CARE HOME ADULTS 18-65
Cocklebury Farmhouse Cocklebury Lane Off Darcy Close Chippenham Wiltshire SN15 3QW Lead Inspector
Tim Goadby Unannounced Inspection 10th January 2006 14:25 – 17:25 Cocklebury Farmhouse DS0000028301.V277876.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 Cocklebury Farmhouse DS0000028301.V277876.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. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cocklebury Farmhouse Address Cocklebury Lane Off Darcy Close Chippenham Wiltshire SN15 3QW 01249 658670 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) Mr Gregory Stephen Tennant Mrs Rhianydd Taylor, Mr Philip Taylor Mr Gregory Stephen Tennant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd September 2005 Brief Description of the Service: Cocklebury Farmhouse provides care and accommodation for 10 adults with a learning disability. All current service users are male. They receive support with social and behavioural needs, in long-term placements. The service is one of a group of three in Chippenham, which are known as the Cocklebury Farmhouse Homes. This is a private organisation. The owner/managers founded the company in the late 1980s, and remain closely involved in all aspects of its daily operation. This includes regularly working in each of the services. The property is close to the centre of Chippenham. The town offers various amenities, including shops, bars, restaurants, parks, a leisure centre with swimming pool, and a cinema. Rail and road links to Bath and Bristol are available. Service users regularly access a wide range of local amenities. This is a key feature of the programme at Cocklebury Farmhouse. The home is a detached property, set in its own grounds. The old farmhouse was restored during the 1980s. There is also a modern single storey extension. Service user accommodation is on two floors. There are six single bedrooms, and two which are shared. Three bedrooms have en-suite baths or showers. There are two further bathrooms for general use. Communal spaces are on the ground floor. There are two lounge areas, and a dining room. The home also has a sizeable garden, which has areas of both lawn and patio. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in January 2006. A total of 3 hours was spent in the home. Another of the organisation’s services was inspected on the same day, and, where applicable, findings have been applied to both homes. The following inspection methods have been used in the production of this report: indirect observation; pre-inspection questionnaire, completed by the provider; sampling of records, including case tracking; discussions with service users, staff and management; survey of service users and relatives; tour of the premises. What the service does well:
Cocklebury Farmhouse is a well established service with a clear approach to promoting quality of life for its users. Everyone living at the home receives regular input to ensure that they access a wide range of opportunities. The home has succeeded in this approach with people who had previously proved difficult to support in other settings. Service users have their needs and aspirations met. Individual plans and associated documentation reflect the assessed and changing needs and goals of each service user. The ways in which to support them, and the reasons for these, are clearly shown. If any restrictions are needed, these are fully explained. The consent of relevant parties is also shown. The home has managed recent changes in its service user group effectively. Where people have been discharged to other settings, care has been put into ensuring the success of these moves for the individuals concerned. When a person admitted to Cocklebury Farmhouse proved not to be suitable to remain, appropriate steps were taken to address this and ensure the person moved on to somewhere better able to meet their needs. Recently, a previous service user has been re-admitted as an emergency. The home has managed this process capably, to the benefit of that individual, and to ensure the continued effective operation of the service for all other residents. Service users benefit from a well run home. The organisation has a strong pool of senior staff, including the registered owner/managers themselves. They bring a wealth of qualifications and experience. Cocklebury Farmhouse, along with other homes in the organisation, benefits from having a regular direct presence of members of this senior team. This ensures effective direction and leadership. It also means that support is readily available to all staff when needed.
Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 6 The service has a good history of compliance with regulations and standards. Recent inspection reports have identified very few requirements or recommendations. On this occasion, no requirements have been set, and only two recommendations for good practice. Service history also indicates that the organisation takes effective measures to address any issues which are raised. Service users can be confident that the home strives to uphold best practice at all times, to the benefit of the people living there. Comment cards were received from five service users, some of whom had been supported to complete them. All these responses indicate that people living in the home like doing so, and feel well cared for and safe. The social and leisure activities provided were mentioned as a particularly positive aspect by two people. In addition, comment cards were completed by nine relatives and friends of service users. These also give positive feedback about the service provided by Cocklebury Farmhouse. Comments include: “I could not envisage [a service user] receiving any better care or being more happy in any other environment”; “We are amazed at the variety of activities”; “The home always keep me informed.” What has improved since the last inspection?
