Care Home: Rose Orchard

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What the care home does well The service user guide is written in a way that makes it easier to understand so the people living there know what is provided for them at the home. Care plans have a personal profile of the daily routine and show how people like things to be done and at what time. This makes their plan more personal to them. Health plans hold a wealth of information in meeting people`s complex medical and physical conditions. Excellant staff practices were also observed in relation to meeting a person`s health needs which showed patience and compassion. There is a small core team of staff who knows people well. They provide some consistency and have positive relations with individual`s. Staff recruitment is also being sustained and improvements were noticed since we last inspected the home. A proactive approach is taken by staff to ensure that the health and wellbeing of people living in this home is maintained in a timely and consistent way.The registered manager is promoting practices within the home in relation to the provision of end of life care and recognises the importance of developing plans in a sensitive but timely manner. This ensures people wishes are known and carried out when the time comes. People are supported to keep in contact with their family and friends and staff know that these relationships are important to them. Although it is sometimes difficult in supporting people in achieving their ambitions and aspirations staff are trying so that individuals goals are being aimed for thereby making life more meaningful to people regardless of their abilities. Redecoration has taken place and people have been able to choose colour schemes and these reflect individual`s own personality and interests which makes their rooms personalised, stimulating and relaxing. All staff have achieved their NVQ Level 2 which exceeds the recommended expectations and means people are cared and supported by a knowledgeable and skilled staff group that understand their individual needs. There is a newsletter that keeps people updated and promotes involvement of all people in life within the home. What has improved since the last inspection? Tiles needed to be replaced in shower room around the toilet, where they were cracked and loosened which has now been completed which reflects that the home continues to be well maintained. What the care home could do better: All `when required` medications need to have appropriate information in written individual protocols so that staff have all the directions that they require, such as, how to use the medications and when to use. This should also be used as a tool for monitoring these types of medications. To detail whether people who live in the home choose to be assisted in respect of their personal care tasks by a female or male staff member so that people feel comfortable and have their goals met within their preferred way. Consideration should be made to recording fresh fruit that is offered to people on a daily basis to fully support the recommended `five a day` so that people are being encouraged to eat healthy and nutritious diets. To further pursue people`s religious, spiritual and cultural needs and consider reviewing these in case people change their minds as time goes by. Key inspection report Care homes for adults (18-65 years) Name: Address: Rose Orchard 7 Baxter Avenue Kidderminster Worcestershire DY10 2EU The quality rating for this care home is: three star excellent 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: Sally Seel Date: 2 2 0 1 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 37 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 © (2010) 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 37 Information about the care home Name of care home: Address: Rose Orchard 7 Baxter Avenue Kidderminster Worcestershire DY10 2EU 01562750375 01562750375 info.baxteravenue@praxiscaregroup.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Praxis Care Group care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home with Nursing (Code N) 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) 5 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home Rose Orchard is a spacious purpose built bungalow close to the centre of Kidderminster. It is a home for people with both learning and physical disabilities. The home aims to provide nursing care and appropriate support to meet the needs of people who use this service. Specifically this will include promoting independence and opportunities to make real choices in every day life. The registered manager is Anita Cant. Praxis Care Group is the registered provider, and the Director of Care Irene Sloan is the Responsible Individual. Praxis Care Group became the registered provider on 1st April 2006. Interest parties should contact the registered manager at Rose Orchard to gain correct information in relation to the fees charged to live at the home. Charges which are additional to the fee include: Personal toiletries, clothing and electrical items (TV and music centre). Activities not covered by the allowance made by the provider or in the funding authority contract Holidays Major extra outings Hairdressing Reflexology Beauty therapy. Care Homes for Adults (18-65 years) Page 5 of 37 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: three star excellent 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 Care Homes for Adults (18-65 years) Page 6 of 37 How we did our inspection: This is what the inspector did when they were at the care home This was an unannouced key inspection that took place on the 22nd January 2010 over one day by one inspector. The purpose of this inspection is to look at all areas of the service to ensure that the outcomes for people living there is good, safe and appropriate. T his inspection also enables us to ensure that the service runs according to legislation and regulations. During the visit we case tracked two people; this involves reading their records, discussing their care with staff as people who live in this home have limited communication abilities. We also looked at policies and procedures related to safeguarding, concerns and complaints and medication. Any new policies and procedures were also examined. Discussion with team leaders, health support workers, student on placement at the home aswell as the person who drives the homes vehicle. Where appropriate information from these discussions have been referred to. The manager also supplied us with an up dated Annual