Inspection on 20/12/05 for Gorse Farm

This inspection was carried out on 20th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gorse Farm 06/06/08

Gorse Farm 20/07/06

Gorse Farm 20/07/05

Gorse Farm 31/01/05

Gorse Farm 20/08/04

Gorse Farm 26/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Gorse Farm Coleshill Road Marston Green Solihull West Midlands B37 7HP Lead Inspector Kerry Coulter Announced Inspection 20th December 2005 09:30 Gorse Farm DS0000004534.V267057.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 Gorse Farm DS0000004534.V267057.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. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Gorse Farm Address Coleshill Road Marston Green Solihull West Midlands B37 7HP 0121 770 9085 0121 770 9647 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) autism. west midlands Mrs. Gail Ann Jennings Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th July 2005 Brief Description of the Service: Gorse Farm is part of the Autism West Midlands group, which provides a range of residential, day care, education and employment opportunities for people with a diagnosis of autistic spectrum disorder. Gorse Farm provides residential and day services to fourteen young adults with an autistic spectrum disorder. Gorse Farm is located in the village of Marston Green. The converted barn facilities and specifically developed buildings comprise of an administration building, two purpose built separate bungalows and a day centre. The two bungalows comprise of seven single bedrooms, lounge, dining room, and an additional lounge with sensory stimulation equipment, kitchen and a range of toilet and bathroom facilities, laundry and staff facilities. The day service building comprises of art and craft facilities, kitchen, fully equipped sensory room, music and drama area, computer room and quiet workrooms. The establishment is set in spacious and private grounds and are formed around a quadrangle with a lawned area. The home also has a sensory garden and allotment for the use of the Service Users. There is ample parking to the side of the home. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and was conducted by two Inspectors. This was the second of the statutory inspections for this home for 2005/2006 and not all of the National Minimum Standards were assessed. To get a full picture of the home it is advised to read this report in conjunction with the report from July 2005. At this inspection time was spent observing care practices, interactions and support from staff. Some of the service users have verbal communication difficulties and their ability to communicate to the Inspectors their views of the home was limited. A tour of the home was made. Service user care plans, risk assessments and a number of Health and Safety records were inspected. Information was also supplied through the pre inspection questionnaire completed by the Manager and comment cards from service users, relatives and social care and health professionals. The Inspector had the opportunity to talk with several members of staff, the Manager and the Deputy Manager. During this visit one of the Inspectors also met with the Speech and Language Therapist. What the service does well: The home has a team of enthusiastic staff who have a good knowledge of the needs of the people in their care. Observations revealed positive relationships between staff and service users. Members of staff actively encourage service users to take responsibility for as many things are they are able, within their individual capabilities. There is evidence of service users receiving regular health checks. Staff at the home seek input from other health and social care professionals to assist in meeting individual need. The home benefits from having an on site day centre with designated staff to offer time-tabled activities to service users. Comment cards received from health and social care professionals in contact with the home were positive in their comments about the service provided. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Unfortunately some behaviour guidelines, to include physical intervention were not dated on production or on review. Given the number of critical incidents these documents should have been subject to frequent review to ensure they are appropriate. The practice of locking all the toilets during the day must be reviewed, it is not acceptable for service users to have to ask in front of other people to go to the toilet. Further development of the homes medication and healthcare recording and monitoring systems were required so that the home can evidence that service users needs are properly monitored and kept under review. Staff need to ensure they regularly monitor the temperature of the home or alternatively consider installing protective covers to radiator controls in communal rooms. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 7 Current arrangements with regards to training are at times failing to meet the needs of the service users. Refresher training is required for some staff in fire and Studio III. Training records need to include all training undertaken by staff. There has been an unacceptably high level of assaults on staff from one service user. The home must improve some areas of Health and Safety and make sure the home is safe for the people who live and work there. 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. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 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 Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Satisfactory assessment and admission procedures are in place. EVIDENCE: No new service users have been admitted to the home since the last inspection. Previous inspections have identified that prior to admission to the home service users are assessed as to whether the home can meet their needs. From this assessments are completed by the home with the service user and their relatives where appropriate. The Manager was able to talk through the assessment and admission process. An admission policy is available but this was not sampled. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 10 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, 9 and 10 The care planning system in place generally provides staff with the information they need to satisfactorily meet service users needs but some guidelines required dating to evidence review. A new format has been developed to include service users in the risk assessment process but further attention is needed to ensure assessments are dated and regularly reviewed. EVIDENCE: The files of four service users were sampled. Since the last inspection in July 2005 staff have obviously worked hard to reorganise the files to include archiving old information. Files included individual care plans for service users which detailed how the service user was to be supported in their daily routines, management of their behaviour, dietary needs, leisure/social activities, contact with their family and health needs. Unfortunately care practice observed regarding the locking of toilets in one of the bungalows did not match the guidance in the care plan, this is further detailed in Standard 16. Records indicated that where appropriate service users relatives are invited to service users review meetings. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 11 Discussion with the Speech and Language Therapist indicates that she is assisting West Midlands Autism to introduce person centred plans for service users. This will hopefully result in the service users having a copy of their own plan in a format they can understand, in line with the Government paper, ‘Valuing People’. Service user risk assessments were sampled. A wide range of assessments had been completed to include community activities, domestic tasks, using transport, anxiety and risk of challenging behaviour. Some service users have recently presented some extremely challenging behaviour. Unfortunately some behaviour guidelines, to include physical intervention were not dated on production or on review. Given the number of critical incidents these documents should have been subject to frequent review to ensure they are appropriate. The Speech and Language Therapist has worked with staff to produce a risk assessment format for this service user that is in a format he can understand. The Manager hopes that by involving the service user in the risk assessment process then the assessment will be more accurate and include all areas of risk. The new format is good, however as the format is new there was not an opportunity to observe a completed assessment at this inspection. Service users individual records are stored securely. Staff are mindful of issues discussed in the presence of service users, and were not observed to breach confidentiality. The home uses accident books that are compliant with the Data Protection Act. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 12 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, 15 and 16 Arrangements are in place so that service users experience a meaningful lifestyle to include participation in a wide range of activities. Contact with relatives is actively promoted. Not all service users rights are respected as the practice of locking of toilets can impact on dignity. EVIDENCE: Full consideration is made to identify the service users social and emotional needs and as such a range of communication aids are drawn up which assist with this process. This includes the use of Makaton sign language, objects of references, pictorial aids and the use of individual timetables. Staff have worked with the Speech and Language Therapist to implement the use of ‘Communication Passports’ with service users. The home benefits from having an on site day centre with designated staff to offer time-tabled activities to service users. The day centre comprises of art and craft facilities, kitchen, fully equipped sensory room, music and drama area, computer room and quiet workrooms. A Christmas party was organised for service users on the afternoon of the inspection. Individual activity plans Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 13 are provided for each service user and are presented by use of pictures that describe the activities on offer during each weekday. Although the home has the on site day centre community access for service users is also offered. There was documentary evidence that service users enjoy going to pubs, the cinema, parks, bowling, swimming and going out for meals. Service users also have the opportunity to go on holiday, choices have included Wales and a barge holiday. The home has its own vehicles for service users use to access the local community. Five comment cards were received from service users, all recorded that they felt there was lots to do at the home. It is evident that service users are supported to maintain contact with their family and friends. Visitors are welcome to the home. Some service users visit their family