CARE HOME ADULTS 18-65
Cocklebury Farmhouse Cocklebury Lane Off Darcy Close Chippenham Wiltshire SN15 3QW Lead Inspector
Tim Goadby Key Unannounced Inspection 15th May 2007 09:30 DS0000028301.V337509.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 DS0000028301.V337509.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. DS0000028301.V337509.R01.S.doc Version 5.2 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 Mr Philip Taylor Care Home 10 Category(ies) of Learning disability (10) registration, with number of places DS0000028301.V337509.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th January 2006 Brief Description of the Service: Cocklebury Farmhouse provides care and accommodation for ten 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 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 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. Fees for care and accommodation range between £700 and £1200 per week. The lower fees apply to people who have lived in the home since it opened. Information about the home includes a welcome pack and a Service User Guide which has been produced in an accessible version, with the use of photos and pictures to support the text. It includes details about the CSCI and our inspection reports. The organisation is also considering developing a website. DS0000028301.V337509.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was completed in May 2007. The process included a review of regulatory contact since the previous main inspection in January 2006. Written information about the service was supplied by the providers. Survey forms were distributed, and responses were received from six service users, one person who regularly visits the home and seven members of staff. Some service users were supported by family members or professionals to complete their survey forms. An unannounced visit then took place to the home. The lead inspector was accompanied by a colleague for the first part of this, who focused on the organisation’s arrangements for quality assurance. The fieldwork also included sampling of records, with case tracking; a tour of the premises; sampling a meal; and discussions with service users, staff and management. 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 access a wide range of opportunities. The home has succeeded in this approach with people who have had difficulty in other settings. Service users have their needs and aspirations met. There is an effective admission process for new service users, ensuring that their needs are met and that they are compatible with the existing group. A range of information is available to prospective service users and their supporters, including some in accessible formats. Visits to the service are encouraged. Assessment is carried out thoroughly. All relevant information is obtained and key issues of concern are followed up. Steps are taken to prepare staff to give effective support from the day a new service user moves in. Practical aspects of moving are dealt with promptly, to minimise disruption to the new service user’s life. There are appropriate systems to regularly review how the new placement is working and to adjust goals accordingly. Individual plans and other documents 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. There is a strong focus on the provision of activities and opportunities for all service users, which gives them a full, active and interesting life. Activities are provided on a daily basis, both at home and in the wider community. A range of opportunities are offered, ensuring that all service users have a choice of things likely to appeal to them. Some sessions repeat regularly, to the benefit of those who enjoy the security and familiarity of routines. Flexibility is also
DS0000028301.V337509.R01.S.doc Version 5.2 Page 6 available. Some activities are on a group basis, whereas others may be individual, and service users are enabled to be independent when they are safe and competent to do so. Physical exercise is a key component of many activities, helping with health promotion. All service users also have access to periodic outings and holidays, in line with their known needs and preferences. Service users can be confident they will all have equal access to opportunities likely to be of interest and benefit to them. Staffing levels support the effective delivery of a service which meets the high needs of Cocklebury Farmhouse’s service users. The numbers on duty at peak times provide high ratios of staff to service users, enabling the wide range of activities described above to take place. These levels also help to promote safety for service users and staff. When numbers on duty are reduced, there are effective systems in place which allow for backup to be accessed promptly if it is ever required. 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 many qualifications and much experience. Cocklebury Farmhouse benefits from having a regular 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. Service users with complex behavioural needs can be confident that they will receive effective support. The approaches that the home uses are in line with recognised good practice guidance and are individually tailored. Staff receive relevant training which enables them to uphold their own and service users’ safety. Any incidents which occur are managed appropriately and the impact on the home is kept to a minimum. For instance, an event had occurred shortly before this inspection began, but a calm atmosphere had been restored and there were no observable effects. The service has a good history of compliance with regulations and standards. Inspections have consistently identified very few requirements or recommendations. On this occasion, no requirements have been set, and just one recommendation for good practice. Service history also shows that the organisation takes effective measures to address any issues 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. All comments received from service users, staff and others were very positive about the service provided at Cocklebury Farmhouse. Service users were assisted to complete their survey forms if necessary. Their responses show satisfaction with all areas of service delivery. Where people were able to give additional comments, these included statements such as “I like it here” and “Staff help me”; whilst a relative who helped a service user to complete a form noted that coming to live at Cocklebury Farmhouse was the “Best move [the service user] has ever made”.
