Inspection on 20/07/06 for Gorse Farm

This inspection was carried out on 20th July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 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 20/12/05

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 Unannounced Inspection 20th July 2006 09:15 Gorse Farm DS0000004534.V305906.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 Gorse Farm DS0000004534.V305906.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. Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 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.V305906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 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. Information on fees was not provided on the pre inspection questionnaire completed by the Manager. Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the field work visit taking place a range of information was gathered to include notifications received from the home, reports from the provider, comment cards from residents, relatives and professionals and a pre inspection questionnaire completed by the Manager. Two inspectors carried out the unannounced fieldwork visit over eight and a half hours. This was the homes key inspection for the inspection year 2006 to 2007. The inspectors met with several residents and time was spent observing care practices, interactions and support from staff. Case tracking of the care provided to four residents was undertaken. A tour of the premises took place. Care, staff and health and safety records were looked at. 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. Residents were well dressed and this was appropriate to their age and the hot weather. Residents had their own individual style of dress and hair. Staff at the home seek input from other health and social care professionals to assist in meeting individual need. The staff are very good at helping people stay in touch with their family. This includes making phone-calls, writing letters and in person. The home benefits from having an on site day centre with designated staff to offer time-tabled activities to residents. The home also has a large allotment area where residents have been supported by staff to grow a variety of vegetables, this year they have even been successful in growing grape vines. Comment cards received from residents, relatives and health and social care professionals in contact with the home were positive in their comments about the service provided. Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Agreement is needed on the use of listening devices that are used to reduce risk, to ensure that residents rights to privacy are respected. Further action is needed to ensure the risk of medication errors occurring is reduced to ensure residents get the medication they need, safely. Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 7 The recording of the use of physical intervention needs to improve to show that residents are being protected from abuse and their welfare promoted. Recording of testing of the fire alarms needs to be done on a weekly basis to show that the system is in full working order and that residents and staff would be alerted to a fire starting in the home. 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.V305906.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 Gorse Farm DS0000004534.V305906.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed choice about whether or not they want to live in the home. Prospective residents needs and goals are assessed before they move in to see whether it is a suitable place for them to live. EVIDENCE: Previous inspections have evidenced that the statement of purpose and service user guide include all the relevant and required information. Discussion with the Manager indicates that these documents are updated on an annual basis. Copies were observed to be available in the home. Comment cards completed by residents indicate that they felt they had received enough information about the home prior to moving there. No new residents have been admitted to the home since the last inspection. Previous inspections have identified that prior to admission to the home residents are assessed as to whether the home can meet their needs. From this assessments are completed by the home with the resident and their relatives where appropriate. Discussion with the Manager and observation of documents shows that assessments are currently being undertaken for two Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 10 residents prior to a possible move to a smaller home where it is thought their needs can be better met. Gorse Farm DS0000004534.V305906.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Staff had the information they need to know how to support each resident to meet their needs, goals and aspirations. Residents are supported to make choices about their day-to-day lives. Residents are supported to take risks within a risk assessment framework. EVIDENCE: Four residents were case tracked, this included looking at their individual care plan either in full or part. Plans detailed how the resident was to be supported in their daily routines, personal care, management of their behaviour, dietary needs, leisure/social activities, religion, contact with their family and health needs. Plans were up to date and there was evidence of annual review meetings involving staff, social care professionals, relatives and the resident if they chose to attend. Due to the complex needs of some of the residents it can be difficult for them to make choices and decisions about their lives. Staff were observed supporting individual residents to make choices about their day-to-day lives. Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 12 This included what they wear, eat, what activities they took part in and where they spent their time. Comment cards completed by residents indicate they feel they are able to make decisions about their lives. Resident’s records sampled included individual risk assessments. A wide range of assessments had been completed to include community activities, domestic tasks, using transport, anxiety and risk of challenging behaviour. Sampled assessments were up to date and satisfactory. Gorse Farm DS0000004534.V305906.