Inspection on 27/01/09 for Easterbrook Farm

This inspection was carried out on 27th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Easterbrook Farm 20/10/07

Easterbrook Farm 24/10/06

Easterbrook Farm 14/02/06

Easterbrook Farm 25/10/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOME ADULTS 18-65 Easterbrook Farm Exbourne Okehampton Devon EX20 3QY Lead Inspector Anita Sutcliffe Unannounced Inspection 27th January 2009 10:00 Easterbrook Farm DS0000063712.V373926.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 Easterbrook Farm DS0000063712.V373926.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. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Easterbrook Farm Address Exbourne Okehampton Devon EX20 3QY 01837 851674 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) mike@easterbrookfarm.co.uk Easterbrook Farm Limited Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following caregory of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 12 20th October 2007 Date of last inspection Brief Description of the Service: Easterbrook Farm is registered to accommodate up to twelve people with a learning disability between the ages of 18 and 65. All people who use the service currently are young adults of similar age. The home consists of three separate buildings, the Farmhouse, Shippon and Granary. Each has bedrooms, a lounge and kitchen area. The main communal lounge and kitchen, a sleep in room, and the office, is in the Farm House. There is a laundry and staff sleeping accommodation in the Granary. Easterbrook Farm is north of the village of Exbourne, surrounded by it’s own farmland and not close to any amenities. The farm has a number of farm and out buildings, including two poly-tunnels. There are also ponies, chickens and pets. The service is staffed 24 hours per day with two of the houses having staff ‘sleep in’ at night. One has no sleep in cover but a bell to alert the staff if they need. People who use the service are encouraged to be involved in a range of activities and abide by house ‘rules’ and expectations, which are to promote a sense of responsibility. The registered manager told us that current scale of charges is £900 to £1,300 per week, people do not pay for their holidays or any money toward travel from the farm but they do pay for any personal items. A copy of the Service User Guide is given to each person who is to move to Easterbrook. A copy of Statement of Purpose is kept in the conservatory/ Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 5 office and is available for any one to read. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 6 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 was the first key inspection of the service since October 2007. We reviewed the service October 2008, at which time we received information from surveys sent to people who use the service and staff. We were also provided with current information on how the home was performing and data, such as staff numbers and training. Since the previous key inspection concerns were raised which led to a safeguarding referral, undertaken by the local authority safeguarding team. This has not yet been concluded. Based on information from our review, and the safeguarding alert, we brought the key inspection date forward. This inspection included two unannounced visits to Easterbrook Farm. As part of the visit to the farm we looked at all communal areas, and were shown some of the bedrooms. We watched the people who use the service (clients) and support staff, interviewed some staff and looked at some records, policies and documents pertaining to care and staffing. We spoke with people’s care managers and people’s family. We looked in detail at the care and support that two people received and specific aspects of the care of three others. We saw each person who lives at the home. We spoke with the manager at the second visit. What the service does well: What has improved since the last inspection? Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 7 People are now consulted on their spiritual needs. Medicines are now handled more safely: Records match the actual stock, there is clear information for staff on when ‘as necessary’ or ‘as required’ medicines can be given to people, so their use should be consistent, and people who administer their own medicines have any risk from this assessed. All the checks, necessary to ensure new staff are safe to work with vulnerable adults, are now completed before they start work at the home. Issues surrounding management at the home have affected both people using the service and staff. This has now settled. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Easterbrook Farm DS0000063712.V373926.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 Easterbrook Farm DS0000063712.V373926.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): 1, 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There should be a higher profile placed on the understanding and meeting of people’s diverse needs during all stages of the admission process. EVIDENCE: The last person to be admitted to Easterbrook Farm was over one year ago and during different management at the home. Most admissions to the home are through local authority care management arrangements and include a full assessment of people’s needs. The information currently used to tell people about the service at Easterbrook Farm is being reviewed. At this point in time it is in a lengthy, written format and unlikely to be of use to any potential new resident, although informative for their representative. We previously recommended that this information, the Service User Guide, be in a format, which is of use to people with reduced reading skills. That recommendation has not been met. The home attempts to understand people’s personal and diverse needs (gender, ethnic origin, sexual orientation and belief currently listed on the questionnaire) but the information we saw did not adequately reflect the Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 10 person as an individual and staff have not received training on how to achieve this. We were told that when a person was admitted with a physical disability, though not a serious restriction, the necessary change of equipment they requested was not in place for many months. The home’s admissions policy is that potential residents visit the home on one or more occasions prior to admission and will be expected to sleep over to meet staff and others using the service. There is a three-month trial period and each person receives a contract agreement so it is clear on both sides what is expected. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some people who use the service are vulnerable because their support is not planned and managed in a systematic way. Areas where people can affect change are limited. EVIDENCE: In summer 2008 concerns were raised that Easterbrook Farm uses institutional practices and people’s individual needs are not being addressed. Toward this inspection we therefore talked to five care managers who have recently reviewed people’s care. One told us: “Previously we were worried about institutionalism, but the home are now aware of that. They need to promote independence more but are taking steps toward this”. Another said: “The attitude to work and the philosophy towards independent living is not person centred”. The majority opinion was that the need for person centred care is understood and, for most people, met, but there remains the need for Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 12 continued improvement. The home is working toward increased person centred planning for each person. We looked at how people’s support and care is planned. We looked specifically at two areas of concern that had come to our attention. The first is protection, where people are known to be vulnerable to abuse. The second is behaviours, which have a negative affect on the person themselves and others around them. We found that there was very limited assessment of risk. Where an incident had occurred, which put a female in a vulnerable position, the manager told us ‘it was sorted’ and described steps taken to do this and protect her. However the person’s care had not been reviewed following the incident or the risk from the incident assessed. We looked at two other relevant care plans and found the same lack of information. We are told that two people have negative, challenging, behaviours. The manager told us he has tried to find reasons for this and one family commented: “The manager has been very good in trying to help us with this but there has not been enough effort in looking for reasons why xxx becomes upset”. We were told of arrangements in place to reduce ‘problems’ but we saw that staff do not always follow them. Their Care Managers tell us that insufficient professional help has been sought. They do not currently have confidence in the way the home supports people to manage behaviour that is a challenge. Support and care need to be approached in a systematic way through the care planning process. Family of one person told us: “They try to find triggers but this is still ongoing. It needs a lot of hard work”. One Care Manager told us: “They are not moving toward independence but sometimes manage behaviours in a negative way”. Some staff have received some training specific to challenging behaviours and the home has arranged for further professional help with training. Most people’s needs appear to be met. We were told: “XXX support plan is quite comprehensive although rights, choices and independence needs to be developed more” and “XXX had actually matured, and was settled”. However, no person has a documented, systematic and managed approach to meeting their needs or adequate assessment of risks. Without this staff may not deliver care and support in a consistent way and this leaves people vulnerable and their goals and aspirations may not be achieved. The provider of the home tells us: “Staff actively support service users to be as independent as possible”. There is a weekly meeting where people decide as a group what they want to do the following week, a monthly one to one meeting with a key worker and a yearly survey of people’s opinion but little evidence Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 13 that people are able to make truly informed choices. Where people who use the service like and benefit from a lot of structure, Care Managers tell us those needs are met. They also said: There is a need to promote independence more but the home are taking steps toward this”. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is the opportunity for a fulfilling and interesting life for people who want to live in the countryside but there should be more time available to the individual person. EVIDENCE: The place to live, and personal support received, should focus on helping people achieve independence and lead appropriate, fulfilling lifestyles. To this end people need to be fully informed of the opportunities available to them, helped to make decisions and to meet their goals. Care manager’s told us: • “xxx now has some additional independence and ‘time to chill’.” • “xxx benefits from meeting other people and has proudly shown the farm to parents.” Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 15 • • “The attitude to work and the philosophy towards independent living is not person centred”. “People need more community activity”. Family told us: “xxx needs more things to do. As long as they are able to get off the farm to meet other people. She needs to be occupied”. During our visit a film project was taking place in which some people were actively involved. We saw that people go swimming, shopping, to play bowls and there are regular trips to a local pub. Those who wish attend a local church. People have taken courses in photography, computing and drama. Some people attend a club and others visited London. We spoke with people who told us they loved the farm activities and the animals. We saw people putting flat pack furniture together, which created lots of fun. There were no holidays arranged last year, but they are being planned for 2009: “ probably a trip on a narrow boat for some and a holiday camp for others”. We saw that people’s rooms reflect their age and gender. Where one person likes to cook, we saw them doing so. Where one person likes to do laundry, they do so. All people at the home are encouraged to help with the housework and look after their own rooms, laundry and banking. At present people who are able make their own breakfast and other snacks, but the main meal of the day is cooked in the farmhouse. People are able to take turns to do this, but it is not necessarily in their own ‘home’. We discussed with staff the issue of relationships at the home. They told us that no strong personal relationships have developed at the farm and would take advice, but support them, if they did. A community liaison nurse tells us there are plans to provide training to staff in sexuality and relationships in young adults. There have been parties at the home to which family are invited and we are told people spend time at their parental homes when they wish. People have a pre-set day when they go shopping and banking (known as two to one day). Staff told us: “Sometimes people need more one to one (time with staff). For example, xxx might get pushed to the side. People benefit from more one to one. It’s usually two to one”. We saw that the manager has been directed, following the home’s own survey to: “encourage to make daily living skills more exciting and encourage people to go to college, etc.”