DS0000028301.V337509.R01.S.doc Version 5.2 Page 7 Staff feedback shows high levels of job satisfaction. They enjoy a strong rapport with service users and their colleagues. They are positive about support received from managers, available training opportunities and quality of care provided to service users. Service users can be confident they are supported by committed and motivated staff who feel valued and well led. A visitor who has known the home since 1988 commented positively on many aspects of the home, including accommodation, food, activities and staffing. They stated that they are kept informed and consulted on all relevant topics. In conclusion, this respondent stated: “…the home gives a high emphasis on creating a relaxed and happy environment… The running, management and efficiency of the home appears first class!” 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. DS0000028301.V337509.R01.S.doc Version 5.2 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 DS0000028301.V337509.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are protected by effective processes for admissions to the home. EVIDENCE: The home was fully occupied at this inspection. When there is a vacancy, prospective service users are encouraged to visit the home, to meet and chat with service users and staff and get a feel of the atmosphere. Various information is available, including a welcome pack and a Service User Guide. The guide is in an accessible format, with the use of pictures and photos to support the text. Service users living in the home get a personalised version, with photos of their own room and some of the activities they undertake. There has been one admission to the home since the last main inspection. Records relating to this process were seen during this visit. Relevant information about the individual was obtained before admission. Particular issues of concern were discussed during the assessment stage. The individual was able to visit the home before moving in. Staff confirm that they DS0000028301.V337509.R01.S.doc Version 5.2 Page 10 were given clear information about the needs of the new service user, so that they were prepared to give them effective support from the first day. After admission further reviews took place. Practical aspects of the move were also dealt with promptly, such as inventorying the service user’s possessions and registering them with a local GP. Evidence shows that the placement is proving successful in meeting this service user’s needs and helping them to make progress on identified goals. Review has involved professionals specialising in learning disability and the service user’s funding authority. The home has also produced its own detailed review notes, with a particular focus on the issues of most concern. Goals have been adapted and made more realistic. The individual is engaging fully with the home’s programme and extending their range of activities as a result. DS0000028301.V337509.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: Two service users’ files were checked during this inspection. Records are personalised, with use of photos to support some of the information. For instance, there are pictures of the activities which people undertake.
DS0000028301.V337509.R01.S.doc Version 5.2 Page 12 Care and support records are detailed and informative. There is guidance about how all need areas are supported, and goals are set. There is regular review of needs. Reviews also take place after specific events, if required. Care plans address various topics, including personal care, medical and health issues, communication, occupation and leisure, relationships and behaviour. Each section sets out the needs and problems a service user has and the staff support and interventions to respond to these. The reasons for particular approaches are always clearly explained. 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. There is also recognition of an individual’s right to exhibit certain behaviours if they do not raise issues of concern. The input of the individual is shown, where appropriate. Other relevant agencies are consulted for their views. Service users receive support with money management. Their varying individual needs are set out in their care plans. The registered persons act as appointees for some service users. Relevant records are kept. Service users have been assisted to follow up any concerns over their money, such as the level of benefit income received. DS0000028301.V337509.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: DS0000028301.V337509.R01.S.doc Version 5.2 Page 14 Some service users are at college or in employment for part of each week. At other times, the programme for each person is facilitated by the home. 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 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 they attend 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. Some of the group are local people and others are from different parts of the country. So relatives may live nearby, or be some distance away. Some people visit their relatives independently. Others are supported by staff. The frequency of contact varies, depending upon individual wishes. 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.