Quality Assurance Assessment (AQAA). Each registered service is required to submit an AQAA each year, this is a form of selfassessment. Information from this has been used in the following report. During the process of the inspection we viewed a variety of areas of the home including, Care Homes for Adults (18-65 years) Page 7 of 37 dining/lounge areas, other communal areas, such as, toilets and bathroom, private rooms of the people who live there and the garden. We would like to thank the people who live at Rose Orchard and staff members for their help and cooperation throughout the inspection process. What the care home does well The service user guide is written in a way that makes it easier to understand so the people living there know what is provided for them at the home. Care plans have a personal profile of the daily routine and show how people like things to be done and at what time. This makes their plan more personal to them. Health plans hold a wealth of information in meeting peoples complex medical and physical conditions. Excellant staff practices were also observed in relation to meeting a persons health needs which showed patience and compassion. There is a small core team of staff who knows people well. They provide some consistency and have positive relations with individuals. Staff recruitment is also being sustained and improvements were noticed since we last inspected the home. A proactive approach is taken by staff to ensure that the health and wellbeing of people living in this home is maintained in a timely and consistent way. Care Homes for Adults (18-65 years) Page 8 of 37 The registered manager is promoting practices within the home in relation to the provision of end of life care and recognises the importance of developing plans in a sensitive but timely manner. This ensures people wishes are known and carried out when the time comes. People are supported to keep in contact with their family and friends and staff know that these relationships are important to them. Although it is sometimes difficult in supporting people in achieving their ambitions and aspirations staff are trying so that individuals goals are being aimed for thereby making life more meaningful to people regardless of their abilities. Redecoration has taken place and people have been able to choose colour schemes and these reflect individuals own personality and interests which makes their rooms personalised, stimulating and relaxing. All staff have achieved their NVQ Level 2 which exceeds the recommended expectations and means people are cared and supported by a knowledgeable and skilled staff group that understand their individual needs. There is a newsletter that keeps people updated and promotes involvement of all people in life within the home. Care Homes for Adults (18-65 years) Page 9 of 37 What has got better from the last inspection What the care home could do better All when required medications need to have appropriate information in written individual protocols so that staff have all the directions that they require, such as, how to use the medications and when to use. This should also be used as a tool for monitoring these types of medications. To detail whether people who live in the home choose to be assisted in respect of their personal care tasks by a female or male staff member so that people feel comfortable and have their goals met within their preferred way. Consideration should be made to recording fresh fruit that is offered to people on a daily basis to fully support the recommended five a day so that people are being encouraged to eat healthy and nutritious diets. To further pursue peoples religious, spiritual and cultural needs and consider reviewing these in case people change their minds as time goes by. Care Homes for Adults (18-65 years) Page 10 of 37 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sally Seel 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 set out 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 11 of 37 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 12 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people who come to live at Rose Orchard are given plenty of information which is readily available together with options to visit and stay overnight so that people are able to decide whether it is the right place for them. The needs of each person are fully explored so that they can be assured that staff are able to meet these before they move into the home. Evidence: The statement of purpose and service user guide have lots of information about what the home is like and how peoples needs would be met if they chose to live at Rose Orchard. We looked through the statement of purpose and service user guide. We saw that they had both been reviewed with dates when this happened so that all information given actually reflects a true picture of the facilities on offer within the home, staffing details and their qualifications and the complaints procedure. The statement of purpose does have information about what items are included within the fees charged for living at the home but there are no ranges of the fees actually confirmed within the statement of purpose so that people are able to consider these before moving into the home. We are told that the fees charged for living at the home are given in each persons conditions of residency. On looking in care records we found this to be the case but in one persons Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: records their conditions of residency had not been signed. Staff were aware of this and action is being taken to make sure that the persons representative signs this document to state their agreement to the contents. We were told that the service user guide is readily available in easily understandable formats, such as, using pictures and symbols to illustrate the written word and audio tape. We saw that the service user guide which can be found in the reception hallway of the home is produced using pictures and symbols. This is important as people considering living in this home would not have the abilities to make sense of what the home could offer and or how their needs will be met if these information guides were only produced in the written word. In the AQAA it says that a person has their service user guide in their bedroom in an audio tape version to suit their particular needs. This makes sure that people of differing abilities should be able to understand the contents to aid their decision making about whether to live at the home. We saw that the homes registration