Inspection on 13/11/06 for Boldshaves Oast

This inspection was carried out on 13th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Boldshaves Oast 27/08/08

Boldshaves Oast 22/02/06

Boldshaves Oast 26/09/05

Boldshaves Oast 29/11/04

Boldshaves Oast 09/08/04

Boldshaves Oast 25/01/04

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

CARE HOME ADULTS 18-65 Boldshaves Oast Boldshaves Oast Frogs Lane Woodchurch Ashford Kent TN26 3RA Lead Inspector Mrs Sally Gill Unannounced Inspection 13th November 2006 09:10 Boldshaves Oast DS0000023331.V301405.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 Boldshaves Oast DS0000023331.V301405.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. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Boldshaves Oast Address 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) Boldshaves Oast Frogs Lane Woodchurch Ashford Kent TN26 3RA 01233 860039 leotrust@btinternet.com The Leo Trust Mr Joseph Graham Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users resident in the cottage are restricted to two whose DOB are 27/06/1974 and 26/07/1946. 22nd February 2006 Date of last inspection Brief Description of the Service: Boldshaves Oast is registered to provide accommodation for up to 13 adults with a learning disability. Two of which are accommodated in a self-contained cottage in the grounds with some staff support. Another two are accommodated in a purpose built log cabin in the grounds with staff support. The company The Leo Trust owns the business. The Registered Manager, Mr Joe Graham has day-to-day responsibility for the Home and also manages another home. The main premise is a converted Oast with accommodation on three floors. All bedrooms in the main Oast are singles. Five rooms have ensuite facilities. The other four residents either have the sole use of a bathroom or share with one other. There is a kitchen, dining room and two lounges. All rooms have extensive views over the countryside. There is a deckling and porch area from the main Oast, which is surrounded by a large well-maintained garden with large duck ponds, and horticulture project with Poly-tunnels, further paddock and car parking space. The home is situated down a drive from a quiet country lane. In a remote rural position, one and a half miles from the village of Woodchurch and four and a half miles from Tenterden. Within the village of Woodchurch there is the local GPs surgery, post office, church and two pubs, the home has transport, which can be used for residents if they wish. The current range of fees is from £475.09 to £1852.20 per week. There are additional charges for hairdressing, magazines and newspapers and personal toiletries. A copy of the latest inspection report can be viewed at the home. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was carried out over a period of time and concluded with an unannounced site visit to the home between 9.10am and 3pm. Thirteen people were living at the home. The inspector spoke to residents, staff and the manager. Observations included interactions between residents, the manager and staff. The inspection process consisted of information collected before and during the visit to the home. Surveys were sent to relatives, care managers and the doctor’s surgery. Feedback was received from doctors, relatives and a care manager all of which was positive. Various records were viewed during the inspection. The inspector accessed the cottage, the cabin, both lounges, the laundry and one bedroom in the Oast. What the service does well: Residents say they like living here and are happy. They like the staff who spend time with them individually. Staff are caring and treat them with kindness. Residents have many opportunities to enjoy a full and busy life. There is a wide choice of activities such as golf, swimming and football. Outings to places of interest are organised often and there is lots of involvement in the local community. Residents are able to develop and enjoy relationships and good family contact is encouraged. Relative’s feedback included comments ‘the standard of care and commitment is excellent’ and ‘Boldshaves is outstanding. There is nothing I have found that compares with it. It is exceptional. It is an example to others in the business as to how to do it properly 10 out of 10’. ‘A very happy atmosphere’. Resident’s benefit from a home where they have the say in what happens. The manager puts residents first and is always looking to improve their quality of life. Resident’s benefit from a very nice home which is well maintained, clean, comfortable and homely. It has spacious grounds and good individual accommodation for two couples. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 7 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 Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 8 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): 2, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and relatives have the opportunity to visit the home. They have the information they need to make a choice about whether to move in. Contracts of terms and conditions are in place for each resident but these are not always signed. EVIDENCE: Assessments are obtained from professionals involved in residents care prior to their admission. Staff also visit prospective residents in their own environment to make their own assessment of needs. Most of the assessments are held on files. This information is used to develop a care plan. Residents said they had chosen whether to move to Boldshaves Oast. They and their relatives had been able to visit the home prior to moving in. Contracts are in place. However those seen are not yet agreed and signed by the resident/representative. It is recommended that all contracts are agreed and signed. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 9 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, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans reflect help needed from staff and residents goals. They do not reflect a person centre approach or recommendations made by professionals and not all are regularly reviewed. Residents are able to make decisions about their day-to-day lives. participate as far as possible in running of home. They Residents are given assistance to aid independence, which is supported by risk assessments. But some of these are not regularly reviewed. EVIDENCE: Care plans are at present being changed. Another format is being added to give more detail. Goals are in place but there is no written detail as to how these are being achieved although staff were able to say. The care plans still lack a person centred approach and resident’s involvement. Reviews of care plans can be confusing. Some reviews were not up to date. An Occupational Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 10 Therapist’s assessment had been received but the recommendations had not been followed through into the care plan. Daily records showed good detail and care needs being met. Residents said key workers spend 1:1 time with them. Residents said they have choices, which was agreed by staff and relatives. Residents meetings are held weekly. Where the menus, outings and activities are talked about. Residents are able to what they want to join in and are involved in staff recruitment. Risk taking to aid independence is supported with written risk assessments. Reviews of risk assessments again is not consistent. Risk assessments for selfadministration of medicines need better detail. See medication standard. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 11 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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to develop themselves and enjoy a full and busy life. There is a wide choice of activities and outings with plenty of involvement in the local community. Residents are well supported by staff to develop and maintain relationships and family contact. Routines are flexible although responsibilities are recognised. Residents enjoy their meals, which they help plan and prepare. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 12 EVIDENCE: The home is remote but this does not restrict activities and opportunities. Relative’s feedback agreed that ‘residents are kept busy but have their privacy if they wish’. Residents were keen to talk about the many activities and outings that they obviously enjoy. Activities include horse riding, disco, horticulture, ten-pin bowling and the gym. Residents are involved in voluntary and other work including nearby stables, a care home for older people and a supermarket. Others said they attend college and evening classes There is also plenty of involvement in the local community as members of groups, the local farmers market and church or helping out with local clubs such as brownies. Resident’s chose where they want to go for day trips out and recently have been to Hastings and Bedgebury Forest. All residents have an annual holiday. It is apparent that relatives are an important part of resident’s lives. Feedback from relatives ranges from good to excellent. Comments included ‘my son/daughter is very happy there’. ‘I am extremely satisfied and happy with the level of care and consideration X receives. Parents and family are always welcomed and often invited to take part in events held at Boldshaves’. ‘When I visited X I was treated with hospitality and kindness. It seems a happy little unit’. Residents have developed relationships, which are well supported by staff with guidance from professionals. Two couples live as independently as possible in self-contained accommodation within the grounds of the home. Daily routines promote independence and choice. Residents were getting their own breakfast and lunch. They said they are involved in meal planning and room cleaning. There was plenty of fresh fruit in the fruit bowl. Residents talked about Sunday lunch where everyone eats together in main Oast. The cottage and cabin eat most of their meals independently and plan and cook them with assistance. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. Residents are happy with the support given by staff and their health care needs are met. Generally sound medication systems are in place but procedures for selfmedication need improvement. EVIDENCE: Support is given in a way, which is sensitive and ensures dignity. Times for getting up were flexible. One resident went to have his haircut. He was very pleased with his new style, which he was keen to show off. Details are recorded of regular health care check ups and appointments. Observations showed that any concerns are monitored and then refer appropriately. See earlier comments regarding recommendations from the Occupational Therapist being followed through into the care plan. Generally medication is handle and recorded well. Risk assessments are in place for self-administration. These need better detail. The Medication Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 14 Administration Record should show the audit trail of medication handed over to residents. Staff are trained in administration of medicines and another course planned. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Resident’s views are listened to and acted upon. Staff training could improve resident’s protection from abuse. EVIDENCE: There have been no complaints received by the home for some considerable time. Residents said they felt happy to speak to staff or Joe about any concerns they had. Residents have the opportunity to air their views at weekly meetings as well as 1:1 time with the key worker. Staff were clear about what to do in the home if an incident or suspicion of abuse occurred. However they were not clear where to report abuse outside of the home. Training records did not list adult protection training. The staff that was spoken to had not received this training. All staff should have adult protection training. Good systems are in place to deal with resident’s monies. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 16 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, 25, 26, 27, 28 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a spacious, well-maintained, clean, comfortable and homely environment with good individual accommodation for two couples also provided. EVIDENCE: The Oast accommodates nine residents. All in single rooms and they have the sole use or share a bathroom with one other. There are eight bathrooms. The cottage accommodates two residents that live as independently as possible as a couple. They have a bedroom, lounge, bathroom and kitchen/diner. The new cabin accommodates another two residents that live as a couple as independently as possible (but less so than in the cottage). They have a lounge/diner/kitchette, an extremely spacious bedroom and a bathroom. Fixtures, fittings and furniture are of good quality and result in a homely environment, which is comfortable. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 17 Bedrooms vary in size. They are very personalised reflecting interests and hobbies. Residents said they are happy with their room, cottage or cabin. The Oast’s lounge furniture has also been replaced and rearranged which has resulted in a nicer environment. All units have a patio area outside and seating. The Oast has a newly decked area with covered porch leading from the lounge via new patio doors. The grounds are well maintained and include two large ponds and the horticultural project (poly tunnels & gardens). The kitchen is smallish which means meal preparation involving residents has to be organised. The laundry facilities are outside in a wooden building. The home was clean and staff practiced good hygiene. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 18 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, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a very caring staff team some of which are qualified and trained but the team could be more effective if there were improvements to records, supervision and training opportunities. EVIDENCE: Records showed that just fewer than 50 of staff have achieved a National Vocational Qualification (NVQ) qualification. Staff were observed to communicate well with residents using a very caring attitude but on a adult to adult basis. Staff showed a clear commitment and enthusiasm for their role. Relative feedback about staff was good. Including comments that ‘staff are friendly and very helpful’ and the staff are very pleasant. On the day of the visit there were sufficient staff on duty to meet the needs of all residents. Files evidenced a robust recruitment procedure is followed. The application form should be reviewed to include the full employment history. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 19 Staff have undertaken an induction programme which includes shadowing of experienced staff. However this is not the Skills for Care induction, which is recommended. Staff also commented that their induction was a bit muddled. Staff training records were not fully up to date. The registered manager agreed to up date the records. Then an audit of training should be completed and a plan produced to address any shortfalls. A member of staff said they felt supported but did not receive supervision. The records for supervision again were not up to date. Team meetings have recently been increased from monthly to weekly to improve communication and consistency. As the senior team leader has recently left addition support and supervision is necessary. Formal staff supervision should be restarted. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 20 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, 38, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a home where their views underpin what happens and is run in their best interests. The manager is competent and has an approach, which is inclusive and open. The health safety and welfare of residents is promoted but further staff training would benefit. EVIDENCE: The registered manager is also responsible for another small home. He is a qualified social worker with a wealth of experience in the care and managing services. He is keen to keep up to date and be aware of changes. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 21 A senior team leader has recently left leaving a gap in day-to-day management. The registered manager is aware he will need to spend more time within the home until the new structure is efficient. The registered manager is very good at communication the aims of the home through to ensure resident and staff are clear. His style is open, inclusive and approachable. Residents and staff confirmed this. The atmosphere is happy and relaxed. Quality assurance has recently been informal. There is plenty of contact with relatives. There are regular residents meetings and regulation 26 visits. The reports for the regulation 26 visits need to be improved inline with Inspecting for Better Lives (IBL) 2. There is a development plan for the home. Training has taken place in food hygiene, fire awareness and first aid. The records show a lack of health and safety training. See also staffing. One daily report evidenced an accident, which was not recorded on an accident report. All accidents must be recorded properly. Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 22 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 X 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 4 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 4 3 X X 2 X Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 2 3 Standard YA6 YA9 YA20 YA35 Regulation 15 13(2) 17(1) 18 & schedule 2 17 & schedule 3 Requirement Timescale for action 13/12/06 4 YA42 Care plans and risk assessments must be kept under review and updated as required The home must operate a safe 13/12/06 system for self administration of medication Up date staff training records, 31/12/06 complete an audit of training and produce a plan to address any shortfalls All accidents must be recorded 20/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA5 YA6 YA23 Good Practice Recommendations Residents contract of terms and conditions to be agreed and signed by them/their representative Recommendation by professional should be followed through into the care plan All staff should receive adult protection training DS0000023331.V301405.R01.S.doc Version 5.2 Page 24 Boldshaves Oast 4 5 6 YA34 YA35 YA36 The application form should be reviewed to include the full employment history Skills for Care induction One-to-one staff supervision to take place for all staff at least six times each year Boldshaves Oast DS0000023331.V301405.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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