DS0000028301.V337509.R01.S.doc Version 5.2 Page 15 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. 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. Arrangements for food are well organised. There are seasonal menus, drawn up over a four week cycle. Fresh ingredients are used. The menu reflects an effort to promote a balanced diet and has recently been reviewed to enhance the focus on healthy eating. The choices of service users are also respected. Menus are regularly discussed with them. Cocklebury Farmhouse employs a cook on weekday mornings. She prepares the main cooked meal, which is eaten at lunchtime. Service users and staff dine together. On the day of this inspection the meal was home-made steak and mushroom pie and vegetables, with a choice of fresh fruit for dessert. When the cook is not present, care staff prepare meals. All staff receive food hygiene training. Service users also help out, on a rota basis. Levels of participation vary. All service users need some degree of staff supervision and assistance whilst in the kitchen. Service users do not need assistance with eating. have any special dietary needs. None of the current group There are usually three main meals per day: breakfast, lunch, and supper. Drinks are served mid-morning, and during the afternoon. Service users also have the opportunity to access drinks and snacks at other times, when they wish to. The kitchen is always accessible. DS0000028301.V337509.R01.S.doc Version 5.2 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. 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. Service users are supported to address their personal and health care needs effectively. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The service user group has a wide range of personal care needs. Some are largely independent. Others require a high degree of support. Individual needs and preferences are set out in each person’s care plan. DS0000028301.V337509.R01.S.doc Version 5.2 Page 17 Physical and mental health needs are well supported. Any concerns for particular individuals are recognised and addressed. There is regular contact with relevant professionals. This includes periodic health checks in various areas, as well as responding to any issues that might arise. Records are kept of all these consultations. Physical exercise is a key element of many of the activities offered for service users. This assists with health promotion. Service users taking medication have this administered by staff. Policies and procedures set out the home’s approach. Arrangements for storage, recording and administration are appropriate. The pharmacy supplying medication visits every three months to check the home’s practice and give advice. 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. 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 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. DS0000028301.V337509.R01.S.doc Version 5.2 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. 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. 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. DS0000028301.V337509.R01.S.doc Version 5.2 Page 19 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. Staff who are expected to practise physical interventions attend a 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 receive additional support from colleagues. There is detailed guidance on the physical interventions used in the home, along with information about which are suitable for individual service users. These can vary, depending on the characteristics of their behaviour, and other features, such as their build and state of physical health. The home has consulted with all relevant parties in deciding which of the techniques may be applied to a particular person. Evidence was seen during this inspection of an effective response to behavioural needs. A service user who was involved in an incident earlier in the day was given clear and consistent support by all the staff on duty. Staff dealt with the individual’s questions directly and respectfully. Reasons were given for why one activity could not be provided and alternatives were offered. DS0000028301.V337509.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 residential area, set in its own grounds, 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. DS0000028301.V337509.R01.S.doc Version 5.2 Page 21 Décor and furnishings are of a good standard. There is a comfortable and homely feel. Individual bedrooms reflect the taste of their occupants. The two shared rooms have been partitioned into separate spaces as much as possible. Three bedrooms, including both of the shared rooms, have en suite facilities. Two of these have showers and the other a bath. 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. DS0000028301.V337509.R01.S.doc Version 5.2 Page 22 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, 33, 34 & 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported by suitable numbers of appropriately trained staff. Induction of new staff could be enhanced by re-establishing clear links to nationally recognised standards and frameworks. Service users are protected by effective practices in staff recruitment. EVIDENCE: Staff are on duty at all times, including one person sleeping in overnight. They have access to on-call support, if required. But 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
