Inspection on 22/01/08 for Dalwood Farm

This inspection was carried out on 22nd January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dalwood Farm 10/10/06

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 Unannounced Inspection 22 January 2008 10:15 nd Dalwood Farm DS0000028348.V352075.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.V352075.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.V352075.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.V352075.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. 10th October 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 resident 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. Mr J Nosko is a director and also the company secretary. 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 and chickens. Residents 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. Residents generally 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 £1377 and £1449 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.V352075.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place on the 22nd January 2008 between the hours of 10.15am and 5.30pm. Mr A Nosko, the registered manager was not on duty. Mr J Nosko however was available throughout and received feedback. We spoke with three residents and staff members on duty. We examined the medication systems and the management of residents’ personal monies. We looked at care-planning information, training records and recruitment documentation. As part of the inspection process, we sent surveys to the home for residents to complete, if they wanted to. We also sent surveys, to be distributed by the home to residents’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Mr Nosko an Annual Quality Assurance Assessment (AQAA) to complete. This was returned on time. Some information from the AQAA is detailed within this report. 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 experiences of people using the service. What the service does well: The home has a clear admission policy, which takes into account the needs of the potential resident and those already living at the home. Dalwood Farm is resident focused with an emphasis on involvement within the day-to-day running of the home. Residents have good access to leisure facilities and enjoy a varied activity programme. Maintaining important relationships is promoted and staff facilitate journeys to parental homes, as required. Staffing levels are flexible and enable one-to-one support with residents during the day. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 6 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 incorporates individual wishes, personal preference and healthy eating. What has improved since the last inspection? What they could do better: Care plans would benefit from being more person centred. Rather than presenting some negative, restricting approaches, consideration should be given to enabling and empowering. Restrictions and consequences of actions should be reviewed to ensure they are relevant and remain appropriate. While it is acknowledged that care plans are being sent to care managers to be agreed, the involvement of other professionals such as a psychologist may be of benefit. Care plans must include specific areas of need such as the management of epilepsy, weight loss and smoking. All documentation should include factual information rather than subjective terminology. Staff tasks and risks associated with the environment must be considered within the risk assessment process. The assessments must be documented and include fire, maintaining the animals and travelling in the home’s vehicle. A review of staff training is required to ensure all staff are up to date with mandatory subjects. Such areas include first aid, food hygiene and managing challenging behaviour. Additional topics associated with residents’ needs and health care conditions, should be added to the home’s training plan. While questionnaires have been sent out for feedback about the service, a quality auditing system is required to ensure regular on going development. Within the AQAA to be completed next year, greater detail demonstrating developments would be of benefit. Please contact the provider for advice of actions taken in response to this Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a detailed, well-organised admission procedure that involves consultation with existing residents. EVIDENCE: Dalwood Farm continues to provide long-term care provision. There have been no new placements to the home, since the last inspection. It was therefore not possible to look at the admission procedure in detail. In the past, placements have been well organised. Potential residents have been encouraged to visit the home before making their decision to move in. All residents are assessed to ensure their needs can be met. The home receives a copy of the assessment completed by the placing authority. Residents are asked for their views in relation to the placement. The compatibility of all residents is considered. Within surveys, all residents said they were asked if they wanted to move into the home. They also said they received enough information about the house, before doing so. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents would benefit from a more person centred approach to care planning. Residents are encouraged to make decisions about their every day lives and take appropriate risks. EVIDENCE: Each resident has a care plan, which is based on a series of guidelines. Each plan demonstrates the support each resident requires. This includes support needed to bathe and launder clothes. We suggested however, that as a way to improve the plans, they should be more person centred. Some aspects of care plans gave a high emphasis on the management of behaviours. This portrayed a culture, which involved apparent control rather than empowering. For example, one plan states ‘must not eat too much…s/he is to eat all meals at the dining room table with other residents and staff. S/he is to not to eat meals in any other room. If XX refuses meals s/he is not be given sweets for the remainder of the day.’ We advised Mr J Nosko to review the content of plans to enable residents to have more equality and responsibility within their Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 11 day-to-day lives. Discussion with a specialist professional, such as a psychologist may also be beneficial. Mr J Nosko agreed that the plans could be made ‘softer.’ Each resident’s care manager had been sent a copy of the resident’s care plan to sign. While some restrictions had been agreed, some had not been endorsed. The care manager also said that any restrictions should be agreed with the resident and portrayed visually, to ensure understanding. There was no evidence of pictorial formats within the care plan. Further work is therefore required in this area. Care plans contained guidance in relation to particular issues. These included the frequency of drinks, medication to be taken as required and not wanting to work. We advised Mr J Nosko that daily records should reflect any intervention in relation to the guidelines. For example, in one plan it was stated ‘behaviour warranted XX to be given ‘prn’ medication.’ There was no evidence of an incident or any staff intervention to minimise any such behaviour. Daily records were well written and contained details such as mood, food consumed and activities undertaken. Some aspects such as smoking and an encouragement to lose weight were not identified with the resident’s care plan. The management of epilepsy was also not identified. A key worker report had been completed on a monthly basis. Each format contained details about activity, general health and behaviour. One entry stated ‘XX has been very well behaved during [month] but [month] was disappointing.’ Another entry stated ‘XX became aggressive towards me.’ We advised Mr J Nosko to ensure staff record factual information rather than subjective terminology. Within surveys, one relative believed that the home always meets the needs of their relative. Another told us, their relative’s needs are usually met. They said ‘they always act and try hard to meet any need.’ Both relatives agreed that the home provides the support they expect. One relative said ‘they do their best.’ Residents generally receive one-to-one staff support during the day. Due to this, there is a high level of communication and interaction between residents and staff. We heard conversations about planned activities of the day, sport events and anticipated plans of winning the Lottery. The kitchen is seen as the hub of the house. Residents and staff therefore share discussions over coffee or while looking at the newspaper. Residents are encouraged to follow their preferred routines, more so during a weekend. During the week, residents are expected to have a structure to their day. This means rising at a specific time and following their agreed programme. All have responsibilities related to the running of the home. This may involve household chores and assisting with the animals and gardens. This is classed as ‘work’ for some residents and a small payment is received for the work completed. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 12 Residents are assisted to take appropriate risks on a day-to-day basis. This involves making drinks and using garden machinery. Risks are assessed and control measures are applied, as required. Risk assessments are in place within the resident’s care plan. Activities addressed within the risk assessment process included swimming, horse riding and verbal/physical aggression. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents undertake a range of activities that are linked to individual need and preference. Residents are supported to maintain important relationships. Consequences of actions are used to modify behaviours yet these may not need to be so stringent. Meal provision ensures variety, healthy eating and individual preference. EVIDENCE: Residents have access to a varied social activity programme depending on individual preferences. A weekly programme is detailed within each resident’s care plan. Activities include car boot sales, shopping, meals out and the Blue Skies and Redwood Club. One resident told us they liked swimming and horse riding. Another said they liked the pub. They also said they enjoyed a recent day at the races. During the inspection, one resident returned from playing badminton. They said they enjoyed their game and had paid for another term. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 14 Staff told us that external activity is given priority and staffing levels enable one-to-one work. Within surveys, under the heading what the service does well, staff commented about the activities available to residents. They said ‘gives clients plenty of choice of activities to participate in’ and ‘provides a wide range of activities for service users. Provides a welcoming homely atmosphere for residents. Relaxed approach helps take away the fact that it’s a care home.’ One staff member said ‘clients are given lots of opportunities to mix with the community. All that want to, lead varied and busy social lives. Clients are helped to be as independent as possible.’ Under the heading, what the home could do better, one member of staff wrote a number of comments about supporting clients in the local community and the impact on clients behaviour on members of the public. This view was discussed with Mr J Nosko. To some extent, Mr J Nosko agreed with their view. We discussed residents’ rights and antidiscrimination, but also the opportunity of enabling residents to visit a selection of other community resources. Mr J Nosko said this might be an option, which he would discuss with both residents and the staff. Within surveys, all residents said they could make decisions about what they did each day. One said ‘I enjoy shopping and riding.’ Another said ‘I like to go and play badminton on Tuesdays.’ Another said ‘I like going to the pub and gardening.’ All residents are actively involved in the running of the house. All have specific responsibilities and are encouraged to make their own snacks and drinks with staff support. One resident told us they stayed up late. They said they liked watching television. Some residents are paid for their work with the animals and maintaining the outside space. Care plans state, that if residents do not want to work, they do not get paid. One resident said they have a break for lunch and start again when they are ready. While residents are encouraged to make choices within their daily lives, consequences of actions are used to manage behaviours. Records demonstrated occasions when a visit to the pub had been stopped due to an earlier incident. We talked about consequences of actions. Mr J Nosko believed them to be an important part of the management of behaviours. We agreed that this area should be regularly reviewed and discussed with all interested parties. The involvement of a psychologist would also be of benefit to ensure an expert view in relation to management strategies. Visitors are welcomed at any time. Staff also support residents to keep in contact with their family through letters or telephone contact. Within their survey, one relative said ‘we live in XX. We do not drive long distances but the staff are helpful in driving XX near to home.’ Another relative said ‘excellent – they encourage XX to phone every night.’ Relatives told us that staff always keep them informed of any issues. There is a basic menu that is based on residents’ individual preferences. Mr J Nosko told us that the menu is used as a guide but can be changed when Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 15 required. Residents are supported to make his/her own breakfast and lunch. Staff generally cook the main evening meal. Some residents may help with vegetable preparation. We saw residents looking in the cupboards to choose what they wanted for lunch. All residents had different meals. This included ham on toast, corned beef sandwiches and hot dogs. Residents and staff eat together. Meal times are seen as a social occasion so residents are discouraged from eating in the lounge or their own room. Residents are able to make their own drinks although some guidelines are in place, regarding frequencies. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents would benefit from a review of management guidelines to ensure they all remain appropriate. Residents have access to health care services, as required. Medication systems are generally well managed, which reduces the risk of error. EVIDENCE: Residents are supported with all aspects of daily living. A high level of one-toone staff support is given. Guidelines, regarding the support needed is detailed within care plans. Some guidelines give restrictions such as asking a resident to go to their room for 30 minutes, following an incident. The care manager has agreed some of the restrictions. However some aspects were not endorsed, but remain in the care plan. These should be removed. Following the last inspection, all incidents requiring restraint are documented and evaluated. The number of such incidents has reduced. Staff told us that residents appear settled and therefore interactions between individuals have improved. Residents have access to a range of health care services. Staff told us that residents are generally well and only really have routine checks with services Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 17 such as the dentist. A record is maintained of all health care appointments. Staff would support residents with outpatient appointments as required. The home uses a monitored dosage system to administer residents’ medication. Residents do not self medicate. Medication was satisfactorily receipted. All medication was signed to demonstrate administration. However, two entries had been made in error and correction fluid had been used. We advised that any written error should be crossed out. We advised Mr J Nosko to review medication policies with staff, so that errors would not be made. Medication reviews are regularly held with the GP. The GP has recently reviewed the homely remedies policy. However, one resident had been given Lemslip, a non-prescription medication, not stated in the homely remedies policy. We advised that staff should only give medications, which are included on the home remedies list, unless agreed with a GP. Patient information sheets are available for each prescribed medication, for staff reference. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A detailed complaint procedure is in place yet some residents rely on staff involvement to determine and address possible discontentment. Satisfactory systems are in place to minimise the risk of abuse to residents. EVIDENCE: The home has a clear complaints procedure although our contact details need to be updated. Due to capacity, residents are not able to raise a formal complaint. Staff told us that residents would say if they were unhappy. Staff also said that relatives would raise any concern on the resident’s behalf. One resident told us they would tell Ray if they had a problem. Within their survey, another resident said, ‘I can speak to Sheila – deputy manager.’ Two relatives told us that they knew how to make a formal complaint. One relative could not remember. Mr J Nosko told us that there had been no complaints since the last inspection. Staff told us that they would immediately report any suspicion or allegation of abuse to management. They told us they had been given a copy of the local Safeguarding Adults policy entitled ‘No Secrets in Swindon and Wiltshire.’ This document was also displayed on the notice board in the office. Staff have completed adult protection training. Within surveys all staff said they knew what to do in the event of a complaint or allegation of abuse. One staff member said ‘staff regularly chat to residents and would be informed at an early stage if there were issues, these would be passed on immediately. We all have info for outside agencies and know the ‘No Secrets’ procedures.’ Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 19 Mr J Nosko told us that any incident which affects wellbeing is reported to the resident’s placing authority and the Safeguarding Adults Unit. Within care plans and residents’ contracts we saw that residents are responsible for any cost of damage to property. One file contained an invoice regarding damage to a vehicle. Mr J Nosko was advised, in these instances to notify the resident’s care manager. Residents have some personal money that is kept for safekeeping. Records showed that one member of staff completed each transaction. We advised that another member of staff countersigns the record. Mr J Nosko told us the records are audited weekly and therefore any error would be quickly identified. Within daily records, an entry was made about a resident withdrawing money from their own account. Mr J Nosko was not sure whether the resident needed support from staff to do this. We advised Mr Nosko to investigate this area, devise a suitable procedure and document all details within the resident’s care plan. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s location provides tranquillity and the opportunity for residents to assist with the up keep of the grounds and animals. The accommodation is domestic in style and residents are able to personalise their own space, as they wish. 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. The home has animals, such as ponies, chickens and guinea pigs. Residents are supported to feed and maintain the animals. One resident told us they liked feeding the animals but did not like cleaning them out. Another said they liked maintaining the gounds, collecting the eggs and burning the rubbish. They told us they did not usually help with the animals. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 21 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 meeting area. The worktops and the cooker have recently been replaced and new flooring has been applied. At the last inspection, we noted that this room was used as a smoking area. Residents and staff now need to go outside if they want to have a cigarette. All areas of the home are domestic in style. Residents have a single room, either on the ground or first floor. Rooms are personalised to varying degrees according to individual wishes. There is a bathroom on the first floor. The bath has recently been replaced and new flooring fitted. Radiators are covered to minimise any potential risks of injury. The temperature of the hot water is monitored on a daily basis, with records maintained. At the last inspection, we identified that the impact of doors being domestic, rather than fire safety doors, should be considered. Mr J Nosko told us, as a small care home, he did not feel the need to have fire doors in place. We advised, that associated risks of this, should be identified within the fire risk assessment. One resident had vacuumed the lounge and their room during the inspection. Staff told us residents are given support to maintain their environment. The home demonstrated an adequate level of cleanliness. Within surveys, all residents said the home was always fresh and clean. They said ‘I help to clean every day’ and ‘I enjoy helping with housework.’ The laundry facilities were not viewed on this occasion. Staff told us there had been no changes to the area. They said the facilities continued to meet residents’ needs. One resident told us that they had changed their bed earlier in the day. They said staff had helped them. Residents appeared well groomed and their clothing appeared clean and appropriately ironed. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are maintained according to activities of the day so residents often benefit from one-to-one support. Residents are protected through a clear, well-managed recruitment procedure. Staff are not being kept up to date with current practices through insufficient training. Residents would benefit from staff having more training in relation to equality and diversity. EVIDENCE: There are generally two or three staff on duty during the day. Staffing levels vary due to the particular activities taking place each day. Residents generally receive one-to-one support. At night two members of staff provide sleeping in provision. An on call management system is also in operation. Within surveys, under the heading what the service does well, one relative wrote ‘they are well staffed in a small unit.’ The home benefits from an established staff team who know service users well. There are very few changes to the staff team, which enables continuity. There is a key worker system is place. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 23 One relative within their survey said ‘We have a good team – first class.’ The AQAA stated that five staff have NVQ level 2 or above and one is working towards the award. This ensures that the home exceeds the required 50 ratio of staff with an NVQ. The AQAA also stated that staff training is on going. However staff told us, they hadn’t covered many topics in the past year. One member of staff said they had recently completed a care provision course. They had not however done anything else. Training records demonstrated that recent training was limited. Some staff needed updated first aid, food hygiene and managing challenging behaviour training. This must include the latest guidance on restraint. Mr J Nosko had identified that some staff also needed epilepsy training. Within the list identifying staff qualifications, there had been no recent training relating to residents’ needs or learning disability. The staff member’s comment within a survey, relating to ‘protecting the public from residents’ attention seeking behaviour’ clearly identifies the need for additional training. Within staff surveys, there were various comments about training. Specific comments included ‘most staff did their NVQ some years ago,’ ‘currently not undergoing any training at the moment. But have had relevant training’ and ‘not currently being given training but have been trained previously, including NVQ in care level 3.’ One member of staff said ‘we are also able to ask for other training that we would like to partake in if we are particularly interested in a certain aspect of learning or physical disability.’ Another said ‘although I have a qualification I feel further training would be an advantage. I have NVQ level 2. Would feel NVQ 3 would further my training.’ Also ‘I think we could do more training.’ Since the last inspection, there has been one new member of staff. We looked at the recruitment documentation of this staff member. The file contained the required information. They had been checked against the Protection of Vulnerable Adults register before commencing employment. A Criminal Records Disclosure was in place. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Views about service provision are gained yet a structured quality auditing system would further enhance the service. The welfare of residents and staff would be further enhanced through greater attention to systems such as risk assessment. EVIDENCE: Within the AQAA, it was stated that Mr A Nosko had recently completed the Registered Manager’s Award. As Mr A Nosko was not on duty, it was not possible to discuss further planned or completed training. Staff told us that events and ways of developing the service are discussed with residents informally at meal times. Residents meetings are also held. Staff told us however, that sometimes residents are not really motivated to give their views. The meetings therefore are not always productive. Mr J Nosko told us Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 25 questionnaires had been sent out to relatives in order to gain views about the service. As stated at the last inspection, a quality assurance manual had been purchased. However, the manual is too complicated and does not meet the needs of the home. We discussed formats that might be more beneficial. Mr J Nosko told us that he would discuss quality auditing with the manager and the staff team. A more simplified system would then be devised. We talked about the AQAA. We advised that when completing the document next year, more detail should be included. We advised that the document should give a clear picture of how the home has developed and what improvements are planned for the future. Mr J Nosko told us that specific staff have responsibility for making regular checks to the environment, to ensure safe practices. A number of policies and procedures regarding health and safety are in place. Radiators are covered to minimise the risk of injury. Hot water is monitored daily to reduce the risk of scalding. Portable electrical appliances are visually checked for wear and tear. Risks to residents in relation to some activities have been addressed within the risk assessment process. However, the home does not have a fire risk assessment. Risks associated with maintaining the animals and travelling in the home’s vehicle have not been addressed. We advised Mr J Nosko that further consideration is needed with environmental risk assessments. Not all staff have had up to date manual handling. Mr J Nosko told us that staff do not lift any objects. While this may be so, we advised that the subject should be risk assessed. Some staff also need updated first aid, food hygiene and managing challenging behaviour training. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 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 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 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 3 X X 2 X Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 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 YA6 Regulation 15 Requirement Timescale for action 31/03/08 2 YA35 3 YA42 The registered person must ensure that care plans fully reflect the individual’s need and how these needs are to be met. This must include aspects such as the management of epilepsy, weight loss and smoking. 18(1)(a) The registered person must ensure that all staff are up to date with their training such first aid, food hygiene and the management of challenging behaviour. 13(4)(a)(c) The registered person must ensure that tasks staff undertake and the general environment are reviewed within the risk assessment process. This must include fire, maintaining the animals and travelling in the home’s vehicle. 30/04/08 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 28 No. 1 2 3 Refer to Standard YA6 YA6 YA6 Good Practice Recommendations The registered person should ensure that care plans are more person centred. The registered person should ensure that the content of care plans reflects enablement rather than at times control. The registered person should ensure that any restrictions within care provision are agreed with the resident and their care manager and be within a format, which is easy to understand. The registered person should ensure that all documentation contains factual information rather than subjective terminology. The registered person should ensure that ‘consequences of actions’ are reviewed to ensure they remain appropriate. The registered person should ensure that staff cross out errors and do not use correction fluid on formal documentation. The registered person should ensure that staff only administer medication, which is prescribed or identified on the homely remedy list. The registered person should ensure that the need for any resident to pay for the damage they have caused to property is discussed with the resident’s care manager. The registered person should ensure that two staff members undertake any financial transaction of residents’ personal monies. The registered person should ensure that topics associated with residents’ needs and health care conditions form part of the home’s training plan. 4 5 6 7 8 9 10 YA6 YA16 YA20 YA20 YA23 YA23 YA35 Dalwood Farm DS0000028348.V352075.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V352075.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. 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