Care and Social Services Inspectorate Wales

Transcription

1 Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report Orchard House 11a Norman Street Caerleon Newport NP18 1BB Type of Inspection focussed unannounced Date of inspection 19 June 2014 Date of publication 28 July 2014 Welsh Government Crown copyright You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or You must reproduce our material accurately and not use it in a misleading context.

2 Summary About the service Orchard House is a residential care home which has been registered with the Care and Social Services Inspectorate Wales (CSSIW) since 2002 to provide accommodation for a maximum of 10 adults aged 18 years or over who have a learning disability and are in need of personal care. The home is part of the National Autistic Society (Provider) who owns the land, but the home (property) is owned by Chartered Housing Association. There is a nominated individual to represent the company. The registered manager is Mr Gareth Phillips. What type of inspection was carried out? An unannounced inspection was made to the home on 19 June Analysis of information held by CSSIW in respect of the setting led us to plan a focussed inspection to establish if the service was now compliant in the areas where non compliance notices were previously issued (see report published 02 April 2014) The inspection focussed on the quality of life for people using the service and tested out if compliance with regulations had been achieved. To inform the report we considered the following: The care files of two specific residents with subsequent case tracking of the delivery of care e.g. activity monitoring and food intake charts Visual inspection of the building Discussions with the registered manager (post inspection) as he was on annual leave at time of inspection Discussions with the senior care workers Incident and accident reporting Brief observation of residents within their home What does the service do well? We (CSSIW) did not identify any specific areas of excellence within the focus of this inspection. What has improved since the last inspection? We found that the décor, ambience and general upkeep of environment had improved. Extensive redecoration of the home has taken place since last inspection. We found that the service is now compliant with regulation 24 (2) (b) and 24(2) (d). relating to the state of repair of the building, and the cleanliness of the environment and this notice has now been removed. What needs to be done to improve the service? No new areas of non compliance were noted during this inspection. However we found that the service was still not compliant with the Care Homes (Wales) Regulation 2002, in the following areas The registered persons were advised they remain non compliant with regulation 15(2) (c).

3 This is because that although some work to improve the systems for reviewing and updating peoples care documentation had taken place, we still found evidence that there was insufficient guidance and direction in the service delivery plans to meet individual s physical heath needs. The registered persons were advised they remain non compliant with regulation 24(e). This is because there were not adequate communal areas for all of the service users living at the home. 3

4 Quality of life We found that people using the service are supported with difficult feelings and are helped to develop coping strategies. People experience responsive care from staff that have a good understanding of their individual needs and preferences. We saw that people had individual Support Plans (Essential Life Plan 1) that contained comprehensive personal histories, assessments and clear guidance on how to provide care to individuals. Plans included behaviour triggers, de-escalating techniques, and cues for staff to support individuals. Despite people living at Orchard house having complex communication needs they experience positive interactions and engagement with staff, substantial work has been put into their life history and behaviour support plans. Staff we spoke to told us in detail about the people they cared for and demonstrated skills and techniques used to keep people safe, calm and well. Files we looked at evidenced that people s behaviour stabilised through the support they received. People could not always be confident that systems and processes were in place to ensure that their ongoing or acute physical health needs would be identified and addressed, because there was a lack of robust service planning and review systems in place. The review of two service user s plans identified there was insufficient guidance for staff in meeting their individual health needs which could impact on staffs ability to deliver care consistently and safely, potentially putting service users at risk. One file we examined had a recording that referred to the application of cream on an individual; staff confirmed that the cream was a prescription; however there was no record of a health condition or prescription within the file. In addition, accessing the latest care delivery plan for individual s was difficult as organisation of care documentation was not systematic; there were gaps in outcomes and documents were filed in an ad hoc way which meant plans did not always reflect current needs. Peoples care documentation was kept across two or three large files with lots of duplication of information. This meant that up to date information on how care was to be delivered was not always available or easily accessible for carers, potentially causing risk to people living at the home. This is a serious matter and we were not confident that the register manager has a system in place that will improve this area; therefore the outstanding Non compliance notifications were upheld in regard to Regulations 14(2) (a) (b) and Regulation 15(2) (c). People living at the home are supported to access the local community, follow interests and be active. During inspection most of the people living at the home were out on activities or accessing day services. We saw evidence in people s files of activity plans which were individually tailored to meet people s hobbies and interests. These included horse riding and out door pursuits. We saw people being supported to go for a coffee in the local area and access the shops and amenities. This promotes integration within the local community and affords individuals a sense of familiarity with the wider environment. 4

5 Quality of staffing This inspection focussed on testing out if compliance was achieved in areas where non compliance notices were issued (see Quality of Life, Quality of Leadership and management and Quality of Environment). We did not focus on this area as there were no non compliance notices issued in this area. This area will be explored in future inspections. 5

