Inspection on 29/11/07 for Barnfield Farm

This inspection was carried out on 29th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Barnfield Farm 18/07/06

Barnfield Farm 05/12/05

Barnfield Farm 17/05/05

Barnfield Farm 12/10/04

Barnfield Farm 18/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Barnfield Farm Greenacre Farm Communities Luppitt Honiton Devon EX14 4SJ Lead Inspector Michelle Oliver Unannounced Inspection 29th November 2007 09.30 Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barnfield Farm Address Greenacre Farm Communities Luppitt Honiton Devon EX14 4SJ 01404 891627 01404 891963 barnfieldfarm@roc-uk.org 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) Greenacre Farm Communities ****Post Vacant**** Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2006 Brief Description of the Service: The home is registered to accommodate up to 15 adults who have a learning disability. The home has reduced the number of people living there to 11. Barnfield Farm is in a rural setting on the edge of the village of Luppitt with extensive grounds. The nearest main town and shopping facilities are in Honiton. There are two main buildings, one very old thatched house known as Long Barn, which is a listed building and a separate modern house known as The Shippon. There are several outbuildings, which are used as workshops and for keeping pets. Peoples bedroom accommodation is on the first floor of each house. The rooms in the older building are only accessible via very steep and narrow staircases. The home is operated by Robert Owen Communities, previously known as Greenacre Farm Communities. Currently the fees for the home are £400 - £800 per week. The home is looking at ways in which they will make the CSCI reports available to people. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7.5 hours on Thursday 29th November 2007 During the inspection 3 people were case tracked. This involves looking at peoples’ individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to 11 people living at the home, 11 representatives, 7 health and social care professionals (including GPs and care managers) and 7 staff. At the time of writing the report, responses had been received from 7 people living at the home, 5 representatives, 2 health and social care professionals and 2 staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 7 people living at the home were spoken with individually and 5 in a group setting, as well as observing staff and people living at the home throughout the day. We also spoke with 4 staff and the manager . A full tour of the buildings was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files Some people living at the home have limited verbal communication skills, and as we are not skilled in their other methods of communication it was difficult for us to have any meaningful communication with these people. However, the interaction between the people living at the home and those who care for them was closely observed closely observed. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . What the service does well: Relatives and professionals were, overall, happy with the care provided to people living at the home. A relative told us, “I have always thought that my daughter is most fortunate to live there. I continue to think so” and another told us staff “anticipates my sons needs. Have got to know him well and consequently have been able to integrate all the residents in a balanced way”. The home obtains information about people prior to them moving in so as to ensure individual needs can be met. Good care planning and delivery takes Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 6 into account peoples’ needs and preferences, which ensure that health and social care needs can be met. Staff act in a caring and respectful manner towards people, and work hard to provide opportunities for a wide range of social and therapeutic activities at home and in the local community. The meals at the home provide a varied diet and take into account people’s likes and dislikes. Relatives are welcomed at the home and there appears to be good communication with families. Relatives are encouraged to be involved and participate in the care planning and reviewing process. Most relatives felt the home kept them informed of important events and changes. Concerns and complaints are taken seriously and people are protected from abuse or harm by well informed staff and good reporting procedures. People’s finances are protected by rigorous systems. People are supported by a team of staff who are competent and qualified and well supervised (See what the home could do better). On the whole the health, safety and welfare of people living at the home is promoted and protected (See what the home could do better). Comments in questionnaires received before this visit included; “ Barnfield has handled the last year very well with all the new residents and development of the site”, “the staff team always appears friendly and helpful when we visit.” “a friendly and positive team. Excellent environment”, “Creates a family feeling to those in their care. Provide good leisure, work and skill training opportunities for residents” and.”Barnfield is an excellent environment for residential care for our daughter both in terms of location, rooms and facilities/ services”. What has improved since the last inspection? Since the last inspection in 2007 the home has completed a major refurbishment. Nine of the rooms now have ensuite bathrooms and two rooms share one bathroom. There are also kitchen areas in the buildings away from the main house to encourage residents to be independent and so that they have access to drinks and snacks at all times. All staff have received training in first aid which benefits people living at the home. Plans of care have been improved and now include more individual, person centred information to enable staff to care and support people living at the home. Details now include information about individual spiritual and religious wishes. This means that people can be supported to maintain their beliefs as they wish. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 7 Assessments of risk to people living at the home are now regularly reviewed. They reflect up to date information to keep people safe and also to promote independence within a safe framework. At the last inspection daily information about people living at the home was recorded on one sheet. Information is now recorded individually. This means that peoples privacy and dignity is protected, as all information is confidential. What they could do better: The home’s Statement of Purpose and Service User Guide included out of date information. For example, photos of staff working at the home, which people may contact if they are unhappy, have been included so that people could more easily recognise them. However, several of these no longer worked at the home. This could be very confusing to people living at the home. Not all areas of the home had been well maintained and the arrangements for regular maintenance were poor. Some equipment needed attention and some that had broken down had not been replaced. There are not always enough staff on duty to meet peoples’ social needs. Staff have not been provided with fire prevention training. This potentially puts people living at the home and staff at risk. It is not clear whether when agency staff work at the home that they are fully aware of up to date information relating to the health and social care needs of people living there. This potentially compromises the continuity of person centred care provided at the home. The transport arrangements at the home does not ensure that people are always able to choose what they want to do or when. Although peoples’ private accommodation is capable of being locked people have not been offered the choice of having a key to enable them to do so. The kitchen is not fully equipped. For example, people aren’t able to bake because of a lack of baking tins. The home needs to improve the availability of equipment so that people can use the kitchen better. The home does not currently have a formalised quality assurance system, which would include seeking the views of people where possible, relatives and outside stakeholders on how the home is run. This would ensure the home is run in peoples’ best interests. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 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 Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4. Quality in this outcome area is good. The assessment process ensures that people considering making Barnfield farm their home can be confident that their needs will be met. Barnfield Farm does not currently provide up to date information about the home, in the Service User Guide, to people who may be considering making it their home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The process of a person moving into the home is a gradual one. People who are considering making Barnfield Farm their home are invited to visit, meet others living there and staff. Comprehensive information is gathered by staff to make sure that the home meets peoples needs and that staff have the experience and competancy to meet individual assessed health and social care needs. Staff get information from parents, health care professionals and other sources before agreeing to offer the person Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 11 ‘transitional visits’ where they can get to know other people living at the home. Staff at Barnfield Farm then complete their own assessment which covers all areas of need, ranging from health, emotional, mobility, dietary, spiritual, likes and dislikes and much more. To make sure that people are provided with as much information about the home as possible, the manager said that people are given a copy of the homes’ Service User Guide, which is explained, to all people when they come to the home. However, at the time of this visit the home’s Statement of Purpose and Service User Guide included out of date information. For example, photos of staff working at the home had been included so that people could more easily recognise them. However, several of these no longer worked at the home. This could be very confusing to people living at the home. The manager was aware of this and information provided to the Commission before this inspection stated that the home could improve by reviewing both the Statement of Purpose and Service User Guide regularly and including people living at the home in this process. Comments included in questionnaires returned from people living at the home, with the assitance of staff, before this inspection included, “came to home to look around with their parents” and another “wasn’t asked whether they wanted to move to the home and doesn’t know whether they were given enough information. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9. Quality in this outcome area is good. Staff are provided with good information to meet peoples’ needs and goals safely and consistently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person living at the home has a plan of care in which information is recorded about his or her individual needs and details of how to make sure individual needs / goals are met and monitored. Each person living at the home has a key worker, who is responsible for co-ordinating all aspects of their care and completing monthly reviews of the care plans. Since the last inspection people living at the home have been asked about their spiritual or religious needs. Those people who wished to share this information agreed to it being recorded in their plans of care. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 13 People living at the home were aware of their care plans and said that they were involved when information is recorded and when their keyworker reviewed the plans. We saw some plans that people had signed to say that they have agreed them. Staff spoken to during this visit demonstrated an excellent knowledge and understanding of each person’s individual needs. Staff communicated with individuals appropriately and were kind and respectful to them during this visit. Agency staff often work at the home when permanent staff are unavailable. Although a record is maintained of permanent staff having read people’s plans of care there is no evidence to suggest that agency staff have. This means that people living at the home may be cared for by staff who are not be familiar with their needs and how these are to be met Regular meetings are held at the home when people living there discuss aspects of daily life and have a say in the running of the home. Most people said they are able to go shopping to choose their own clothes. People can get up and go to bed when they choose although this usually fits in with the time that staff become sleeping staff. One person said that if they wanted to stay out late arrangements would be made. Staff confirmed this. One person spoken to during this visit said they are usually able to make decisions about what they do each day. Staff record the days events on individual monitoring sheets. Information recorded includes times people chose to get up and go to bed, what they ate and whether a choice was offered, activities, daily living skills, interactions with others, methods of communication used, contact with relatives, appointments and other comments. The daily records did not always reflect if care plan goals had been met. However, care plan goals tended to concentrate on general care and did not include day-to-day goals, particularly goals relating to independent living skills. Despite this, the information within care plans is good and the manager intends to review how care plans are written and used. Staff said they found the monitoring sheets much more useful and made reviewing the care easier. Any risks to people through general health, needs or activities are assessed and clear action to reduce any risks are recorded. Staff demonstrated a good understanding of such risks and were able to describe what they should do to reduce them. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good. People living at the home benefit from being supported and encouraged to maintain contact with the local community and taking part in appropriate activities. People are provided with a healthy, varied diet and encouraged to make choices. Staff respect peoples rights at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peoples’ care plans included information about what they enjoyed doing in relation to activities. For example one person enjoys swimming, daily Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 15 monitoring sheets, and staff, confirmed this took place. Other activities include trips out to Honiton show, the pub, pool and darts, karaoke, walks, shopping and many more. Although the home is set in a rural setting and there is no access to public transport people living at the home have contact in the local community. People spoken to during this visit confirmed that they enjoy this contact. Two people are currently working with a local recycling company and another works part time at a local brewery Barnfield Farm currently has 3 cars, one large enough to take up to 8 people to go out together. However, people living at the home, and staff, said that the vehicles are old and need repairs to be carried out. Currently one vehicle is out of service; another needs a service leaving only one in use. A person who lives at the home said that if the only serviceable vehicle is being used there is no other available in case of an emergency. People said they couldn’t always go out in the evening because of availability of vehicles and staff. [Refer to Section 7 “staffing”] On the day of the inspection two people went out in the home’s transport and a group were looking forward to a trip to Exeter to do their Christmas shopping and to see the lights. Several people were watching TV, listening to music or spending time with staff. The atmosphere at the home was warm and friendly. We were shown around the extensive gardens during this visit, and shown a area of ground that several people had enjoyed digging and clearing. Those involved told us that they would like to grow their own vegetables for all to enjoy at the home. People spoken to on the day of the inspection confirmed that the home supported them to maintain regular contact with their relatives. People said that their relatives could visit them whenever they wish and if they want to see their visitors in private then they may use their bedrooms. There is an open door policy about visitors but often relatives phone before visiting to ensure that the person they are visiting is not out. The Commission received feedback from 5 relatives. Four confirmed that staff were good at communicating with them and said they were very happy with the care their relative received. One commented, “ Would appreciate more communication”. Menus demonstrated a varied and healthy diet is offered to people living at the home. Staff explained that they were aware of individuals likes and dislikes and would always offer an alternative if a person said they did not want or like what was on offer. People living at the home are involved in planning, shopping for and cooking meals. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 16 We joined people and staff for a lunch of a choice of sandwiches and fresh salad, which everyone seemed to enjoy. Fresh fruit was offered at lunchtime and bowls of fruit were seen in the kitchen. The main meal tends to be the evening meal although the staff and manager said this could be flexible to suit peoples’ needs and activities. Many of the people living at the home enjoy cooking. We were told that there was a shortage of cooking equipment for them to use. They said they would like to make cakes but there were no cake tins. Casseroles were old, worn and we were there were times when larger ones were needed. We were also told that there was not enough crockery supplied at the home. Daily routines within the home are flexible; people said that they are able to go to bed when they wish. They said during the week they are called if they are going out but at weekend they have a lie in. Bedroom doors have locks fitted since the last inspection. However, none of the people spoken to have been provided with keys and no assessments of any associated risks of having a key had been undertaken. Several said that they would like to be able to lock their doors when they go out. During this visit all people shown great respect for individuals right to privacy. A person who lives at the home showed us around the buildings and if there was no reply when they knocked at a door they did not enter. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20. Quality in this outcome area is good. Health needs of people living at the home are well met and their dignity and privacy is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home said that staff were helpful and encouraged and supported them to do things for themselves. They knew who their key worker was and felt that they were the person they would talk to if they had any concerns or worries. They confirmed that staff knock on their bedroom doors and wait to be invited before coming in. Staff described ways in which they respect privacy and dignity if offering support for personal care. Staff had a good knowledge of how people living at the home preferred to receive personal care. Care plans provide staff with information on personal care and how much support is necessary. Staff were respectful, fun and kind. It was clear that people living at the home have a relaxed, trusting and friendly relationship with staff. Throughout the inspection there was laughter and fun. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 18 Feedback from relatives also confirmed the staff team were kind, helpful and polite. There are good records of peoples’ health care needs and how they are monitored. There was good evidence that such monitoring takes place. Staff support and encourage people to attend medical appointments. Details were seen of additional health appointments being undertaken such as optical, dental and chiropody. Good records are maintained of the outcome of appointments ensuring that peoples’ health care needs are met. The home uses a monitored dosage system from a pharmacy. Currently no people living at the home looks after their own medicines and all medication is stored in a locked cupboard in a locked room. The manager confirmed that if a person living at the home wished to manage their own medicines, and were assessed as being able to safely, lockable facilities would be provided in their private accommodation. This means that all medicines are safely stored. Staff receive training from the pharmacy to ensure that they understand the procedures. During this visit we saw people being given medicines. Staff explained to them the reason for taking the medicine and gave them the choice of whether they wanted to take it or not. Medication administration records were accurate and clearly showed when a person had refused a medicine. The service has a medication policy which requires staff to be trained to dispense the medication. All staff who administer medication have received appropriate training and their competencies are assessed by the manager informally to ensure they understand the training they have received and remain safe to manage medication. The manager intends to formalise these assessments by keeping a record. The staff confirmed the manager monitors their performance in relation to medication. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. People living at the home are listened to, all complaints are dealt with appropriately and they are fully protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, written for those living at the home, included in the Service User Guide. The procedure does not currently provide people with up to date information. Photographs of staff that people may speak to about any concerns and details of how they may contact the Commission are out of date. People living at the home said that they would either go to their key worker or the manager if they were unhappy about something within the home. The home has had 2 complaints since the last inspection and the Commission has received none. We saw records detailing how the home had dealt with complaints they receive. They had taken the issues seriously, acted promptly, looked into the issues, recorded outcomes and replied to the complaints. One complainant was satisfied with the outcome the other issue has not yet been fully resolved. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 20 Five relatives who responded to questionnaires before this inspection said they felt confident that any concerns or complaints would be dealt with efficiently and effectively. One person living at the home commented, “My first point of call would be mum and dad and staff”. Training in Adult Protection is included in the homes’ training package, which all staff at the home undertakes. The home has a whistle blowing policy to ensure that staff report any incidents of concern. Staff demonstrated a good understanding of abuse issues and knew what to do if they suspected any poor practise. Staff were able to describe all types of abuse and also highlighted subtle forms of abuse. Peoples’ finances are managed well and fully protect them from potential financial abuse. We looked at 3 records all of which were accurate and receipts had been kept of all outgoings. All people spoken to said they felt safe and protected living at Barnfield Farm. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. People live in clean, safe and comfortable surroundings that meet their needs. Routine maintenance of the home is not well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Barnfield Farm provides a homely and comfortable place for those who have chosen to make it their home. The people who use the service appeared comfortable in their home and on the day of inspection had access to all areas of the home. Peoples’ bedrooms are personalised with individuals favourite colours used to decorate and furnishings to suit their needs. All people living at the home have their own rooms and some have private bathrooms. All said they were happy with the accommodation provided. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 22 Since the last inspection in 2007 the home has completed a major refurbishment. Nine of the rooms now have ensuite bathrooms and two rooms share one bathroom. There are also kitchen areas in the buildings away from the main house to encourage residents to be independent and so that they have access to drinks and snacks at all times. The home has a lounge, dining room and kitchen in the main building and a kitchen and lounge in each of the other 2 buildings. The lounges have a TV and music system and one also has a computer. This enables people to get away from each other if they choose but still have the same facilities. The standard of decorations and furnishings create a warm, friendly and homely atmosphere. However, improvement is needed in the homes’ arrangement for general maintenance. People living at the home pointed out a number of issues that they thought needed attention. For example, supports holding up a curtain pole were loose and one person thought this could fall on someone’s head, a dishwasher leaked water on to the floor and several people thought they could slip as a result. Several electrical faults were highlighted and lights that were not working. One person was very concerned that the window in their bedroom did not close properly and caused a draft. We looked at the window and there was a draft caused by the ill-fitting window. During this inspection electricians came to the home and arrangements have been made to repair/ replace electrical items. When being shown around the gardens we noted broken concrete around a drain covering that people could trip over. We spoke to the manager about the arrangements for routine maintenance at the home. The home does not employ a maintenance person and maintenance tends to be in response to, rather than to prevent, a problem. We noted that several carpets were stained. People living at the home said they would like to be able to hire a carpet cleaner as they did not like the dirty carpets. A separate laundry is provided for people at the home. This was clean and well organised at the time of this visit. People were concerned that one commercial washing machine is not sufficient to cope with 11 peoples’ laundry and a tumble drier has been out of order for some time and has not been replaced. This means that in poor weather people have to queue to dry their washing. The home has been redeveloped and refurnished since the last inspection and people told us they had been asked about colour schemes, furnishings and decoration. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 23 At the time of this visit all parts of the home were clean and fresh. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33 & 35. Quality in this outcome area is adequate. Although people who use services have confidence in the quality of staff that care for them, often there are not enough staff available to meet peoples’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people we spoke with all said staff were kind and caring. Comments made in questionnaires received before this visit included ‘A friendly and positive team’ and ‘the staff really understand the needs of my daughter’. People living at the home, staff and relatives expressed concerns that there are not always enough staff on duty to meet the needs of the people at the home. This has not made an impact on their health needs but more on their social needs. The manager is on duty 5 days a week and also aims to have 2 staff on duty throughout the day and night. The staff on duty at night are sleep in staff. On Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 25 two days of the week an additional carer is on duty from 9-5, when one person at the home has 1:1 time allocated for them. We were told that on some Fridays an additional member of staff is on duty from 2-10pm. One person told us that three people enjoy playing football one evening a week. One member of staff accompanies them leaving one member of staff in the home from 6.45-9.15 responsible for 8 people. This worried them “because if an accident or an emergency happened there aren’t enough staff to look after us”. We were notified before this visit that one person went missing from the home recently. During this visit we were told there were not enough staff to look for them although emergency services were alerted promptly and correct procedures were followed. Comments in questionnaires returned before this visit included “Maybe have more staff to enable the garden facilities to be used”, and when asked how they thought the home can improve “Staff coverage on weekends seem sparse sometimes, could improve” and “ Staff could be more available to residents i.e. more time with them and less time in the office”. All staff told us that poor staffing was their main cause of stress in the workplace. Staff told us they had tried to cover shifts for each other and that many had done overtime but staff were now tired which was reflected in sickness levels. When permanent staff cannot cover shifts the home employs agency staff. They try to make sure that only agency staff that are