Inspection on 24/06/08 for Ferndale

This inspection was carried out on 24th June 2008.

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

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

Other inspections for this house

Ferndale 20/07/06

Ferndale 21/02/06

Ferndale 29/11/05

Ferndale 18/02/05

Ferndale 10/08/04

Ferndale 11/03/04

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 27/09/2008.

CARE HOME ADULTS 18-65 Ferndale 131 Whitstone Road Shepton Mallet Somerset BA4 5PS Lead Inspector David Smith Announced Key Inspection 24th June 2008 09:00 Ferndale DS0000016293.V362520.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 Ferndale DS0000016293.V362520.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. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ferndale Address 131 Whitstone Road Shepton Mallet Somerset BA4 5PS 01749 345885 01749 345197 ferndale@orchardvaletrust.org.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) The Orchard Vale Trust Mr Melvyn Phillips Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: 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 3. Date of last inspection 20/07/06 Brief Description of the Service: Ferndale is operated by the Orchard Vale Trust, a non-profit making company and a registered charity. The home provides a high level of specialist care and support to three service users who have a learning disability and who can display varying levels of challenging behaviour. It is located in a residential area of Shepton Mallet and has easy access to local shops, facilities and bus routes. On the ground floor of the main house is a utility area, kitchen diner with patio doors leading to a large rear garden with a patio and lawned area. Two service users each have a personal lounge on the ground floor and bedrooms on the first floor with their own en-suite facilities. A large extension has been built onto the rear of the property and this now provides a self-contained flat for one individual. The construction of this property was an essential part in the development of a bespoke service for this person. They also have access to the kitchen diner in the main part of the house and the gardens. There is a third bedroom and a separate bathroom on the first floor which is used by staff who sleep-in. There is also a small study area, which is used for administration duties. A behavioural management approach has been tailored to meet the specific needs of the people who live in the home. A small staff team supports them within a ‘low arousal’ environment. The home has access to additional support from other health care professionals. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an announced visit to the home as part of a Key Inspection of this service. We needed to advise the home we intended to visit to ensure staff would be available to support the inspection process. We spent eight hours in the home on the day of our visit. The review of evidence and pre-inspection planning involved reviewing the report of the last Key Inspection carried out in July 2006, the Annual Service Review conducted in July 2007 and the service history, which details all contact with the home including notifications of significant events which they have reported to us. We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA, pronounced as ‘aqua’) and a range of survey forms prior to our visit. The AQAA was completed and returned, together with two surveys. We gathered additional information during this visit through informal discussions with one person who lives in the home, the Manager, his line Manager and other staff members. Interaction and communication between staff and people who live in the home was also observed throughout the course of the day. Care plans and associated records were examined together with Risk Assessments, finances, medication administration, staff personnel and training records and health and safety records. We also viewed all communal areas of the home, the individual’s own rooms and the self-contained flat. What the service does well: The service user we spoke with said they liked living at Ferndale and preferred this to their previous home. Other service users were seen to be supported in a caring, respectful and confident way by each member of staff. The relatives who responded by survey said the home meets the needs of their relative, supports them to live fulfilling lives and they believe the staff who support them have the right skills and experience. The service continues to offer care and support in a consistent manner where the needs of the individual are met by a staff team who have a developed understanding of these needs. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 6 The home itself is generally clean and comfortable; each individual has separate facilities with the exception of the communal kitchen diner and laundry area. These arrangements best suit each person’s needs and reflect their own interests. The standard of care planning and record keeping remains high. Activities are based on personal likes and choices and the staff are very pro-active in supporting service users to access all community-based facilities. A consistent approach and continuity of staff continue to promote good practices in relation to the management of behaviours. The Manager and the staff team remain committed to providing a high quality service. Professional expertise is sought when necessary in order to ensure a specialist approach of support is promoted for each individual. There remains an extremely low turnover of staff. This helps to ensure consistency in supporting each person and maintaining a cohesive staff team. What has improved since the last inspection? What they could do better: Staff members must be supervised on a regular basis and a clear record of all supervision meetings maintained. This will ensure staff are supported to provide support to each service user. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 7 All staff must complete the current mandatory and specialist training programme to enable them to provide appropriate care and support to each person who lives in the home. The organisation must ensure that monthly auditing visits are conducted and recorded. This will promote the welfare and safety of the people who live or work in the home. The home should consider carrying out some minor repairs and redecorating some areas of the home to ensure a clean and comfortable living and working environment is maintained. 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. Ferndale DS0000016293.V362520.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 Ferndale DS0000016293.V362520.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, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a thorough and tailored process of information sharing, assessment and visiting which enables each individual and their family to make an informed decision about where to live. EVIDENCE: The home has a brochure, which is used as both the Statement of Purpose and Service Users Guide. This includes an introduction to the Trust, a description of the facilities at the home, their philosophy, principles of practice and details of staffing. There has been one new admission to the home since the last Key Inspection. We therefore took this opportunity to speak with this person, review their care records and view the self contained flat, which has been provided for them in the extension built onto the rear of the home. The care records show that the organisation had previously supported this service user and their care needs were therefore known to them. In addition to this a comprehensive behavioural assessment was carried out and reactive Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 10 strategy designed, which has been developed further since they have been living at Ferndale. This individual was asked if they wished to move to Ferndale, did visit prior to moving in and was therefore able to watch their new home being built. We spoke with this individual for a short while on their return home from work. They said they did like living at Ferndale and they preferred it to their previous home. They like it here as it was a smaller home and there are less people. Their relatives said the accommodation ‘was created for his particular needs. We are delighted with the staff and the home’. Ferndale DS0000016293.V362520.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each individual takes into account their personal preferences, supported by both written information in care plans and risk assessments which are subject to regular review. Individuals are consulted on, and participate in, all aspects of life in the home. EVIDENCE: One care plan was examined in detail during this visit. This care plan is both sophisticated and detailed. It contains clear guidance on the areas of support this person requires such as how to communicate effectively, support they may need with their finances, their morning and evening routines and how this support should be provided. The care-planning format used within the home has been improved since our last visit. These are now written in the ‘first person’, minimise the use of Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 12 professional terminology and make the information contained in them as assessable to as many people as possible to help them understand their content and aid their involvement in the care planning and review processes. The daily records complement this by ensuring there is a constant process of evaluation and review of the support being provided and the outcomes for each individual focused upon. In addition to this ongoing review process within the home, annual review meetings are held with service users, their families, staff from the home and a representative from their Funding Authority. The home produces extremely comprehensive review documents which are shared with each person involved in the review process. Each person is encouraged to read, comment on and sign these documents and we were shown copies which have been signed by various family members and social workers. This is good practice. Each person who lives in the home is encouraged to make as many choices as possible and this is evident through both discussions with service users and staff and observation of their communication and interaction. They are actively involved in all aspects of home life such as cooking, cleaning, and gardening as well as deciding what activities outside of the home they would like to take part in. On the day of our visit one individual was out at their usual place of work for most of the day, another attended an art group and one person helped with tasks in the home and with food shopping. Care and support continues to be provided within a risk assessment framework. Healthy risk taking is encouraged and supported, as evidenced within the wide range of opportunities and activities each individual has been able to enjoy. Each of the person centred risk assessments examined are detailed and subject to regular review. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 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. Each individual has opportunities and appropriate support to develop, access work, leisure and educational facilities both locally and in the wider community and to maintain relationships with their family and friends. Each person’s rights and responsibilities are recognised in their daily lives. A healthy and balanced diet for each individual is promoted. EVIDENCE: Each individual is supported to reach their full potential in relation to their personal development. A great deal of importance is placed on service users being able to participate in all aspects of home life. They are supported to access work opportunities, a range of leisure activities, outings to places of interest, and to choose and attend holidays. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 14 The records examined show that each person uses community facilities. These include local shops, pubs, restaurants, a Leisure Club in Midsomer Norton (where they have use of the swimming pool, jacuzzi, sauna and bar), concerts, visits to places of intererest and going ten-pin bowling. Two individuals have recently been to Exmoor for a holiday, with another choosing a holiday in Spain as they enjoyed a trip there some years ago. Each person who lives at Ferndale has made significant progress since living in the home. Prior to moving here, each person has had many restrictions placed upon them due to the behaviours they may exhibit. These have ranged from loosing their independence to being excluded from using community facilities. One person works at a local café four days per week. They travel to and from work independently and there are very good links between the home and their work place. During their leisure time they choose the things they wish to do and continue to travel independently using buses. Another person who lives in the home is involved in Art and Pottery sessions and has access to Music Therapy. It is evident that the positive outcomes for each individual remain the focus of the care planning processes and support of the staff team. By remaining focused on these, the home demonstrates its commitment to a person centred approach. Each member of staff spoken with spoke very highly of the varied opportunities offered to each person. It is also evident that the latest person to move into Ferndale has helped develop the way each person is supported to have choice and control over their own life. This is seen as an ‘exciting development’. Families are fully involved, wherever possible, in the home’s assessment and care planning process. Orchard Vale Trust was originally a family led organisation and the involvement and support of each person’s family remains central to the philosophy of the home. Each individual has contact with members of their families and friends and there are no restrictions on visiting times and relatives are free to visit whenever they wish. Clear records are maintained relating to any contact with families. Each relative who responded by survey said the home meets the needs of their relative, supports them to live fulfilling lives, helps them keep in touch with them, always keeps them up to date with important issues and they believe the staff who support them have the right skills and experience. One relative said the home ‘provides a high standard of care, with a wide range of social, leisure and work activities. As parents we are very satisfied Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 15 with the standard of care’. Another said ‘we are absolutely delighted with (our son’s) placement’. It was evident that each individual is aware of their rights and also their responsibilities in residing at Ferndale. For example, in one care plan we examined there was a clear set of ‘independence rules’, which this individual had agreed to accept responsibility for. The home does not have set menus as such, as individuals are fully involved in menu planning and shopping for food for the home. Each person chooses what they would like to eat on a day-to-day basis with individual preferences, likes and dislikes taken into consideration. Each person usually has a small breakfast, brunch and main evening meal with snack and drinks being available throughout the day. People generally eat their meals in the kitchen diner (which overlooks the rear garden) or on the patio area in the garden if the weather allows. Should people wish to eat alone or in their own rooms, this is respected. The records we examined show that a wide variety of food is offered to each person and a healthy and balanced diet is promoted. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are supported in their preferred manner and their personal and healthcare support needs are well met. Individuals are supported to retain and administer their own medication where possible. The home’s policy relating to administration of medication ensures each person’s welfare and safety. EVIDENCE: Each individual is registered with a local GP and dentist. Other health care professionals support the home when required. In addition to external resources, there remains a high level of clinical expertise within the organisation to ensure that the care planning meets the needs of each person. The continuity the home has managed to maintain within the staff team also assists in providing consistency and quality of support in this area. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 17 Two people who live in the home are independent with their personal care. One person has become much more independent due to the consistent support provided by staff. Each individual has their own bathing and toilet facilities, which ensures their privacy. Staff spoken with continue to have a good knowledge of each individual’s support needs and are clear on the support and guidance they should provide. The record keeping in this area is excellent and can be easily tracked. This process ensures that each person’s health care is monitored and the support provided is subject to review. The home uses the Lloyds Pharmacy monitored dosage system of medication administration. The medication is kept securely within the home with one member of staff on duty holding the key. The storage facilities were clean and tidy. Each individual has their own named storage containers for non-blister packed medication and dispensing pots. There are clear guidelines to follow in relation to medication taken when necessary (known a ‘PRN’ medication) and a robust check of all stock. One person who lives in the home self-medicates. They are provided with their medication each week, which they keep securely. Staff sign to say the medication has been provided and this individual is then responsible for taking it. There is a Risk Assessment in place to support this practice, although the home must ensure this is regularly reviewed and may wish to include this as part of the comprehensive review document they produce. Medication for the other individuals is dispensed and administered by staff, although one person does dispense their own medication from the ‘blister pack’ under the supervision of staff. Clear records are maintained within the home and the recording sheets we examined were all complete with no gaps evident. Staff are provided with formal medication administration training using ‘Red Crier’ training materials. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect individuals from the likelihood of abuse, neglect and self-harm. EVIDENCE: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. The complaints procedure sets out the various stages and levels that a complaint or concern may be dealt with, makes reference to other related policies and procedures, and refers to a complainant’s right to contact us. The home has never had a complaint. We have not had any concerns or complaints direct regarding the service at Ferndale. The relatives who responded by survey said they know how to make a complaint about the care provided by the home and felt the staff would ‘always’ respond appropriately if they ever had cause to raise any concerns. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 19 The home has clear guidelines in place for supporting service users who are distressed or presenting behaviours which may be perceived as challenging the service provided. These behavioural approaches contain a clear rationale, long-term goals, direct treatment, reactive strategies and restrictions. ‘Contracts’ to address how individuals manage their behaviour have been developed to meet their needs. Each person’s plan has been developed and ‘fine tuned’ using the information recorded by staff each day. The organisation’s methodology appears to be drawn from a select variety of sources such as Studio 3 and Somerset County Council current best practice. We note that the behavioural strategies have been thoroughly examined and ratified by Somerset’s ‘Good Practice’ Panel. The behaviour plans are well recorded and shared with all appropriate parties such as family members, representatives, and other health care professionals involved with each individual. The home has up to date Risk Assessments in relation to physical interventions which may be used, however the home has not had to use this type of intervention for a considerable period of time. The quality of record keeping in this area is excellent. This enables each individual’s approaches to be continually assessed and changes made when necessary. The home also maintains clear records of each accident or incident which occurs in the home. Staff are provided with training in responding to challenging behaviour using the Trust’s policy of Management of Agression, and on each individual’s reactive (emergency) strategies. They are also provided with Protection of Vulnerable Adults training and are subject to Enhanced Criminal Record Bureau Disclosures (generally known as ‘CRBs’) prior to starting work in the home. Each individual has a bank account and their benefits are paid directly into these. Each person’s Bank Statements are checked to ensure both the funds coming in and the money going out of the account are correct. Two individual’s monies are kept in the same cash tin in the home, but separate records are maintained. Staff said this system has worked well for some time, makes checking the cash balances each day easier and does not compromise the audit trail. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ferndale generally provides a homely, comfortable and safe environment for people to live in. EVIDENCE: Ferndale is a detached property, which blends in well with the local community. It faces the main road and has a small front garden and a large rear garden, which also provides a small car parking area. It is located in a residential area of Shepton Mallet and has easy access to local shops, facilities and bus routes. The accommodation is arranged over two floors. On the ground floor of the main house is a utility area, toilet, two lounge areas (which two individuals have personal use of) and a kitchen diner with patio doors leading to the rear garden and patio area. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 21 On the first floor there are three bedrooms and one separate bathroom. Two bedrooms are occupied by service users and these now both have en-suite facilities. The remaining bedroom is used by staff members who sleep-in and they now have use of the bathroom on this floor. There is also a small study area, which is used for administration duties. A large extension has been built onto the rear of the property and this now provides a self-contained flat for one individual. The design of this area has been recently commended by Mendip Planning Department at an awards ceremony. We did view all of the communal areas of the home, the self-contained flat, the garden area and each of the bedrooms. One individual was asked if they would like to show us their own room, which they appeared to be happy to do. Ferndale is very domestic in style and the staff team continue to work hard to ensure that the home is kept as family like wherever possible. The lounges and bedrooms in the main part of the house, together with the self-contained flat, have been decorated in the style and preference of each service user. Each person chooses their own furnishings and fittings