certificate is displayed so that people can see at a glance that it provides nursing care to five people with learning disabilities. Currently there are five people living at Rose Orchard, three females and two males. We also saw displayed the homes public liability insurance certificate. We looked at one persons admission processes into the home and we saw that their care and support needs had been fully identified, such as, personal care, health needs, mobility aids, eating and drinking requirements and social interests. It was positive to see that the person who assessed this persons needs made sure that they collected other professionals view points and background accounts so that this could inform holistic care plans when the person moved into the home. This demonstrates that this person did not move into the home until it was guaranteed that the homes facilities, staffing numbers, skills and qualifications meant that their full range of needs would be able to be met in a consistent and safe manner. On the day we visited we spoke to a mixture of staff that provides care and assistance to people at Rose Orchard. We spoke to the, team leaders, staff that supports people with their daily tasks and interests together with a staff member that drives the homes vehicle. Full discussions with people living at the home were not appropriate. Therefore our observations and discussions with staff will be referred to throughout this report. Care Homes for Adults (18-65 years) Page 14 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans promote the strengths of each person together with what support each person needs from staff to maintain their safety without unnecessary restrictions placed upon peoples daily life choices. Evidence: Each person has a range of care plans that provide staff with information about what people can do, where people may need assistance and support to live each day as they choose. We looked at the care plans of two people and found these contained detailed information to enable staff to meet peoples needs. Areas included, daily preferred routines, personal care, communication, family contact, making choices, meals, behaviour, health, activities and cultural needs. Person centred care was promoted within each care plan which means that people living in the home and or their representative were having their say on how and when their care needs will be met. These could be further enhanced by considering gender specific care. We did see in one care plan that a persons choices were for a female member of staff to assist and support them but did not see this in the other persons care records we looked in. We are confident that the registered manager will continue to maintain the ethos of person centred planning which Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: makes a difference to how people are supported within their daily routines as they have told us in the AQAA that the following improvements will be made:To provide an appropriate format for sharing the results of our Dignity Audit to Service Users and relatives which can be incorporated into our next quarterly Newsletter. To continue to develop service user and communication plans to ensure service users their carers and advocates are involved in developing our service. To further develop support plans covering individual needs and choices. People living in the home have key workers and co-keyworkers. These are members of staff that build close relationships with individuals. This means key workers become knowledgeable about a persons practical, health, social, emotional and psychological needs to ensure support and care offered in these areas is consistent in acknowledging individuals preferences. Also people are able to share any issues and or concerns they may have in the presence of a staff member they feel comfortable with. When speaking with staff members, positive comments were made about the care that people receive within this home. These included, We understand service users needs and We are all trained about the service users needs and We know how to support their needs. Positive comments were also made by the registered manager who confirmed in the AQAA their approach to ensuring individual needs are met whilst retaining peoples independence by confirming, Decision making is incorporated into the everyday lives of service users by the use of available and appropriate objects of reference, picture cards and speech with gestures. We sampled risk assessments in the care files we looked at. We found that people are supported to take manageable risks, and individuals are encouraged to have an independent lifestyle. Assessments were up to date and included epilepsy, moving and handling, bathing and any social risks. These stated how staff are to support individuals to minimise the risks involved. For example, the moving and handling assessments held detailed instructions which named the precise equipment and aids that would be required for each person so that all equipment was relevant to that persons weight and height. Risk assessments are reviewed monthly or as required to make sure they continue to be relevant and or to reflect any changes. This process ensures that all staff viewing risk assessments have up to date information to hand so that people in the home are protected from harm. Each person who lives in the home has daily records which provide very helpful information about peoples ongoing lives, their health, welfare and progress and show their plans are being followed. Also staff hand over information about how people who live in the home spend their day, when staff change shift, to their colleagues. This information sharing is in relation to people living in the home and describes life events, their behaviours, moods, health problems and activities taken part in. This makes sure that people are receiving consistent care and any difficulties are resolved in a timely manner. Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: We saw that meetings are held with other professionals when decisions need to be made in relation to the areas of peoples lives. Some of these meetings are held to look at any difficulties people who live in the home may be experiencing which could be health related issues and or behaviour difficulties. This demonstrates that where required the registered manager and staff are proactive in seeking help and guidance to ensure peoples needs are met in all areas of their lives by professionals who have knowledge in a particular subject area. We were told that people who live in the home are able if they choose to attend team meetings. We were also told and shown that surveys are given to people who live in the home, family members and external professionals. The information received by the registered manager is then used to improve practices and facilities within the home so that people who live there are placed at the heart of what needs to happen within their home and what is really good. Care Homes for Adults (18-65 years) Page 17 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With continual review and hard work staff try to enable people to experience a range of activities which are a reflection of peoples individuality and independence. Further improvements should be considered in meeting peoples relgious, spiritual and cultural needs. Family and friends are always made welcome at the home and staff help people to keep in touch with any events that take place in the home. Meals are varied and choices are given so that people are able to enjoy their food. Evidence: The registered manager and staff are working hard to provide people at the home with good opportunities to experience activities both within the home and the community. The activity planners told us that the interests followed in the community range from, drama, concerts, shopping, art and crafts, day centre, work in a library, picnics and so on. It was positive to note that a person centred approach is being weaved through activities offered. For example, one person really likes to go and watch their football team; this is Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: fully supported and encouraged by all staff including the driver of the homes vehicle. The day we visited some people went shopping in the homes vehicle which they seemed to enjoy. A person who is a music therapist was visiting the home on the day of the inspection. The daily records we looked at told us that people are also encouraged and supported to participate in, hand massages, enjoyed mince pie making, had a relaxing hydro bath, helped with laundry, did some drawing and colouring, household chores and attended team meeting and so on. The AQAA also tells us that, Staff have a good understanding of service users communication styles and when they are expressing that they wish to have time alone. This is respected by staff, immediately supporting service users to their rooms. This shows that each persons own preferences are known and observed at all times so that they are supported to lead their own lifestyles. We are confident that the registered manager will continue to strive to improve the range of activities that people who live at Rose Orchard are able to take part in. In one persons room we saw their life story book (My Life) which provides valuable information about a persons background, family, friends, interests and so on. These provide talking points and enable this persons likes and dislikes to be explored using another information method that is meaningful to people. This is also particularly important when recording individuals cultural and spiritual needs. However, it was unclear as to what provision is made for people to attend their preferred places of worship and or visits by a representative from their individual faith. Some staff spoken with could not clearly state whether any representatives from peoples own cultural faith visit the home. Consideration should be made at times of reviews that staff can be prompted to ask people again about meeting their cultural and spiritual needs in case in time they change their minds. It needs to be acknowledged that the registered manager is aware of the improvements that could be made in relation to meeting peoples cultural, religious and spiritual needs. For example, we saw information about a persons faith and cultural to inform staff knowledge in this area. Also the AQAA states, Staff to receive training in cultural and religious needs. Race equality training. Daily records and care records sampled show contact with family and friends are supported. One person is being supported to send letters and photographs to their parent so that relationships important to people are strengthened. One person has shared care which is provided by staff at the home and their own family members when they go home to spend some time. Relatives are also invited to review meetings where appropriate. We were told that there are regular parent and carer liaison meetings and we looked at records which confirmed this is the case. This practice ensures good communication links are maintained with relatives and is person centred led. We were shown daily records of what people eat and these reflected that meals are varied. We also saw that although there are no choices on the menus for the main meal of the day which is offered in the evening. However, it was confirmed by all staff spoken with that people can have choices on any given day if they do not want the meal on that day. This was also confirmed in the daily records of what people eat. This shows that meals are given in a flexible way and in Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: line with what people want on any given day. Any dislikes and likes in relation to eating meals was recorded which included any aids needed to assist people to be as independent as possible when eating their meals. We saw main meals of, savoury mince, baked potatoes, gravy, sausage and mash, peas, fish, chips and mushy peas, pork loin chops, mixed vegetable bake etc. The AQAA confirms, Service users are offered a varied and well balanced diet within a relaxed environment. Meal times are flexible around the needs of the service user. Service users are supported by sufficient carers to maintain their safety whilst eating. It was positive to see that daily vegetables that people eat. We saw puddings ranged from, angel delight, rice pudding, apple pie and custard, ginger cake and custard, trifle, cheese cake and fruit crumble and cream etc. Further consideration should be given to always recording of fresh fruit portions people are offered and eat on a daily basis. By doing this in practice would make sure people are receiving their recommended five a day to promote healthy and nutritious diets. This was mentioned to staff at the time of our inspection visit and we were shown tins of fruit in the cupboard. We were told that pictures of meals are used to aid menu planning and that two people who live in the home help with planning the meals for the week with support from staff. The environmental health officer visited the home recently and awarded