Inspection on 02/09/05 for Cocklebury Farmhouse

This inspection was carried out on 2nd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cocklebury Farmhouse 15/05/07

Cocklebury Farmhouse 10/01/06

Cocklebury Farmhouse 04/02/05

Cocklebury Farmhouse 19/08/04

Cocklebury Farmhouse 25/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Cocklebury Farmhouse Cocklebury Lane Off Darcy Close Chippenham Wiltshire SN15 3QW Lead Inspector Tim Goadby Unannounced 2nd September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 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 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 Mr Gregory Stephen Tennant Care Home 10 Category(ies) of LD Learning Disability registration, with number of places Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th February 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 3 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 2 floors. There are 6 single bedrooms, and 2 which are shared. 3 bedrooms have en-suite baths or showers. There are 2 further bathrooms for general use. Communal spaces are on the ground floor. There are 2 lounge areas, and a dining room. The home also has a sizeable garden, which has areas of both lawn and patio. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in September 2005. A total of 5.5 hours were spent in the home. The following inspection methods have been used in the production of this report: indirect observation; sampling of records, with case tracking; sampling a meal; discussions with service users, staff and management. What the service does well: 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 February 2005 visit. There had been some significant changes at Cocklebury Farmhouse over the weeks before this inspection. Owing to the unexpected death of a service user in another of the organisation’s homes, one person had now moved out, and another had taken their place. In a break with previous practice, the latter had been accepted as a short notice admission. This period of upheaval appeared Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 6 to have been managed well, with minimum disruption. The service continued to present as a stable and well run home. It was particularly commendable that a full and detailed care plan, along with other relevant documentation, was already in place for the newest admission. This individual had been at Cocklebury Farmhouse for just two weeks at the time of this visit. It was clear that much work had gone into assessing the needs of the person, both before admission, and since they moved in. The plan was being kept under ongoing review. 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 D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 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 standard(s) 1, 2, 3 & 4 Information for prospective service users is in place, but needs reviewing and updating. The service operates effective practices around the admission and discharge of service users, promoting their welfare at these key stages. 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. Each service user has received a personalised copy of the Guide. These have been made more accessible, with the use of photos and pictures to support the text. The Service User Guide needs some attention to ensure that all relevant criteria are included. At the moment, there is no information about service users’ views of the home; and no mention of CSCI inspection reports about the home, and how to obtain these. The Guide also includes the names of all current service users, and a brief outline of their background. As the document could be made available to a range of prospective service users, and those supporting them, it is not appropriate to include this information. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 9 General information about the home had already been updated to reflect a recent change in the service user group. 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. Specialist support has also been 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 had been one change to the service user group since the previous inspection. A person had moved out of Cocklebury Farmhouse to another of the organisation’s homes. Appropriate processes had been followed in taking this step, including consultation with the individual, their relatives, and their placing authority. Arrangements were in place to monitor the success of the move, and the option of returning to Cocklebury Farmhouse remained as a contingency plan. A new admission had also taken place, into the vacant space created. In a break with its previous practice, the service had taken this person at fairly short notice. Circumstances meant that the usual programme of trial visits could not be undertaken. But the home did carry out all possible groundwork, prior to accepting the admission. A senior manager attended meetings and carried out assessments, and a full range of relevant information was obtained. A detailed initial care plan had been drawn up, along with accompanying risk assessments. These were being kept under regular review. At the time of this inspection, it was too early to say whether the admission would prove successful. The new service user was recovering from a recent operation, and had now had to be readmitted to hospital. So a new assessment would be required at the point of discharge back to Cocklebury Farmhouse. Arrangements were in place to keep the situation under review. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Service users have their abilities, needs and goals reflected in their individual plans. Service users are supported to exercise choice and control in all aspects of their daily lives. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. 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. 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 Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 11 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. Cocklebury Farmhouse demonstrates particularly good practice in the processes of risk assessment. These are detailed, and 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. All significant issues relevant to the care and welfare of service users are addressed. The input of the individual is shown, where appropriate. Other relevant agencies are consulted for their views. 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. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 15, 16 & 17 Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Service users are able to maintain and develop appropriate relationships with family and friends. 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: 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. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 13 Many activities take place during the daytime, when most staff are on duty. But social events will also be provided in the evenings. Rotas are drawn up accordingly, to enable these. 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 2 or 3 service users, supported by 1 or 2 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 2 weeks, and groups go for a week at a time. The first party were due to go on the weekend after this inspection, and arrangements were well underway. People spoke about how much they were looking forward to it. 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. 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. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 14 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. 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 affected service users. There is a clear process for keeping these under regular review. All relevant persons are consulted about them. This includes accessing the service user’s own view, to the best possible degree. Arrangements for food are well organised. There are seasonal menus, drawn up over a 4 week cycle. Fresh ingredients are used. The menu reflects an effort to promote a balanced diet. The choices of service users are also respected. Menus are regularly discussed with them. Cocklebury Farmhouse employs a cook, who works on weekday mornings. She prepares the main cooked meal, which is eaten at lunchtime. Service users and staff dine together. When the cook is not present, care staff prepare meals. All staff receive food hygiene training. 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 and biscuits 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. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 19 Service users are supported to address their personal and health care needs effectively. Additional advice is needed to ensure that safe and effective support is given to the home’s newest service user, whilst they overcome short term health and mobility problems. 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. 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. Both physical and mental health needs are supported. Physical exercise is a key element of many of the activities offered for service users. This assists with health promotion. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 16 The home’s most recent admission had significant personal and health care needs in the short term, as they had come to Cocklebury Farmhouse directly from a stay in hospital. This service user was recovering from an operation, and had restricted mobility for a period. This included needing to use a wheelchair. The district nursing service was attending to give necessary elements of health care. Personal care was being given by the home’s own staff. Ground floor accommodation had been provided. Care plans and risk assessments set out the support to be given by staff. The advice on moving and handling had been devised in house. This should be done in conjunction with relevant professional advice, to ensure that safe current practices are being observed. As the individual had now had to be readmitted to hospital for a time, the intention was to get new guidance at the point of discharge back to Cocklebury Farmhouse. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Service users are safeguarded by the home’s policies and procedures for complaints and protection. Service users would benefit from greater clarity about how the home may apply physical interventions. EVIDENCE: The home’s complaints procedure is included as an insert in the Service User Guide. The procedure includes information about people who can be contacted if an individual is not happy about something. Service users have been given a copy of the procedure to keep in their own rooms. Information has also been provided for families on how to raise concerns. The organisation has reviewed its complaints procedure, to produce a more user friendly version. This includes greater use of photos and symbols, to promote understanding as much as possible. No complaints had been received about the home. 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. Relevant professionals are involved in helping individual service users to address any issues that may make them particularly vulnerable. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 18 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 the external disclosure routes that are available, if people felt 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. Staff who will be expected to practise physical interventions attend an initial 5 day residential course. There are then refresher courses, every 2 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. So 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. The organisation was still trying to establish whether the training provider it uses for this topic is to be given accreditation, under the national best practice guidance that has been produced for physical interventions. This will ensure that the philosophy and techniques taught are in keeping with Department of Health expectations. A recommendation from previous inspections concerned guidance on the use of physical interventions for individual service users. Although this is detailed, the inspector considered that it could usefully be developed further. It should 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 is being undertaken to address this recommendation. The home has been consulting with all relevant parties. Written descriptions of some techniques in use have been obtained. But they are quite lengthy, and therefore impractical to include in individual guidelines. It was discussed, during the recent inspection of another of the organisation’s homes, that it may be sensible to have descriptions of any approved techniques in general procedures. Individual service user plans can then be cross referenced to these, depending which of the techniques may be applied to a particular person. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 Service users live in a comfortable, clean and safe environment. 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. Cocklebury Farmhouse presents as high quality accommodation. It is clean and well maintained. Funds are made available, as required, for any necessary works. 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 D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 & 36 Service users are supported by suitable numbers of staff. Service users are protected by effective practices in the recruitment and supervision of staff. EVIDENCE: Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 21 As a service that was registered under previous care home legislation, Cocklebury Farmhouse must uphold minimum staffing levels as prescribed by the registration authority before March 2002. 