletter was being produced periodically and sent to relatives. A relative said, “We are very happy with the high standard of care”. Another relative commented that “improvements in anything is always possible and it appears that every attempt is made by the Managers and staff to provide this”. Systems monitoring health and safety processes within the home were in place. Monthly health and safety audits were being completed to check that these were being done. Fire and environmental risk assessments were in place. Fire systems were being checked in accordance with the risk assessment and fire drills taking place. The registered manager said that he was planning a nighttime fire drill. Good food hygiene practice was observed to be in place. Staff confirmed that they complete mandatory training and had access to an open learning system for refresher courses. The AQAA confirmed documents seen in the home that servicing of equipment and utilities were taking place. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 24 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 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 X X 3 X Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 17(1)(b) Requirement Confidential information about people living at the home must be stored securely and not displayed in communal areas. This is to ensure that information about people is treated with respect. Medication must be administered safely. Staff must have access to accredited training in the safe handling of medication. Carpets in the home must be kept in a good state of repair to safeguard people from possible harm. Staff need to have information and increased awareness about the needs of people with dementia and autistic spectrum disorder. This is so that they can understand the needs of people they support. AA full employment history must be provided and any gaps in employment history for new staff must be verified. This is to safeguard people from possible harm. Training needs to be provided to staff as identified in the text to DS0000062769.V343234.R01.S.doc Timescale for action 31/12/07 2. YA20 13(2) 31/03/08 3. YA24 23(2)(b) 30/06/08 4. YA32 18(1)(c) 31/03/08 5. YA34 19(1)(b) Sch 2.6 31/12/07 6. YA35 18(1)(c) 30/06/08 Orchard Leigh Version 5.2 Page 26 ensure that staff acquire the necessary skills and knowledge needed to support people living at the home. 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. 3. 4. Refer to Standard YA20 YA22 YA23 YA23 Good Practice Recommendations The temperature of the medication cabinet should be taken and recorded to ensure that medication is stored below 25°C. Relatives should be reminded about the complaints procedure periodically. Staff should receive information about the mental capacity act. Systems should be put in place to enable liaison between the Behaviour Specialist and CLDT to ensure a consistent approach. Orchard Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Leigh DS0000062769.V343234.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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