CARE HOME ADULTS 18-65
Bawden Manor Farm West Polberro St Agnes Cornwall TR5 0ST Lead Inspector
Lowenna Harty Announced 07 June 2005 09:30 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 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 Stationary 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. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Bawden Manor Farm Address West Polberro St Agnes Cornwall TR5 0ST 01872 552237 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Spectrum Mr Christopher Halford Care Home 7 Category(ies) of Learning Disability (7) registration, with number of places Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31 January 2005 Brief Description of the Service: Bawden Manor Farm is a care home providing accommodation and personal care for up to 7 adults of both sexes, with a learning disability. The registered provider is Spectrum, an organisation that specialises in providing services to people with autistic spectrum disorders. Spectrum employes a manager who is registered with the Commission and a team of care staff to run the home on a day-to-day basis. Senior managers fom Spectrum, who are based outside of the home, are available to provide specialist input and support to the residents as required. The home is a detached, two-storey building, set in its own, extensive grounds with a spectacular view of the Cornish coastline. All of the residents have individual bedrooms and are able to access a large communal lounge, a smaller, quiet lounge and separate dining room. Some of the bedrooms have en-suite bathrooms and there are separate toilets and bathrooms in addition to these. The home has a communal kitchen and car parking space outside the main building. The homes main entrance is accessible by steps but there is a separate entrance with level access and there are bedrooms on the ground floor of the building. The building could be adapted to meet the needs of people with physical disabilities if necessary. There is a lift that goes to the first floor of the building, but it is not currently in use. The home has separate office facilities with space for staff to sleep in. The home is in a quiet, secluded area on the outskirts of the village of St. Agnes. The village is within walking distance and local towns are accessible by car.
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection as part of the home’s annual inspection programme on 7 & 8 June 2005. The inspection lasted for approximately nine and a half hours and consisted of the following activities: 1. Inspection of records, including assessment information, care plan daily records and information on staff working in the home. 2. Discussion with the registered manager and deputy manager on how the home operates on a day-to-day basis 3. Inspection of the building 4. Observation of and Interviews with staff 5. Participation in the activities of the home with residents for an afternoon 6. Observation of the daily life of the home. The inspector found that whilst there had been good progress towards improving the quality of the service for the benefit of the residents, further work is needed, particularly to help them develop their communication skills so that they can be more active in making decisions for themselves about their lives in the home. The inspector would like to thank the service users, registered manager and staff for their kind assistance in the conduct of this inspection. What the service does well:
Bawden Manor Farm is a highly specialised service caring for people with very complex needs. In light of this they are carefully assessed before they move into the home and move on from it to ensure that the home is suitable for them. There are currently plans for two of the resident to move on to other homes and for two new residents to move in. This is being arranged so that the changes are made gradually for them all, with opportunities for them to visit the homes, meet other residents and the staff who will be working with them. Most of the residents have very detailed written care plans and risk assessments that their families and professional representatives have signed their agreement to. These set out plans and goals for residents in the short, medium and long term. Residents appeared to be content and well cared for by the staff team, who were in constant contact with them throughout the
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 6 inspection. Staff work alongside the residents to help them to develop practical skills in caring for themselves. Residents are helped to take responsible risks with full assistance from staff working with them. They are helped to undertake a range of activities in and out of the home, including educational activities provided by visiting tutors from a local college. Although this had broken down for a period before the inspection, a new tutor was engaged to work with them while the inspection was being conducted. Residents are encouraged to maintain contact with their families and friends from outside of the home and some of them were preparing to go home for the weekend at the time of the inspection. The home has a mixed gender staff team, reflecting the resident group. Residents are helped to develop their personal care skills with discrete and sensitive support from staff, with full regard for their privacy and dignity. There are good records of healthcare input and support from a range of healthcare professionals from outside the home, including specialist healthcare providers. Most of the staff team have now had training in the safe handling of medication. The home has written complaints procedures and relatives have been invited to supply their views on the quality of the service the home provides. Most of their comments were positive. The home had sufficient staff on duty at the time of the inspection. Staff have clear job descriptions to guide them in what they are supposed to do and there is a relatively low turnover of staff, so they are familiar with the residents. The home is in a very rural situation with spectacular views of the Cornish coastline and extensive grounds, which the residents were enjoying at the time of the inspection. There are several places where they can go for walks with staff, which they appear to enjoy. Residents have personalised bedrooms of their own, which are well decorated and lockable. There are systems in place to ensure the health and safety of residents and staff in most respects. What has improved since the last inspection?