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. 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. 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. Records relating to recent appointments showed that all required recruitment checks are carried out, at the appropriate stages. Where possible issues affecting employment have been identified, these have been addressed openly and effectively with the staff concerned. Individual supervision sessions take place. Records are kept of these. Frequency of supervision tends to be higher for newer employees. Samples showed that relevant issues are discussed. Staff confirmed that the sessions are used to review their performance, and that they can also raise any concerns of their own. Information is regularly exchanged between staff. In addition to handovers for each shift, staff meetings take place, usually about every four weeks. These Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 22 are used to discuss issues relating to service users, and any other topics relevant to the conduct of the home. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 41 & 42 Service users benefit from a well run home, with clear leadership and involvement from senior figures. Service users benefit from the open and supportive ethos of the home. Effective record keeping is maintained, upholding service users’ best interests. Greater care in the use of terminology would enhance practice further. Service users’ health and safety are protected by the systems in place. Review in certain areas would strengthen the existing safeguards. 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. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 24 Mr Tennant and Mr Taylor are supported by a deputy manager, Mrs Carol Pearson; and an assistant manager, Mr Simon Willis. The service benefits from a strong presence of senior managers and carers at all times. There are usually 2 of this group present during the days. On-call arrangements also ensure that a senior person can attend quickly, if the need arises. Both Mr Tennant and Mr Taylor have completed the new Registered Managers Award (RMA) qualification. Mrs Pearson has now also done so, and will go on to study for the NVQ Level 4 award in care. Mr Willis is also working towards the NVQ 4. Cocklebury Farmhouse is successful in promoting an open and inclusive atmosphere. The frequent presence of the registered persons in the service ensures their accessibility to all key parties. Service users were observed to have positive relationships with all staff, including the most senior figures. Staff confirmed that they feel valued and involved. They are able to approach senior colleagues whenever there is anything they wish to discuss, and have found that actions get taken as a result. This was greatly appreciated. The records examined during the inspection were being well maintained. These included required documentation relating to service users, staff, and other general topics. Systems appear to be well established. Some terminology in service user records was inappropriate. For instance, describing an individual as “obstinate” or “manipulative” is subjective and judgemental. It presupposes underlying reasons for behaviour, when these may not be fully known. It is better to give objective descriptions of the actual issues of concern. Also, whilst the range of interventions set out as possible responses to behaviour were largely appropriate, a reference to “reprimanding” implied a paternalistic approach from staff to service users. Clear guidance on consistent language to use when setting boundaries could be given, without the need to define the style of the interaction. The fire log book showed that all required checks and instruction are recorded as being carried out, and up to date. Discussion took place about the home’s fire evacuation procedures. These were being considered for review, particularly because of the restricted mobility of the newest admission. The present procedures require full evacuation of the premises, including at night, when there is only one staff member present. Not all service users would necessarily be speedily compliant, and the staff member is required to visit each room, in a set order, Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 25 to ensure that they all assemble downstairs. The night-time procedure, as currently written, suggests that full evacuation would take some time, and involve a number of risks. It also fails to consider how the location of any fire might impact on the set approach. The home believes that service users understand the current practice, and that confusion might arise from any changes. But it was recommended that review should take place, in conjunction with getting appropriate advice from a fire safety officer. 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. The home’s newest service user was temporarily making use of a wheelchair. A risk assessment was in place for this. But it did not address the issue of use of a lap strap. This element should also be included. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x 4 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x N/A x Standard No 11 12 13 14 15 16 17 x x 4 4 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cocklebury Farmhouse Score 3 3 x N/A Standard No 37 38 39 40 41 42 43 Score 4 3 x x 3 3 x D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 27 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. 1. Standard Regulation Requirement No requirements were identified at this inspection visit 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. 3. Refer to Standard YA1 YA18 YA23 Good Practice Recommendations The Service User Guide should be reviewed and amended, in line with the comments in the relevant section of this report. The home should ensure that relevant professional advice is obtained on any moving and handling techniques that may need to be applied to individual service users. 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. The home has been engaged in further consultation with its training provider. Care should be taken to avoid the use of inappropriate terminology in service user records. Guidelines for the support of a service user temporarily requiring a wheelchair should be reviewed. Fire evacuation procedures should be reviewed, in D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 28 4. 5. 6. YA41 YA42 YA42 Cocklebury Farmhouse consultation with appropriate advice. Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 29 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cocklebury Farmhouse D51_D01_S28301_COCKLEBURY_v233270_220605_Stage4.doc Version 1.30 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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