6 Quality of leadership and management People can not be completely confident that their care will be well managed due to the lack of systems and processes with regard to the monitoring and audit of the day to day care of individuals. During our inspection care staff found it difficult to locate specific information from the service user files, and told us that they found the records for individuals were extensive and often duplicated across numerous files. We spoke to the registered manager post inspection and he acknowledged that since the last inspection he was in the process of streamlining and updating the system for storing, reviewing and keeping up to date care documentation so that it better assists staff with care delivery. The manager told us that he had been in regular consultation with managers from across National Autistic Society (NAS) homes, with a view to developing a uniform approach to record keeping and documentation. Whilst this suggests that people using the service can have confidence that the provider will respond positively to feedback, It does not address the immediate potential risk to people using the service. A referenced in previous section of the report, the non compliance identified in regard to Regulations 14(2) (a) (b) and Regulation 15(2) (c) during our last visit in March of this year were therefore upheld. People cannot be assured that the service is run with a clear vision and development plan for the future. We were told at the last inspection that there was a proposed plan being finalised that would involve a restructure and downsizing of the home to reduce the numbers and modernise the service. This will potentially impact on service users at Orchard house as some residents will be moving to alternative accommodation. However we have yet to receive any communication from the registered persons with an indication of the plan of action and timescales. Good practice recommends the concentration of group homes (more than 4 people) for adults with learning disability can have a negative affect for people living at the home, creating issues around stigma and lack of integration with the community. (Welsh Assembly Government Guidance circulated in 2010 Local community living Accommodation and support for adults with a learning disability). Staff we spoke to on the day of inspection told us they were unclear about proposed changes and felt anxious about how this would impact on their roles within the organisation. 6

7 Quality of environment Orchard House is a listed building, which is a large detached property within its own grounds. The home was originally used as a children s home and since being taken over by NAS the environment has been adapted to contain 2 two bedroom flats and two 1 bedroom flats. There are also four bedrooms and communal areas within the main house. The home accommodates 10 adults in total. We found the environment to be clean, and free of malodours, since last inspection the home has been redecorated throughout, which made the environment feel fresher cleaner, and more homely. The manager advised us that there is now a cleaning and maintenance rota in place which is overseen by a senior carer. The results are apparent by the improved environment and ambience which overall will result in a better standard of accommodation for people living at the home. The home is therefore now compliant with Regulation 24 (2) (b). and 24(2) (d) notices will be removed. Most People can move freely around the environment and access communal and private space. There is a large garden area at the outside of the home and communal areas in the shared accommodation. The homes updated statement of purpose advises that the building is specifically designed to meet the needs of individuals with autism however the accommodation does not meet the needs of all the people living at the home; we found that two people living within one of the self contained flats do not have access to a communal lounge within the house (their lounge is accessed via a courtyard), This was identified at last inspection and a non compliance notice was issued in regard to Regulation 24(e). We found that this building was still being used as a sitting room, and although redecoration and repair had been carried out the access issues had not been resolved and it is unreasonable that people should have to go outside to access a living room. The manager advised us that there are plans to develop the service which will result in fewer individuals living at the home. However since last inspection we have not received any concrete timescales or proposals in regard to the development of the service therefore the service remains non compliant. The registered persons will be asked to attend a provider meeting with CSSIW as part of our non compliance process. 7

8 How we inspect and report on services We conduct two types of inspection; baseline and focussed. Both consider the experience of people using services. Baseline inspections assess whether the registration of a service is justified and whether the conditions of registration are appropriate. For most services, we carry out these inspections every three years. Exceptions are registered child minders, out of school care, sessional care, crèches and open access provision, which are every four years. At these inspections we check whether the service has a clear, effective Statement of Purpose and whether the service delivers on the commitments set out in its Statement of Purpose. In assessing whether registration is justified inspectors check that the service can demonstrate a history of compliance with regulations. Focussed inspections consider the experience of people using services and we will look at compliance with regulations when poor outcomes for people using services are identified. We carry out these inspections in between baseline inspections. Focussed inspections will always consider the quality of life of people using services and may look at other areas. Baseline and focussed inspections may be scheduled or carried out in response to concerns. Inspectors use a variety of methods to gather information during inspections. These may include; Talking with people who use services and their representatives Talking to staff and the manager Looking at documentation Observation of staff interactions with people and of the environment Comments made within questionnaires returned from people who use services, staff and health and social care professionals We inspect and report our findings under Quality Themes. Those relevant to each type of service are referred to within our inspection reports. Further information about what we do can be found in our leaflet Improving Care and Social Services in Wales. You can download this from our website, Improving Care and Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW regional office. 8