There have been several improvements since the last inspection. Information to prospective residents and their representatives has been updated and improved and now contains better details on the staff working at the home and respite care provided there, so that people can make a more informed decision about whether or not to move in. All of the residents’ representatives have now signed up to their contracts and there is full assessment information available for all the residents who are placed in the home. All but one of the residents now has a detailed written care plan and risk assessment, which has been agreed by their representatives. A resident with sensory needs has now been referred for specialist input to ensure that everything possible is being done to help them to communicate meaningfully and all of residents’ care plans now reflect their needs for assistance with communication, where this is relevant. Their care plans also address their cultural and faith needs to ensure
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 7 these are known and kept under review. The manager has obtained information from residents’ representatives on their individual wishes in the event of their ageing, illness and unexpected death. Staff are now provided with access to training in infection control and records of team meetings and staff supervision have improved. Records on staff are now available to provide evidence of fair, safe and effective recruitment and selection. Spectrum has invested in a computerised system for this to improve practice and ensure confidentiality. The registered manager has developed a basic annual business plan for the service, which could act as the basis for a more detailed plan for its future development. What they could do better:
The main concerns raised at this inspection were in relation to residents’ communication needs. This includes the need for key documents about the service and resident’s personal records to be translated into formats that would enable them to access more of the information directly for themselves. They should be provided with advocates to ensure that they have an independent voice to help them to make decisions about their lives and all need to be referred for specialist support to ensure that all options to help them to develop their communication skills are explored fully. There needs to be better evidence that they are helped to access activities on an individual basis that clearly link to achieving the outcomes listed in their individual care plans. Spectrum is in the process of updating and improving its written policies and procedures and practices around managing medication for service users and this work needs to be completed. There are a few improvements needed to the home’s premises, with particular reference to repair or replacement of worn and torn furniture covers on the living room settees, cleaning or replacement of stained carpets and modernisation of the kitchen. There need to be suitable arrangements made for the disinfection of heavily soiled laundry to prevent the risk of the spread of infection in the home. It would be useful to provide at least one staff member with training in intermediate food hygiene, as staff are responsible for preparing food for home. At the moment the proportion of staff qualified to NVQ level 2 or above is slightly below the 50 level recommended in the National Minimum Standard and the records of their ongoing training and training needs are unclear. The registered manager needs to draw up individual training profiles for all staff and keep them up to date. There also needs to be a whole house training plan so that the manager can tell at a glance what training staff need and prioritise it accordingly. Staff would benefit from improved training in the protection of vulnerable adults from abuse and the registered manager said that this is being arranged for them. They would benefit from being able to access local multi-agency training in order to be
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 8 clear about how the local agencies work together to protect vulnerable adults from harm and abuse. The registered manager should also obtain copies of written vulnerable adult protection procedures from all the local authorities that place service users at the home to complement the local procedures that are available. Whilst systems for recording and storing information on staff working at the home have improved considerably, it was apparent at this inspection that not all the information required to protect service users was available. One staff member’s records were lacking a reference and full employment history and steps need to be taken now that systems are in place, to ensure that all the information is held correctly on them. Spectrum is taking steps to do this. Whilst there is evidence in the home that senior managers from Spectrum visit it on a regular basis to ensure quality of outcomes for service users, copies of their reports need to be sent to the Commission each month, so that there can be an ongoing external review of the management of the home. The registered manager should develop a more detailed business plan for the home, which is linked to improving the quality of care for service users and clearly sets out the costs attached. 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. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 5 Residents and their representatives are provided with information to help them make a choice about where to live although this would be improved by providing copies of it in formats they can access directly. Residents are admitted on the basis of detailed written assessments of their needs and are invited to visit the home prior to moving in. They are given written contracts for their placements at the home, which they or their representatives sign agreement to. EVIDENCE: The home’s statement of purpose and service users’ guides have been updated and now contain all the information required by regulation, including details of staff working at the home and their qualifications. They have still not been translated into alternative formats although the registered manager stated that there are plans for this to be done. The service users’ guide also serves as a contract for residents and is sent out to all their representatives for signature as evidence that they agree with the terms and conditions of the placement. The statement of purpose now contains information on the respite care provision that is offered by the home to a limited number of residents. There have not been any new admissions to the home since the previous inspection although there are plans for two residents to move to alternative homes within the Spectrum organisation and for two new residents to be admitted. All the residents concerned are being provided with detailed, professional assessments to demonstrate the positive benefits of the moves for them,
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 11 which are currently in progress. They have all visited their new placements and met with staff and residents living in them. Their external representatives, including social workers and relatives have been informed and involved and there are full records to demonstrate this. A resident more recently admitted to the home has detailed assessment information on their file, including information from external professionals involved in their care. This accords with the home’s statement of purpose. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 & 9 Most of the residents have detailed written care plans and risk assessment documents, which set out individual goals to be achieved with them, although this was missing for one. Their abilities to make decisions are restricted in most cases, by their difficulties in communication and more specialist input is needed to help them in this respect. Residents play an active part in the daily routines of the home but the extent to which they are consulted on this is limited. They are supported to take responsible risks and encouraged to develop skills in basic activities of daily living. EVIDENCE: All but one of the residents currently in the home has a detailed written care plan, which has been sent to their representatives for signature as evidence of their agreement with the contents. There are copies of care plan reviews and signed evidence of attendance by residents and/or their representatives on their individual files. In the case of the resident whose care plan is outstanding, some work has been done, but it needs to be completed urgently, in light of the length of time that they have been at the home. Because of the specialist needs that residents have with communication, the registered provider should ensure that they access an independent advocacy service. The home’s statement of purpose does provide information on how to do this, but
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 13 residents themselves are not able to make use of this information in its current format. Residents’ care plans make reference to their communication needs, but this is only being followed up via active referral to NHS services in the case of one and needs to be extended to all those who would benefit from this. Residents’ care plans consider their decision-making skills and set goals on a short, medium and long-term basis. They address issues around their cultural and faith needs and keep these under review. They are reviewed at least every six months where they are in place. Care plans are currently in detailed written formats, which are not suitable for them to access directly. Key aspects should be provided to residents in formats they can understand. Residents are encouraged and helped by staff to undertake a range of practical tasks in the home, including shopping and tidying their rooms, for example, as part of a formal skills assessment programme. They had been engaged in this for most of the morning on the day of the observation visit. The degree to which they can be actively consulted, however, is limited by their communication difficulties and there must be evidence in the home that all measures possible have been taken towards helping them to maximise their communication skills. All of the residents have detailed written risk assessments, which are thorough and are shared with their relatives and external professional representatives. They are provided with opportunities to undertake responsible risks such as going horse riding and out of the home with staff to a variety of local community settings. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 & 16 Residents have opportunities for personal development and take part in a range of activities although there is need for improvement. They are supported to maintain relationships with their families and Spectrum’s senior managers provide support and guidance on sexuality issues where necessary. The degree to which residents’ rights are respected is affected by their communication skills and they need to be provided with the maximum amount of support possible in developing them. EVIDENCE: At the time of the inspection, residents were involved in a variety of activities, including activities around the home to help them to develop their skills and abilities in practically daily tasks such as cleaning their own rooms and doing household shopping. Their care plans consider their skills, abilities and interests, set individual goals for them and staff were observed working with them towards achieving these. Their care plans consider their religious and cultural needs and these are addressed appropriately. Until recently, residents have been provided with a tutor from a local college who came into the home to undertake a variety of arts and crafts work with them and there is evidence of their work throughout the home. At the time of the inspection, however, this
