Inspection on 10/10/06 for Dalwood Farm

This inspection was carried out on 10th October 2006.

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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dalwood Farm 22/01/08

Dalwood Farm 21/02/06

Dalwood Farm 20/09/05

Dalwood Farm 13/01/05

Dalwood Farm 27/05/04

Dalwood Farm 11/12/03

Dalwood Farm 17/04/03

Dalwood Farm 07/11/02

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

CARE HOME ADULTS 18-65 Dalwood Farm Dinton Salisbury Wiltshire SP3 5EY Lead Inspector Alison Duffy Key Unannounced Inspection 10th October 2006 09:30 Dalwood Farm DS0000028348.V299061.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 Dalwood Farm DS0000028348.V299061.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. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dalwood Farm Address Dinton Salisbury Wiltshire SP3 5EY 01722 717922 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) andynosko@aol.com Ability Associates Limited Mr Andrew Nosko Care Home 3 Category(ies) of Learning disability (2), Physical disability (1) registration, with number of places Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 2 male service users with a Learning Disability at any one time No more than one male service user with a Learning Disability AND a Physical Disability at any one time. 21st February 2006 Date of last inspection Brief Description of the Service: Dalwood Farm is a residential care home registered to care for three adults with a learning disability. One service user may also have a physical disability. The home is situated in the village of Dinton, which is on the B3089 approximately half an hours drive from Salisbury. The Registered Provider is Ability Associates Ltd and the Registered Manager is Mr Andrew Nosko. Mr Nosko also manages another small care home within the organisation. Dalwood Farm is an old farmhouse providing single room accommodation on both the ground and first floor. There is a small sitting room and a large spacious kitchen with a dining area. An additional room on the ground floor has been allocated to a games room with a pool table in situ. In addition to the farmhouse there are a number of outbuildings, large vegetable gardens, an orchard and adjoining fields. The farm also has a number of animals including Shetland ponies, goats and chickens. Service users and staff maintain the environment and animals. Due to its rural, tranquil positioning, the home has two company cars for journeys as required. Staffing levels are maintained according to individual need and generally service users receive one-to-one support during the day. At night two members of staff provide sleeping in provision. There is also an on call management system in place. The fees for the home are variable depending on the level of care required. At present, fees range between £1215 and £1420 a week. This includes two holidays a year. Additional charges include personal items such as toiletries, hairdressing and social events. A minimal charge is made for transport. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on the 10th October 2006 between the hours of 9.30am and 6.35pm. On arrival at the home Mrs Sheila Powell, deputy manager was on duty with a number of support workers. Mr John Nosko, Company Secretary, was also working in his office. Discussion took place with Mrs Powell regarding care provision. Mrs Powell also assisted with the location of various documentations including care plans, risk assessments, menus and staffing rosters. The medication systems were also examined. At the end of the day, Mr Nosko assisted with staffing information. This included staff training, supervision and recruitment documentation. All service users were in the home at varying times of the day. One service user gave a tour of the garden and the building. Another service user showed his room. All service users spoke of important matters within their lives. Other comments involved daily routines, activities, food and favourite staff members. Within the inspection, service users were involved in housekeeping tasks and offered to make drinks at regular intervals. Some service users were also observed working in the garden. As part of the inspection, comment cards were sent to all relatives, care managers and GPs. All of those returned were satisfied with the care provided. Specific comments included ‘we feel fortunate that XX lives there – of course we have occasional hiccups but we have utmost trust in the staff who do an excellent job, especially Mrs Powell. Mr Nosko encourages a family feel to Dalwood home’ and ‘always welcome at Dalwood Farm.’ Two care managers responded. The comments were ‘I carried out the yearly review of XX and found Dalwood Farm staff helpful and professional. I did notice that the bedroom doors may not be ‘fire doors’’ and ‘Ability Associates have been very good at providing support to my service user. They met with him prior to the move and assisted with the transition process. They have been very good at ensuring his dietary needs are met well. Communication is very good and staff have kept me well informed of his progress.’ All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Dalwood Farm is service user focused with an emphasis on involvement and activity. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 6 Staffing levels are flexible and enable one-to-one support with service users during the day. The positioning of the home gives opportunities to be involved with the countryside through maintaining the gardens and looking after the animals. Health care and medication systems are well managed. Meal provision is of a good standard and incorporates individuality, personal preference and healthy eating. 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. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a detailed, well-organised admission procedure that involves consultation with existing service users. EVIDENCE: Documentation demonstrated that a detailed assessment had been gained from the placing authority of the service user most recently admitted to the home. This gave a detailed past history, any support required and potential risk areas. The service user confirmed that he had visited the home before moving in. He was able to meet with staff and other service users and have a meal. Mr Nosko confirmed that with particular attention to the size of the home, serious consideration had been given to ensuring an appropriate placement. The compatibility of service users was a key aspect. Service users were consulted with and all felt it would be better to have another male service user. A review was held to formally agree the placement. As stated earlier in this report, the care manager reported that the admission process had been positive. Within this, communication had been good and the staff had kept the care manager informed. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good yet behaviour management strategies require review to ensure that current arrangements remain appropriate. This judgement has been made from evidence gathered both during and before the visit to this service. Care planning is of a good standard, which ensures service users’ individual needs are addressed. Decision-making and sensible risk taking are encouraged. However, in relation to the use of restriction and restraint, further consultation and clarity within documentation is needed for greater protection. EVIDENCE: Care plans are detailed and contain a large amount of information. Each contains a photograph yet one photograph is small and does not distinguish the service user. Mr Nosko was informed of the need to replace this with a more appropriate photograph. The plans demonstrate support required in aspects of daily living. Health care matters are also identified and are supported with a record of intervention from health care professionals. Mrs Powell was advised however, to ensure specific matters are concluded within documentation. Care plans have clear guidelines regarding the management of some challenging behaviour. Within a number of incident records however, Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 10 restraint had been used. Mrs Powell was informed of the need to investigate the use of restraint and clearly agree guidelines with the service user’s care manager. Mrs Powell was also advised to ensure strategies used, before the need for restraint, are clearly evidenced. The home operates a key-worker system. One of the key-worker’s responsibilities is to ensure monthly key-worker reports are undertaken. This keeps information up to date and is a time to also reflect on individual need. The reports document key events under headings such as activity, behaviour and health. Within the behaviour section, information such as ‘behaviour has not been so good this month’ was evident. It was suggested to Mrs Powell, that if required, this information should be factual rather than a subjective opinion of either being ‘good or bad.’ Service users generally receive one-to-one staff support during the day. Due to this, there is a high level of communication and interaction between service users and staff. It was noted for example, that general conversation took place over a coffee, but also during the completion of housekeeping tasks. Service users were consulted with, regarding matters such as their choice of lunch and also what they wanted to do. Mrs Powell reported that service user meetings were tried although were deemed unsuccessful due to limited involvement. Consultation is now undertaken informally on a daily basis. This is often while in the kitchen, which appears the hub of the house. Service users are encouraged to follow their preferred routines, more so during a weekend. During the week, Mrs Powell reported that all are expected to have a structure. This means rising at a specific time and following their agreed programme. Generally, all have responsibilities of tasks such as collecting the eggs, burning the rubbish and assisting with the animals and gardens. In some instances, this is classed as ‘work.’ Structured frameworks are built in with specific breaks. A small payment is received for the work completed. Within one care plan, it was noted that a service user was sent to his room for 30 minutes, as he did not want to do his work. This matter was discussed with Mrs Powell as the documentation presented a punitive approach. Mrs Powell reported that all service users are expected to undertake a certain level of maintaining their environment. They are placed in the home with this knowledge and an aim to develop their initial interest of the countryside. The outcome of service users not wanting to be involved in this area was discussed. Mrs Powell reported that the way forward would be a decision for the management of the home. It was agreed however that the expectations of undertaking work, should be clearly stated within care planning information and the Statement of Purpose. The purpose and outcome of practices such as sending a service user to their room must also be investigated and be discussed with the service user’s care manager. If it is established that such strategies are required, they must be agreed and fully documented. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 11 Service users are able to make decisions regarding what they wish to be included within their programme. For example, swimming, bowling and badminton are established activities. Service users are also able to choose activities such as going for a walk or into Salisbury. All service users spoke of the pub with enthusiasm. It was evident that this was a regular occurrence whereby service users could meet friends and play pool. It was noted however that in some instances, consequences of actions would remove the opportunity of going to the pub. For example, in the event of challenging behaviour, the service user would not be allowed to go to the pub. This was discussed with Mrs Powell, as it appeared to be another example of punitive treatment. Mrs Powell acknowledged this yet believed it to be a system of behavioural management, which worked. It was agreed that this would be reviewed with care managers. As with the example stated above, if required, specific guidelines would be devised and agreed with the service users’ care manager. Service users are assisted to take risks in their daily living. This involves practices such as making hot drinks, cooking and using garden machinery. Risks are assessed and control measures are applied, as required. A number of risk assessments demonstrate this. One member of staff reported however, that some risks are deemed too high. For example, one service user assists with burning the rubbish while another said they weren’t allowed, as it was too dangerous. Within some risk assessments, restriction seemed to be used. This was apparent in an assessment detailing the use of tools. It was recorded that if the service user used the tools inappropriately, a pub night would be withdrawn. Mrs Powell was advised to review this process, in line with the other apparent restrictions detailed earlier within this report. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users undertake a range of activities that are linked to individual need and preference. Friendships are encouraged and visitors are welcomed. Communication and involvement are paramount yet ‘consequences of actions’ require review and greater clarification in order to develop individual responsibility. Meal provision is of a good standard while promoting healthy eating and individual preference. EVIDENCE: On the morning of the inspection, one service user was going to play badminton and another was working in the garden. Another service user was completing household tasks. Service users spoke of their favourite things and swimming, bowling and going to the pub were raised. One service user said he liked to meet his friends at the pub, while another said he would soon be going horse riding. In the past one service user attended college. Due to funding however, the course has been withdrawn. Mrs Powell confirmed that alternatives have now been found which are proving more enjoyable for the Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 13 service user. As stated earlier in this report, service users continue with their responsibilities around the farm on a paid employment basis. One service user confirmed that he cuts the grass while another reported that he helps with the vegetable garden, picks up the apples and feeds the animals. Mrs Powell reported that one service user is now involved with the Shaw Trust. This enables supervised gardening work, at various locations. Although it is only early days, Mrs Powell confirmed the placement, appears positive. Dalwood Farm is an isolated property on the outskirts of the village of Dinton. The home is surrounded by open countryside and has large gardens, outbuildings and an orchard. Service users are very much however, part of the local community. During the inspection, one service user was assisted to walk to the local post office to get his lottery ticket. On other occasions the local shop and petrol station are used for small items, which are needed. At the end of the inspection all service users were getting ready to go to the pub. One member of staff reported that service users are well known with the locals and all have a chat over their drink. The local leisure centre is regularly used for sports such as badminton. Service users also go to the cinema when they wish and go shopping in Salisbury. Car boot sales are popular and one service user enjoys horseracing. Staff reported that applying bets and assisting the service user identify horses within the newspaper are important aspects of the weekend. Service users are supported to maintain important relationships. This is achieved through the use of the telephone, sending cards, visits to Dalwood Farm and visits to parental or friends’ homes. Mrs Powell reported that staff often provide transport in order to make the visit easier. Service users have developed positive relationships through the pub and also new opportunities such as the Shaw Trust are enabling new friendships. Service users are encouraged to develop opportunities through their weekly programme. They are able to exercise choice over events although as stated earlier in this report, some restrictions apply, as a result of consequences of actions. Mrs Powell was advised to review this practice and ensure agreements are in place following consultations with care managers. One service user reported that he could use his room to play his music. Service users’ bedrooms do not have locks on although are aware of each other’s space. Communication between service users and staff is high. The home has a basic menu, which is devised with the knowledge of service users’ preferences. Healthy eating and variety is also built in. Mrs Powell confirmed, that the menu is very flexible and is often changed in relation to individual preference on the day. Service users also relate to staff members’ speciality so may also ask for something that they know the staff member cooks well. Service users are supported to get their own breakfast and to make a snack at lunchtime. One service user confirmed that they had helped make their cheese on toast. Another stated that they had helped peel the potatoes Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 14 for tea and had also removed the bread from the freezer for the following day. Service users confirmed that the food is good. One service user reported that ‘Sheila is the best cook.’ All meals consumed are documented. This demonstrated that service users have individual meals and rarely have the same as each other. Service users are able to make their own drinks although guidelines are in place as required. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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 the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Consideration needs to be given to ensure that interactions of staff do not escalate challenging behaviours. Restrictions associated with behaviours also need to be reviewed. Health care is well managed with service users receiving medical input as required. The medication systems are also well managed therefore reducing the risk of error to service users. EVIDENCE: Service users are supported with all aspects of daily living. A high level of oneto-one staff support is given. Within documentation, in some instances, it appeared apparent that restrictions are applied when service users are reluctant to perform personal care tasks. For example, it was recorded that a service user would not be able to go to the pub if he did not have a bath. This was discussed with Mrs Powell who reported that in the past, this strategy addressed a particular difficulty. Mrs Powell was advised to review this area of practice and assess if any other strategies could be used as an alternative. Mrs Powell confirmed that personal care is no longer a problem and the restriction could probably now be removed. Within documentation notifying CSCI of a number of incidents, it was apparent that staff members’ reactions could escalate behaviours. For example, one service user was escorted to his room Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 16 and was told to stay there for 30 minutes. Another was told to stay outside to calm down. A kettle lead had also been confiscated during an incident of repeatedly making drinks. Some of these restrictions were documented in care planning guidelines and had been part of original assessments. Mrs Powell was informed however, of the need to review the ways in which behaviours are managed. It was agreed, as stated earlier in this report that any restriction, if required, must be agreed in writing with the service user’s care manager. The restriction’s purpose, its value and guidelines for when such restriction may be used, must be assessed and fully documented. The use of restraint must also be addressed in this way. Service users are able to communicate if they are unwell yet rely on staff to ensure that intervention from a health care professional is arranged if required. One service user confirmed he had recently been to the dentist. A record is maintained of all appointments. The home appears pro-active and has recently arranged for an investigation into an alleged condition. The condition was proved unfounded and the service user is now being slowly introduced to a ‘normal’ diet. The home uses a monitored dosage system to administer medication to service users. This is kept in a locked locker. The key to the locker is also locked in a separate cabinet. Service user’s do not self medicate. One service user reported that they have their medication at 9o’clock and it is given in a little pot. Staff confirmed this and also stated that observation takes place to ensure that the medication is taken. Records demonstrated that all medication is satisfactorily receipted. All medication was also signed appropriately to demonstrate administration. A number of instructions had been handwritten. Mr Nosko was advised to ensure another member of staff countersigns any handwritten instruction. Staff have recently undertaken medication training and information sheets are available for each medication. Medication reviews are regularly held with the GP. At present, Mrs Powell is developing guidelines for ‘as required’ medication. These are to be agreed with the service user’s GP and care manager. The home has a comprehensive homely remedies policy, which a GP has signed. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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 the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. While a detailed complaint procedure is in place, some service users rely on staff involvement to determine and address possible discontentment. Satisfactory systems are in place to minimise the risk of abuse to service users yet training to include local reporting procedures would ensure further protection. EVIDENCE: The home has a clear complaints procedure. This also indicates the process to follow if a complaint is directed at individual members of the management team, including the Directors of Ability Associates. Due to capacity, service users would be unable to follow the procedure. Mr Nosko confirmed however, that two service users would say if they were unhappy. The third service user would rely on staff or other representatives to recognise possible signs of discontentment. Within comment cards relatives reported that they are aware of the home’s complaints procedure. Relatives therefore act as service users’ advocates. Staff reported that positive relationships have been built with relatives and any issues are addressed at an early stage. There have not been any formal complaints since the last inspection. Within the office/sleeping in room, a copy of the ‘No Secrets’ documentation is displayed. All staff have their own individual copy and have signed confirming they have read and understood the document. Mrs Powell has recently undertaken Abuse training with Age Concern. In the past other staff have undertaken in house training. Mr Nosko was advised to consider enabling an Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 18 external trainer to facilitate a training session on adult protection and local reporting procedures. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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 the following standard(s): 24, 26 and 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home’s location provides tranquillity and the opportunity for service users to assist with the up keep of the grounds and animals. The accommodation is domestic in style and service users are able to personalise their own space as they wish. Consideration is needed however, to ensure that service users are not exposed unnecessarily to passive smoking. EVIDENCE: Dalwood Farm is located within a rural setting. Being an old farmhouse gives many original features and there are various outbuildings, vegetable gardens and fields as part of the property. One service user gave a tour of the gardens and was enthusiastic of all the things he helped to grow. This included runner beans, potatoes, carrots, onions, strawberries, tomatoes and pumpkins. The service user said that the pumpkins had been used for soup, which was very good. The service user also spoke of the animals and said he liked feeding them. Communal areas consist of a sitting room, games room and a kitchen with an integral dining area. The kitchen is central to the home and is used as a Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 20 meeting area. Within the morning of the inspection it was noted that the area was quite smoky due to being the smoking area of the home. The home has a smoking policy that confirms the kitchen as a smoking area. However the policy states it should not be used during the preparation of food or at meal times. It also reports that non-smokers take precedence. Discussion took place with Mr Nosko regarding this as not all service user smoke. Passive smoking is therefore an issue. The policy is also not being adhered to, as non-smokers are not taking precedence. Mr Nosko reported that sometimes the service user would stand in the doorway for a cigarette. It was agreed however, with the winter approaching that this may not be acceptable for others. It was agreed there may not be an easy solution but smoking in the kitchen needs to be addressed. All areas of the home are domestic in style. Service users have single room accommodation. There is one room available on the ground floor and others are on the first floor. Rooms are personalised to varying degrees according to individual wishes. One service user demonstrated the use of his personal entertainment equipment and also showed his large CD and DVD collection. He reported that he spends time in his room when he wants to. Health and safety issues are addressed within the environment. Radiators have been covered to minimise risk and the temperature of the hot water is monitored on a daily basis. On the day of the inspection, the hot water from the hand washbasin in the downstairs toilet was satisfactory. Within a comment card it was identified that the bedroom doors are not fire doors. Mr Nosko was advised to ensure, the facilities in place, meet the required fire regulations. Service users attend to housekeeping tasks with staff support. On the day of the inspection one service user mopped the floor and another did some polishing. The home demonstrated an adequate level of cleanliness. The laundry facilities were not viewed on this occasion. One service user was observed to bring his bedding to the laundry. Service users appeared well groomed and their clothing appeared clean and appropriately ironed. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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, 34 and 35 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels are maintained according to activities of the day so service users often benefit from one-to-one support. Recruitment is well managed although references from previous employers would ensure greater protection. While training is promoted, a full review of provision is required in order to identify and address any shortfalls. EVIDENCE: Staffing rosters demonstrated that staffing levels vary from day-to-day depending on the activities taking place. Service users generally receive oneto-one support and there are times when such staffing may be higher. Service users are generally supported with individual activities so rarely go out as a group during the day. At night two members of staff provide sleeping in provision. An on call management system is also in operation. The home operates a key worker system. Service users have also developed positive relationships with members of staff who may not be their key worker. One member of staff reported that service users’ preferences with who they work with are incorporated within staffing rosters. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 22 Since the last inspection, there has been one new member to the staff team of the organisation. This member of staff does not work however at Dalwood Farm unless in an emergency situation. The home benefits from an established staff team who know service users well. Service users spoke of staff favourably. Although the newest member of staff does not work at the home, the documentation of the recruitment procedure was viewed. An application and two written references were in place. However, both references were character references from friends, despite the applicant being in employment. Mr Nosko was informed that a written reference from an applicant’s current employer must be an integral part of the recruitment process. A CRB disclosure had been gained before the member of staff commenced employment. Staff are generally up to date with their mandatory training. Mrs Powell confirmed that she is currently arranging refreshers for some staff who require first aid training. Within training records it was evident, that some staff would be requiring other refreshers such as food hygiene. Mr Nosko was advised to review all training provision so that any shortfalls could be identified and addressed as soon as possible. The majority of staff have completed challenging behaviour training. Medication training has also recently been undertaken. At present five members of staff have NVQ level 3 and three members of staff are undertaking NVQ level 2. All staff have individual files whereby a record of formal supervision sessions is maintained. The sessions vary in how often each session takes place. Mr Nosko was advised therefore to ensure that a programme of supervision is undertaken so increased focus is given to this area. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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 and 42 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users views are regularly gained yet a structured audit of care provision would further enhance the service. Consideration is given to health and safety yet some risk assessments would benefit from review. EVIDENCE: As stated earlier in this report, Mr Nosko was not available during the inspection due to being on annual leave. Mrs Powell confirmed that Mr Nosko has completed all work for the Registered Manager’s Award. Final verification is now being awaited. Throughout the inspection there was evidence that service users were at the focus of service provision. Mr Nosko reported that surveys have recently been sent to relatives and individual care managers. All were positive and any suggestions have been implemented. All service users were also given support to complete a survey. Mr Nosko confirmed that the quality assurance manual that has been purchased is very complex and time consuming to action. It was agreed that a simpler format could be developed Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 24 in order to assess various aspects of care provision. Mr Nosko agreed consideration would be given to this area although the CSCI’s annual review format was also being awaited. A number of generic risk assessments are in place. Individual assessments in relation to service users and their chosen activities have also been devised. As stated earlier in this report, the content of the individual assessments should be reviewed so that restrictions are not promoted. Generic assessments would also benefit from review. Vehicle checks are in place and staff have now signed a declaration so that they have to inform the Manager of any driving offences. Documentation demonstrated that satisfactory checks had been made of the fire safety equipment. All staff had received fire instruction as required and a fire drill had taken place within each designated period. It is recommended, however to ensure that the area targeted within the fire drill is documented so that further alternatives can be assimilated. Within a comment card it was raised that the bedroom doors may not be ‘fire doors.’ Mr Nosko is therefore required to address this within the home’s fire risk assessment. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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 3 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 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 2 X X 3 X Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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. 1 Standard YA6 Regulation 12(1)(a) Requirement The Registered Person must ensure the use of restraint is reviewed. If required, specific guidelines must be in place. This must include initial strategies to be used before the use of restraint. Following any form of restraint, the Registered Manager must review the appropriateness of the practice and discuss this with the staff involved. This must be documented and the service users’ care manager must be informed. The Registered Person must ensure that any restriction used as a consequence of behaviour is reviewed and discussed with the service user’s care manager and next of kin. If it is established the restriction is required, clear guidelines must be in place. These must be agreed with all involved and documented within care planning information. The Registered Person must discuss with the staff team, the implications of their actions, so that behaviours, which challenge DS0000028348.V299061.R01.S.doc Timescale for action 30/11/06 2 YA7 12(1)(a) 31/12/06 3 YA18 12(1)(a) 30/11/06 Dalwood Farm Version 5.2 Page 27 are not exacerbated. 4 YA42 13(4) The Registered Person must ensure that service user’s safety in relation to the omission of fire doors is addressed within the home’s fire risk assessment. 30/11/06 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 YA6 YA6 YA7 Good Practice Recommendations The Registered Person should ensure that each photograph within care planning documentation is an accurate portrayal of the service user. The Registered Person should ensure that the behavioural management section of the monthly key worker report is factual rather than containing subjective information. The Registered Person should ensure that expectations of service users working at the home are clearly stated within care planning information. This should include payment if appropriate and any restriction identified with not wanting to work. The Registered Person should ensure that a member of staff countersigns any written instruction to the medication administration sheets. The Registered Person should ensure that an external trainer is arranged to provide training to the staff team in relation to abuse and local reporting policies. The Registered Person should ensure that smoking does not take place in the kitchen so that service users who do not smoke are able to have a smoke free environment. An alternative smoking area should be found. The Registered Person should ensure that a reference from a candidate’s existing employer is gained rather than two character references. The Registered Person should ensure that a review of training provision is undertaken so that any shortfalls can be identified and addressed accordingly. The Registered Person should ensure that all staff receive regular formal supervision, which is documented as appropriate. DS0000028348.V299061.R01.S.doc Version 5.2 Page 28 4 5 6 YA20 YA23 YA24 7 8 9 YA34 YA35 YA36 Dalwood Farm 10 YA42 The Registered Person should ensure that the area targeted within the fire drill is documented so that further alternatives can be assimilated. Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 Page 29 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 © 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 Dalwood Farm DS0000028348.V299061.R01.S.doc Version 5.2 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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