. The manager told us that to date he has not sought help with finding outside paid work placements for people but 60 of people have a work placement or are involved in one or more educational outlets. The standard of food at the farm is of a good quality and includes produce from the farm. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 16 Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and health care support is properly managed. EVIDENCE: We saw some detailed information in care plans on how people are to be supported to receive their personal care. This included some good detail, such as people’s dress preferences. A learning disability community liaison nurse told us that each person at Easterbrook Farm has a yearly health check. All were done about six months ago. Said she has no concerns about how health care is managed at the home. Records showed that health concerns have been dealt with appropriately and that people’s health is promoted. We previously recommended that age and gender appropriate health care checks, to ensure continued good health, should be arranged. We are told that this has not yet happened although steps have been taken toward this arrangement with the community nurse team. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 18 The manager told us that he is arranging for a senior member of staff to coordinate health care appointments and arrangements so that nothing is missed and health is fully promoted. We looked at how the home manages medicines. Currently one person manages their own and any risk from this is assessed and managed. We found that medicines are not stored securely. Although locked in a cupboard in a locked room all staff have access to the keys and so there is no person accountable for them at any one time. Although the size of the farm means this is difficult, medicines must have a person designated responsible for them to ensure their safety and so a full audit is possible. We found that there are protocols in place for the use of medicines used in an emergency and staff are fully trained in their use. However, it must be clearly recorded, at all times, where those medicines are. Currently there is no record of this when they are out of the home environment and so a full audit of their use is not possible which introduces a risk to their use. Now there are guidelines in care plan for when ‘as necessary’ and ‘as required’ medicines may be given. This ensures their use will be consistent. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for handling complaints and safeguarding could be further improved. EVIDENCE: We were told that there have been no complaints made about the service. People who use the service are unlikely to make a formal complaint, but there are weekly meetings at which problems might be raised and people have a monthly meeting with their key support worker where concerns might be raised. The complaints procedure is posted on a toilet door where all will see it. Although in pictorial form, as well as written text, it is unnecessarily complex. For example, it includes the phrase: ‘If this does not resolve the issue’ where they might have written: ‘If you are still unhappy’. People who use the service and staff appeared to be relaxed and comfortable in each others company and family also said this was the case. Two people told us they felt safe at the home. We have received no complaints at the Commission, but there are on going safeguarding concerns relating to possible institutional practices at the home. This is not yet formally concluded. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 20 Staff knew where the whistle blowing policy could be found. This would inform them what steps to take if they had concerns, which might be abuse. It contains the contact details of the Commission and local authority safeguarding team. However, it is not clear in the policy that the Safeguarding team are the authority to be contacted if there are concerns. Staff receive information on types of abuse and most staff have received training in how to safeguard people. However, when asked how they would respond to any concerns they were unaware of the local authority safeguarding arrangements, although the manager understood the correct actions to take. It is clear that some people at the home are particularly vulnerable to abuse. Despite this their protection is not part of care planning or risk assessment. (See, Standard on Individual Needs and Choices). Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home environment meets most people’s needs most of the time and is clean, comfortable and well maintained. EVIDENCE: The premises in their entirety have been the subject of several changes. The accommodation now consists of: The Farmhouse, which accommodates four people who live at the home, the Granary, which can accommodate six people, and the Shipham, which accommodates two people. The main communal lounge and kitchen, and the office, is in the Farm House. There is a laundry and staff sleeping accommodation in the Granary and staff accommodation in the Farmhouse. Each of the ‘houses’ has a lounge and kitchen. All laundry is taken to the shared laundry room, which has equipment suitable for the home’s requirements. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 22 We found the home to be clean, hygienic and containing furniture and fittings suitable to the young people living there. There is ongoing upgrading; we saw new carpet being laid in the Farmhouse lounge and people putting new furniture together for the office. Bedrooms visited were personalised and appeared comfortable. One person told us how much they like their room. People are able to lock their room doors for privacy. The home was in a good state of repair. Maintenance is carried out promptly and servicing is up to date. The grounds are quite extensive and include outbuildings and two poly-tunnels. People are able to wash their hands when they have been working on the farm. Liquid soap and paper towels are readily available for this and the laundry equipment is suitable for the type of laundry for which it is needed. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 23 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 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected through robust recruitment practice and staff are keen to provide a good service. EVIDENCE: There has been little change of staff at the home, which provides a consistency for people. We saw that people were comfortable with staff and we heard laughter and fun. We talked to several staff. They appeared to be interested in their work and motivated to do a good job. We found that staff have received training in conditions which might be associated with learning difficulty, but there was not a training programme which ensured all staff are fully trained in conditions associated with the people in their care. We also found that staff knowledge was not as sound as it should be in some areas, for example, behaviour that challenges. One Care manager told us: “Staff who don’t understand and are enforcing poor behaviour” and one staff told the provider that they want more training in Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 24 challenging behaviour. We are told that arrangements are being put in place to achieve this. Staff were more positive about the training arrangements than in October when there was negativity about it and we found that staff are encouraged to take vocational qualifications in care. Opinion as to whether there is enough staff to meet people’s needs varies. People who use the service need the opportunity to leave the farm environment when they choose but this increases the need for staff to support them in this. On the other hand, we saw support staff working on farm tasks, alone and therefore not working to support the people as their role suggests. Staff told the provider in the annual survey that they do not always have enough time to spend with people adding: “There are always other tasks to be completed”. Others told us: “Sometimes people need more one to one (time with staff). For example, xxx might get pushed to the side. People benefit from more one to one. It’s usually two to one”. We looked at whether recruitment practices at the home protect people who use the service from staff who might be unsuitable or unsafe to work with them. We found that all the checks had been completed before they started their employment and the recruitment is robust. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sound and consistent management has yet to be achieved at the home although outcomes for people are improving. EVIDENCE: The current manager started at the home on August 2008. He has applied to the Commission to be registered. Since the previous key inspection he is the third manager at Easterbrook Farm. Professional visitors, summer 2008, and prior to the current manager, told us there was a “strained atmosphere at the home” when they visited. A Care manager said this January: “Turmoil has been in the change of staffing (management) but things are in hand”. Staff told us: “Things are now again settling down. The atmosphere was very different previously because of tensions”. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 26 Some health and social care professionals say they have confidence in the new manager but some tell us have no confidence in the new manager at all. One person’s family tell us they like and trust him and we see that people who use the service come to talk and seem relaxed in his presence. We found the manager was keen to make improvements at the home and talked of plans toward improvement. However, areas of weakness, especially toward person centred planning and risk management, were a concern. We asked on our arrival which staff was in charge at the time as the manager was not on duty. There was debate as to whether it was the administrator or a senior staff member. It must be clear, at all times, who is the person responsible for the care and well being of people at the home. An annual audit of how the service performs is undertaken by the provider organisation. This involves surveying the opinion of people who use the service, their family representatives and staff. We saw that the results were collated and the manager was informed where changes were needed. Those changes indicate that the home is keen to provide opportunities and a good standard of life for people at the home. There are social occasions where people’s family come together with the provider, manager and staff. The provider also does a monthly, unannounced visit where he checks certain standards at the home and reports his findings to the manager. We saw no concerns relating to the maintenance at the home and staff receive health and safety training. However, there is insufficient assessment of risk, both individual to people and generic to the home. This includes people’s contact with cleaning chemicals and the risk of people sleeping in a house with no staff present. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 27 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 2 2 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 28 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) Requirement People’s needs, aspirations and goals, and how they are to be achieved, must be set out in their care plan. Action must be taken to minimize identified risks and hazards to people. Timescale for action 31/03/09 2. YA9 13(4) 31/03/09 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. 4. 5. Refer to Standard YA1 YA9 YA7 YA19 YA22 Good Practice Recommendations The Service User’s Guide should be in a format appropriate to them. It is their guide and so should be of use to them. This recommendation was not met. People should be given training about their personal safety. People should be better supported to make important life decisions, not only day-to-day choices. There should be age and gender appropriate health care checks to ensure good health is promoted. This recommendation was not met. The complaints procedure should be in plain English and suitable for people with learning disability. DS0000063712.V373926.R01.S.doc Version 5.2 Page 29 Easterbrook Farm 6. YA23 7. 8. YA32 YA42 It should be clear from the whistle blowing policy that the local authority Safeguarding team are the authority to be contacted if there are concerns, which might be abuse and staff should be aware of this. Staff should be competent in understanding and dealing with behaviours that are a challenge to people. There should be a broad approach to the assessment and management of risk at the home. Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West 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 Easterbrook Farm DS0000063712.V373926.R01.S.doc Version 5.2 Page 31 - 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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