Please wait

Inspection on 21/12/09 for Easterbrook Farm

Also see our care home review for Easterbrook Farm for more information

This is the latest available inspection report for this service, carried out on 21st December 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People’s personal and physical health care needs are met. Easterbrook Farm offers a good standard of accommodation. It is clean, well maintained and appropriately furnished. Bedrooms are furnished and decorated to suit young peoples’ individual taste. The grounds are extensive, providing the opportunity for ‘a country life’ with ponies, chickens, bees, pets and vegetable growing. There are three vehicles available to take people out from the home.Easterbrook FarmDS0000063712.V378685.R01.S.docVersion 5.3In addition to a wide variety of activities on the farm there is a wide programme of leisure activities for people to choose from, including drama, arts and crafts, swimming, retail work including selling farm produce and visits to the local town and pub. Staff are motivated and keen to provide a good service. Staff recruitment protects people from those who may be unsuitable to work with them.

What has improved since the last inspection?

There is now much improved structure as to how people’s goals are to be achieved, needs to be met and risks to be managed. Efforts by management and staff to understand behaviours that challenge are improved through close work with professionals and training. Information is now in more suitable format for people so they are less disadvantaged and more able to make decisions, which affect their future.

What the care home could do better:

Staff should receive ongoing training in how to help people who have behaviour which is a challenge to them and others, which is accredited with the British Institute of Learning Difficulty so that they are fully skilled and knowledgeable in this subject. The home should have a policy on sexuality and relationships and people should be given training about their personal safety with respect to the consequences of physical/intimate contact with others. Only one set of medicine keys should be in use at any one time; it might not be known who accessed medicines where there are more than one set. Medicine records must be accurate; a medicine was not where the record said it should be and this could lead to mistakes or might be mishandling. All medicines brought into the home must be recorded with staff signature and record of the amount of tablets so that full audit is always possible. All medicines, prescribed to be used ‘as required’ or ‘as necessary’ must be part of care planning, without which their use might vary depending on the staff and circumstance. Incidents, which might be abuse, must be reported under local Devon County Council safeguarding arrangements so that people are fully protected. The Commission must be notified, within a reasonable timescale, of any incident which adversely affects the well-being of people at the home, this includes incidents which might be abuse.Easterbrook FarmDS0000063712.V378685.R01.S.docVersion 5.3

Key inspection report CARE HOME ADULTS 18-65 Easterbrook Farm Exbourne Okehampton Devon EX20 3QY Lead Inspector Anita Sutcliffe Key Unannounced Inspection 21st December 2009 09:30 Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 1 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. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Easterbrook Farm Address Exbourne Okehampton Devon EX20 3QY 01837 851674 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) mike@easterbrookfarm.co.uk Easterbrook Farm Limited Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 12 27th January 2009 Date of last inspection Brief Description of the Service: Easterbrook Farm is registered to accommodate up to twelve people with a learning disability between the ages of 18 and 65. All people who use the service currently are young adults of similar age. The home consists of three separate buildings, the Farmhouse, Shippon and Granary. Each has bedrooms, a lounge and kitchen area. The main communal lounge and kitchen and a sleep in room is in the Farm House. There is a laundry and staff sleeping accommodation in the Granary. Easterbrook Farm is north of the village of Exbourne, surrounded by its own farmland and not close to any amenities. The farm has a number of farm and out buildings, including two poly-tunnels. There are also ponies, bee hives, chickens and pets. The service is staffed 24 hours per day with two of the houses having staff ‘sleep in’ at night. One has no sleep in cover but a bell to alert the staff if they need. People who use the service are encouraged to be involved in a range of activities and abide by house ‘rules’ and expectations, which are to promote a sense of responsibility. The acting manager told us that current scale of charges is £935 to £1,175 per week, people do not pay for their holidays or any money toward travel from the farm but they do pay for any personal items. A copy of the Service User Guide is given to each person who is to move to Easterbrook. A copy of the Statement of Purpose is kept in the office and is Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 5 available for any one to read. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission has collected information about Easterbrook Farm since the previous key inspection January 2009. The home provided us with information about the service. This includes data, such as how many staff work there and when policies were last reviewed. It also gives the home the opportunity to tell us what they do well, any barriers to improvement and what improvements are planned. We did one unannounced visit to the home. We looked closely at the care of one person who uses the service. This included meeting them, speaking with staff about their needs and examining records pertaining to their care. We also looked at the care of six others. We met most of them; spoke to their family and social workers/care managers. We attended a meeting which had been called under the local authority safeguarding arrangements where two people who use the service were discussed; health and social care providers and the acting manager of the home gave information. We observed staff going about their work and their interaction with the people in their care. We saw some of the buildings and one bedroom. We examined some policies, procedures and records. We asked questions of staff and the acting manager, who was present throughout. People who use the service may be described within this report as residents, clients, service users or patients. What the service does well: People’s personal and physical health care needs are met. Easterbrook Farm offers a good standard of accommodation. It is clean, well maintained and appropriately furnished. Bedrooms are furnished and decorated to suit young peoples’ individual taste. The grounds are extensive, providing the opportunity for ‘a country life’ with ponies, chickens, bees, pets and vegetable growing. There are three vehicles available to take people out from the home. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 7 In addition to a wide variety of activities on the farm there is a wide programme of leisure activities for people to choose from, including drama, arts and crafts, swimming, retail work including selling farm produce and visits to the local town and pub. Staff are motivated and keen to provide a good service. Staff recruitment protects people from those who may be unsuitable to work with them. What has improved since the last inspection? What they could do better: Staff should receive ongoing training in how to help people who have behaviour which is a challenge to them and others, which is accredited with the British Institute of Learning Difficulty so that they are fully skilled and knowledgeable in this subject. The home should have a policy on sexuality and relationships and people should be given training about their personal safety with respect to the consequences of physical/intimate contact with others. Only one set of medicine keys should be in use at any one time; it might not be known who accessed medicines where there are more than one set. Medicine records must be accurate; a medicine was not where the record said it should be and this could lead to mistakes or might be mishandling. All medicines brought into the home must be recorded with staff signature and record of the amount of tablets so that full audit is always possible. All medicines, prescribed to be used ‘as required’ or ‘as necessary’ must be part of care planning, without which their use might vary depending on the staff and circumstance. Incidents, which might be abuse, must be reported under local Devon County Council safeguarding arrangements so that people are fully protected. The Commission must be notified, within a reasonable timescale, of any incident which adversely affects the well-being of people at the home, this includes incidents which might be abuse. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 9 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 Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering living at Easterbrook Farm have information to help them decide if it is the right place for them and their needs will be assessed before they are offered a place. EVIDENCE: The home reports: ‘The Manager goes to visit potential service users. We tell them and their family all about Easterbrook Farm, we show them photographs of the buildings, farm and activities available and provide them with a ‘welcome pack’. The prospective service user and family are invited for lunch and to spend the afternoon’. We were shown updated information about Easterbrook Farm from which people should be able to decide if it is suitable for them, and which is also a guide should they live there. It was detailed and informative and is available in easy read format for those with poor reading skills. We found a copy of the Service User Guide in the bedroom of the last person admitted, so we know he has this information. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 11 We spoke with the care manager of the last person admitted to Easterbrook Farm. She told us she had no concerns over the admission arrangements and since moving to the home the communication of her client was much improved. She said: “The home is very much helping him to develop these skills”. The home did not have the local authority assessment for the last admission as this was not yet received. However, the information that was available had been used to plan how care was to be delivered. This included risks specific to the person. The care plan was sufficiently detailed and staff were aware of his needs, which appeared to be well met. The home reports that it has nothing to improve regarding helping people choose the right home for them. However, the acting manager told us she is reviewing admission procedure so that future admissions will include information relevant to the Mental Capacity Act 2005 and deprivation of liberty safeguards, which form a legal framework to protect people with limited decision making skills. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 12 Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to have achievable goals and a plan of how to achieve those goals in a risk managed way. EVIDENCE: At the inspection January 2009 we found that some people who use the service were vulnerable because their support was not planned and managed in a systematic way and areas where people could affect change in their lives were limited. Toward this inspection we spoke with social workers/care managers who have clients at the home and some people’s family. Although some still express reservations the overriding opinion was of improvement. Comments include: • “The home has definitely improved. He can express his own views now.” DS0000063712.V378685.R01.S.doc Version 5.3 Page 14 Easterbrook Farm • • • “Xxx spent hours producing his computerised personal centred plan.” “The home is very much helping him to develop communication skills”. “No concerns” and quite impressed with what I have seen. Xxx does exceptionally well there. Reviews and recording are good”. The home reports that it has improved the method for assessing risk, enlisted the help of an outside consultant to collate and update person centred plans for all people who use the service, improved activity boards so that people have clear information on what they have decided to do, house meetings are now held in individual houses and them home is continuing to monitor and add, as needed and on a regular basis, to the risk assessment process. We found this to be the case. We looked at the care file of two people who use the service. They contained information which was clear and easily understandable. Where one of the two had a history of behaviour which is a challenge to themselves and others the plan now addresses areas of their anxiety and staff have a clear plan of how to proceed if anxiety leads to challenging behaviour. We know that incidents are now very much reduced, which is a credit to how the staff have followed the plan. The acting manager was unsure as to whether the training staff receive in the management of challenging behaviour is accredited to the British Institute of Learning Difficulties, which is strongly recommended. Although the home has achieved some good results recently this has been with considerable input from outside professionals; knowledge, skills and expertise need to be built upon. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 15 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): This is what people staying in this care home experience: 12, 13, 14 ,15, 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is opportunity for a fulfilling and interesting life for people who want to live in the countryside. EVIDENCE: People at Easterbrook Farm have much opportunity available to them and are supported to undertake a wide variety of leisure and work activities. Family and people associated with the home told us: • “Xxx loves the animals, working on the horticultural side and the drama club. There was a fencing tournament, Film for Exeter film festival, visits to the pub, the 1-1 day which she loves: she does her cleaning in the morning and banking and shopping in the afternoon. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 16 • • • “Xxx is really happy there and I’ve got no concerns really; definitely a rounded life. She goes horse riding and swimming and to Okehampton quite a lot. Staff are around her age. She was brought up on a farm and is perfectly happy in the environment. “Xxx sees a useful role on the farm and feels that he contributes. He likes the physical work”. “Xxx had work experience at Castel Drago”. We are told that most people are supported to enjoy and maintain good links with their family; several communicate with family by audio/video communication. Peer relationships are also encouraged but within boundaries, such as respecting each others private space. However, concern has been expressed around how this operates at the home; how to support, but protect, people wanting more intimate relationships, to which any consenting adult has a legal right. We found that the home does not have a policy on relationships and sexuality in relation to people who use the service. There was a previous recommendation that people be given training about their personal safety. This recommendation is repeated and should include the consequences of physical/intimate contact with others. The acting manager understands both her duty of care (regarding consent and risk) and her duty to support people’s rights as free citizens. She told us the measures she will take to ensure these are upheld, which will include taking external professional advice and getting the Codes of Practice relating to the Mental Capacity Act 2005 and deprivation of liberty safeguards, which forms the legal framework under which deprivation can be agreed if this is in people’s best interest. She agreed to keep the Commission fully informed. People have 2-1 (two service users to one staff) or 1-1 days when they are helped to clean their room, change their bed and do their personal laundry. They are supported to get their own breakfast in their own houses. During the week a lunch and evening meal is cooked for people which we are told is based on a basic, healthy and balanced menu. At weekends people, with support, get their own lunches. All take turns to help in the main kitchen, to prepare the meals and go shopping once a week if they wish. The weekly menu is decided at the house meeting each week. The home reports: ‘We have appointed a Horticultural Manager, which has helped the service users to develop their allotments, build fruit cages and continue to grow vegetables in the poly tunnels. The area around the poly tunnels has been landscaped and can be used all year round. The service users have helped to build a summer house and bee hives have been purchased. A large potting shed has recently been purchased, so that all the service users may actively be involved with the planting process. The gym and games room have been finished and a full time cook has been appointed’. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 17 Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care support is well managed but improvement in medicine management would further protect people. EVIDENCE: People living at Easterbrook appear to be well cared for in that the standard of personal care is high and people’s presentation suggests they are encouraged to make the best of themselves but dress as they would choose. Most would be able to manage their own personal care arrangements. We looked closely at the care of two people who use the service. Their health and personal care needs and preferences were well documented as part of their care plan. One person requires frequent help to optimise their health. Their care plan was very clear as to what staff assistance was required. The acting manager has been keen to support people’s choice. For example, after fully explaining the implications, some made the choice not to have the Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 19 winter flu injection. Professional help is being sought so that gender related tests, such as breast screening, can be explained and understood. The family of one person praised how well their daughter’s health was managed, saying: “The home was brilliant at getting Xxxx’s weight down. They used a very positive approach”. We looked at the arrangements regarding medicines. People are supported to manage their own medicines (including ointments and lotions) where they can do this safely. It is required that medicine use can be fully audited. Audit ensures that, if mistakes or mishandling occur, full investigation is possible. In that way people who need medicines, and staff who administer them, are protected. We found the system in use was not fully auditable in that: • • • There are more than one set of keys in use at any one time; it might not be known who accessed medicines A record was incorrect; a medicine was not where the record said it should be Not all medicines brought into the home had been checked in; no staff signature or record of the amount of tablets We also found that medicines prescribed to be used ‘as required’ or ‘as necessary’ were not part of care planning, without which their use might vary depending on the staff and circumstance. Generally medicines are safely stored and records of their use are clear and complete; essentially safe. However, this is the third inspection at which the standard relating to medicines is not fully met. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s ability to make a complaint is supported but protection must be given a higher priority at the home. EVIDENCE: We were told that there have been no complaints made about the service. People who use the service are unlikely to make a formal complaint, but there are weekly meetings at which problems might be raised and people have a monthly meeting with their key support worker where concerns might be raised. The complaints procedure is posted on a toilet door where all will see it. It is in pictorial form, as well as written text, and far more ‘user friendly’ and accessible than the previous, complex, procedure. People who use the service and staff appeared to be relaxed and comfortable in each others company and family also said this was the case. We have received no complaints at the Commission and previous safeguarding concerns relating to possible institutional practices at the home are now concluded. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 21 We attended a safeguarding meeting immediately prior to the inspection. This was to discuss the behaviour of one person living at the farm, which would be defined as abusive, and adversely affecting another. There are extensive records to support this. Other, similar, concerns came to light which should have been alerted under the Local Authority Safeguarding protocols, but were not. The previous manager, now left, had not reported these events but the recently employed acting manager had informed the appropriate care managers of the situation, and taken steps to ensure people are now safer. It is for this reason only that this outcome is rated as good and not adequate or poor. We discussed the need for safeguarding people in line with local Devon County Council guidance so that correct procedures can be followed to report possible abuse issues promptly. Staff knew where the whistle blowing policy could be found. This should inform them what steps to take if they have concerns, which might be abuse. It contains the contact details of the Commission and local Devon County Council safeguarding team. However, they had either not realised that ‘abuse’ can be between people living at the home, or they had chosen not to alert the proper authorities (the safeguarding team) about this. The home’s policies and procedures provide detailed information for staff but it appears they did not follow it. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment meets the needs of the people living there. There are very good arrangements in place to maintain cleanliness. EVIDENCE: One person we spoke with told us: “The environment is fantastic”. People live within one of three buildings at Easterbrook. Each has a kitchen, lounge and bathrooms facilities. We found the home to be clean, hygienic and containing furniture and fittings suitable to the young people living there. There is continual upgrading of the buildings, gardens and farmland facilities and less ‘homely’ shared areas of Easterbrook are being gradually improved. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 23 The one bedroom visited was much personalised and appeared comfortable. The owner was clearly ‘at home’ and surrounded by objects of importance. People are able to lock their room door for privacy. Their room is their private space. The home was in a good state of repair. Maintenance is carried out promptly and servicing is up to date. The grounds are quite extensive and include outbuildings and two poly-tunnels. The entrance to Easterbrook has been rerouted since the previous inspection. Visitors are now directed away from the courtyard, leaving that space more available to people living at the home and also safer. People are able to wash their hands before entering the home when they have been working on the farm. Liquid soap and paper towels are readily available for this and also in the laundry. There is personal protective clothing available for use. The laundry facility and equipment is adequate to meet the needs of the service and people living at the home. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 24 & 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a service from staff which are motivated, safely recruited and who receive sufficient training and supervision of their work. EVIDENCE: Most comments received about staff were positive and commended them for their work. We were told by people’s family: Xxx (support worker) is “Fantastic, on the ball and up front” and “Staff keep people happy. Generally they’re really caring. They’ve always been very nice”. A health care professional told us: “Key worker, Xxx is very committed to caring for Xxx”. Several families of people who use the service commented on the lack of “stability of staff”. The home reports that four staff have left in the last 12 months, including the manager. (See Outcome called Conduct and Management of the Home). Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 25 We spoke with two staff. They appeared to be motivated and keen to do their work well. They had good knowledge of the people for whom they are ‘key workers’. We watched them working with people; there was good, positive and respectful interaction. We looked at whether there are sufficient staff to meet the individual needs of people at Easterbrook. No mention was made of staff numbers either in the information provided by the home or the various people we spoke with. However, there was comment about staff performing farm tasks alone; not working with the people they are employed to support. Staff told us that this does happen occasionally. People who use the service benefit from a staff of both gender and various ages: there are four female and five male care workers. The acting manager told us that currently there are four support staff on day shift, plus a farm manager, office administrator and cook, two support staff after tea and four support staff during weekends. There are two ‘sleeping in’ staff at nights, one in each of two houses. She said she keeps staff deployment under constant review. Staff we spoke with felt that new staff receive sufficient induction training when they are new at Easterbrook. The home reports that 12 care staff have completed the induction training recommended by Skills for Care, which is the expected standard. We saw that there is a computerised training matrix, so that training is properly planned and recorded. Staff training includes