five stars which is the highest grade given to reflect the high standard of kitchen and food hygiene practices within the home. Staff told us:- Care Homes for Adults (18-65 years) Page 20 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is supported with their health and personal care with their choices and rights respected in these areas. Medication is being managed in a safe way by knowledgeable staff in order that people get the right medication at the right times. Evidence: In the AQAA the registered manager confirms, The home works in conjunction with other professionals as required by service user need i.e. Physiotherapists, occupational therapists, Dietician, NHS healthcare facilities e.g. Dentist, Optician, podiatry, Diabetic specialist nurse. We found this to be true as care plans and health action plans provide some complex information about individuals past and present medical conditions. We saw communication and appointments attended with peoples doctors, psychiatrists, dieticians, physiotherapists etc. This reflects that people living in this home can be confident that their health needs are being consistently met, reviewed and promoted. Weight records showed that staff were regularly checking peoples weight to ensure they are not losing or gaining a significant amount of weight that could be an indicator of an underlying health need. This is particularly essential for people who have limited communication and would not be able to always express if they are unwell. Satisfactory plans were seen to be in place in one care record that we looked at in Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: relation to providing staff with information to manage a persons epilepsy with types of seizures noted together with timescales. We also observed staff practices in relation to the care they provided to a person who requires a lot of nursing attention. This was done with patience, respect and compassion which assist people in maintaining a good quality of life even through their complex medical and physical conditions. Staff should be commended for their practices in this sensitive area and the care plans were also very detailed for this person to make sure all their personal and health care needs could be exactly met. We observed and spoke to some staff which confirmed that all personal care is given in private to promote dignity for all people who live at Rose Orchard. Care plans sampled included information for staff on how to support individuals to meet their personal care and health needs. The people living there were well dressed in good quality clothes that were appropriate to their age, gender and the activities they were doing. There were examples on the care records of what individuals could do independently whilst carrying out their personal care tasks. For example in one care record it was documented, I then go into my bedroom and have my hair blow dried and styled, then I have some perfume on and choose jewellery. This means people are able to be supported to retain their own personal tastes which reflect their personalities. We saw communication plans are in place so that staff have guidelines in relation to peoples preferred communication styles, such as, the use of gestures, sign language, using objects, pictures and symbols for reference purposes. From looking at care records we also saw that descriptions are provided which give staff clues about how people express their emotions through their own body language which includes signs of pain. We observed staff communicating with people who live in the home and this was done with patience in a respectful manner. Staff who administer medication are registered nurses. We sampled some peoples Medication Administration Records (MARS) and found that these were satisfactorily completed to ensure people living in the home receive their correct prescribed medication at the right time. Where people are prescribed PRN (as required) medication a protocol must be in place stating when, why and how this should be given. We were told that there were no individual PRN protocols in place but we have now made this a requirement so that this information is recorded for all staff to follow consistently. At the time of our visit peoples medication was stored appropriately. There is appropriate storage for controlled drugs but we were told that none are prescribed to people living in the home at this time. We were told that one persons end of life care planning is going to be arranged to be completed so that the wishes of people and their family is respected and action replicates the plans made. The registered manager has also completed a Diploma in Professional in Palliative Care which further shows their commitment to this important time in peoples lives. Page 22 of 37 Care Homes for Adults (18-65 years) Evidence: Care Homes for Adults (18-65 years) Page 23 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is comprehensive and is accessible to people should they need to make a complaint. There are systems in place to ensure people are safeguarded and protected from harm. Evidence: We were told that there have been no complaints made in the last twelve months and this is also confirmed in the AQAA. The Care Quality Commission (CQC) have also not received any complaints and or concerns. An easy read complaints procedure is available to each person who lives at Rose Orchard making it more accessible for people with communication support needs. This included the relevant and required information so it was clear how people could make a complaint if they are unhappy with the service provided at the home. The levels of learning disability of most of the people living in this home indicate that they would require a great deal of support or advocacy to ensure their rights are protected. Therefore the one to one time that people have with their keyworkers is important as people are able to comfortably raise any concerns and or complaints knowing these will be listened to and action is taken appropriately. The AQAA also tells us, Two service users are able to communicate, at their own level and pace if they are happy or not. This is supported and encouraged. This reflects that people who live in the home are listened to and actions taken where necessary. As mentioned previously in this report there are parent and liaison meetings and we saw Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: in the care records we looked at that relatives are invited by letter to these meetings. So that family members are be able to discuss any complaints and or