CARE HOME ADULTS 18-65
Risdon Farm Risdon Farm Jacobstowe Okehampton Devon EX20 3AJ Lead Inspector
Jane Gurnell Unannounced Inspection 11th October 2005 & 13th December 2005 11:00 Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 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 Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 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. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Risdon Farm Address Risdon Farm Jacobstowe Okehampton Devon EX20 3AJ 01837 851240 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) Gilead Foundation Charity Miss Beth Rosanna Samuel Care Home 10 Category(ies) of Past or present alcohol dependence (10), Past or registration, with number present drug dependence (10) of places Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The three new bungalows must be completed and available for occupation by 31.03.06 The Farmhouse modernisation and extension programme must be completed by 31.12.06 The mobile homes/caravans must be removed from the site once the bungalows are occupied (As per planning application) South Little Down Bungalow must not be used for Service Users once the Bungalows have been commissioned Miss Samuel must complete the NVQ4 Registered Managers Award by 1st December 2005 4th April 2005 Date of last inspection Brief Description of the Service: The Gilead Foundation is a Registered Charity which provides care services and supported living in an extended family community which follows the principles of Christianity. Risdon Farm is registered to provide care and accommodation for people who wish to recover from drug and alcohol dependency. The current registration allows for the admission of up to 10 clients of both sexes between the ages of 18 and 65. The home is part of a working dairy and livestock farm which provides opportunities for work and an income to support the charity.The home is set in a rural area near the town of Okehampton in Mid Devon. Accommodation is provided in temporary static caravans, which are to be replced with three large bungalows with modern amenities, and the farmhouse. Some of the bedrooms are shared. There are sufficent bathrooms and toilets in the caravans and the farmhouse. Communal areas are provided in the caravans, farmhouse and the cummunity centre. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 2 days: the first an unannounced visit on 11th October and the second, an arranged visit on 13th December 2005. The second visit had been arranged as, at the time of the first visit, there were no students undergoing phase 1 of the rehabilitation programme. Phase 1 of the programme provides supervised detoxification from addictive substances. The General Manager, the Registered Manager and other members of the management team were all present or available throughout the inspection. The inspectors met 2 clients – known as students - looked at the care plans and the fire log book; toured the accommodation and communal areas. Currently the accommodation is provided in static caravans and the farmhouse. Work is in progress to build three large bungalows that will provide homes for the students receiving 24hr care services and their support workers, however this work has been delayed due to funding issues: one bungalow is scheduled to be completed by the spring. What the service does well:
The staff and managers at Risdon Farm support the students round the clock in a sensitive and respectful way while they withdraw from drug and alcohol dependency. The approach to recovery promotes healthy eating. Most of the food provided is home grown and organic. Risdon Farm provides a secure and positive lifestyle that values students and staff at all levels, and encourages a Christian approach to life. The managers and staff are dedicated to their work of supporting the students to overcome their problems and to get involved with work tasks on the farm, participating in personal development classes and education in daily living skills. The students spoke highly of the care they received when they were admitted to the home. Students recognised that the therapeutic work approach adopted at Risdon Farm had been beneficial in their recovery from addiction. The atmosphere at the home was warm and welcoming. All the staff and managers were helpful and showed a sincere willingness to learn and improve their care services. At the end of the two days spent at Risdon Farm the inspector felt positive and reassured that this home was providing a much needed and valued service to people who wished to change their lives for the better. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 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. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 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 Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 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): 1, 2, 3, 4, 5 The students are given information to allow them to make positive choices about whether or not this home is suitable for them. EVIDENCE: The students described the admission process as warm and welcoming and there is a Service User Guide that gives all the information to ensure prospective students can make an informed choice. Personal files showed an assessment of need and what they wanted to do with their lives once they were free from addiction. The students said they had chosen this home because of its therapeutic work approach and Christian Values, recognising that this approach offered something different that previous admissions for rehabilitation had not. They also said they had chosen not to visit before being admitted for personal reasons. They knew they could visit if they’d wanted to. Each student had signed a contract and terms and conditions which were seen on their files. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 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, 8, 9, 10 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet the students’ needs. EVIDENCE: Each student had read and signed their care plan. Students said they understood why their movements and freedoms were restricted and had agreed to these before entering the programme for rehabilitation. They said they understood why they were supervised when they first came into the home. Students said that they were involved in the running of the home by working on the farm and doing other jobs in the kitchen. They attended meetings and were encouraged to voice their opinions. Students said that they felt confident to share their experiences with senior staff who would respect their privacy as appropriate. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 10 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): 11, 12, 13, 14, 15, 16, 17 The routines of the home are structured to promote an organised working lifestyle as well as leisure and social activities for people who may have lost this ability through drug and alcohol dependency. EVIDENCE: The philosophy of the recovery programme is well documented and is based on assisting the students to develop their personal and life skills through education and work. The students, staff and volunteers of all ages participate in Christian worship and activities that encourage social interaction. The students said that they valued the opportunity to explore their faith and to use their faith to develop coping skills for their future recovery. The care home is a rural community where people live and work together. As students recover from addiction they visit the local town initially with support and eventually unescorted. Students described the relationship with the support staff as very friendly and that their individual needs were respected and valued.
Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 11 Students described the leisure activities organised by the support staff, which included trips and outings and music evenings, which enabled them to develop their social skills and regain their confidence in social situations. On the farm there is TV and video, music and musical instruments, snooker and darts, a trampoline and table tennis. Staff and students observe the Christian principles of love and friendship. Close personal and sexual relationships are not encouraged. Indeed, are actively discouraged and form part of the moral principles under which the organisation operates. These are clearly stated in the service users’ guide. Students described how well they have been supported in maintaining contact with their families. Everyone said how much they enjoyed the meals provided and praised the quality of the food served. Much of the food is produced on the farm and is organic ie milk and cream, meat, vegetables and eggs. Some other food is supplied free from local retailers. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 12 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, 20 Personal support is offered in such a way to promote and respect the students’ dignity and independence. The staff support the students through their emotional upheavals and promote a return to healthy living by providing a safe and drug free lifestyle. EVIDENCE: Case files showed records and healthcare assessments, letters and details of physical and mental health care and treatments. Professional counselling is available to all students by a counsellor employed by The Gilead Foundation, who also undertakes and reviews risk assessments relating to student health, welfare and safety issues. The Registered Manager described how a former student, who has successfully recovered from substance abuse and has made a decision to stay at Risdon Farm, supports newly admitted students. The relationship is designed not only to offer support and advise but also to ensure those students who may be vulnerable from self-neglect or self-harm are closely supervised. The students are registered with the local GP who has expertise in substance misuse and oversees each student’s recovery. Because of the nature of their conditions, none of the students manage their own medication. Medication is stored centrally and those records examined appeared well maintained.
Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 13 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, 23 The home is run on Christian principles that treat people kindly and fairly, with dignity and respect which is very important to people who have lost all their self respect through their addictive behaviour. EVIDENCE: The students felt that their views are listened to when they attend meetings and in the 1:1 sessions they have with their house parents and responsible persons who support them and with whom they live. They knew how and to whom to make a complaint. There was a complaints procedure included in the Service User guide. Staff received training in the Protection of Vulnerable Adults in September 2005. Valuables belonging to the 2 newly admitted students were recorded upon admission. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 14 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, 25, 26, 27, 28, 29, 30 The living accommodation in static caravans is not suitable or safe for longterm care. EVIDENCE: People live in either static caravans or in the farmhouse pending the building of three large bungalows in the grounds. Although the accommodation doesn’t meet the standards, the caravans were warm, homely and comfortable. Each person has a small single bedroom. Cleanliness in the caravans had improved since the previous inspection, as had the laundry room, kitchen and food storage areas indication that regular cleaning is taking place. The smoke detectors found to be not working at the previous inspection had been replaced and were working. The Activities Centre houses a very large activities room and the large dining room. A TV room is provided in one of the buildings on the farm. There are toilets and a shower room in the Centre. A number of washing machines are available for use by staff and students. Personal clothing, bed linen, towels and working clothes are all washed in the laundry room. A further washing machine was provided in the kitchen to enable kitchen linen to be washed separately to prevent the risk of cross infection.
Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 15 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): 31, 32, 33, 34, 35, 36 Staff morale was high resulting in an enthusiastic dedicated workforce that works positively with the students to improve their whole quality of life. EVIDENCE: Staff fully understood their roles and responsibilities. There were job descriptions for each job. Many of the staff and volunteers live in the extended family community on the farm and provide round the clock support to the students. Students knew who was in charge and who to go to with any queries. The managers and support workers have experience and skills to support the students throughout their rehabilitation. Those staff records examined contained written references and proof of identity as well as a Criminal Record Bureau disclosure indicating that recruitment practices protected students. All staff are undertaking NVQ training at levels 2/3/4. Other ongoing training includes first aid, food hygiene, counselling and issues relating to substance misuse and rehabilitation. Staff are formally supervised individually and in groups by senior staff and these are now recorded. The Counsellor undertakes formal staff appraisals every 6 months and these were evident of those staff files examined. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 16 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, 38, 39, 40, 41, 42 The care home and farm are generally well run by a team of qualified and experienced managers and senior support workers. EVIDENCE: The Registered Manager works as part of the senior team in running the home. She is nearing the end of the Registered Managers’ Award. The home is run on Christian principles which promotes family values and respect for each other. Evidence of this was seen over the two days of the inspection and the students confirmed that they felt valued and respected and were treated with dignity and fairness at all times. The home is run for the students and their welfare and recovery is of prime importance to the staff. A formal Quality Assurance process has commenced to gathers the views of the students, their relatives or representatives in relation to how well the home is meeting its aims and objectives: the results of this consultation were not yet available. The homes’ policies and procedures reflect and guide the practice seen and were available to staff and the students as appropriate. Records viewed were well maintained and securely kept to ensure privacy and confidentiality.
Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 17 Health and safety in the home and on the farm is a priority. Everyone has completed health and Safety training and awareness, basic first aid and fire awareness training and a fire drill. However, fire alarm call points in the farmhouse were being tested monthly rather than weekly as recommended by Devon Fire and Rescue services. A risk assessment for the control of Legionnaires Disease was available and the Registered Manager described her plans to regular monitor the temperature of the hot and cold water to ensure these control measures are working. First floor window openings in the farmhouse have not been restricted. Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 1 1 2 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Risdon Farm Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 2 X DS0000061096.V273509.R01.S.doc Version 5.0 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 16 & 23 Requirement Permanent accommodation must be provided for students in one of the completed bungalows. This timescale has been extended. Fire safety systems must be recorded as per the guidelines issued by the Fire Authority. Data sheets for substances hazardous to health must be obtained to ensure all staff are aware of the safe use. Window openings above ground level must be restricted. This timescale has been extended. Timescale for action 31/03/06 2 YA42 13, 23 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 Refer to Standard YA39 Good Practice Recommendations The results of the formal quality assurance consultation process should be sent to the Commission.
DS0000061096.V273509.R01.S.doc Version 5.0 Page 20 Risdon Farm Risdon Farm DS0000061096.V273509.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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