CARE HOME ADULTS 18-65
Fenners Farmhouse Fersfield Diss Norfolk IP22 2AW Lead Inspector
Mrs Judith Huggins Announced Inspection 13th February 2006 4:15 Fenners Farmhouse DS0000027455.V275272.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 Fenners Farmhouse DS0000027455.V275272.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. Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Fenners Farmhouse Address Fersfield Diss Norfolk IP22 2AW 01379 687269 01379 687234 fenners@clara.co.uk 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) Fenners Limited Mrs Gillian Frances Bradfield Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Fenners Farmhouse provides residential care and support for up to 9 adults with learning disabilities, in a sixteenth century farmhouse with an extension, set in half an acre of grounds, it is in a rural setting about three miles from the town of Diss. The home has been registered to provide this service since 3 October 1989. Transport is available in order to access local facilities. Accommodation is on two floors, offering 9 single rooms. A purpose built art studio/day care facility is situated in the grounds with easy access from the main home. Day care is provided on and off site. Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and spread over two days, starting on Monday 13th to meet the residents, and continuing from 9.30 on Tuesday 14th. It lasted just over 7 hours. All the residents present were spoken to, three at some length. In addition, two relatives, the general manager and registered manager were spoken to. Comment cards were received from 7 relatives, 5 residents, and three visiting professionals. A letter was received from the fire officer. Where appropriate the views expressed have been incorporated in this report. Additional information was gathered from three care plans, a sample of other records, observation and from the pre-inspection questionnaire. The inspector would like to thank the residents for their warm welcome and help in completing the inspection as well as giving permission for her to attend their meeting. What the service does well:
There is a homely and family atmosphere despite the different needs and abilities of the people who live at the home. Changing needs are responded to flexibly. Residents are involved in the day to day running of the home and are consulted about a range of issues. Care is taken that those people who are less confident are not overlooked or “steam rollered” by those who are more confident in expressing their views. Relatives feel welcome in the home at any time, and find it “warm and friendly”. The home is well maintained, well furnished and provides residents with good quality accommodation, including a choice of communal areas (dining room, main lounge, sun lounge and quiet room). Residents have opportunities to choose from a range of social, recreational and educational opportunities both on site and off. Visiting health professionals consider the standard of care to be good. Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fenners Farmhouse DS0000027455.V275272.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 Fenners Farmhouse DS0000027455.V275272.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): 2 and 4 Prospective residents have their needs assessed and can visit to “test drive” the home. EVIDENCE: There has been one admission since the last inspection. Records show that information was gathered from the person’s placement and family, and the homes own assessments (including risk assessments) were completed. There are clear records documenting the person’s introduction to the home, including short visits, visits by the family and extension of the trial period because the person concerned was not sure they wanted to live at the home permanently. These records also show that information about the home was explained to the person concerned. Fenners Farmhouse DS0000027455.V275272.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, 8 Residents assessed needs and goals are reflected in their plans, although there are minor shortfalls in updating these to reflect change. Residents are consulted on and involved in all aspects of life in the home. EVIDENCE: A full range of need is assessed and documented. However, the dates show that there has been some “slippage” in reviewing these. Additionally, the assessment information for one-person records continence, while other documentation shows that this can sometimes be a problem. The assessment has not been reviewed to reflect this although care notes do show that appropriate support is offered. The manager indicates an intention to review the documentation available and to develop an alternative system. There is good practice in encouraging residents who are able to do so, to sign some of the records. All of the relatives responding say they are kept informed of important matters and consulted about care when this is appropriate. Two relatives spoken to confirm that they attend reviews at least once each year and are informed of any issues arising.
Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 10 There are recording sheets in use for monitoring particular issues, although the use of these it not always consistent with some entries on different types of record and others in daily notes. (The proposed review of care plans and associated recording systems should help to address this so that the purpose of the records is clear and they provide the full range of information being sought.) The inspector attended a residents’ meeting. These take place every week and are recorded. Each resident was consulted about activities, encouraged to share their news, and asked about preferred menu choices among other issues. Residents who were not so assertive were supported and encouraged to make their views known. The meeting showed that issues are discussed with residents, including changes to the staff roster, and new staff taking up their posts. Fenners Farmhouse DS0000027455.V275272.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): 13, 15, and 16 Residents are part of the local community, and their rights and responsibilities are recognised. Residents have appropriate personal and family relationships. EVIDENCE: Discussion with residents, observation at the residents’ meeting, and records show that residents participate in activities in the community. These include use of the swimming pool, market, pub, cinemas, church and shops. All but one resident completing comment cards said that suitable activities were provided. The home has its own transport. Staff are expected to spend time with residents outside the home and make arrangements for 1:1 time as well as group outings. Care records show that residents are supported and encouraged to maintain links with family members, including assistance to write letters, cards or to make phone calls if this is needed. Relatives confirm this and two visitors were
Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 12 warmly welcomed into the home. They confirm that this is always the case, as do all visitors completing comment cards. Notes show that arrangements are made to help people to attend family events (including one some distance away) with staff support as needed. There are well-developed friendships between the residents and St Valentines Day was clearly an important event. The rights of residents to develop relationships are acknowledged and the management team are aware of issues such as differences in personalities, which might mean one individual might be “dominated” by another. Residents are encouraged to recognise and acknowledge people who formerly lived at the home, with arrangements to visit, or for those who have moved to visit Fenners. At the residents’ meeting they were also consulted about visiting the graves of two residents who had passed away, to take some flowers for their birthdays. Residents are consulted and able to make choices, via work with the staff and through the regular residents’ meetings. Staff are now expected, according to the general manager and staff meeting records, to ring the doorbell when they enter their work place and the residents’ home. This is good practice. Residents who are able to, have keys for their rooms, subject to risk assessment. Post (largely Valentine cards during the inspection) is given to residents unopened and they are assisted to read or deal with it if they need help. Each person has a “domiciliary day” when they tidy and clean their rooms, change the bed or attend to other household tasks. They are also encouraged to participate in activities such as shopping, laying tables, clearing away, or cleaning communal areas as part of the daily routine. Staff interacted with residents, talking to them, supporting and encouraging, throughout the inspection. There is a flexible routine, dependent upon daytime commitments, with residents able to use their own rooms or communal areas as they wish. One person chose to get up late on the second day of the inspection. Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 13 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): 19 and 21 Residents’ physical and emotional health needs are met. Ageing, illness and death are handled with respect. EVIDENCE: Two visiting health professionals comment on the care that is offered, one saying that care is above average given the complex needs of the group of residents. Notes from recent events show that staff are alert to any changes in residents’ conditions and respond by seeking the appropriate medical advice. Residents have their conditions explained to them and are supported when in hospital based on discussion with a resident and records. An incident report seen recorded that emotional agitation was recognised but that perhaps it was not defused sufficiently early to prevent escalation. There has been an improvement in this area, based on notes, as the person’s needs have become better understood. Staff have training in the management of epilepsy including the administration of rectal diazepam should this be necessary. There is policy guidance for them to follow.
Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 14 Training is planned in the near future to increase awareness and understanding of diabetes, with links, says the manager, to the diabetic nurse at West Suffolk Hospital. In the interim, a care plan covering a full range of relevant issues has been put into place. Explanation was offered to the resident about changes to their diet. Discussions and past history of the home show sensitivity to the needs of residents whose health is declining, including support to find alternative nursing placements where this is needed and to maintain links with the home. Residents are supported to deal with the death of their friends who have lived at the home, and arrangements were made to visit two graves during the residents’ meeting. Observation shows that residents for whom religion is important are offered the opportunity to attend places of worship. Discussion with the management team shows that additional aids are acquired where this may enable a resident to remain at the home for longer, when they become increasingly physically frail. Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 15 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): None Both key standards were checked at the last inspection. See also below. EVIDENCE: The recommendation made at the last inspection has been addressed. Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 16 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): None Key standards were checked at the last inspection. EVIDENCE: Fenners Farmhouse DS0000027455.V275272.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): 32, 34 and 35 Residents are supported by competent, qualified and appropriately trained staff. Residents are generally protected by recruitment policies although one minor shortfall was identified. EVIDENCE: The training records supplied with the pre-inspection questionnaire shows that a range of relevant training is provided and that staff have access to opportunities for NVQ training. Currently half of the care staff (including relief staff) have obtained NVQ’s. The general manager has achieved the registered manager’s award. The registered manager has now started this and is also a registered nurse for people with learning disabilities. The recruitment file for one person recently recruited was checked. This shows that references and both checks against the protection of vulnerable adults (POVA) list and for criminal records are fully completed before staff start work at the home. There was a full employment history but written verification of why the person had ceased to work in previous care posts had not been obtained. This is required following amendments of schedule 2 of the Care Homes Regulations in June 2004. Fenners Farmhouse DS0000027455.V275272.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): 39 Residents can be confidant their views underpin self-monitoring and development by the home. EVIDENCE: A quality assurance survey was conducted last year involving Friends of Fenners and providing for the views of residents to be taken into account. This now needs repeating and the forthcoming changes in the inspection process were explained to the management team. (An ongoing process of selfevaluation and improvement plans will be needed). Monthly visits on behalf of the registered providers are carried out and reports supplied to the Commission. Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 19 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 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 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 4 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x 3 x x 3 x x x x Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO 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 14 and 15 Requirement The registered persons must ensure that assessments and care plans are reviewed and updated at least every six months or more often when needed. The registered persons must ensure that written verification is obtained of the reasons applicants have left previous caring posts. Timescale for action 31/03/06 2 YA34 19 Sch 2 as amended 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA6 YA6 Good Practice Recommendations The registered persons should evaluate and review the effectiveness of existing care plan records and alter the system should this be considered necessary. The registered persons should ensure that the review outlined above takes into account monitoring required by other professionals, the purpose of the information, and provides for consistent practice. The registered persons should pursue consultation with other professionals in their efforts to ensure that
DS0000027455.V275272.R01.S.doc Version 5.1 Page 21 3 YA15 Fenners Farmhouse relationships between residents are supported appropriately and ensure the staff team are aware of issues. Fenners Farmhouse DS0000027455.V275272.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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