CARE HOME ADULTS 18-65
Chard Manor Tatworth Road Chard Somerset TA20 2DP Lead Inspector
Belinda Heginworth Unannounced Inspection 31st January 2006 09:45 Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 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 Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 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. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Chard Manor Address Tatworth Road Chard Somerset TA20 2DP 01460 261016 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) Voyage Ltd Mr Gary Bush Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Two places are permitted for named individuals aged between 16 and 17 years 9th November 2004 Date of last inspection Brief Description of the Service: Chard Manor Farm is an attractive listed building. The house has been purchased, renovated and refurbished by Voyage Ltd, to a high standard. It provides personal and supportive care for up to ten people with a learning disability age 18 - 65. The home no longer has anyone under the age of 18 years. The home is not far from the town centre, off the Axminster Road, close to the Church. It is accessed by a private drive, shared by other properties nearby. It is surrounded by gardens that are partitioned to provide two separate enclosed, safe areas and other, more open garden facilities. There are ten single rooms, all with en-suite baths. Some rooms have also been fitted with shower facilities. There are two spacious living rooms, a large sunroom and a dining room next to the kitchen. The home also has en-suite facilities for staff on sleep-in duties. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector would like to thank the staff and residents for the warm welcome and help throughout the inspection. This unannounced inspection took place over three hour hours with the manager being present throughout. Chard Manor currently has 8 residents living in the home. Many of the residents have limited verbal communication skills. Seven residents were seen and consulted, not all were able to express an understanding or full opinion about life at the home. However observation were made while spending time with residents and staff. All residents seemed happy and the relationships between staff and residents appeared good. Four staff were consulted and their views on the home and practices were discussed. The inspector looked around parts of the home and some records were inspected. The manager completed a questionnaire prior to the inspection. This provided additional evidence of how the home is run. Not all standards were inspected on this occasion. Only Key Standards not inspected during the last visit were looked at and standards not fully met at the last inspection were re-visited. What the service does well:
The staff team act in a respectful manner, they were seen to be kind, caring and motivated. The atmosphere in the home is warm and friendly. Staff receive appropriate support and training to help them meet the needs of residents. A wide range of activities is offered to residents. These range from swimming, horse riding, music, pub outings and so on. The house is very homely and decorated and furnished to a high standard. Records kept about residents are clear and ensure staff are provided with good information to help meet the needs of residents. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 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. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 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 Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 No standards in this section were inspected on this occasion. Key standard number two was fully met during the last inspection. EVIDENCE: Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Staff are provided with good information relating to residents. The home has improved decision-making arrangements. EVIDENCE: Many residents have limited communication skills and have a limited understanding of care plans and are therefore unable to easily contribute to their formulation or reviews. It was clear through observations made that the staff team work hard to meet residents’ needs. Care staff demonstrated a good knowledge and understanding of the care plans and any associated risks. Two care plans were looked at on this occasion. Since the last inspection the manager has improved the wording in some risk assessments. This ensures that staff have clearer information and actions on how to reduce risks to residents. Good daily records are kept on each resident. These are used to help communicate between staff shifts. The records are also used to monitor residents’ needs and the progress and achievements they are making. “Keyworkers” complete a monthly care plan review sheet. A summary of all needs
Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 10 are recorded and any changes necessary to meet residents’ needs would be highlighted. During the last inspection many areas of the home had restricted access to residents. Some of these restrictions were to ensure the safety of residents. However, the decision making process had not involved residents or others who represent them. This was also true of the decision to have the main meal at lunchtime. Since the last inspection the manager has held residents’ meetings where these issues have been discussed and agreed. The manager said that residents who were able to contribute said they were happy with these decisions. The inspector spoke to some residents who said they found the meetings useful and were happy with having their main meal at lunchtime. Some doors in the home have had the coded keypads removed. This now gives residents access to more areas of the house. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 15 & 16 Residents benefit from using the local and surrounding facilities to meet social needs. Improvements are needed to improve such opportunities in the evenings. EVIDENCE: Residents use the local and surrounding facilities for swimming, horse riding, shopping and walks. On the day of the inspection some residents were looking forward to going swimming that morning and horse riding in the afternoon. During the last inspection it was highlighted that the majority of activities take place during the day apart from planned evening activities. However, because the day shift ends at 8.30pm when three night staff start duty, residents do not have the opportunity to go out on unplanned evening activities. The majority of residents require a minimum of two staff when out of the house, therefore after 8.30pm there is not enough staff on duty. A review of the rota system was recommended. (See section 31 – 36) Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 12 During the last inspection it was recommended that the use of some coded keypads should be reviewed. As mentioned previously (see section 6 – 10) some of these locks have now been removed. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 No standards were inspected on this occasion. Key standards 18, 19 & 20 were fully met during the last inspection. EVIDENCE: Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 22 & 23 Residents’ views are listened to & acted on. Residents are protected from abuse, neglect and self-harm. EVIDENCE: Residents who were able knew what to do and who to talk to if they were unhappy about anything. They said staff and the manager listen to their views and always try to act on any concerns they raise. The home has a detailed complaint’s procedure. The manager said that relatives are provided with a copy. Issues relating to the protection of vulnerable adults were looked at during the last inspection. Residents’ finances were inspected on this occasion. Residents have there own bank accounts, some residents require a lot of support to operate the accounts. All financial transactions were detailed and accurate and ensured residents are protected from financial abuse. Voyage Ltd act as cooperate appointees for all residents. This means that all benefits are paid into the organisation’s bank account. Residents’ contributions to the fess are taken from the benefits and personal monies are then transferred to their own bank accounts. Where organisations are appointees and have benefits paid, the bank account should be separate from the business and should not form part its assets. These accounts should be available for inspection. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 0 No standards from this section were inspected on this occasion. Key standards 24 & 30 were fully met during the last inspection. EVIDENCE: Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 33 Residents benefit from an effective team of staff. Some improvements are needed to meet residents’ social needs in the evenings. EVIDENCE: The manager provides six staff on duty until 6pm where the number is then reduced to three until 8.30pm when 3 staff are on duty for the night. Staffing arrangements during the day appear to meet the needs of the residents. Wide and varied activities take place, in and out of the home, because there is a good ratio of staff. The current shift pattern does not take into account residents’ social needs in the evening. Due to the complex needs of the residents, unplanned social and leisure pursuits cannot be provided outside of the home with three staff. Although the manager is trying hard to prioritise where he feels the greatest need is, it is important that social needs in the evenings are not forgotten. Despite residents’ disabilities and limitations ad hoc trips out in the evening is “normal” practice for a young adult and therefore needs consideration. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 41 Residents benefit from a well run home with systems in place to monitor the quality of services. Improvements are needed to one recording tool. EVIDENCE: Staff and residents spoke highly of the manager. Both said he always had time to listen and would try to resolve issues quickly. The manager said he has almost completed the Registered Manager’s Award. This means he would be suitably qualified to run the home. The inspection process showed a well run home where standards of care are high. The home has good systems in place that monitor the quality of care delivered to residents therefore residents are well protected. These range from care plan reviews, resident meetings, staff training and supervision, visits and detailed audits from the providers. Voyage Ltd have produced a quality monitoring tool that will assess all aspects of the service, including satisfaction surveys to residents, staff, relatives and outside stake holders. This was not inspected on this occasion.
Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 18 The home uses a “handover” book to communicate information to staff between shifts. This book contains detailed, sensitive and personal information about residents. Because this book is not loose leafed, the information relating to all residents can be on one page. This means that other professionals or relatives who are able to have access to such information on the resident would be able to read information about the other residents. This is not maintaining residents’ confidentiality or maintaining records in accordance with the Data Protection Act. Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 19 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 3 X 3 X 2 X X Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 20 N/A 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. Standard Regulation Requirement Timescale for action 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 YA23 YA33 Good Practice Recommendations All records relating to residents’ fiancés should be available for inspection. This includes residents’ financial records held by the organisation. (Cooperate appointees) The registered person should review staffing shifts to ensure the home is able to meet social needs at all times of the day and evening. Residents’ records should be maintained and used in accordance with the Data Protection Act 1998. (This refers to the handover book) 3. YA41 Chard Manor DS0000060801.V276128.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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