with staff support where needed. Each individual is encouraged to keep the home clean and to help with maintenance and gardening. The home has a support worker who specialises in maintenance and this enables the home to adapt to each person’s developing needs. This staff member was working in the home on the day of our visit. The home provides a ‘low arousal environment’, which is suited to the needs of each person who lives here. This allows each person to live in a quiet setting, with their own private areas of the home. They have a choice of using the communal areas when and if they wish to do so. In general the home is maintianed to a high standard, such as the kitchen area, each person’s bedroom and the self-contained flat. Each person has their own personal items, pictures, artwork and photographs which help to personalise their home. However, there have been recent incidents of challenging behaviour which have had an impact on some areas of the home. Both lounges in the main part of the house do now require some minor repairs and redecoration and this is acknowledged by the home. The staff sleeping in room is also in need of redecoration as is the bathroom on the first floor. It would appear that each of these areas will be attended to as part of the planned maintenence for the home. The home was clean, tidy and hygienic when we visited. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person that lives in the home is supported by a cohesive and effective staff team who remain committed to providing a good service. The home’s recruitment policy promotes both individuals’ rights and their safety. The training and supervision of staff are designed to provide a consistent approach to the support of staff and individuals. EVIDENCE: Ferndale has a small staff team that provides a consistent approach to the care and support to the people who live here. The home works closely with a ‘sister’ home located a few miles away who are also able to provide staff cover in times of annual leave and sickness. This ensures that continuity and consistency is maintained. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 23 The home has a core group of four staff excluding the Manager, who remains hands on and works shifts at the home. The numbers of staff on duty can vary depending on the plans of the people who live in the home. On the day of our visit two staff members were on duty in addition to the Manager. The home has been very successful in retaining staff and this ensures the core team remains consistent. This has led to a committed and skilled team being developed, with whom the service users have developed close trusting relationships. The positive outcomes for each individual continue to reflect the commitment and cohesion of the staff team. Discussions with staff members and observation of their work practices demonstrate that they are approachable, good communicators and are comfortable with individuals living at Ferndale who were seen to be at ease with them. It is evident staff have a clear understanding of the needs of each individual, their care plan and how to implement it. The relatives who responded by survey said they feel the staff do have the right skills and experience to support their relative properly and they provide the support and care they expect. One relative said ‘staff have professional training’ they require to provide a high level of care and support. The home has a robust recruitment policy. The personnel records examined included copies of application forms, documents proving identity and eligibility to work in the UK, medical questionnaires, at least two satisfactory references and Enhanced Criminal Record Bureau Disclosures. The home uses ‘Red Crier’ training materials, which can be delivered in-house. This training package contains elements such as First Aid, Manual Handling, Fire Safety, Protection of Vulnerable Adults, Health and Safety and Medication Administration. Once staff complete each training module they receive a certificate to confirm their competence in each area. The staff training records examined, show varying levels of training which staff have attended. Most staff members have completed both mandatory and more specialist training. The home is also currently supporting a number of staff to gain a National Vocational Qualification (known as an ‘NVQ’). A small number of staff need to complete refresher training in certain subjects and this has been noted and acted upon by the Manager. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 24 Staff are provided with 1:1 formal supervision meetings with the Manager. The aim is to provide these sessions every six to eight weeks for each member of staff. Staff also have discussions, many of which could be considered to be informal supervision, on an almost daily basis. The formal supervision records examined suggest that these sessions have become irregular for some staff, for example one staff member did not have a record of any supervision since January 2008 and another member of staff last had supervision in September 2007, although it appears there have been two subsequent supervision meetings which have not yet been written up. The home has now developed an effective system to record both formal and informal supervisions and staff members said they are supervised regularly. It may therefore be that the records of these meetings are inconsistent rather than the meetings not taking place. This was discussed with the Manager during the inspection visit who acknowledged that the recording of the sessions needs to be improved upon to evidence that staff are being well supported in their roles. Ferndale DS0000016293.V362520.