Inspection on 31/08/06 for Fenners Farmhouse

This inspection was carried out on 31st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fenners Farmhouse 13/02/06

Fenners Farmhouse 02/08/05

Fenners Farmhouse 02/03/05

Fenners Farmhouse 10/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Fenners Farmhouse Fersfield Diss Norfolk IP22 2AW Lead Inspector Mrs Judith Huggins Unannounced Inspection 31st August 2006 02:45 Fenners Farmhouse DS0000027455.V310963.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 Fenners Farmhouse DS0000027455.V310963.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. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 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.V310963.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2006 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. Charges for the service are from £480 to £757.06 per week according to need. There are additional charges for transport, holidays over 7 days, TV rental and concessionary licences and personal spending. The management team make the inspection report available where visitors enter the home, although the last one was missing from the area. Five out of eight relatives giving written comments to the Commission say that they know how to access the report. This area could be improved. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was told about the inspection just in advance, so that they could tell residents about it. If things change without warning, some people can find that hard to cope with. The inspector was at the home for about six and a half hours. The people who run the home sent some information to the inspector. The inspector found out other things about the home from what 8 relatives and 9 residents wrote. She also talked to five residents, one relative, the people in charge, one member of staff and the administrator. Some things were checked by what was written down in records and care plans, and what the inspector saw or heard while she was visiting. What the service does well: What has improved since the last inspection? People’s care plans have been looked at more regularly, to make sure that they show what has changed for residents. There are also better checks on where staff have worked before, why they left, and what they did if they had some time where they did not have a job. The Friends of Fenners have helped the people who own the home to look at how well it is running, what is good about the service, and what needs to be improved. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 6 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.V310963.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No one has been admitted to the home since the last time the inspector visited. When the last person came, a proper process had been followed, and the person’s needs had been looked at so the home could be sure that they would meet them. The inspector therefore considers that, if the process were once again to be followed should a vacancy arise, the standard would be met. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know their changing needs and goals will be set out in their plans, that they will be supported to make decisions with due regard to risk. EVIDENCE: A full range of need is assessed and documented. Records show that the review frequency has been addressed, and that additional updates are made where needs change. The alternative system proposed at the last inspection has not yet been implemented at present and records are kept as previously. Discussion with the director, a staff member, residents and feedback from relatives shows that staff understand the needs of residents. Relatives are kept informed and consulted about needs at review based on comment cards (100 ). The staff member spoken to says that keyworkers participate in the review process and residents sign some records. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 10 Residents spoken to or completing comment cards say that they feel well cared for. All of them say they have care plans and talk about what is in them. Residents are consulted about decisions, both formally and informally. One person who has difficulty with short term memory also has a 1:1 session with the person who takes residents meetings, and their own set of records for these so that they can be confident about plans for the group, and helped to remember what they had decided about activities for example. There are risk assessments in place to reflect where people need additional help or supervision. These also reflect where people are able to manage keys or medication. There is a risk identified to one person at night which is minimised by the use of monitoring equipment the management team say is only used at night. However, it had not been properly turned off. A recommendation has been made. Assessments of strengths and areas of need are cross-referenced with risk assessments where needed. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents can take part in appropriate activities inside and outside the home, making use of the local community facilities. They are able to maintain family links, their rights are respected and they enjoy their meals and mealtimes. EVIDENCE: All key standards have been consistently met and two have been exceeded the last time they were inspected. No regression was noted. Records, observation and discussion show that people have good community links and social inclusion. This includes use of local amenities such as shops, community centres and the swimming pool. Local activities are discussed at residents’ meetings so people can decide what they wish to join in with. During the fieldwork visit, residents were in and out of the home, dependent on their activities. During the visit a group went to Diss Cue Club to play snooker or pool, and someone attended a sports club. There had been a swimming session that morning. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 12 The duty roster shows a reminder to staff that one person goes to a session to help them be more assertive. Some residents go to college placements during term time. Drumming classes take place in the home, as do music sessions. One person spoken to confirms a regular weekly work placement, which is clearly enjoyed. There are skilled staff working in the on site day care facilities who support residents with communication, numeracy and literacy, and learning new artistic skills. A recent exhibition has been held and residents spoken to had clearly enjoyed seeing their work on display in a public gallery and selling some of it. Some work was seen in the Granary. Difficulties that residents may have with routines are recorded in care plans. One person now requires more additional prompting in order to manage to attend daytime activities outside the home and this is agreed in the plan. Plans also reflect where people’s routines are varied, for example meals taken late or early in order to meet preferences. Throughout the visit, staff spoke to and responded to residents frequently. On no occasion did the inspector see staff as being too busy to stop and respond to comments or enquiries. During the visit one person had also chose to spend time alone in their room. One relative commented that a resident could benefit from more encouragement to join activities outside the home. Discussion with staff, the management team and residents, as well as observation and records shows that efforts are made to encourage people to join with activities, but that individual decisions are ultimately respected. Residents are supported to keep in contact with or visit family members if they need help. One has been supported following a recent bereavement saying that the director had helped them a lot. Residents are supported with personal relationships within a risk assessment framework. The standard for meals and mealtimes is noted as exceeded the last time it was inspected. No regression was seen at this inspection. There is a flexible routine, meals are planned at residents’ meetings with each person being given the chance to choose. There are pictures for people to help with choosing balanced packed lunches when they prepare these for daytime activities “off site”. Weights are monitored regularly and advice sought where there are concerns. The needs for one person with diabetes are discussed, staff have had training, and there is information available in the service user plan. Other residents have also been informed of issues and supported to understand that they cannot necessarily share their sweets with one another as freely as they may wish. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 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): 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. Outcomes have been met consistently. Residents receive the support they need as they would wish, their health care needs are met, and they are generally protected by policies and procedures for dealing with medicines. EVIDENCE: No regression in any of the standards was noted at this inspection. People are given help with personal hygiene as they need this. From interaction heard between staff and a resident, residents are supported to make bath time or showers a relaxing and enjoyable process – even if they need help. Records show that other health professionals are involved and consulted where necessary or where needs change. Discussion with the management team shows that they are alert to changes in mental health as well as physical health. External health professionals support emotional wellbeing with records showing psychology or psychiatry input. The service is also able to support people following bereavement. Staff have received training in the use of equipment for monitoring blood sugars, and also training to understand the condition itself. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 14 There is clear guidance about the administration of medicines. This also covers blood sugar testing and the administration of insulin, as well as appropriate disposal of equipment. There has been recent training, and that issues raised have been discussed as they relate to the practices in the home. One person is supported to administer their own medication with appropriate checks and reviews. During the inspection, one tablet was prepared for a resident by reference to dosage instructions on the packaging and without reference to the medication administration record. However, subsequent discussion showed that this is a routine part of the process and the person realised that they had not done it. The manager addressed the issue promptly. The MAR chart was “buried” under significant amounts of other information that the manager was discussing with the inspector at the time. The outcome is considered met based on overall standards, discussion, and the routine monitoring practices in place to audit practice, records and stocks. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know their views are listened to and acted on, and they are protected from abuse, neglect and self-harm. EVIDENCE: All of the residents completing comment cards know who to talk to if they are unhappy. All say they feel safe at the home and are well treated. One of the eight relatives had felt it necessary to make a complaint although this was not within the last twelve months based on the pre-inspection questionnaire. All of the relatives responding are happy with overall care provided. An in-house seminar on basic awareness of abuse issues as they relate to vulnerable adults took place in June. Training records for a new member of staff show that this has been covered in induction. The staff member had completed a questionnaire to show that they had understood the training and how it related to their work. The staff member spoken to had a clear understanding of the need to report any concerns. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 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): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment that is clean and hygienic. EVIDENCE: A full tour of the home was not made, although as noted at previous inspections, the building is well maintained. Adaptations are made as people’s needs change and action is taken to increase safety. There is a clear schedule of maintenance work. At present there is some damage to the exterior wall arising from an accident with a delivery lorry, which the owners are addressing. This does not significantly impact upon the environment for residents. Regulation 26 visit reports provide for an inspection of the premises and record and identify where work might be needed. Staff have written guidance about infection control. The washing machine is located in a separate utility room, so washing does not need to be taken through areas where food is prepared. The environmental health officer has expressed no concerns to the Commission. Areas seen were clean. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 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, 24 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent staff who are trained to meet their needs. Recruitment practices make sure that residents are protected. EVIDENCE: There is a core of experienced staff working at the home, and supporting residents with their activities inside and outside the home. Observation of interaction between staff and residents show that the staff respect the people they work to support. Training is arranged for staff as the needs of residents change. At present the ratio of 50 of staff with NVQ 2 qualifications or above has not been achieved although it was noted as met at a previous inspection. The preinspection questionnaire shows this as achieved, but includes the managing director and administrator. (It should be noted that both do some direct work with residents.) One person has completed their probation period and the managing director says that the person will go on to NVQ training in the near future. A recommendation has been made. At the last inspection a requirement was made about employment histories. This has been met. The recruitment file for one person seen showed that Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 18 issues and gaps were explored and records annotated to show the outcome of discussions. There was also a written explanation from the staff member. Statutory staffing records were available on the file. Discussion with the management team shows that the probationary period is used effectively and that staff who do not have or develop the appropriate skills to support, empower and relate well to residents are not retained. Structured induction training is provided, and there is evidence that areas of understanding are checked (see abuse standards). The administrator has attended training in the common induction standards now applicable. The Learning Disability Awards Framework – LDAF – is not used. A recommendation has been made. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home (although the manager has not yet completed her registered manager’s award). Residents can be confident their views underpin service development. The health, safety and welfare of service users is promoted and protected. EVIDENCE: The managing director has completed her Registered Manager’s Award and is directly involved in care and management tasks. The Registered Manager herself has started to work towards the award and is a qualified nurse for people with learning disabilities. Both have clear job descriptions setting out their areas of responsibility and both participate in additional training as needed. The “Friends of Fenners” have recently completed an assessment of service quality. This shows that residents were involved. Where issues were Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 20 identified that needed following up, records supplied of a subsequent staff meeting shows that these were explained and discussed. Regular residents meetings take place (weekly), are minuted and followed up. Records seen and one supplied show discussion took place about inspection when the Commission’s comment cards were sent out, and that residents were helped to understand and prepare for the process. All residents completing comment cards confirm that they have meetings to talk about what is good and what could be changed. Records of testing of equipment for safety were seen. See also comments under premises about changes to fire safety measures. There are regular fire drills and the administrator ensures that these are at different times of the day so that residents will be in different places and need to be encouraged to use varying escape routes. The time taken for evacuation would be a useful tool in assessing whether there are developing problems or patterns relating to the time of day, which may determine staff focus on specific areas or tasks first. A recommendation has been made. The home has guidance about food safety, and some of the staff have had formal training. The environmental health officer has raised no concerns with the Commission. Remedial work needed to the electrical system has been completed based on records seen. There are proper arrangements for the disposal of clinical waste (contract seen). There are regular updates for staff in first aid. Accident records were seen and are recorded appropriately. Policies related to safety are updated regularly. These policies include infection control, control of substances hazardous to health, clinical waste arrangements, food safety, health and safety at work and risk assessment. The manager has checklists that she completes regularly and which relate to health and safety, maintenance and general housekeeping to help monitor that standards are maintained. Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 21 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 2 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 4 14 x 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations The registered persons should review practices for using an electronic audio monitoring system to make sure this is consistent with minimising risk without intruding on privacy. If wholly necessary there needs to be a checking process to ensure it is only operating during identified and recorded risk periods. The registered persons should show the Commission how they are working to ensure the ratio of care staff holding NVQ level 2 or above will be improved and sustained. The registered persons should consider using the LDAF for the delivery of induction. The registered persons should record the time taken to evacuate the premises to help with monitoring any developing problems and in making informed changes to procedure where necessary. 2. 3. 4. YA32 YA35 YA42 Fenners Farmhouse DS0000027455.V310963.R01.S.doc Version 5.2 Page 23 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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