familiar with the people living at the home cover the shifts. The manager told us that the home is currently seeking to recruit one full time member of staff. Recruitment records were seen for staff; they are stored securely and well organised. They contain the necessary checks required such as references and Criminal Records Bureau (CRB) checks. Ensuring the recruitment procedure is consistent and that all required information is obtained for all employees will protects people, as only those who have undergone this robust procedure will be employed to work at the home. Staff said they felt the induction they had received at the home had met their needs. The Organisation has its own training department and all staff completes a package of training, which includes Food Hygiene, First Aid and Dealing with Challenging Behaviour. We looked at records of staff induction training during this visit. We were told that 6 staff are currently undertaking a Nationally recognised training qualification [NVQ] and one is about to start. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is good. People benefit from living in a well managed home and from having opportunities to give their views in relation to quality. With some adjustments people living at the home will be assured that their needs in relation to safety are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently employed a manager who will be making an application to the Commission to be registered. They have been involved in care since 1993 and were employed as a deputy manager of a service before taking up this post. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 27 People living at the home said they are “given a chance to voice their thoughts”. Regular weekly “ Residents Meetings” are held, people living at the home are involved in staff recruitment and are invited at attend monthly staff meetings. As an outcome of a recent meeting swimming has been introduced as an option for people to take part in. We spoke to the manager about how the views of those living at the home are sought, and what quality assurance and monitoring systems are in place to measure success in achieving the aims and objectives of the home. The manager said that a Quality Assurance questionnaire is due to be updated to include the views of family, friends, advocates, health care professionals and other interested parties. Staff receive training annually in the use of safe ways of moving people and objects that avoid injury to people living at the home or staff. All staff have undertaken training in first aid since the last inspection. This means that there is always a member of staff on duty who is able to carry out first aid in the case of an accident or an emergency. All staff currently employed at the home have undertaken a period of induction training and several hare now undertaking or completing a Nationally recognised qualification. [NVQ] We looked at records kept of accidents that have occurred at the home. All included good information and were countersigned by the manager after he had read them. The fire logbook was up to date and accurate. However, records of training in the prevention of fire indicated that not all staff are up to date. This potentially puts people living at the home at risk. People living at the home and staff said that they would all know what to do if the fire alarm went off and that they had practised fire drills. Prior to the inspection the Manager submitted an AQAA (annual quality assurance assessment), which requests information regarding maintenance records and policies and procedures. This information is used to help form a judgement as to whether the home has the correct policies to keep people safe. Information received before this inspection indicated that all equipment is well maintained regularly. Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 28 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 2 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 6[a][b] Requirement Information included in the home’s Statement of Purpose and service User Guide should be updated. Timescale for action 29/01/08 2 YA24 23[2][b] This is to make sure that people who are considering making Barnfield Farm their home base their decision on information that is up to date. All areas of the home should be 29/01/08 kept in a good state of repair both inside and outside. Equipment provided at the home for use of people living there and staff should be kept in good working order. Enough staff must be on duty at all times to meet peoples’ health and social care needs. Arrangements must be made for all staff working at the home to receive training in fire prevention. 3 4 YA33 YA42 18 23[4] 29/01/08 29/01/08 Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 30 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. Refer to Standard YA6 YA13 Good Practice Recommendations Agency staff employed at the home should be aware of information recorded in individuals’ plans of care. People living at the home should have access to transport to enable them to pursue their chosen lifestyle and activities. This relates to not all the home’s vehicles being road worthy. People living at the home should be offered a key to their bedroom after risk assessments have been undertaken. This is to make sure that peoples’ privacy is respected and it is safe for them to have a key. People living at the home should be provided with sufficient crockery, cutlery and utensils for the preparation of food. The complaints procedure should include up to date information to enable people to know who to contact if they have any complaints or issues. The home should develop a planned maintenance programme with records kept of work to be done and when completed. 3 YA16 3 4. 5 YA17 YA22 YA24 Barnfield Farm DS0000021883.V349215.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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