concerns they may have. We were told that there are staff meetings where individuals are able to share any complaints and or concerns they may have. We saw the results of surveys that have been given to people who live in the home and their relatives to see if individuals are happy with the running of the home and staff care practices. In the AQAA it is confirmed that there have been no incidents of alleged or actual abuse reported. The registered manager informed us that all staff working at the home receives adult abuse training on a yearly basis which is also confirmed in the training matrix that we looked at. Staff members spoken to on the day of our visit were able to describe the actions that they would take if they witnessed any form of abuse. The AQAA tells us that one of the improvements for the next twelve months is for staff to receive awareness sessions in relation to the Deprivation of Liberty Safeguards (DOLS). It is important for staff to have this shared knowledge when supporting people who have learning disabilities. This is because DOLS examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. As was found at the previous inspection there are relevant financial policies and procedures in place to make sure the money of people living in the home is kept safe. Two individuals monies were audited and the amounts remaining tallied with all balances and receipts. We sampled two staff records and found that appropriate recruitment and selection checks have been followed. This means that the systems in place for the recruitment of new staff are generally satisfactory which is discussed further in the staffing standards of this report. Care Homes for Adults (18-65 years) Page 25 of 37 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. People who live in this home are provided with a homely, clean environment, with aids and equipment in place to ensure peoples independence, dignity and safety is promoted. Evidence: Rose Orchard is situated in a residential area and is situated off the main road of houses. Some people who are not familiar with the area could possibly have some difficulties in finding the home as there are no visible signs from the road area to show people where Rose Orchard is. Staff are aware of this. As at the previous inspection we were shown around the home. Rose Orchard is a spacious purpose built bungalow, with five bedrooms, two bathrooms, separate toilet, laundry and fully fitted kitchen. There is an open plan dining room and lounge with sliding doors to separate the rooms if required. The home has been redecorated throughout and on the day we visited one persons room had just been finished. We noticed that although Rose Orchard is a nursing home the registered manager and staff have managed to create a pleasant and homely place for people to live which is not overly clinical and or intuitional. We saw that the environment is all on one level and various types of equipment and aids were observed. For example, Arjo hoists, tracking hoists, specialist bath and beds, and wheelchairs. Where needed people are assessed by physiotherapists and occupational Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: therapists so that their physical abilities and independence can be promoted giving them more freedom in their home. We were shown some of the bedrooms and found these to be nicely decorated to reflect individuals chosen colour preferences together with their own personal tastes. For example, we saw that peoples furniture was all differently designed and looked well made, ornaments and items, door name plaques that held meaning to each person. Relaxing light objects were also seen in peoples rooms. This demonstrates that peoples rooms reflect a relaxing and calming atmosphere where people can gain a sense of belonging. The lounge area has been redecorated and part of it has comfortable settees and chairs for people to sit and relax and or watch some television as they choose. On the day we visited we saw people using the lounge as they chose. In the other part there is a table and chairs so that all people can eat their meals here if they wish. The kitchen area looked clean and well organised. We were told and saw that the home have been visited by the environmental health officer who awarded five stars which reflects excellent hygiene practices are maintained within this home. Certainly on the day we visited there were no malodours and staff spoken with assured us that this is always the case. There are toilets, bathroom with bath or shower so that people can choose how their personal care tasks are completed. At the last inspection it was recommended that, Tiles need to be replaced in shower room around the toilet, where they have cracked and loosened. We saw that these tiles have now been replaced. The bathroom looked clean and had appropriate hand wash facilities such as liquid soap and paper towels so that staff could follow good infection control methods. The rear garden is well laid out in relation to its design which is fully enclosed, secure and safe. We were told that this is actively used in the warmer months as people chose. We saw raised beds bird table, shed which is used and a swing which is designed to take wheelchairs. We were told that the homes environment will continue to improve and change where necessary so that people living there will be reassured that their home can meet individuals needs to include their physical and emotional wellbeing. The AQAA tells us that the, Management and staff pride themselves on a clean, happy and friendly environment for service users and visitors alike this is evident from comments received from family members and professionals. The AQAA also highlights that staff have received training in infection control as discussed further in the staffing section. On the day we visited we found the home to be clean, hygienic and tidy and provides a homely and welcoming environment to live in. Care Homes for Adults (18-65 years) Page 27 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are enthusiastic, caring and work hard to provide individual care to people. The homes recruitment practices keep vulnerable safe and staff are well trained which enhances their knowledge in respect of meeting individuals needs. Evidence: On the day we visited we observed staff helping people where necessary in a respectful manner. We were shown the staffing rotas and told by staff that individuals needs are met appropriately by the numbers of staff on duty at any given time. We were told that there is one staffing vacancy. The rotas do