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that residents experience a meaningful lifestyle to include participation in a wide range of activities. Contact with relatives is actively promoted. EVIDENCE: Full consideration is made to identify the residents 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 residents. For one individual a re-assessment of their language skills has indicated that they not only understand English but they are able to understand and speak a second language from their cultural background. The home has worked hard to ensure they are meeting this individuals communication needs to include seeking the support of a translator, Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 14 employing a member of staff who speaks the same language and building up a communication dictionary of words for staff to use. The home benefits from having an on site day centre with designated staff to offer time-tabled activities to residents. The day centre comprises of art and craft facilities, kitchen, fully equipped sensory room, music and drama area, computer room and quiet workrooms. The home also has a large allotment area where residents have been supported by staff to grow a variety of vegetables, this year they have even been successful in growing grape vines. Individual activity plans are provided for each resident and are presented by use of pictures that describe the activities on offer during each weekday. One resident spoken with said that they enjoyed the activities on offer such as walking, horse-riding, colouring and going to college. Although the home has the on site day centre good community access for residents is also offered. The home has its own vehicles for residents use to access the local community. There was documentary evidence that residents enjoy going to college, pubs, the cinema, parks, bowling, swimming and going out for meals. Residents also have the opportunity to go on holiday. One resident had recently been supported by two staff to go to France for a relatives wedding. The home had received a complimentary letter from the relatives about the excellent support provided by the staff during the visit. One resident had recently finished a college course on horticulture. It is good that staff have enabled him to pursue this interest further by finding him voluntary work at a local park. This individual also spends time working on the home’s allotment. It is evident that residents are supported to maintain contact with their family and friends. Visitors are welcome to the home. Some residents visit their family and stay overnight where appropriate. Where appropriate staff support residents in visits to their relative. Four comment cards were received from relatives and overall they were positive in their comments about the home. Three relatives were spoken with during the visit. All were very happy about the quality of service provided. Two of the relatives were meeting with the Manager and Deputy Manager. It is good that the Manager was seeking their views about the work staff were doing to meet the residents needs regarding their cultural language skills. Staff members advised of the very structured approach necessary to support the residents independence and self determination but choice is promoted as far as possible. Where decisions have been made that affect the rights of individuals the home consults other professionals or relatives and record this in the care plan. At the last inspection in December 2005 all the toilets in one of the bungalows were observed to be locked. Staff said they had to be kept locked due to the behaviour of a resident. On checking the care plan the only information available on locking toilets referred to night time and said that all Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 15 toilets but one should be locked. It was therefore required that the practice of locking all the toilets during the day must be reviewed. This has now been done. Records of staff meetings showed that this issue had been raised with staff and that it was expected that residents had access to toilets. Toilets were unlocked at this visit. One resident has a listening monitor in his bedroom, staff said that this was used at night so that staff are alerted if they have a seizure. The use of such a device could impact on this individuals privacy. The Manager therefore needs to ensure consent for its use is obtained from the individual or their representative and documented. Clear guidelines need to be agreed as to when the monitor can be used to ensure the individuals privacy is protected as far as possible, within a risk assessment framework. Menus seen showed that a variety of food is offered to residents. Discussion with the Manager indicates that it is intended to further improve the menu by adding more fish and ensuring favourite meals of each resident are included. A wide selection of fresh fruit and vegetables were available. As stated earlier in this report much of the vegetables used are home grown. Adequate and varied food stocks were available as were a wide variety of breakfast cereals. Staff sat with residents to support them appropriately during their lunch time meal. The home has a cook who prepares the meals Monday to Friday. At weekends when many residents are away visiting relatives care staff prepare the meals or take away meals are sometimes offered. Gorse Farm DS0000004534.V305906.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and require and their health needs are generally well met. The systems for the administration of medication require minor improvement to ensure resident’s medication needs are safely met. EVIDENCE: Observation and records indicated that personal care support from staff is done in privacy and in a gender sensitive manner. Residents were well dressed in good quality clothing appropriate to the weather, their age and the activities they were doing. It was very hot on the day of the visit, staff were observed ensuring residents were wearing sun cream before going out to activities to reduce the risk of sun burn. Some residents require 1:1 support from staff and additional funding has been secured to facilitate this. Each resident has a health action plan. A health action plan is a plan about what an individual needs to stay healthy. Whilst these are generally satisfactory the format may not be appropriate for all residents. This is something that the Manager is aware of and intends to develop individual formats in the future. Records sampled show that residents had regular check Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 17 ups with the chiropodist, dentist and optician. It was identified at the last inspection that weight monitoring for residents needed to improve, this has been done. 