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 15 had ceased because the college tutor had been unavailable for several weeks. The situation has subsequently been resolved and another tutor has been engaged to work at the home. In the meantime, residents’ daily records did not provide an adequate record that they are involved in a full range of purposeful activities towards achieving their individual goals in and out of the home. The inspector accompanied some of the residents on a walk with staff, which they appeared to enjoy. Others were enjoying the sunshine and spending time in the garden, preparing for visits with relatives and staff were in attendance at all times. The home provides transport for residents and there are sufficient drivers to take them out. Residents’ rights to make decisions about their lives are limited by their communication difficulties, which is recognised in their care plans, but there needs to be better evidence that they are fully supported to develop their communication skills. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 & 21 Staff assist residents with the personal care they need but they need more support to enable them to communicate their preferences. Their physical and mental health needs are met. The home’s policies and procedures in respect of medication are currently being reviewed and revised. There are systems in place to deal sensitively with issues around the ageing, illness and death of a service user. EVIDENCE: Residents’ records provide staff with detailed instructions on how they should assist them with their personal care. They are encouraged to develop their self-care skills. Four of them have en suite bathrooms and all receive personal assistance in private. All of the residents appeared to be well groomed and fashionably dressed at the time of the inspection. There is a mixed gender staff team to reflect the resident group. There are records of input by general and specialist NHS healthcare providers for all of the residents and one has now been referred for specialist assessment with regard to their communication needs although this needs to be extended to all those who would benefit from this. The home is currently undergoing a review of its medication policies and procedures following a recent inspection by the Commission’s Pharmacy Inspector and this standard will be reviewed in more detail at the next inspection, when this work is complete. In the meantime most of the staff have
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 17 completed or are in the process of completing training in safe handling of medication via a local college’s distance learning programme. Service users’ care plans consider their long-term needs and their representatives have been consulted with regard to their wishes in the event of their serious illness, ageing or death. There are records of their individual wishes as well as written policies and procedures to guide staff on dealing with these issues. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Residents’ views are currently difficult to ascertain because of their communication difficulties. Written policies and procedures for protecting service users from abuse need to be updated and staff need improved access to training. EVIDENCE: The home has a written complaints procedure that meets the regulations, which is communicated to residents’ personal and professional representatives external to the home, but is not provided to them in formats that they can access for themselves. Most have difficulties that limit their abilities to make their views known and better evidence that they are fully supported to access specialist support to maximise their communication skills is needed. Staff are provided with some training on the protection of vulnerable adults from abuse as part of their induction. The home has written policies and procedures that all the staff have signed up to, but they need to be updated to reflect current best practice. All of the staff have copies of the GSCC Code of Practice. Spectrum has introduced a new internal course on the protection of vulnerable adults from abuse and staff need to sign up for this. They should also be provided with support to attend multi-agency training available locally. The registered provider has copies of the local Council’s inter-agency guidelines but should also obtain them from residents’ placing authorities where they come from outside the local area. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28, 29 & 30 Residents live in a homely environment although the inspector noted several improvements that were either needed or being undertaken during the inspection. They have individual bedrooms that suit their needs with sufficient toilets and bathrooms. The home has a range of communal spaces and some equipment for residents with specialist needs. Standards in relation to hygiene are in need of further improvement EVIDENCE: The home is located in a very rural situation with extensive, well-tended gardens at the front and rear of the building and a spectacular view of the Cornish coastline. It is well situated for residents to access a variety of pleasant local walks and beaches. The local village is within short driving distance. The building itself consists of a domestic, two-storey dwelling that provides each resident with a single bedroom. Several have en-suite bathrooms, including one with a whirlpool bath. There are sufficient communal bathrooms and toilets. Residents’ bedrooms are furnished and personalised according to their individual tastes and needs. The home has sufficient communal space to offer residents a variety of spaces to occupy themselves outside of their own rooms, including a large and comfortable lounge. There