DS0000028301.V337509.R01.S.doc Version 5.2 Page 23 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. 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 usually begin at another service. If they are then felt suitable, they may move on to Cocklebury Farmhouse. The home has had a stable staff team with low turnover. 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. A senior manager co-ordinates training for the organisation. This ensures that everyone attends the necessary courses, and that they have updates when required. As well as the mandatory topics covered, the training programme includes elements based on the needs of service users. Some key topics are covered in-house, such as the values of care, awareness of key documentation and expected standards of staff conduct. Training records are kept for all staff, including copies of any certificates gained. Induction of new staff is recorded. It covers a range of topics, including introduction to the home and its service users, values of care, policies and procedures, confidentiality and health and safety issues. Staff are also given relevant leaflets, such as the code of conduct for social care workers and information about Wiltshire’s procedures for safeguarding vulnerable adults. Recent induction has not been in line with the national framework for staff working in learning disability services, due to failure to find a suitable training provider who would facilitate this. The need to ensure a clear link to the DS0000028301.V337509.R01.S.doc Version 5.2 Page 24 national induction standards for the social care workforce was also discussed during the inspection. After being in post for a while staff 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 well above the minimum 50 target required for people with this level of qualification. 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. Records relating to two recent appointments showed that all required recruitment checks are carried out, at the appropriate stages. Specific issues relating to the employment of individual staff are dealt with via risk assessments, where necessary. The organisation is aware of the principles of equal opportunities in recruitment and selection. The registered persons were able to give examples of how these have been applied in practice. DS0000028301.V337509.R01.S.doc Version 5.2 Page 25 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, 39 & 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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. Service users’ health and safety are protected by the systems in place. EVIDENCE: DS0000028301.V337509.R01.S.doc Version 5.2 Page 26 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 and have regular contact with service users and staff. They are supported by a deputy manager, Mrs Carol Pearson; and an assistant manager, Mr Simon Willis. Each of these senior managers has allocated responsibilities and also overlap roles when required. 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 Registered Managers Award (RMA) and a National Vocational Qualification (NVQ) Level 4. Mr Willis has also obtained the NVQ 4, and is to undertake the RMA. Records about annual development and improvement are contained in a quality assurance file. There is a policy on quality assurance, with guidance about how this is managed in the home. The assistant manager, who was met with during the visit, oversees the arrangements for quality assurance. Methods of obtaining feedback have been identified. For service users, these include individual review meetings, monthly group discussions and questionnaires in a pictorial format. Minutes of the group discussions are kept. These show that service users often make suggestions, for example about new outings, social activities and the sort of meals that they would like. Questionnaires have been used to gain the views of people outside the home. The registered persons also carry out audits and make regular checks in areas such as health and safety and medication. During the visit, a staff member said that any maintenance items are always dealt with promptly. Management meetings are held, when improvements are discussed and priorities identified for the year ahead. The outcome of an Annual Development Plan for the period 1 April 2006 – 31 March 2007 has recently been reviewed and reported on. The report gives a detailed account of work that has been carried out in various areas, such as the physical environment, the provision of activities for service users, staff training and the development of new systems and procedures. The latter includes new ‘Health Action Plans’ for service users, which have been produced in both written and pictorial formats. A new Annual Development Plan has been written for the period 1 April 2007 – 31 March 2008. The assistant manager said that one priority for the year ahead is to continue producing information in formats that are more DS0000028301.V337509.R01.S.doc Version 5.2 Page 27 appropriate for service users. Consideration is also being given to creating a website for Cocklebury Farmhouse homes. Risk assessments clearly address any health and safety concerns. This is done for general topics, and for individual service user issues. The measures put in place to minimise risks are set out. There are suitable arrangements for fire safety, including a range of checks, practices and staff instruction. The regular weekly test of the fire alarm system took place during this inspection visit. Staff receive training on a range of health and safety topics. This includes moving and handling, food hygiene and first aid. DS0000028301.V337509.R01.S.doc Version 5.2 Page 28 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 4 X X 3 X DS0000028301.V337509.R01.S.doc Version 5.2 Page 29 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 Refer to Standard YA35 Good Practice Recommendations The home’s induction for new staff should be clearly linked to national standards for the social care workforce and the learning disability sector. DS0000028301.V337509.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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
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