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. Where appropriate health care professionals are involved in the care of residents. These include the Speech and Language Therapist, Dietician, Occupational Therapist, Psychologist and the Psychiatrist. Six comment cards were received from professionals involved in the care of residents, these were generally positive in content. Comments included ‘any problems and they contact me by phone’ and ‘monitoring sheets I have requested have been completed satisfactory’. The medication administration systems were sampled in each of the bungalows. Residents records sampled show that medication reviews are undertaken on a regular basis. A local pharmacist supplies the medication to the home using the Nomad system. Following the last inspection visit to the home it was required that topical creams and ointments must be dated on opening and then discarded within 28 days. This is now being done. The medication cabinets were clean and organised. The Medication Administration Records (MAR) had been signed appropriately indicating that medication had been given as prescribed. Where residents are prescribed PRN (as required) medication a protocol is in place stating when, why and in what dosage the medication should be given. Some of those sampled were not dated, this needs to be done to ensure that the guidelines are current. Staff spoken with said that they had received medication training. Since the inspection in December 2005 the Manager has notified the CSCI of three incidents where errors have been made in the administration of medication. Action must be taken to reduce the risk of this happening again. Discussion with the Manager indicates that competence assessments are not completed for staff who administer medication. It is therefore recommended that these are developed and completed for staff on an annual basis or following any medication administration error. The Manager and Deputy Manager said that the home was intending to change the medication training attended by staff. They agreed to forward details of the new training planned to establish if it was satisfactory in content. Gorse Farm DS0000004534.V305906.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure which ensures residents views are listened to and acted upon. The recording of the use of physical intervention needs to improve to show that residents are being protected from abuse and their welfare promoted. EVIDENCE: The home has a satisfactory complaints procedure in place, this is in both a written and picture/symbol format to make it more accessible to residents. Comment cards received from residents and relatives recorded that they were aware of how to make a complaint. One relative spoken with said that any concerns she had raised had always been satisfactorily addressed. The home has received one complaint since the last inspection regarding a delay in redecoration of a residents bedroom. Discussion with the Manager and observation of a letter written to the complainant shows that this had been satisfactorily responded to. The CSCI has received two complaints and a concern about Gorse Farm since the last inspection in December 2005. The issues raised have been similar and relate to the behaviour of one resident and the effect this is having on other residents and staff. It was also raised that staff concerns are not listened to and that medication errors have gone unreported. The complaints were passed to the provider to investigate and the majority of issues were not upheld. The concerns raised were also looked at during this visit, evidence available did not Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 19 support the concerns raised. Seven staff were spoken with. Those asked said that the behaviours of this resident were now being well managed and that he had minimal impact on others he lived with. Staff also said that they felt well supported and were able to raise any concerns they had with the Manager or Deputy Manager. The residents needs are such that the organisation provides the staff team with physical intervention training. It has been identified at previous inspections that some staff have not received the training they require. From sampling the training records and discussion with staff it is evident that staff are now receiving the training they need to include annual refresher training to reduce the risk of injury to themselves and also to residents. The Manager ensures incident forms are completed and a monthly log of the number of incidents to include if physical intervention was used. The log and discussion with staff show that the number of incidents involving the resident who was part of the complaint made to the CSCI has greatly reduced. 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 however not all of the records detailed the duration of the physical intervention or showed that service users are checked for injury following the physical intervention. Discussions with staff indicated that they felt well supported following the use of physical intervention and are offered debriefing sessions to discuss the incident. Staff at the home have received prevention of abuse training to ensure they are aware of the possible signs of abuse and action needed to safeguard the resident. Resident’s records included an inventory of their belongings. This was detailed and regularly updated to ensure a tracking system is in place for purchase and disposal of items. Gorse Farm DS0000004534.V305906.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained and decorated to a good standard, meeting residents needs. EVIDENCE: The home provides a range of generally comfortable, safe and accessible shared space, which meets the assessed needs of the residents. Facilities available at the home consist of an allotment, sensory garden, sensory lounge, 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. At the last inspection in December one communal room was observed to be very cold and a requirement was made to ensure the temperature of the home was regularly monitored and maintained at around 21°C. At this inspection visit the weather was very hot, staff had done their best to keep the temperature Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 21 cool inside the bungalows. In the day centre air conditioning units were being used in an area that had become too hot. Previous inspections had identified that the kitchens in both bungalows were worn and required refurbishment. These have now been done making the kitchens look nicer. Sampled resident bedrooms were observed to be personalised according to individual preferences and needs. Resident’s bedrooms seen were well decorated according to individual’s tastes, interest and age. Discussion with one resident about their bedroom indicates that they were happy with the decor. The Manager said that five resident bedrooms had been scheduled for redecoration in this financial year, four having been completed with one still to do. 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.V305906.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing the home, their support and development was good, ensuring that residents needs are met. EVIDENCE: It was noted that both staff and residents appear comfortable in each other’s company and enjoy a good general rapport. Comment cards completed by residents indicate they feel that staff treat them well. 