The service has consistently performed well over recent inspections, and there were very few areas for improvement identified at the visit of September 2005. The home already has extensive guidance on the possible use of physical interventions. In response to recommendations of previous reports, this has been developed further. Written descriptions of the actual techniques approved for use in the home, and which have been taught to staff, have been produced. Individual service user plans are now being updated to reflect which of the techniques may be applied to a particular person. This provides further protection for service users who may need the occasional use of such interventions. The Service User Guide has been amended and completed, in response to recommendations at the last inspection. It now includes information about service users’ views of the home. It also mentions CSCI inspection reports, and where to obtain these. Confidential information about existing service users has been removed. This ensures that prospective service users have all the material they need to make an informed choice about the home; and that existing service users have their privacy protected. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 7 Fire evacuation procedures have been reviewed with a local fire safety officer. This has endorsed the suitability of the home’s current approach, so that service users can feel confident there are proper arrangements to uphold their welfare and safety. 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. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 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 the following standard(s): 2&3 Service users are protected by effective processes for admissions to the home, including short notice admissions. Service users have their needs and aspirations met by the home. EVIDENCE: The home has produced a Statement of Purpose, and a Service User Guide. The Guide has been reviewed and completed since the previous inspection. Each service user has received a personalised copy. These have been made more accessible, with the use of photos and pictures to support the text. The service has a good understanding of the complex needs of its users. Appropriate resources and facilities are in place to meet these. As well as ensuring the safety and welfare of people, the home actively promotes quality of life and new opportunities. Cocklebury Farmhouse’s stated aims are to work for the long term reduction and control of behavioural difficulties that have impacted on service users’ lives. Within that process, the service works to give people an active and enjoyable life. This necessitates high levels of guidance and support to service users. All staff display an enthusiasm and commitment towards these goals. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 10 Specialist support is also available to individuals, when required. For instance, there has been input from professionals within the local Community Team for People with a Learning Disability. Service users come from various parts of the country. Often they are people who have experienced difficulties in other settings. The home has a good success record in providing stability for such individuals. There are appropriate procedures for the admission and discharge of service users. The home has had a number of changes in its resident group over recent months. Firstly one person moved on, to another of the homes operated by the organisation. A person admitted to this vacancy, shortly before the previous inspection, was later assessed as not suitable to remain at Cocklebury Farmhouse. Another service user then moved out, again to another of the company’s homes. Finally, in December 2005, a former resident of the home returned unexpectedly and was re-admitted as an emergency. One vacant place remained at the time of this inspection. Both people who have moved from Cocklebury Farmhouse to another of the organisation’s homes appear to have benefited from the change. The company took careful steps to identify people likely to be compatible, and supported the moves with the simultaneous redeployment of some staff, to ensure consistency and security for the individual service users involved. At Cocklebury Farmhouse itself, records show that there has been a thorough and appropriate re-admission process for the returning service user. Care plans, risk assessments and other documentation have been revised thoroughly, with a commendable level of detail being put in place very promptly. A suitable programme of support has been implemented, pending a long term decision about the individual’s future. All relevant agencies have been kept involved and informed. A meeting to review the placement has been set up. Full records are available to explain the events occurring, and the decisions taken to date. The input of the service user is shown. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 11 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, 8 & 9 Service users have their abilities, needs and goals reflected in their individual plans. Service users can make choices and decisions in their daily lives, and about the conduct of the home. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. The approach to risk management would be enhanced by some improvements in the documenting of judgements, to ensure service users benefit from wide consultation and regular review. EVIDENCE: Care and support records are detailed and informative. There is regular review of needs. Reviews also take place in response to specific events, if required. Detailed guidance is produced about how all need areas are to be supported. Goals are set as well. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 12 Ongoing records relating to care are not necessarily made every day. The usual practice is to make an entry at least once a week, over the weekend. But other significant events are noted down as they occur. There is an appropriate level of detail. There is also clear cross-referencing, if there is linked information in more than one record. Service users participate in decisions about their own care, in line with their capabilities. Users’ families are involved too, as are other relevant professionals. Within the home, senior staff have lead responsibility for producing and updating plans. But all staff contribute to the process. There is clear information about any factors that may limit someone’s rights. Restrictions in place are linked to an individual’s assessed needs. The consent of the service user is recorded, where appropriate. There is a detailed approach to risk assessment. Documents address a wide range of significant areas. The topics assessed may be generally applicable, or specific to individuals. Information sets out the possible risks; the factors influencing these; preventive measures; and management strategies, with reasons for the approach chosen. There is a proactive approach to ensuring that all identified risks are followed up thoroughly. Risk taking is promoted, where it will benefit service users. The input of the individual is shown, where appropriate. Other relevant agencies are consulted for their views. But documents do not always show who has been involved in a risk management decision. This is particularly important if a new restriction has been imposed. Although risk assessments are dated, they do not always show when they are due for review. Frequency may need to vary, depending on the particular issue, and it is useful to show this within the initial document. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 13 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): 12, 13, 14, 15 & 16 Service users are provided with full and active lifestyles, offering them full engagement with their local community. Service users are supported to maintain and develop relationships. Service users’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. EVIDENCE: Some service users have sessions at college or in employment for part of each week. At other times, the programme for each person is facilitated by the home itself. All service users take part in different community activities. These involve interaction and communication with others. There are some well established group social events that take place each week. Service users’ social needs are regularly assessed, as part of the care planning arrangements. There had
Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 14 been a particularly busy time over the recent Christmas and New Year period, with various parties and social events taking place. Many activities take place during the daytime, when most staff are on duty. Social events will also be provided in the evenings. Rotas ensure that staff are available, to enable these to happen. Service users make frequent trips into Chippenham, and elsewhere. These may be for shopping, or in connection with other household matters. Many of the activities attended by service users are within walking distance of the home. The home also has its own minibus for outings, and public transport is readily accessible. Outings will usually be undertaken with two or three service users, supported by one or two staff. There are larger groups for some activities, which can also involve linking up with the organisation’s other homes. People in receipt of mobility allowance contribute a weekly sum towards transport costs. Additional charges may be made for longer journeys, according to the mileage. Service users also have the opportunity to go on an annual holiday. Accommodation in Cornwall is booked for two weeks, and groups go for a week at a time. A holiday park in the Cotswolds is also used for short breaks. This is because some users find it difficult to cope with long periods away. The chosen site is less than a couple of hours’ drive from Cocklebury Farmhouse. So it is easy to bring someone home early, if it is clear that is what they want. Service users who retain contact with their relatives are assisted to do so. The group at the home are a mixture of local people, and others from different parts of the country. So relatives may live nearby, or be some distance away. Some people visit their relatives independently. Others are transported by staff. The frequency of contact varies, depending upon individual wishes. All service users had either visited their families over the Christmas period, or were just about to do so. Cocklebury Farmhouse works at maintaining good relationships with families. There have been successes in re-establishing closer links for some people. Service users may also have other friendships and relationships. They are able to maintain these as well. Service users can move freely throughout communal areas of the home. Peoples’ privacy within their own rooms is respected. There is a wide range of information available about the home generally, and about individual service users. This addresses the issues of independence, choice, and restrictions very clearly.
Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 15 Routines of the home are set out. But there is flexibility within these for people to exercise choice. Where restrictions may be put in place, this is always linked to assessed needs of the service users concerned. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 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 the following standard(s): 20 Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Service users who are prescribed medication have this administered by staff. Policies and procedures set out the home’s approach. Arrangements for storage, recording and administration are appropriate. Only senior staff administer medication. They receive relevant training from the pharmacist that the home uses. Training has also been given to other carers, to promote their understanding of the topic. Most of the medication prescribed for service users is dispensed via a monitored dosage system, which means that the pharmacy supplies it already divided out according to the dates and times for administration. Drugs are always checked when they are first received. Medicines are accompanied by a photo of the person they belong to, which helps to minimise any risk of errors occurring. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 17 The home has devised its own recording charts. These records are maintained appropriately. They denote times of administration, who has given the drug, and use various codes to show any reasons for non-administration, such as a service user’s absence. Some medication is prescribed to be given ‘as required’. This means that a prescribing decision has to be taken by the person administering. There are arrangements in place to support staff in doing so. Records show that this is usually an infrequent occurrence. Individual guidelines for the relevant service users set out how to judge when medication may be needed. Review of prescribed medication may take place either by a service user’s GP, or through the consultant specialising in learning disability who gives support to the home. Some medicines available without prescription, known as ‘homely remedies’, are also kept. The home keeps a list of the products held, and which individual may have what. This has been authorised by a GP. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 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 the following standard(s): 23 Service users are safeguarded by the home’s policies and procedures for protection. Service users benefit from an effective and appropriate approach to the management of behavioural needs. EVIDENCE: Procedures relating to abuse and adult protection are in place. This includes information about the multi-agency processes within Wiltshire. Staff have received training on this topic. The organisation has operated appropriately within this framework when the need has arisen. There is also a procedure relating to how staff may raise any concerns they have about practice. This is usually referred to as whistle blowing. It includes information about other agencies concerns might be disclosed to, if people feel the need to make use of them. The nature of the service user group at Cocklebury Farmhouse means that physical interventions may be needed on occasions. There is detailed information available about how this is practised. There are clear expectations for staff about how to manage any incidents. The approach set out for the use of physical interventions upholds all the recognised best practice principles. The various alternative strategies to be tried are also described. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 19 Staff who will be expected to practise physical interventions attend an initial five day residential course. There are then refresher courses, every two years. Generally only male staff receive this training. But the female deputy manager has also done so. Other female staff are not expected to participate in any holding or restraint. But there have been isolated occasions when they have been on the receiving end of assaults. They are provided with training in breakaway techniques, which should equip them to extricate themselves from such situations as speedily and safely as possible. Until new staff have attended such training, they may need additional support from colleagues. A recommendation from previous inspections concerns guidance on the use of physical interventions for individual service users. Although this is detailed, the Commission considered that it could usefully be developed further, to include clear definitions of the exact types of physical intervention that may or may not be used for each person. This can vary, depending on the characteristics of their behaviour, and other features, such as their build and state of physical health. Because use of physical interventions is always a potentially sensitive issue, it is best to have as much detail as possible in relevant documentation. Work has been undertaken to address this recommendation. The home has consulted with all relevant parties. Written descriptions of the techniques in use have been produced. Individual service user plans are now being updated to reflect which of the techniques may be applied to a particular person. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 20 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): 24, 25, 26, 27, 28 & 30 Service users live in a comfortable, clean and safe environment, suitable to their needs. EVIDENCE: The service enjoys a location well suited to its purpose. It is in a quiet residential area, set in its own grounds, and not directly next to public roads. But it is also near to the full range of local amenities. All parts of the home were seen during this inspection. Cocklebury Farmhouse presents as high quality accommodation. It is clean and well maintained. Funds are made available, as required, for any necessary works. The vacant bedroom was being redecorated at the time of this visit. Décor and furnishings are of a good standard. There is a comfortable and homely feel. An alarm has been placed on the back door, which alerts sleeping staff if a service user leaves the house at night. This is mainly to ensure that someone does not inadvertently lock themselves out, with nobody knowing about it. The alarm is not in use during the day.
Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 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 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 & 35 Service users are supported by suitable numbers of appropriately trained staff. EVIDENCE: Staff are on duty at all times. This includes one person sleeping in overnight. They have access to on-call support, if required. However, this is rarely necessary. The team structure includes managers, deputy and assistant managers, senior carers, and carers. The arrangements promote effective teamwork. Daytime shifts are covered by managers, senior carers, and other care staff. A minimum of two staff are present during the day and evening. Over the main part of the day, when most activities are provided, numbers are at high ratios. There may be up to six staff present. Numbers tend to reduce in the evening. But more staff will be rostered to work, if there is a particular activity taking place. Again, on-call staff are available to attend at short notice, if required. The home also employs a cook, and a cleaner, who work weekday mornings. Care staff carry out these tasks at other times.
Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 22 If there are gaps in the rota, staff from elsewhere within the organisation may cover these. No use is made of agency workers. This is because unfamiliar employees can be unsettling to some of the service users. The organisation will tend to employ suitable applicants, even if this means going slightly over usual staff establishment levels for a time. People may then be deployed wherever their abilities are felt to be of most use. So staff may be based in one home for a time, but then go on to work in another. This means that some people can be available as relief cover, who already have a knowledge of the service and its users. Employees who are new to the organisation begin at another home. If they are then felt suitable, they may move on to Cocklebury Farmhouse. Senior staff take on areas of additional responsibility. These include involvement with medication; service users’ money; administration and paperwork; and leading of shifts in the absence of other managers. Staff training is provided on a range of relevant topics. This includes induction in line with the national framework for learning disability services. People can then go on to undertake National Vocational Qualifications (NVQs). All staff who have been with the organisation for a while have achieved an NVQ award, at either Level 2 or 3. The home is above the minimum 50 target required for people with this level of qualification. Progress is continuing. At the time of this inspection, eight employees across the organisation were studying towards NVQ Level 2 or 3. Two of the company’s own senior staff are NVQ assessors, so they can carry out observations with candidates. An external body is used to oversee and facilitate the NVQ process. A senior manager co-ordinates the planning of training for the organisation. This ensures that everyone attends the full range of courses, and that they have updates as and when necessary. As well as the mandatory topics that are covered, the training programme includes elements based on the needs of the service user group. Some key topics are covered in-house, such as the values of care, awareness of key documentation, and expected standards of staff conduct. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 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 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 Service users benefit from a well run home, with clear leadership and involvement from senior figures. Quality assurance measures underpin service developments, and include actions based on the views of service users. EVIDENCE: The organisation’s registered managers are Mr Greg Tennant, and Mr Phil Taylor. They were originally registered under previous care homes legislation. They have operated and managed services since establishing their company in 1988. Both continue to work in their homes. So they have regular direct contact with service users and staff. Mr Tennant and Mr Taylor are supported by a deputy manager, Mrs Carol Pearson; and an assistant manager, Mr Simon Willis. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 24 The service benefits from a strong presence of managers and senior carers at all times. There are usually two people from within these groups present during the days. On-call arrangements also ensure that a senior person can attend quickly, if the need arises. Mr Tennant, Mr Taylor and Mrs Pearson have all completed the new Registered Managers Award (RMA) qualification. Mr Taylor has also achieved the National Vocational Qualification (NVQ) Level 4 award in care. Mr Willis has also obtained the NVQ 4, and will shortly be starting the RMA. Mrs Pearson is working towards the NVQ 4. The organisation has a quality assurance process. A statement sets out information about the principles, and the system used. The owner/managers take the chief lead on overseeing this area, as they have the closest responsibility for the conduct of the home. The rest of the management team are also involved in reviews, which take place every three months. Service delivery is audited in a number of ways. This includes accessing the views of service users, families, and other key people. Information shows the different sources of evidence used, and the frequencies with which each is updated. Because direct input from service users is not possible in all cases, other ways of interpreting their views have been suggested. These include feedback on outcomes for individuals from other agencies, including placing authorities and the CSCI. Action is taken on any issues identified. An annual development plan has been produced for the organisation. This includes issues specific to each of its services, including Cocklebury Farmhouse. Topics identified include premises issues, documentation, service user and staff routines, activities, and staff training and development. From the goals set, progress is then measured and evaluated. The most recent review before this inspection was completed in December 2005. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 4 3 3 4 N/A 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 N/A 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 4 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X 4 X 3 X X X X Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 26 No 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 YA9 YA23 Good Practice Recommendations Risk assessments should show who has been involved in their production, and the date when they are due for review. Guidance on the possible application of physical interventions to individual service users should be developed, to include more detail about the techniques that are appropriate with each person. COMMENT: Work is ongoing to address this recommendation. Cocklebury Farmhouse DS0000028301.V277876.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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