not show any staffing levels falling below what the home confirmed with us. We observed staff interacting with individuals in an unhurried manner and any tasks were completed which further confirms that staffing levels seem to be appropriate for the five people living in the home at this time. Staff recruitment seems to have improved since we last inspected the home. Therefore the staffing group seems to be more stable and we saw that the registered manager tries to cover gaps in the rota with relief staff that work at the home on a regular basis. We also spoke with a member of staff who provides some relief cover at the home and has done this for the last two years. This means that people who live in this home have consistency in the support they receive due to building familiar relationships with staff. Staff told us:I have learnt so much. Always encouraged to attend training course. The registered manager has demonstrated that they are open and transparent in relation to staffing levels in the home. For example, they have acknowledged in the AQAA that there has Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: been some staff sickness which has required managing but they have said, Absences have been covered with a consistent core of agency staff or by regular staff fulfilling extra hours to promote consistency of care. Three staff records were sampled and we found appropriate recruitment documentation, such as, Criminal Record Bureau (CRB) checks, and completed application forms. Records included two written references for each person and a copy of an application form. This demonstrates that the registered manager has carried out appropriate checks to make sure staff employed by them are suitable to work with vulnerable adults. The AQAA confirms that fifteen members of staff have achieved their National Vocational Qualification, (NVQ), Level 2 in Care. This exceeds the standard of 50 . We were alsom made aware that some staff are progessing with the NVQ Level 3 which shows positively that training is progressed beyond the recommended standards. The AQAA also confirms, The home facilitates a learning and training environment, which reflects on the staff team being skilled, Knowledgeable and committed to providing a high standard of care to service users. We found that the training matrix tells us that staff have been maintaining their mandatory training in health and safety, moving and handling, food hygiene, safe handling of medications, COSHH (Control of Substances hazardous to Health), first aid, infection control, Protection of Vulnerable Adults (POVA) and fire training. It was positive to find that some staff have received specialist training in order to meet individuals needs, such as, safe use of wheelchairs, continence care, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguarding (DOLS), dignity and respect, epilepsy, hydration and nutrition, palliative care needs, risk assessments, and equality and diversity. This ensures that people living at Rose Orchard can feel confident that the care and support they receive is provided by a skilled and knowledgeable staff group. On the day of inspection we spoke with a person who has started their student placement at the home and they were very complimentary in their responses about how staff have supported them. This person also told us that before they came to the home to undertake their placement they visited the home for the purpose of meeting the people who live in the home. They told us that, There is lots of time for interaction between residents and staff. There is a routine but not really as daily tasks happen when a person is ready. The home is not institutional and routines are very flexible. Staff told us:- All aspects of the home give good outcomes cant think of anything bad. It is a really good care team. They try their best. Staff are friendly. I feel people are very well looked after. We are a happy team. Care Homes for Adults (18-65 years) Page 29 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements ensure that the home is run in a way that benefits the people living there and promotes their best interests. Evidence: As at the previous inspection Mrs. Anita Cant is the registered manager of Rose Orchard and is registered with CQC in this role. In the AQAA it tells us, The Manager is a Registered Nurse in Learning Disabilities who has over 30 years experience of meeting the needs of the service user group and has Managed the home since May 2005. The manager has a qualification in Teaching and assessing in Clinical practice, this assists with developing the knowledge and skills of the staff team. Also, promotes a teaching and learning environment which influences practice. The Manager is an NVQ assessor (active) and verifier (not currently active) which supports staff within the home to gain their competencies when working toward achieving their NVQs. The Manager has a Diploma in Epilepsy Care which supports providing a competent service to those service users with Epilepsy. The Manager has a Diploma in Palliative care which supports the meeting of the palliative needs and end of life needs of service users in the home. We also saw on the Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: training matrix that the registered manager keeps up to date with all mandatory training courses to ensure that their skills and knowledge is constantly updated so that they are able to effectively manage Rose Orchard. Staff spoke to seemed happy with the registered manager and the way the home was run. On the day we inspected the home the registered manager was on annual leave but we were fully assisted by the team leaders who were on duty on the day. Team leaders are registered nurses as discussed previously in this report and part of their roles involves being keyworkers to people. There are six team leaders who assist the registered manager in the day to day running of the home. For example team leaders, organise activities, promote health and safety in everyday practices, supervision of staff, induction of staff, and facilitating the skills of staff which benefit the delivery of care and support to people who live at Rose Orchard. The registered manager has shown throughout the AQAA that they are open and transparent in relation to what the home could do better together with plans for improvements in the next twelve months. For example the registered manager provides us with some of their plans for improvements:To review Risk assessment formats by introducing HSE Five Steps to Risk Assessment. To write a summary of the