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, 38, 39, 40, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and individuals benefit from the ethos, leadership and management approach of the home. Individuals’ views, and those of their families, are central to the review and development of the service. Each person’s rights and best interests are promoted by the home’s policies, procedures and record keeping. Each person is generally provided with competent and accountable management of the service and their health, safety and welfare is promoted and protected. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager is Mr.Melvyn Phillips. Mr.Phillips has a formal nurse qualification (RNMH), is also an Applied Psychology Graduate and has an NVQ Level 4. He has approximately 25 years experience in working with people with learning difficulties and ensures that he keeps himself well informed and aware of best practice by attending refresher courses and appropriate conferences. The home is currently being managed by Mr.P.Maggs, who is the Registered Manager of the organisations’ ‘sister’ home in Midsomer Norton. He holds the City & Guilds 325.3 Advanced Management in Care qualification, a NEBS supervisory management qualification and an NVQ Level 4. This temporary transfer of managers between the two homes has allowed Mr.Phillips to complete a thorough review for one individual who lives at this ‘sister’ home. We have been kept fully informed of these changes by the Trust. Both are long standing members of the Trust’s staff team and have considerable knowledge of the service and each person who lives here. Mr. Phillips continues to play an active role in supporting Mr.Maggs with the running of the home and the support of the service users. Mr Phillips has considerable experience within the learning disabilities field with a particular clinical expertise in the management of challenging behaviour. The management approach is open and positive, with a clear sense of direction and leadership. Staff spoken with said their views are listened to, and that they are well supported by the management and organisational structure. Due to relatively small nature of Orchard Vale Trust, it is apparent that resources will always be limited and due to new pressures, some of which are required by changes to existing regulatory legislation, this will remain a difficult issue for the home to address as it does not to wish to reduce resources, and in particular time, spent directly supporting the people who live here. Whilst we remain sympathetic to this issue it is important for the home and the Trust to continue to make the best possible use of all resources available to ensure the home complies with all relevant legislation and principles of good practice. There are efficient management systems and structures in place to ensure the home runs effectively. The quality of record keeping in the home is good, with all records required during our visit easy to access and stored securely when not in use. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 27 The home has a number of policies and procedures, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Full details of each policy were provided by the Manager as part of the AQAA he completed for us as part of this Key Inspection process. The home has a quality assurance policy and procedure. This system provides an ongoing audit of each shift. This information is used to minimise errors and maintain and develop standards. A representative of the Trust conducts auditing visits. We note that these visits are not currently being carried out each month as the last records examined are for July 2007, September 2007 and March 2008. Monthly visits must be resumed and a copy of each report made available at each inspection visit. There are recording systems in place to support Health and Safety within the home, which are being used consistently. We examined the fire log, which shows that tests on the alarm system are carried out each week and each person who lives in the home, and staff members, take part in a regular fire drills. The home’s Fire Risk Assessment was last reviewed earlier this month. The home’s AQAA confirms that the safety of the home’s electrical circuits and portable electrical appliances were all tested in January 2008. The safety of gas appliances and the home’s heating system was tested in February 2008. The home has developed a number of general Risk Assessments to promote the welfare and safety of people who live in or work at the home. These include the use of window restrictors, securing wardrobes to walls, using electrical appliances and for the control of Legionnaires Disease. These are clearly written and subject to regular review. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 4 12 3 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 3 3 3 3 3 2 Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 29 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 YA36 Regulation 18(2) Requirement To ensure all staff are supported to provide a safe and responsive service to each individual they must be provided with regular supervision and a record of each session maintained. Timescale for action 24/06/08 2. YA35 18(1) To ensure staff have the knowledge and skills to provide a good quality service they must complete their training programme, including any refresher training. 24/12/08 To ensure a safe and accountable service is provided to each person who lives in the home, auditing visits must be carried out each month. 3. YA43 26(4)(5) 24/06/08 Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 30 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 YA24 Good Practice Recommendations The home should repair and redecorate some areas of the home to ensure a homely and comfortable environment is maintained for each person who lives or works in the home. Ferndale DS0000016293.V362520.R01.S.doc Version 5.2 Page 31 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. 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