CARE HOME ADULTS 18-65
Boldshaves Oast Frogs Lane Woodchurch Ashford Kent TN26 3RA Lead Inspector
Sally Gill Announced 26/09/05 at 10:00hrs 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. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Boldshaves Oast Address Frogs Lane Woodchurch Ashford Kent TN26 3RA 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) 01233 850014 The Leo Trust Mr Joseph Graham Registered Care Home 11 Category(ies) of Adults with Learning Disability 18-65 registration, with number of places Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service Users resident in the cottage are restrictd to two whose DOB are 27/06/1974 and 26/07/1946 Date of last inspection 29th November 2004 Brief Description of the Service: Boldshaves Oast is registered to provide accommodation for up to 11 adults with a learning disability 2 of which are accommodated in a self-contained cottage in the grounds with some 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 another 2 bedded unit. 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 and Service Users have the use of two bathrooms and a shower room. There is a kitchen, dining room and two lounges. All rooms have extensive views over the countryside and the Oast is surrounded by a large well-maintained garden with a large duck pond and horticulture project with Polly-tunnels, further paddock and car parking space.The Home is situated down a drive from a quiet country lane. In a quiet 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 GP’s surgery, post office, church and two pubs, the Home has transport, which can be used for Service Users if they wish. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 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, which took place on Monday, 26th September 2005 between 9.50am and 5.25pm. Additional time was spent in preparation and report writing. During the inspection the Inspector met all the Service Users and spoke to nine either in company or individually. Comments included “I like living here”, “its lovely food” and “I like x (staff member). Also, she spoke to the Registered Manager, six staff and a relative. Surveys were received back from seven Service Users, which were positive. Eight relatives returned surveys, which indicated that they are fully satisfied with their care at Boldshaves Oast. Comments included “we are delighted with X’s progress, his behaviour has improved enormously”, “I am constantly impressed by the level of care and attention to residents needs”, “the professionalism of the staff is constantly sustained, whilst providing a caring and stimulating environment” and “it is a well run home and my x is very happy and has a full and active life “. The care of two Service Users was case tracked. The Inspector examined various records including care plans, risk assessments, client’s finances, the fire safety logbook, Medication Administration Record (MAR) charts, a policy and the accident book. Areas of the home seen by the Inspector included the lounges, hallway, dining room, toilet, cottage lounge and the grounds and horticulture project. The Inspector would like to thank all staff who assisted with the inspection who were extremely helpful throughout. What the service does well:
The home is a lovely Oast, which provides Service Users with a spacious homely, pleasant, comfortable and clean environment. The cottage provides self-contained accommodation to a married couple. With extensive grounds in a very rural setting the emphasis is on outdoor life with Service Users able to work on the horticultural project, which with the help of staff they have developed to provide fruit and vegetables for both the home as well as a local farmers market and shop. It also produces plants to sell. The home also has chickens, which Service Users look after and provide the home with eggs. As well as working on the horticultural project the Service Users have access to a good variety of regular appropriate activities including bowling, horse riding
Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 6 and swimming, which are enjoyed. They are also encouraged to get out and become involved in the local community such as the church and villages groups. Service Users are supported to go to college/adult education. Service Users are fully involved in the running of the home and said they are consulted about changes and helped to plan daily things like menus and trips out. Interaction between the Service Users and staff is good. There is a stable core staff team, which are committed to ensuring that Service Users have a good quality of life. There is an informative staff handover at the start of each shift with the emphasis on Service Users welfare. The admission process is well planned and fully reflects the standards including pre-admission assessments, several trial visits including staff visiting the prospective Service User in their own environment to undertake their own assessment to ensure that the home can meet the needs of the prospective Service User who has all the information they need prior to making a final decision. What has improved since the last inspection? What they could do better:
There remains one Service User without a signed contract/written agreement in place. The medication system/records require improvements to ensure Service Users are not at risk. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 7 Care plans require improvement to ensure that they reflect the Service Users skills and abilities and state the actions/input from staff required to meet their needs. Care plans should be developed from the assessment, which cover all areas of assessed needs (standard 2.3). Care plans should be crossreferenced with other documents to ensure that staff are fully aware of all information. 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. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 8 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 Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 9 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, 4 and 5. Prospective Service Users have the information and opportunities they need to make an informed choice about the home and their individual aspirations and needs are assessed. Not all Service Users have a written contract which they have agreed/signed. EVIDENCE: The home has reviewed its detailed Service User Guide and the Inspector was given a copy to hold on file at the Commission. A relative described the well-planned admission process, which fully reflected the standards including trial visits. A copy of the Care Managers assessment is held on file together with the homes own assessment carried out in the prospective Service Users own environment. The Inspector was advised that all but one Service User now has a signed and agreed written contract in place. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 10 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 and 10 There is no clear care planning system in place to adequately provide staff with the information they need to meet the Service Users assessed needs. Service Users are consulted and are able to make decisions about they day-to-day life. Risks are managed in a way that does not limit individual development. Information is handled and stored appropriately. EVIDENCE: Care Plans do not cover all areas of standard 2.3. The assessed needs highlighted in the initial assessments undertaken by Care Managers are not followed through into the care plan. Care plans should reflect the Service Users skills and abilities but also give clear information regarding the input required by staff to ensure that their needs are met and also that staff adopt a consistent approach to promote independence wherever possible. Care plans where appropriate should also be cross-referenced to other relevant information i.e. risk assessments. A key worker system is in place with Service Users aware of their key worker and what their role is. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 11 Service Users spoke of regular house meetings to discuss menus and other day-to-day decisions. It was evident throughout the inspection that Service Users are able and do make decisions regarding their day-to-day lives. Risk assessments cover a range of risks and included actions to minimise that risk and were reviewed within timescales. Service Users are encouraged to take responsible risks to enable development. Discussions with staff showed they are aware of the principles of confidentiality with were upheld throughout the inspection. Records were observed to be stored individually and securely. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 12 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, 14, 15, 16 and 17 Service Users are able to choose from a variety of appropriate activities and leisure activities and get out and be a part of the wider community. Family contact is encouraged and supported. Service Users rights and responsibilities are promoted. Meals are healthy and mealtimes pleasant. EVIDENCE: Several Service Users are undertaking adult education/college course in a variety of subjects. Some Service Users if they choose are able to work on the horticultural project or have other work placements. A variety of group and individual leisure activities are enjoyed by Service Users including bowling, swimming, gym, golf, discos and horse riding. Recent day trips have included a steam train ride to Bodium Castle and a visit to Leeds Castle. Service Users are encouraged to get out and also become involved in the local community including the church and other village groups. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 13 During the inspection one Service User talked about a holiday with their family and another returned from a home visit. Families stated that they are made to feel welcome at the Home and are always kept informed of events. Discussions with Service Users confirmed they are encouraged to participate in household tasks such as ironing, laundry, room cleaning, meal preparation and cookery. Service Users said that they plan menus weekly. Shopping is undertaken weekly with Service Users at local supermarkets although meat, fruit and vegetables are purchased/delivered from local shops or grown on site. Mealtimes were observed as relaxed, unrushed and flexible to suit Service Users. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 14 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, and 20 There is no clear care planning system in place to ensure Service Users are supported to maximise their independence and receive support in the way they prefer and require. Health care needs are met. Shortfalls in the medication system could potentially place Service Users at risk. EVIDENCE: Care plans do not reflect personal care needs or preferences, the skills and abilities of Service Users or the input required from staff (see standard 6). Discussions highlighted that times for getting up and going to bed are flexible. Service Users are aware of their designated key worker. Records and discussions reflected that all health care needs are met mainly within the community. Where appropriate Service Users are able to self medicate. However the risk assessments should contain details of secure storage, allocation and disposal of medication. All medication must be stored securely and where this is not in the locked medication cupboard a risk assessment must be in place. Where a Service User is self medicating the issuing of the medication must be recorded on the MAR chart including date and quantities. Where staff are administering medication there must always be either a signature or code entered on the
Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 15 MAR chart. All medication that is prescribed PRN must have written instructions to staff including why and when it should be administered and authorisation required. Stickers must not be used to obscure information on the MAR charts. Handwritten entries should be signed and witnessed by staff. Where the instructions for a medication are no longer accurate this should be referred back to the pharmacist or GP. The care plan should contain an accurate record of medication including start and end dates in order to show the history. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 16 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 and 23 Service Users feel safe at the home and their views are listened to and act upon. Staff have a good knowledge and understanding of Adult Protection issues which protects Service Users from harm or abuse. EVIDENCE: There have been no complaints since the last inspection. Regular meetings are held to discuss any issues or problems. Observations during the inspection highlighted that Service Users feel free to discuss any issues or concerns they may have in order that these can be dealt with at an early stage. Discussions with staff showed their awareness of adult protection and the correct reporting process. Service Users finances and records were kept appropriately. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 17 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, 28 and 30 The standard of the environment within this home is very good providing Service Users with a clean, safe, attractive, spacious and homely place to live. EVIDENCE: The home continues to be a well maintained with ongoing maintenance and planned improvements. Since the last inspection the quiet lounge flooring has had a new floor, a ramp has been built for wheelchair access to a rear door, the outside has been painted, a new fire panel installed and new dining tables and chairs. Two Service Users are accommodated in a self-contained cottage within the grounds and the cottage has had a new lounge suite. One of the benefits of this home is the very rural location, which provides safe and large grounds for the Service Users use. The large garden is very attractive and well maintained. There is a large lawn area, large duck pond, patio/seating area, established shrubs and trees. The garden is home to ducks and chickens. One Service User has their own summerhouse within the garden. The grounds extend to nine acres. The horticulture project is located within the garden area and is now well established with Service Users producing fruit, vegetables and plants.
Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 18 The fire safety logbook was viewed and all tests have been carried out to the required frequencies to ensure safety. The areas seen by the inspector were clean and hygienic. The policy on infection control has been reviewed and now includes the procedure, that staff follow when dealing with clinical waste and when it is appropriate to wear personal protective wear. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 19 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) 32, 34 and 35 A competent and stable staff team supports Service Users. Staff morale is high resulting in an enthusiastic workforce that works positively with Service Users to improve their whole quality of life. EVIDENCE: Six staff have completed an NVQ level 2 or above and another three are currently undertaking their qualification. This is on track to meet the 50 target. Staff undertake a LDAF induction programme which the Inspector is pleased to see is competency based, as well as the home own induction programme. Staff files evidenced a robust recruitment process is followed. Since the last inspection two team leaders and a deputy manager have been recruited to strengthen the staff team. The interaction between staff and Service Users is good often with the use of good humour. The main staff team is stable. Discussions and observations highlight the commitment and motivation of staff to improve the quality of life for the Service Users. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 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 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, 40, 41 and 42 There should be some improvement in records to ensure Service Users best interests are safeguarded. Service Users views underpin the self-monitoring and development of the home. The homes policies and procedures safeguard Service Users. The health and safety of Service Users is promoted and protected. EVIDENCE: The Home has gained the Investor in People Award. Evidence was seen that questionnaires are sent to Service Users and relatives and to date no negative feedback has been received. The home could benefit from expanding the quality assurance to Care Managers and other professionals involved in the Home. Regulation 26 visits take place. It was evident that Service Users were aware of the inspection. The Home has a full set of has policies and procedures reflecting the NMS.
Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 21 There are some improvement required to records such as care plans and medication records. Further staff have been trained and there are now eight staff trained in manual handing, all in fire safety, ten in first aid, six in food hygiene and four in infection control. Fridge/freezer temperature are monitored and recorded daily. Hot water safety valves are fitted to baths with additional checks, which are recorded. Window restrictors or risk assessments are in place. The Home has a Legionella check annually. COSHH assessments are in place. Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x 4 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Boldshaves Oast Score 2 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 3 2 3 x H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 23 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 5, 41 Regulation 5 Requirement All Service Users to have a signed contract in place (previous timescale 1/8/05 not met) Implement a safe medication system by addressing areas highlighted in text Timescale for action 26th October 2005 26th October 2005 2. 20, 41 13(2) 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 6, 41 6, 18, 41 Good Practice Recommendations Care plans to cover all areas of 2.3 and to be crossreferenced to other care documents Care plans to detail Service Users skills and abilities and contain sufficent detail of input required by staff in order to meet Service Users assessed needs and adopt a consistent approach Boldshaves Oast H56-H05 S23331 Boldshaves Oast V232447 260905 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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