views of service users and their representatives following feedback received from surveys sent out. Produce an operational/service plan for 09-2010 to identify improvements and comply with quality assurance. We saw from the staff rotas that the registered manager does some hands on work. This demonstrates that the registered manager is able to observe and be physically part of everyday staff practices so that they gain a visual sense of what is working well and what could be improved upon for people. This practice can also assist when appraising staff and for staff meetings. We were told that staff meetings take place regularly which provide staff with the chance to celebrate their working practices both the negatives and the positives so that people living at Rose Orchard gain good outcomes. The Regulation 26 visits are completed by a person chosen by Praxis. We saw that these visits focused upon, environment including any repairs and or redecoration, health and safety checks, service user and staff meetings, discussions held with staff, care practices, staffing and complaints. These visits are used as part of the registered managers quality assurance together with surveys for people who live in the home, family members and professionals. We saw the outcomes of the recent surveys and the main points where the registered manager is looking to improve upon were:During the admission procedure it is important to communicate fully with service users and their representatives. Possibly a written checklist, including points raised by the Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: questionnaire, could be used. In matters concerning culture and religion it appears that communication regarding our ability to manage diversity needs to be improved. It is important for the names of keyworkers to be known by representatives of service users in order to promote effective communication. It is felt that the comments regarding the occasion when staff were unavailable for a visitor to the home relate to a specific day when a training sessions was being held. Procedures for managing similar situations will be reviewed. The registered manager also ensures that relatives are invited to any of the events that take place and the newsletter helps with ensuring effective communication is maintained. This means that people living in the home, their family members and staff have opportunities of influencing any improvements that are made in the home a further example of the management of this home striving to gain good outcomes for people living there. We found that health and safety checks were completed. For example, water temperatures are tested regularly and staff know what the required temperatures should be to ensure they are not too hot or cold. This ensures temperatures stay within the recommended safe limits so that people were not at risk of being scalded. The water had been tested for Legionnella. A suitably qualified engineer completed the test of the gas equipment on the 29th April 2008 and stated that it was in a satisfactory condition. An electrician completed the test of the portable appliances in the month of February 2009 and stated that they were in a satisfactory condition. The fire risk assessment detailed what action, if any, needs to be taken to ensure that the risks of there being a fire are minimised as much as possible. At the previous inspection it was advised that the evacuation plan should be revised to include horizontal evacuation. Aids to assist with horizontal evacuation, such as ski sheets, were discussed with the registered manager and at this inspection we saw that the aids have now been added to the plans. This action is also confirmed in the AQAA, Ski sheets in use to support quick evacuation of the service users in the event of an emergency. An engineer regularly services the fire equipment and we saw that this was done on the 20th October 2008 to ensure it is maintained in good working order. Regular fire drills are held so that staff and the people living there know what to do if there is a fire. All equipment that assists people with their physical limitations, such as, Arjo hoists and tracking hoists have been serviced to make sure that they are in good working order. These records show that people are protected from any risks to their health or care needs within peoples living environment. Throughout our visit and within the completed AQAA we saw that the registered manager and staff are determined to make further improvements to the home so that people living there have good quality outcomes. The conclusion to the analysis of the surveys that Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: have been completed tells us, It appears that in the vast majority of cases the stated aims of the home are being met. This would seem to support the vision statement of Praxis Care - Excellent and innovation in supported living. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes  No  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 34 of 37 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 Description 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 Description Timescale for action 1 20 13 Appropriate information 31/03/2010 relating to when required medication must be kept, for example, individual protocols to ensure that staff know how to use and monitor all medication including when required, as directed medications. This will make certain that all medication is administered safely, correctly, consistently and as intended by the prescriber to meet individual health needs. 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 12 To continue to pursue peoples religious, spiritual and cultural needs so that peoples needs and goals in these Page 35 of 37 Care Homes for Adults (18-65 years) 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 specific areas are fully explored and met on a continuous reviewing basis. 2 17 Consideration should be given to recording fresh fruit that people are offered on a daily basis to reflect that people are being offered five a day to maintain healthy and nutritious diets are fully promoted. It is recommended that gender specific care is offered to all people who live in the home and this is reflected in documentation so that they have a choice of females or males in relation to assisting them with their personal care tasks. 3 18 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or 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 © (2010) Care Quality Commission (CQC). 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