and stay overnight where appropriate. Where appropriate staff support service users in visits to their relatives. Three comment cards were received from relatives of service users. In general comments were positive but two relatives did not think there was always enough staff on duty. Comments included ‘ my son is being well cared for’. Staff members advised of the very structured approach necessary to support the service users independence and self determination but choice is promoted as far as possible. Where decisions have been made that affect the rights of service users the home generally consults other professionals or relatives and record this in the care plan. However during the inspection one service user came into the lounge and asked for the key to the toilet. The Inspectors queried why this service user needed a key to access basic amenities and were told that all toilets had to be kept locked due to the behaviour of another service user. On checking the care plan the only information available on locking toilets referred to night time and said that all toilets but one should be locked. The practice of locking all the toilets during the day must be reviewed, it is not acceptable for service users to have to ask in front of other people to go to the toilet. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 14 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 Further development of the homes medication and healthcare recording and monitoring systems were required so that the home can evidence that service users needs are properly monitored and kept under review. EVIDENCE: Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 15 Observation and records indicated that personal care support from staff is done in privacy and in a gender sensitive manner, in the service users’ bedrooms. The service users were well presented. Times for getting up/going to bed and meals are flexible depending on the individual service users activities and needs. Some service users receive 1:1 support from staff and additional funding has been secured to facilitate this. Since the last inspection basic health action plans have been developed for each service user. A health action plan is a plan about what an individual needs to stay healthy. The format is not of a type that all service users would be able to understand. The Manager explained that it was a basic plan that they hoped to improve in the future and were also continuing to search for more suitable formats to meet the needs of the service users. Sampled records show that service users receive regular health monitoring to include GP, optician and dental input. One service user has had a lot of dental input as he has sensitive teeth. Guidance for staff on how to respond to comments from him about painful teeth should be included in his care plan. As he frequently says his teeth hurt, staff need to be clear about when a dentist appointment should be sought. Where appropriate, referrals are made to other health professionals including the psychiatrist, psychologist, community nurse, occupational therapist and speech and language therapist. For one service user, psychology review meetings are currently being held on a regular basis, minutes of these meetings were available. Comment cards received from health and social care professionals in contact with the home were positive in their comments about the service provided. Weight monitoring records for three service users were sampled. Some gaps were observed in the records. Where individuals are unable to fully communicate their well being regular weight monitoring is important as weight gain or loss can be a sign that a person is unwell. One service user had lost 12lbs in two months. The Senior Support Worker was unsure why the weight loss had occurred. Discussion with the Manager indicated that the service user was on a weight loss diet. The health action plan needs to reflect this and should detail the target weight. The medication administration systems were sampled in each of the bungalows. A local pharmacist supplies the medication to the home using the Nomad system. The pharmacist visits the home every three months to complete an audit of the medication. Whilst the medication system is generally satisfactory in one bungalow topical creams were opened but undated. Topical creams and ointments must be dated on opening and then discarded within 28 days. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 16 One service user is prescribed medication for constipation on an ‘as required’ basis. The written protocol for its use was not available to clarify if one or two tablets should be given, and this medication was being administered by staff on a daily basis. A review is therefore needed with the GP to determine if the administration instructions on an ‘as required’ basis are still appropriate. For one service user his PRN protocol guidelines were dated as February 2005. Given the number of critical incidents that have occurred these documents should have been subject to a more frequent review to ensure they are appropriate. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 17 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): 23 The current behaviours from one service user and lack of refresher training for some staff on the use of physical intervention impact on the homes ability to ensure all service users are fully safeguarded. EVIDENCE: The Service Users needs are such that the organisation provides the staff team with ‘breakaway’ training. It has been identified at previous inspections that some staff have not received the training they require. Gorse Farm has a large staff team and most staff have now attended Studio III training. From sampling the computer training records of 32 staff (inc 5 relief staff) 15 staff were overdue refresher training. The last date of studio III training for the senior supporting one service user on a 1:1 basis was recorded as November 2002. Additionally the Manager and Deputy last attended training in 2003. It is essential that staff receive annual refresher training to reduce the risk of injury to themselves and also to service users. Correspondence received from the organisation after the inspection took place indicates that the required refresher training has now been arranged. The Manager ensures incident forms are completed and a monthly log of the number of incidents to include if physical intervention was used. It was required at the last inspection that records on the use of physical intervention required improvement to ensure they meet the Department of Health guidance for restrictive physical interventions (2002). These records were sampled and observed to be much improved, however not all of the records detailed the duration or showed that service users are checked for injury following the physical intervention. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 18 During the inspection visit one service user had behaviour that was disruptive and difficult to manage. It is of concern that service users are required to tolerate this level of disruption on an ongoing basis. The records sampled did not identify that this service user had physically caused harm to any of the service users, most of his behaviour appears to be directed at staff. It was clear from daily notes that there is sometimes an impact on service users welfare and liberty to move freely around the home. It was not possible to establish with service users how they feel about the situation in the home at present. Assessment on the impact on other service users is needed and a strategy put in place to minimise the effect on service users. Correspondence received from the organisation after the inspection took place indicates that such an assessment has now been instigated. Staff at the home have received prevention of abuse training. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 19 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, 26, 28, 29 and 30 The home is generally well maintained and decorated to a good standard, however staff need to ensure all parts of the home are kept at a temperature comfortable to the service users. EVIDENCE: Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 20 The home provides a range of generally comfortable, safe and accessible shared space, which meets the assessed needs of the service users. Facilities available at the home consist of an allotment, sensory garden, sensory lounge, an indoor and outdoor keep fit area, punch bag and running machine, each bungalow has two lounges. The daycentre also has facilities for cooking and sensory massage as well as a second sensory room, quiet lounge and large area for craftwork and music sessions. Staff facilities within each bungalow include an office and a room for the storage of personal belongings. Unfortunately one communal room was very cold, the radiator in this room was observed not to be switched on. Earlier, one service user had eaten her lunch in this area. Staff were not aware that this room was so cold until informed by the Inspectors. Discussion with staff and the Manager indicates that another service user may have turned off the radiator. If this is the case then staff need to ensure they regularly monitor the temperature of the home or alternatively consider installing protective covers to radiator controls in communal rooms. Some areas of the bungalows to include hallways, kitchens and some bathrooms and bedrooms have been repainted since the last inspection, making the bungalows a nicer place to live. A planned schedule for the refurbishment of the kitchens in 2006 has also been agreed. The previous inspection identified that several windows in both bungalows were without curtains or blinds. Discussion with staff indicated that some service users will not tolerate curtains/blinds. This issue has now been addressed as a new type of protective covering has been fitted to the top of the blind fittings to reduce the risk of them being pulled down. Sampled service user bedrooms were observed to be personalised according to individual preferences and needs. The home provides environmental adaptations to meet the assessed needs of the service users. These include the widening of steps, electrical socket protectors, décor in neutral colours with a matt finish, tactile symbols and pictorial aids that are provided throughout the bungalows. In addition to this staff are also provided with emergency call buttons and two way radios for summoning assistance. On the day of this inspection the home was clean, hygienic and free from offensive odours. Each bungalow has a laundry area, which is separate to the kitchen. The facilities are large enough to accommodate industrial sized washing and drying machines. The washing machines allow for soiled items to be washed at appropriate temperatures. The bungalows also have sluicing facilities. Protective clothing was seen to be available, including aprons and gloves. Clinical waste bins are situated in the bathroom areas. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 21 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, 33, 34, 35, 36 The home has a team of enthusiastic staff but current arrangements with regards to training are at times failing to meet the needs of the service users. Some improvement is needed to staff files to show that recruitment practices safeguard individuals. EVIDENCE: It was noted that both staff and service users appear comfortable in each other’s company and enjoy a good general rapport. Members of staff demonstrate that they have a good personal knowledge of the individuals in their care. Staff spoken with were enthusiastic in their approach and welcomed the inspection process. Information provided on the pre inspection questionnaire shows that 40 of staff have achieved an NVQ in care, this is below the standard of 50 . However the home is well on the way to achieving this as a further nine staff are working towards this qualification. Each bungalow operates with three to four staff per day shift, with additional staff based in the day centre. The staffing ratios at the time of this inspection were seen to reflect this. In addition, two service users have 1:1 support due to their high level of need. Since the last inspection some hard work has been undertaken to reorganise the staff files. As the home has such a large staff team the files have been colour coded making it easier to locate individual files. Most files sampled Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 22 contained all the required information. However two files did not have proof of identity and one did not have a photograph of the member of staff. The home does not keep Criminal Record Bureau disclosures on site. The Human Resources Manager attended part of the inspection and brought with her the disclosures to evidence that the appropriate checks had been done before staff commence work in the home. These disclosures are normally kept at the organisations headquarters. The regulations require that these disclosures are kept in the home, therefore if the organisation wishes to continue in storing them at their headquarters they must write to the CSCI to seek permission to do this. Staff training information was provided as part of the pre inspection questionnaire. Staff receive training in manual handling, health and safety, food hygiene, first aid, epilepsy, autism and communication, sexuality, person centred planning, medication, TEACHH (its structure and importance for people with ASD) and fire safety. As previously stated in Standard 23 many staff require refresher training in Studio III (physical intervention). The records also showed that some staff require training/ refresher training in epilepsy, autism and fire. Correspondence received from the organisation after the inspection took place indicates that the required Studio III refresher training has now been arranged for January and March. The organisation also responded that the majority of staff had received autism training, therefore the training records held at the home need to reflect this. Staff supervision records were sampled. These showed that staff had received supervision on a regular basis to ensure they are appropriately supported. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 23 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 The home has satisfactory quality assurance systems in place. Systems require improvement to ensure the health and safety of service users and staff, the current behaviours of one service user are placing staff at risk from injury. EVIDENCE: The Manager of the home has been in post for several years and previously worked at the home as the Deputy Manager. The Manager said she has completed an NVQ 4 and the Registered Managers Award. The Manager and Deputy both work as extra to the care staff giving them sufficient time for management and administrative tasks. Staff spoken with said that although the Manager is generally office based she visits the bungalows on a daily basis. Given the stressful time for staff from the extreme challenging behaviour of one service user the Manager should consider if it would further boost staff morale and support mechanisms if she spent some ‘hands on’ shifts in the bungalow modelling good practice. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 24 It is the responsibility of the organisation to ensure that their representative visits the home on a monthly basis. Reports of these visits were available in the home. The Manager said that to ensure quality within the home a quality assurance group meets on a three monthly basis. The home is also part of an accreditation system with the National Autistic Society. To further improve the systems in place a questionnaire for seeking the views of relatives is soon to be introduced. Sampling of accident records and recent regulation 37 notifications to CSCI indicate an unacceptably high level of assaults on staff from one service user. Recently there have been ten incidents resulting in injury to staff, six notified to health and safety under RIDDOR. During this difficult time the home have taken a multi disciplinary approach and kept CSCI informed. The Manager and Area Manager have met with Commissioners, Social Workers and health professionals to agree an action plan which they hope will address this issue. Discussion with the Manager indicates that a counselling service is on offer to staff. Fire records indicated that the fire equipment had been regularly tested by staff and serviced