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 20 was maintenance work in progress at the time of the inspection but the inspector noted several outstanding repairs that need to be completed, including cleaning or replacement of a stained carpet in one room and corridor, replacement or repair of the lounge furniture, particularly to a chair with a torn cover and modernisation of the kitchen. Checks of fire safety, equipment and environmental risk assessment records provide evidence that appropriate measures are in place to protect residents. All of the bedrooms have door locks or suitable equipment to ensure their privacy and independence. There are close-circuit TV cameras in the corridors for security reasons, which is explained in the home’s statement of purpose. Residents with specialist needs have some equipment and the home is readily adaptable for people with physical disabilities, with some bedrooms on the ground floor. The home was clean and tidy at the time of the inspection. Staff now have access to infection control training and there are written procedures to guide their practice in this respect. They are also provided with protective equipment. They are able to access training in basic food hygiene, but at least one should undertake intermediate food hygiene training. The home only has an ordinary domestic washing machine and suitable facilities need to be in place for laundry that requires disinfection. There are suitable arrangements for transportation of laundry in the home as observed at the time of the inspection. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35 & 36 Staff work to clear job descriptions. Slightly less than the recommended number are currently qualified and it is difficult to ascertain the training levels and needs of the staff team as a whole because there is no overall training plan for the home. Recruitment records are now available in the home but not all the records required to protect service users were available. There are suitable arrangements for staff supervision although they would benefit from the introduction of an annual appraisal system. EVIDENCE: Copies of staff job descriptions are available for inspection and provide them with clear direction on the work expected of them. There are separate job descriptions for senior staff with supervisory responsibilities and the registered manager. Records of staff rotas demonstrated that the home is covered by sufficient numbers of staff with relatively low rates of staff turnover and use of bank staff. All bank staff are Spectrum employees rather than from external agencies and have knowledge of the needs of the service users. Slightly less than the recommended 50 ratio of care staff are qualified to NVQ level 2 or above although all but one of the team are working towards achieving it and most have nearly completed it. Although there are some records of training completed by individual staff members, there is no overall training plan for the staff team as a whole and this is needed so that gaps in training can be clearly
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 22 identified and training prioritised to ensure that residents are protected at all times by a team that is fully competent to work with them. Spectrum has recently introduced a new computerised record system, which provides access to all the information on staff required by regulation. This provides evidence of fair, safe and effective recruitment and selection, which staff members confirmed when interviewed. Records for the one staff member were incomplete, with a missing reference and unclear/incomplete employment history, but there are systems in place now, to ensure better practice in the future. There are records of individual staff supervision sessions and regular team meetings. Staff would benefit from an annual appraisal or review to ensure that they are meeting the goals and needs of the residents. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 41, 42 & 43 The home has systems to monitor the quality of the services it provides although they should be improved further. There is a business plan for the home’s development but it lacks detail. Most records required by regulation are now available, secure and up-to-date. The health, safety and welfare of residents is mainly protected, with the exception of adequate laundry facilities. The home is well managed by a manager who is registered with the Commission. EVIDENCE: Residents’ representatives have been asked to provide their views on the quality of the services provided by the home, and records indicate that most are satisfied that the home provides a good standard of care. There are records that senior managers from Spectrum visit the home but copies of their reports need to be sent to the Commission on a regular basis. Spectrum has introduced a new computerised record system to provide evidence of fair, safe and effective staff recruitment and selection but full records were lacking for all of them. All other records required by regulation for the safety and welfare of
Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 24 residents are held securely in the home and appeared to be accurate and upto-date. Fire safety risk assessments are in place, with records of fire drills, tests and checks. The registered manager has completed a full and detailed environmental risk assessment for the premises. There are arrangements to prevent the risk of cross-infection but suitable laundry facilities are needed. Spectrum provides the Commission with annual information on the viability of its services as a whole and the registered manager has drawn up a brief business plan for the home but it lacks detail, particularly with regard to costs and quality outcomes for residents. Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23
ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 2 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x 2 3 x 3 2 x Standard No 31 32 33 34 35 36 Score 3 2 x 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bawden Manor Farm Score 2 3 2 3 Standard No 37 38 39 40 41 42 43 Score x x 2 x 2 2 2 D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 26 yes 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 6 Regulation 15(1) 15(2) 17(1)(a) Requirement Timescale for action 30/07/05 2. 6, 7, 8, 16, 18 12(1) 12(2) 12(3) 13(1)(b) 3. 20 13(2) 4. 24 23(2)(b) 23(2)(d) There must be evidence that service users are provided with written care plans in accordance with the regulations upon admission to the home in every case. The timescale for compliance has been re-set from the first notification and extended from 30/04/05 to ensure full compliance for all service users. There must be full evidence in 30/07/05 the home that service users have been given access to specialist services to assist them to develop their communication skills to enable them to fully participate in making decisions about the care and services provided to them. The registered manager must 30/07/05 ensure that arrangements in respect of the management of medicines in the home are in accordance with the guidelines of the Royal Pharmaceutical Society of Great Britain (June 2003) and current best practice. The registered provider must 30/07/05 ensure that the home is kept well decorated and in a good
Version 1.30 Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Page 27 5. 30, 42 13(3) 6. 34, 41 17(1)(a) 17(2) 19(1)(b) 7. 35, 42 18(1)(a) 18(c)(i) 17(2) 8. 39 26(5)(a) state of repair internally with particular reference to the furniture in the main lounge, kitchen units and carpets that are worn and stained. Suitable arrangements must be made to prevent the spread of infection in the home with particular reference to washing machine facilities/ arrangements for laundering heavily soiled materials that require disinfection. The timescale for compliance has been re-set from the first notification and extended from 30/04/05 in recognition of progress towards obtaining staff training in infection control and to enable full compliance. All records required by regulation must be maintained in the home. The timescale for compliance has been re-set from the first notification and extended from 30/04/05 in recognition of progress towards almost full compliance. The registered provider must ensure that there is evidence in the home that staff have induction and subsequent training suitable for the work they are to perform. This must be up-to-date and readily accessible for planning purposes buy the registered manager and inspection by the Commission. The timescale for compliance has been re-set from the first notification and extented from 30/04/05 pending the completion of a full review of its training support to staff by the registered provider. The registered provider must ensure that written reports in accordance with this regulation 30/07/05 30/07/05 30/07/05 30/07/05 Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 28 are submitted to the Commission on a monthly basis. 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. Refer to Standard 1, 5, 6, 22 Good Practice Recommendations The homes statement of purpose, service users guide including complaints procedure and service users care plans should be translated into formats that would enable service users to access relevant information directly. Service users should have independent advocates, particularly those with communication difficulties. Evidence that service users are assisted to access a range of activities in accordance with their individual needs and written objectives of care plans needs to be improved. The registered manager should obtain copies of interagency policies and procedures for the protection of vulenerable adults from abuse from each of the placing authorities for service users resident in the home. Staff should be provided with up-to-date training in the protection of vulnerable adults from abuse, including access to local multi-agency training. At least one staff member should undertake intermediate food hygiene certificate training. Arrangements should be made to ensure that at least 50 of the staff team is qualified to NVQ level 2 There should be a whole staff team training profile to assist the planning of staff training. The registered manager should introduce a system of staff appraisal linked to positive outcomes for service users. The homes annual business plan should contain costs and be more clearly linked to an annual development plan for the home based on quality assurance measures and positive outcomes for service users. 2. 3. 4. 7, 8, 16 12 23 5. 6. 7. 8. 9. 10. 23 30, 42 32 35 36 39, 43 Bawden Manor Farm D52-D04 S8966 Bawden Manor V222581 070605 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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