Inspection on 21/02/06 for Dalwood Farm

This inspection was carried out on 21st February 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 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

Dalwood Farm 22/01/08

Dalwood Farm 10/10/06

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 Unannounced Inspection 21st February 2006 09:30 Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 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) 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.V283710.R01.S.doc Version 5.1 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. 20th September 2005 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 homely 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. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 21st February 2006 from 09:30 – 2pm. On arrival at the home all service users and staff were in the kitchen discussing events of the day over a cup of coffee. Time was spent with service users and then discussion took place with Mr J Nosko in the office. Key themes from the last inspection and recent events within the home were discussed. Care planning information and staffing rosters were then viewed and the medication systems were examined. Further time was spent with one service user in the privacy of private accommodation. Observation of interactions formed an important part of the inspection. Mr A Nosko, Registered Manager arrived for duty shortly after the start of the inspection. Various matters were discussed and Mr Nosko received feedback at the end of the inspection. Throughout the visit, the home was busy and communication formed a natural part of all interaction. The atmosphere was relaxed yet animated, with service users positively undertaking tasks. Hospitality was evident and staff appeared motivated and confident in their role. The feedback received from service users was complimentary and gave evidence of positive relationships and the choice of following preferred activity and routines. What the service does well: What has improved since the last inspection? What they could do better: Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 6 Medication administration would be made clearer through the removal of out of date medication administration sheets. Another member of staff should countersign written medication instructions and agreement from the GP should be gained, in order to change any medication that is not regularly needed, to an ‘as required’ basis. 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.V283710.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 The home has a detailed admission procedure that involves consultation with existing service users. EVIDENCE: Discussion took place with Mr J Nosko regarding the forthcoming admission. It was evident that a full assessment had been undertaken and various visits to Dalwood Farm had been made. Within such a visit the service user who was leaving, had enabled the prospective service user to view the room. Consultation regarding the placement had also taken place with other service users. Staff had given consideration to service users’ roles of maintaining the environment in order not to encroach on existing responsibilities. Full one to one support throughout the day had been arranged for the initial start of the placement. It was expected that this would be reduced when individual need was fully established. Documentation of the new admission was viewed and a range of detailed information was available. This included a clear social history, a detailed assessment of need and varying risk assessments. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7 Care planning information is up to date and of a good standard. Behavioural management strategies that have been agreed with care managers enable service users and staff greater protection. Service users are encouraged, with staff support as required to make their own decisions and follow preferred routines. EVIDENCE: The care plan format is portrayed within guidelines and a monthly key worker report gives clear monitoring and review. The guidelines are comprehensive and give a clear summary of need. Matters identified include preferred routines and activity as well as specific information such as not being in the bath unattended due to epilepsy. There are a number of risk assessments, which have been reviewed regularly and in addition, when a specific incident has occurred. At the last inspection, it was noted that one service user was vulnerable due to certain behaviours. Such matters however were not given high priority within written form and information such as management guidelines were unclear. A requirement was therefore made to formally agree behavioural management strategies with the service user’s care manager. This has been undertaken and the care manager’s signature is clearly stated within Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 10 documentation. Within another care plan there are various behaviour management strategies that involve consequences of actions. Mr Nosko reported that a formal review has been arranged and such strategies will be discussed and agreed, in writing within the setting. One service user reported that they could generally make their own decisions although at times, staff support when going out was annoying. Through discussion however, the reason for such support was recognised and acceptance apparent. The service user continued to report that there were no fixed routines within the home. You could help with the chores if you wanted to or if not, it didn’t matter. You could also spend as much time in your room as you wanted. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Service users are supported to undertake a varied weekly programme of their choice. Additional activities on a one-to-one basis with staff are a regular occurrence. EVIDENCE: One service user continues to attend college, whereby a wide circle of friends has been made. Two other service users continue with their responsibilities around the farm on a paid employment basis. Such tasks involve dating the eggs, burning the rubbish, grass cutting and caring for the animals. Activities such as swimming and shopping also form part of the weekly programme. The staffing ratio enables service users to have regular one-to-one support and therefore, in addition to weekly activities, trips to the beach or places such as the New Forest are also undertaken. Trips to the pub to play darts and pool are also enjoyed and holidays are key events. One service user confirmed that a holiday to Malta was planned for the following week. Due to individual need and interest, the service user and a member of staff were going on their own. Staff aim to involve advocates as required. This was demonstrated when one service user was successfully given assistance to complete an assessment form with an advocate. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The medication systems are well managed therefore reducing the risk of error to service users. EVIDENCE: A small amount of medication is prescribed and this is administered via a monitored dosage system. Service users do not self medicate. All staff have regular competency assessments and some have undertaken medication training. It is planned that the training will be repeated on a rotational basis and therefore all staff in time will have undertaken such. A clear record of mediation receipt and disposal is in place. The medication administration sheets were generally well maintained although a painkiller that had been prescribed three times a day was not signed. Through discussion it was evident that the medication was not regularly required. Mr Nosko was therefore advised to make arrangements for the directions of the medication to be changed to ‘as required.’ On one administration sheet it was noted that antibiotic instructions had been hand written. It was advised to ensure that another member of staff countersigns any hand written instruction. For easier administration, it was recommended to transfer all out of date medication administration sheets from the file, to appropriate storage facilities. At the last inspection it was noted that there were a number of medications that were stored within the cupboard that were not on the MAR sheets. A Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 13 requirement was therefore made to address this matter. On this occasion however, the medication administration record appeared an accurate reflection of medication taken. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not fully addressed on this occasion due to satisfactory practice at the last inspection. Discussion confirmed however that service users express their views to staff as required. EVIDENCE: These standards were not addressed in detail as both were satisfactorily managed at the last inspection. It was noted however that in response to a previous recommendation, the complaints procedure in service users files has been updated. Through discussion it was evident that service users would generally tell a member of staff of any concern. Staff would also however, be relied upon to recognise any signs of distress or discontentment. Mr Nosko reported that the home has not received any formal complaints. There have been no issues reported to CSCI. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 28 Dalwood Farm with its range of animals and external spaces gives varying opportunities to service users. All areas are homely, comfortable and well maintained. Private accommodation is furnished and personalised to varying degrees, based on individual choice and preference. 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. Staff and service users maintain the gardens and also look after the home’s animals. Communal areas consist on a sitting room, games room and a kitchen with an integral dining area. The kitchen appears central to the home. The kettle is often on and service users and staff often congregate in the area for informal discussions. There is a separate sitting room that is comfortable and well maintained. All areas of the home are domestic in style and furnished to a good standard. A damp area on the ceiling of the landing that was noted at the last inspection has been resolved. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 16 Service users have single room accommodation. There is one room available on the ground floor and others are on the first floor. All are decorated and furnished according to service users wishes and contain personal entertainment equipment and other personal possessions. One service user reported that private accommodation was an important place where you could ‘do you could do your own thing.’ It was reported that staff respect this and do not intrude. This particular room was comfortable and gave the feeling of being lived in. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 17 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): 33 Staffing levels are maintained as agreed by the previous Registration Authority. One-to-one time with an established staff team is available to enable service users varying opportunities. EVIDENCE: There have been no changes to the staff team since the last inspection. All staff are therefore established and clearly aware of routines and service user need. Staffing levels vary according to activities of the day although one-to one staff support is generally received. At night two staff provide sleeping in provision. Mr Nosko reported that at the time of the next admission, due to possible nighttime needs, a waking night role will be provided. This will be reviewed accordingly when the service user has settled. Male and female staff are available on each shift in order to reflect the gender of service users. Training was not assessed on this occasion although it was noted that the training needs assessment had been updated at the beginning of the year. Such documentation highlighted planned training and some subjects, which some staff have not as yet undertaken. Since the last inspection First Aid, Medication Administration and Physical intervention have been completed. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 18 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 and 39 A Quality Assurance system remains outstanding, yet feedback from service users regarding the service is positive. Risks of injury to service users through hot water is now reduced through daily testing of the hot water outlets. EVIDENCE: Although Mr Nosko submitted all his work towards the Registered Manager’s Award at the time of the last inspection, final confirmation of completion has not been received. Mr Nosko has addressed this with the training organisation although a reason for the delay has not as yet been given. Mr Nosko is not expecting however to undertake any further work on the Award. Staff meetings are now a regular occurrence and formal supervision is working well. Following a recommendation made at the last inspection, staff are now signing staff meeting minutes. The documentation of such however, was not viewed on this occasion. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 19 At the last inspection, an in house Quality Assurance package had been purchased and a number of questionnaires had been sent out. Further work to develop a system to meet the needs of the home was anticipated. Mr Nosko confirmed however that progress had been slow and staff were struggling with such. The future of CSCI was discussed and as an Annual Quality Review will be required, it was agreed that the home could await further guidelines from CSCI before progressing any further. The property continues to be well maintained and attention is given to health and safety matters as required. In response to a requirement made at the last inspection, hot water temperatures are now taken on a daily basis. Further matters relating to health and safety were not however addressed on this occasion. Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X 3 X 2 X X X X Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 21 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 YA6 Good Practice Recommendations The Registered Person should ensure that limitations or consequences of actions are recorded, agreed with service users and their care managers and regularly reviewed. This is in the process of being addressed within formal review settings. The Registered Person should ensure that advice is gained from the GP regarding any medication that is not regularly needed. 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 old medication administration sheets are removed from the file and stored appropriately. 2. 3. 4. YA20 YA20 YA20 Dalwood Farm DS0000028348.V283710.R01.S.doc Version 5.1 Page 22 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.V283710.R01.S.doc Version 5.1 Page 23 - 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. 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