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 55 of staff have achieved an NVQ in care, this meets the standard of 50 having an NVQ. 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 residents have 1:1 support due to their high level of need. Since the last inspection staffing at night has been reviewed and now each evening one additional member of staff stays until Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 23 11pm or until residents have settled, instead of the previous 10pm. It is good that if staff do have to stay late the organisation will pay their taxi fare home. This change was made due to the potential challenging behaviour of one resident. Generally relatives spoken with, and comment cards received indicate that relatives feel there are enough staff on duty. One relative did comment on previous staffing difficulties but said that they were now improved. Staff spoke with felt that there were enough staff on duty to meet residents needs. The recruitment files for four members of staff were sampled. Two files contained all the required information but the files for the other staff did not contain evidence of Criminal Record Bureau checks being undertaken. This was raised with the Manager during the visit who was able to quickly obtain evidence of the checks being done from the organisations head office. In view of this information initially being missing it is recommended that a full audit is done of each staff file to ensure all the required information is available. Staff training information was provided as part of the pre inspection questionnaire. Staff receive training that includes manual handling, health and safety, food hygiene, first aid, epilepsy, autism and communication, sexuality, person centred planning, medication, Studio III, TEACHH (its structure and importance for people with ASD) and fire safety. Recent training completed by some staff includes person centred planning and cultural awareness. As required at the last inspection fire refresher training has taken place. Staff spoken with said they were satisfied with the training on offer. Sampling of records and discussions with staff show that they are well supported in their role. Regular staff meetings take place, this includes separate meetings for night staff. Recently a ‘coaching and monitoring’ day was also held for staff. Records and discussions with staff show that they receive regular supervision. Staff said that the support was good, one commented that new staff get to ‘shadow shifts’ when they first start so that they have a chance to get to know the residents and the routine of the home. Another staff said that it was good that staff had access to a telephone counselling service. Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 24 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 quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements of the home are good and ensure residents benefit from a well run home. 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 home has a new Deputy Manager in post who previously worked in the home in a support worker role. The Manager and Deputy both work as extra to the care staff giving them sufficient time for management and administrative tasks. 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 home is also part of an accreditation system with the National Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 25 Autistic Society, views of relatives are obtained as part of the system. The organisation has comment cards that are completed by residents as a way of seeking their views, these are called ‘are we doing a good job’. One was sampled, and all the comments were positive. At the last inspection visit sampling of accident records and regulation 37 notifications to CSCI indicated an unacceptably high level of assaults on staff from one resident. Discussions with the Manager, staff and recent notifications received show that the number of assaults is reducing. Staff spoken with felt that this was because the staff team supporting this individual were now more consistent and that an increase in activities organised had been beneficial. Fire records indicated that the fire equipment had been regularly tested by staff and serviced by an engineer. Fire testing records for some parts of the home were up to date but records for one bungalow and the office block did not show that fire testing had been done weekly. The Deputy Manager said he knew that the fire alarms in the office block had been done and but that the record had been forgotten to be completed. The Manager must ensure the alarms are tested weekly and the record completed. Service certificates were available for gas and electrical installations. Risk assessments for the premises were available, although as recommended at the last inspection 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.V305906.R01.S.doc Version 5.2 Page 26 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 4 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 27 YES (ONE) 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 YA16 Regulation 12(1) Requirement Written agreement is needed from residents or their representative regarding the use of listening devices. Guidelines must be available on the use of such devices to ensure residents privacy is respected. Ensure further action is taken to reduce the risk of medication errors occurring. Written protocols for ‘as required’ medication must be dated to show that guidelines are current and subject to regular review. Records on the use of physical 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 requirement from 30/9/05 and 20/02/06. The fire alarms must be tested on a weekly basis with a record maintained in the home. Timescale for action 30/09/06 2. 3. YA20 YA20 13(2) 13(2) 30/08/06 30/08/06 4. YA23 12(1) 13(6-8) 30/08/06 5. YA42 13(4) 23 30/08/06 Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 28 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 YA20 Good Practice Recommendations It is recommended that medication competence assessments for staff are developed and completed on an annual basis or following any medication administration error. It is recommended that a full audit is done of each staff file to ensure all the required recruitment information is available. 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. 2. 3. YA34 YA42 Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 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. Extracts may not be used or reproduced without the express permission of CSCI Gorse Farm DS0000004534.V305906.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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