aspects of health and safety, such as first aid and fire safety. There is also training specific to people’s health needs, such as epilepsy. Staff have received behaviour management training and a care manager told us: “The home’s management of behaviour that challenges is much improved”. However, these skills are new and need to be built upon. (See Outcome called Individual Needs and Choices). The home reports that 8 care staff have National Vocational Qualifications (NVQ) to level 2 or above in Care or Health and Social Care. We were told that 4 have also achieved some units in the specialist learning disability award (LDAF). We looked at whether the recruitment arrangements at Easterbrook protect people from those unsuitable to work with vulnerable adults. Three staff’s records were examined and we found that all the required checks had been completed before they started work at the home. One staff told us that staff supervision is now improved and most prefer the new structure of supervision which, he said, generally benefits people and the staff. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 26 Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Consistent management has yet to be achieved at the home although it is generally well run with good outcomes for people. EVIDENCE: The previous acting manager applied to be registered with the Commission and that application was accepted. However, after very considerable time, checks to ensure their fitness to manage the home could not be completed as they could not provide the required information. The home reports: ‘A new Manager was appointed in September 09 who is very well qualified, who has worked in care for 20 years, has Learning Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 28 Disabilities, Challenging Needs and Elderly Dementia care experience, has all relevant qualification necessary, NVQ to level 4 and the Registered Manager Award and is a Manual Handling trainer.’ People associated with the home tell us they have been unsettled by the changes in staff, they say sometimes without explanation. However, most told us they view the new manager positively. Comments include: • “It was a surprise, however, I feel quite positive about the new managers appointment and approach”, • “Xxx is more proactive and quite a strong lady” • “No concerns and quite impressed with what I have seen”. • “Security has improved. I’m really pleased.” There appears to be more confidence in the new management. The Commission is awaiting her application to register which she must to comply with the law. Toward getting the views of people house meetings are held every week, key worker and staff meetings are monthly and questionnaires are sent yearly to people who use the service. There are social occasions (parent’s forums’) where people’s family come together with the provider, manager and staff. Family tell us they find that opportunity to discuss the service is invaluable. One was planned for Christmas. The provider also does a monthly, unannounced visit where he checks certain standards at the home and reports his findings to the manager. The home records that Policies, Procedures and Codes of practice have been reviewed during 2009 and we saw some record keeping at the home has improved. However, the home is required to inform the Commission of any event which adversely affects the well-being of people who use the service. This should have included incidents of aggression between people, but did not. The Commission need to be kept fully notified of these events. We looked at whether health and safety are promoted at Easterbrook. Staff receive mandatory health and safety training, such as fire safety and first aid. People who use the service are also trained in what to do should a fire occur. An organisation is employed as health and safety consultant to Easterbrook. Following their assessment health and safety signage and risk assessment have been improved. Some changes following this were evident around the home. We saw no concerns relating to the maintenance of the home and the home reports that servicing of equipment is in date. We believe that assessment of risk, both individual to people and generic to the home, is improved. People Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 29 associated with the home commented that it appears to be safer; security has improved, as all who visit the home are now required to sign the visitors book, and changes have been made to the entrance and parking arrangements. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 30 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 2 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 3 3 3 X Version 5.3 Page 31 Easterbrook Farm DS0000063712.V378685.R01.S.doc 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 YA20 Regulation 13(2) Requirement It is required that medicine use can be fully audited. - There must not be multiple sets of keys in use at any one time - Medicine records must be correct - All medicines brought into the home must be recorded, with staff signature and record of the amount of medication. Timescale for action 31/01/10 2 YA20 13(2) 3 YA23 13(6) 4 YA39 37 Audit protects people who use the service and staff from mistakes and the possibility of mishandling. Any medicine which is prescribed 31/01/10 to be given ‘as necessary’ or ‘as required’ must be part of planned care, so that it’s use is consistent and in line with the person’s best interest. Incidents, which might be abuse, 07/01/10 must be reported under local Devon County Council safeguarding arrangements, so that people are fully protected. The Commission must be notified 07/01/10 of any event which adversely affects the well-being of people DS0000063712.V378685.R01.S.doc Version 5.3 Page 32 Easterbrook Farm who use the service. This includes incidents of aggression between people, which might be abuse. 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 Refer to Standard YA6 YA15 YA15 Good Practice Recommendations The home should ensure that staff receive training in challenging behaviour which is accredited with the British Institute of Learning Difficulty. The home should have a policy on sexuality and relationships. People should be given training about their personal safety with respect to the consequences of physical/intimate contact with others. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 33 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Easterbrook Farm DS0000063712.V378685.R01.S.doc Version 5.3 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!