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Disabilities Trust - 4 Pages Orchard Outstanding

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Inspection report

Date of Inspection: 17 July 2014
Date of Publication: 27 August 2014
Inspection Report published 27 August 2014 PDF


Inspection carried out on 17 July 2014

During a routine inspection

4 Pages Orchard is a care home registered for up to three adults with learning disabilities, and is situated in a residential area of Sonning Common, South Oxfordshire. On the day of our inspection three people were living at the home. During the inspection we were unable to communicate directly with people that used the service but we observed the care people received and interactions with care staff. We also conducted a SOFI (Short observational framework for inspection). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also spoke with 2 people�s relatives and looked at three peoples care files. We spoke with four staff including two care workers the registered manager and a visiting senior staff member. We reviewed documents made available by the provider. One inspector carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and/or what we observed as well as records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found this service was safe. People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received training in safeguarding. Some staff had been on SOVA (Safeguarding of Vulnerable Adults) training the day before our visit.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that one person�s behaviour would on occasion �present behaviours of concern�. We saw a detailed care plan which identified this behaviour and provided staff with strategies to support this person

Is the service effective?

We found the service was effective. People who used the service were given appropriate information and support regarding their care. We saw that care guidelines were clearly explained in people�s files and families were actively encouraged to participate in maintaining this information. The service had regular �interaction meetings� throughout the week. These meetings were held for the people that used the service in order to support them in making key decisions about their immediate environment and the running of the home.

People�s independence and community involvement were promoted. One person�s relative told us, �it�s a great relief to me that they are so accepted by the community, they are very involved it�s a great relief as we get older to see that level of support, we have seen more achieved than we ever thought possible�.

Some people didn�t have the mental capacity to give informed consent. The provider had ensured that arrangements were in place to ensure that decisions made in relation to consent were lawful. Every person using the service lacked capacity to make decisions in relation to some aspect of their daily living for example, making important decisions about their care and welfare, along with managing their own finances. We saw that capacity assessments had been completed on admission and were reviewed annually. Capacity assessments were conducted by the organisations psychologist. All decisions were made as a result of best interest meetings which involved family members and other professionals.

People�s files contained goals to ensure they had continued access to the community and maintained their independence. These goals were created with the person and their relatives and were reviewed monthly. One person�s care file identified that they wanted to keep fit and remain active. We saw this person went for regular walks and was a member of the community walking club. People that used the service were encouraged to help with daily tasks such as cooking, cleaning and gardening. We saw people being encouraged to make their own drinks and prepare meals.

Staff we spoke with felt supported and that they received regular training. Staff received appropriate professional development. One care worker we spoke with had just completed their Level 3 Care qualification and felt, �if I said I wanted to keep going to the Level 4 I could�.

Is the service caring?

We found the service was caring. We observed a number of warm and caring interactions during our SOFI. We observed that people were happy and comfortable. Some people were a little anxious because the inspector was unfamiliar to them. Staff provided support and reassurance to these people, reassured and given options to distract them. Which means that people�s needs were put above the inspection. People�s relatives felt people were well cared for. One person�s relative told us, �they have never been happier, they are the happiest I have ever seen them, on visits home, they ask to go back�. Another relative told us, �staff are very caring, it took time to settle but there is such a caring culture�.

We looked at the care file of one person who had �limited speech� and �repetitive behaviour�. We saw that a speech and language therapist had been involved with creating their communication support plan. This included guidance on how to communicate to ensure this person could understand and be understood. We observed care staff adhering to this throughout the day.

People were supported in promoting their independence and community involvement. One person�s relative told us, �it�s a great relief to me that they are so accepted by the community, they are very involved it�s a great relief as we get older to see that level of support, we have seen more achieved than we ever thought possible�.

Is the service responsive?

We found the service was responsive. People expressed their views and were involved in making decisions about their care and treatment. People and their relatives were involved in developing support plans and attending regular reviews along with a multi-disciplinary team that included key care staff and a psychologist. One person�s relative told us, �we enjoy attending the meetings, we get to see progress and just how much they are thought about, the service puts so much effort into people�. We saw that one person�s relatives wanted to encourage this person to continue practising their religion. We saw that this person was supported to say their prayers before going to bed.

We saw that when this person�s care needs changed the service responded. For example, we saw that it had been reported that one person had been having difficulties swallowing some foods. Records showed that a speech and language therapist had been involved and recommendation put in place based on risk assessment. Care staff spoke with us about these recommendations and support plans had been updated.

Is the service well led?

We found the service was well led. People�s relatives told us the service was well led, one person�s relative told us, �the manager has created an atmosphere of complete acceptance and involvement that is a very rare thing�.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The home had a series of audits carried out by a number of different staff within the organisation. Monthly Provider audits were conducted by other service managers within the organisation. These audits audited care files, people finances, medication and staff training. Where issues were identified the manager took appropriate action.