by an engineer. The arrangements for staff training on fire are not satisfactory. Staff require refresher training every six months to ensure they respond appropriately in the event of fire. Training records show that some staff have not had training for over two years. The Manager said that the gas appliances had recently been checked but that the home had not yet received a certificate to evidence this. The Manager agreed to forward the certificate when it is received. In one bungalow two dining chairs were observed to be a little loose at some joints, an immediate requirement was made to ensure the chairs were safe for use. Since the last inspection the water supplies have been risk assessed and tested for Legionella and monitoring of water temperatures have commenced to ensure they are safe for service users. Risk assessments for the premises have also recently been completed although the organisation should reconsider their format to ensure they can be easily understood by staff as the current format is quite complicated. Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 25 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 X 3 X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X 3 X 3 3 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 X 15 3 16 1 17 Standard No 31 32 33 34 35 36 Score X 2 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gorse Farm Score 3 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 1 X DS0000004534.V267057.R01.S.doc Version 5.0 Page 26 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 YA9YA6 Regulation 15 Requirement Service user guidelines and risk assessments must be dated and signed on production and kept under review.Outstanding from 30/9/05 (re guidelines). Ensure the actual care practices of staff are in line with the written care plan. The practice of locking all the toilets during the day must be reviewed to ensure the dignity of service users is respected. Guidance for staff on how to respond to comments from one service user about painful teeth should be included in his care plan. As he frequently says his teeth hurt, staff need to be clear about when a dentist appointment should be sought. Health monitoring records must be kept up to date. Where individuals are assessed as needing to be weighed monthly this must be done, or a record made that the individual has declined to be weighed. The health action plan needs to detail any weight control diet and should detail the target DS0000004534.V267057.R01.S.doc Timescale for action 28/02/06 2. 3. YA6 YA16 12(1) & 15 12(1)(4) 20/02/06 20/02/06 4. YA19 13(1)(b) &15 28/02/06 5. YA19 12(1)(2) & 15 28/02/06 Gorse Farm Version 5.0 Page 27 weight. 6. YA20 All topical creams and ointments must be dated on opening and discarded after 28 days. Outstanding from 30/7/05. 13(2) A review is needed with the GP for medication prescribed to one service user on an ‘as required’ basis but administered daily. Guidance is also required as to when one or two tablets should be given. 12(1) Records on the use of physical 13(6-8) intervention require improvement to ensure they detail the duration of the intervention and record that service users have been checked for signs of injury. Outstanding from 30/9/05. 12(1) Studio III training, ensure all 13(6-8) staff receive yearly refresher 18(1) training. 12(1)(2)(3) Assessment on the impact on other service users is needed and a strategy put in place to minimise the effect on service users from the disruptions of service user with extreme challenging behaviour. 23(2)(p) Staff need to ensure they regularly monitor the temperature of the home or alternatively consider installing protective covers to radiator controls in communal rooms to ensure the home is maintained at a temperature around 21°C. Staff recruitment files must contain all the information required to include photographs of staff and proof of identity. The provider must formally write to the CSCI to request permission to store CRB DS0000004534.V267057.R01.S.doc 13(2) 20/02/06 7. YA20 28/02/06 8. YA23 20/02/06 9. 10. YA35YA23 YA23 30/03/06 20/02/06 11. YA24 20/12/05 12. YA34 19 28/02/06 Gorse Farm Version 5.0 Page 28 13. YA35 12(1) & 18(1)(c) 14. YA42 10(1) & HSWA disclosures at their HQ (or store them at the home). Staff must receive all the 30/03/06 training they require to meet service users needs to include: - Epilepsy - Autism Staff training records must be kept up to date. The provider must ensure 20/02/06 further action is taken to protect staff from the risk of injury from physical assault by service user. Letter now received from the Director of Services and Development outlining actions being taken. Staff require refresher training 28/02/06 every six months to ensure they respond appropriately in the event of fire. Ensure dining room chairs are 21/12/05 safe for use. 15. YA42 23(4)(d) 16. YA42 13(4) 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 YA42 Good Practice Recommendations The organisation should reconsider the format of premises risk assessments to ensure they can be easily understood by staff as the current format is quite complicated. Given the stressful time for staff from the extreme challenging behaviour of one service user the Manager should consider if it would further boost staff morale and support mechanisms if she spent some ‘hands on’ shifts in the bungalow modelling good practice. 2. YA37 Gorse Farm DS0000004534.V267057.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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