Inspection on 06/06/08 for Gorse Farm

This inspection was carried out on 6th June 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gorse Farm 20/07/06

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 27/09/2008.

CARE HOME ADULTS 18-65 Gorse Farm Coleshill Road Marston Green Solihull West Midlands B37 7HP Lead Inspector Martin George Unannounced Inspection 6th June 2008 09:15 Gorse Farm DS0000004534.V365898.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.V365898.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.V365898.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.V365898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st March 2008 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 learning disabilities, specifically an autistic spectrum disorder. Gorse Farm is located in the village of Marston Green, within easy reach of local amenities. 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, music and drama area, computer room and quiet workrooms. The fully equipped sensory room is currently housed in a portacabin whilst further building development work is considered. 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. The fee range was £1,265 to £2,546 per week. The statement of purpose included no extras, apart from contributions to holidays. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out by one inspector between 09:15 and 16:45. As part of the inspection all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’ were inspected. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection we were provided with written information and data about the home through their annual quality assurance assessment (AQAA). Information from the last key inspection report and a recent announced random pharmacist inspection were analysed prior to inspection and helped to formulate a plan for the visit and helped in determining a judgement about the quality of care the home provides. On the day of our visit we looked at the files of four service users, spoke to the registered manager, assistant manager, staff and service users, undertook a tour of the premises, engaged in part of a music therapy session and observed practice and this provided evidence that outcomes identified in assessments and care plans were being met or worked toward. What the service does well: What has improved since the last inspection? The service user guide has been improved and further improvements are still being considered to provide service users and their relatives with an accurate description of how care is provided so they know what to expect from the service. The picture meal choice cards have helped service users express choice about their food preferences. Behaviour management guidelines are a useful aid to staff to assist them in understanding the complex needs of service users and provide guidance on how staff should manage certain behaviours so Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 6 that service users receive a consistent approach. The staff files contain all the necessary information about recruitment and safeguarding checks to show that all possible efforts have been made to recruit safe people. 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. The summary of this inspection report can be made available in other formats on request. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good The assessment and planning process is service user focussed, written in a concise and easy to follow style so that it provides staff with good quality information to help them understand and respond effectively to the complex needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assistant manager has taken a lead on revamping the service user guide, which is printed in comic sans font and with corresponding pictures to provide service users with information in a variety of formats, to cover the differing communication preferences of the service user group. We looked at the needs assessment of the most recently admitted service user, which was completed by the manager and a colleague prior to the service users admission on 25/02/08. It was very comprehensive, with information provided in useful, straightforward English, which clearly identified the range of service user needs. Staff we spoke to were knowledgeable about the needs of service users and the content of assessments and plans and our observations throughout the day supported this. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 9 One of the seniors explained how the person centred plans are based on the initial assessment and how a review process is used to develop the plans to take account of changes in circumstances and ensure service user needs continue to be met. We were told how the home is making significant efforts to make these plans autism specific, to make them more relevant to the service user group. The person centred plans we examined were written throughout in language that was service user focussed and during lunch, the tour of the building and our brief observation of a music therapy session we saw how staff engaged with service users, confirming that their practice was consistent with written plans. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good Service user needs are being met and consistently reviewed through effective person centred planning, involving service users as much as possible so their wishes and choices can inform planning and the care provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Person centred planning is well advanced and the ones we looked at covered all of the aspects of personal and social support and healthcare needs that are detailed in National Minimum Standard 2.3 to ensure that the full range of needs are met. The plans provide staff with the information they need to meet the complex and diverse needs of the service user group and the practice we observed showed a good working knowledge of how individual needs should be met and how particular behaviours can be managed safely. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 11 We saw evidence on file of how the home tries to get the involvement of service users in how staff should help them achieve to their maximum potential. The “Are we doing a good job?” surveys completed by service users (most with the help of staff) contribute some way toward this. The manager explained that some service users choose not to participate and this is respected as their choice. Two service users we spoke to during lunch gave some indication of how they expressed choice, one telling us how she chooses clothes when she goes shopping. During lunch we were shown the picture meal choice cards that help service users make an informed choice about what they would prefer to eat and the service user we joined for lunch indicated that he found it a very useful visual prompt. The home undertakes regular reviews of service user plans and we saw evidence of how these result in actions intended to improve outcomes for the service user. An example of this related to the more effective management of continence of one service user, which involved continence advice from Solihull Primary Care Trust (PCT), and this significantly improved his degree of dignity. We found it useful having amendments made to the person centred plans in red, as this made it easy to see what had been identified in the review and how the home had responded in order to improve outcomes for the service user. The files we examined contained useful “guidelines” for staff around areas such as toileting, bathing routines, mealtimes, going out in the minibus, studio etc and all of these were on one side of A4 paper, providing staff with clearly written and concise guidance, helping them provide effective care to service users. Discussion with the manager, assistant and two senior staff satisfied us that they understand the need to support service users in making decisions about things such as food, clothes and activities and we were told how the home is developing the assessment to determine how able a service user is, in accordance with the Mental Capacity Act. We were provided with a programme of training on the Mental Capacity Act, devised following a management meeting, which will be delivered to staff to enhance their skills in this area of practice. Once training is completed managers and staff will be more able to assess individual capacity in relation to decision making. We observed several interactions between staff and service users, which evidenced how staff try to support and encourage service users to make safe choices. The degree of disability usually means that staff have to guide service users toward a safe choice, but we found this to be in the service user’s best interests as it ensured they were properly safeguarded. Behaviour management guidelines are provided for staff, which are linked to risk Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 12 assessments, and these identify proactive ways of minimising potential risk as well as reactive ways of responding to actual risk. We observed how staff monitor and challenge any behaviour between service users or between service users and staff that does, or may, present a risk. An example of this was when we were informed of how to respond to one service user if she asked us if we had any money. We were told we had to reply “I’m broke”, which is the best answer to give to avoid any undesirable behaviour from the service user. Any behaviour between service users that affects personal safety or invades personal space is addressed quickly and sensitively by staff. One female service user came over to the male service user we were having lunch with and kissed him on the cheek. A member of staff calmly explained to her that she must always make sure the other person is OK with this first. Methods of dealing with particular behaviours are recorded in service user behaviour management plans. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is excellent Service users benefit from a meaningful lifestyle that includes participation in a wide range of activities, both within the home and the wider community, providing mental and physical stimulation. Contact with, and involvement of, relatives is actively promoted to ensure service users retain these important relationships. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found evidence on service user files of how the home responds to comments they receive through the “Are we doing a good job?” comment cards completed by service users. On one of these the service user indicated he wished to improve his reading and writing skills. The home responded by getting him on a literacy course at the local college but he found it too challenging so staff have decided to help him themselves until his confidence improves, when they will try again to encourage him to attend the college. We Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 14 were shown progress reports from the college, which explained the work being done with service users and also gave a brief summary of their achievements. The manager told us that some of the service users regularly use the local library, which was also identified in the AQAA. One service user we spoke to confirmed that she liked to use the library and said it was “nice to choose” which books she wanted. One of the seniors explained the activity programme that was run in the day centre. This included a range of stimulating cognitive and physical activities. We were invited to attend the last 20 minutes of a dance therapy session, which demonstrated how well the service users were encouraged to engage in the activities provided. The home puts on an annual dancing/singing production in the local church, evidencing the desire of the home to integrate the service users in community life as much as possible. Off site activities include trips to the cinema and local pubs. As well as this the home arranges several holidays, which have included trips to Crete and Brittany. During lunch one service user indicated how much he had enjoyed his holiday in Crete and how much he was looking forward to another holiday in Portugal. The best part of the holiday from the service user point of view appeared to be the aeroplane, which elicited a huge smile when the manager was telling me about it. The staff team is well balanced in terms of gender, age and ethnicity and the diversity of the staff team was reflective of the service user group. Our examination of service user files provided evidence of planned contact arrangements, including overnight visits with relatives. One service user we spoke to confirmed that he was going for an overnight stay later that day with a relative of his. The home aims to involve families as much as possible in planning for the needs of their relatives and the AQAA identifies they recently invited two parents to the sensory training as part of an assessment to see what needs they have in order to help them with their level of understanding and ability to meet their relatives’ needs. This enabled them to contribute more fully to the shared care of their relative. We were pleased to observe that staff are constantly interacting with service users, using a variety of communication techniques suited to individual needs of the service user. We saw a visual choice of meals, making it easier for service users to express a choice of what they wish to eat. The AQAA states that their choices are recorded and comments documented to produce a view of diet, nutrition and balance and we saw evidence of this on the service user files we examined. The menus included special dietary needs for those service users for whom it was necessary, which we also saw noted on one of the service user files we checked. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 15 Written agreement from service users or their representative regarding the use of listening devices, and associated guidelines for staff on their use, have now been put in place to ensure the privacy of service users is respected. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate The personal support provided to service users is responsive to their preferences and needs and is respectful and sensitive. The home has responded quickly to medication shortfalls identified at a recent pharmacist inspection, although not all shortfalls have been fully addressed and there remains inconsistency between bungalows. Medication systems do not always ensure service users receive their medication in a safe way. Further work is needed to ensure that both units meet the same standard to look after the people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that all service users are provided with personal/intimate assistance as required and in accordance with the organisation’s intimate care and sexuality policy. In support of this our observation of practice on the day of inspection evidenced a calm approach when one service user removed all of his clothes in a group setting and the response from staff was sensitive and ensured a reasonable level of dignity was maintained. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 17 It also states in the AQAA that service users are encouraged to reflect their personality through what they wear and their general appearance. Our general observations support this. Service user files contained easy to follow information about an individual’s preferred or necessary routines and staff we spoke to were knowledgeable about the particular routines they had to adhere to in order to minimise behavioural difficulties resulting from the autism. In one of the service user files we saw an example of how the home had dealt with the management of continence. At the time of admission the home had noted that the service user had been issued with the wrong type of continence aids, but following consultation with Solihull PCT the home purchased more suitable continence aids and this greatly improved the service users degree of dignity. Because of the degree of autism of the majority of service users their level of independence with regard to personal care needs is limited, but we observed several occasions when staff engaged with service users to try and get their involvement in doing things for themselves. We discussed with the manager and assistant manager the action plan provided to us following the random pharmacist inspection that took place on 23/04/08. The manager told us that some of the requirements made were related to one off occurrences, which the manager assured us had been rectified. Although an action plan had been completed our observations at this visit showed some areas were still outstanding and this meant that not all service users were being properly safeguarded in this important area of practice. Because some of the actions listed above are still awaiting completion we explained that the next inspection would examine these in more depth to ensure service users are being fully safeguarded, but we are pleased that the home is responding to the issues raised by the inspecting pharmacist. The home now needs to remain vigilant with regard to all medication matters. The AQAA states that all staff are trained in the safe handling of medication and this was evidenced in the comprehensive training records held on a database and organised by the assistant manager. The pharmacist inspection took place after the main key inspection. Both units that held medication were inspected. The practice in one unit was good. It had a robust quality assurance system and all medicines for use when required to control behaviour were well documented and accurate. Further work is required in the other unit to bring it up to the same level. On this unit the quantities of medicines received had not been correctly recorded so these records would be incorrect if inspected at a later date and it could not be demonstrated if all the medicines had been administered as prescribed. Despite many homely remedies purchased and the community pharmacist currently writing a policy to support their use, these were not used routinely Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 18 and further homely remedies not supported by any policy had been purchased. It was unclear whether the doctor was aware of their administration or supported their use. Two homely remedies were seen that had been administered but there was no record of this in the home. Concern was raised that the staff purchased medication to treat clinical conditions not diagnosed by the doctor or supported by a homely remedy policy. One inappropriate medicine had been purchased and had not been applied correctly, which may have been detrimental to the health and well being of the service user. There are now written protocols for staff to follow for medicines to be administered to control behaviour. These were similar in content and referred to the care plans in each instance. They appeared to be service user specific with respect to drug name and dosage only. One dose had been incorrectly recorded for one service user. Staff could not give an explanation why only one third of the prescribed dose had been recorded to be administered. In addition many of these medicines had not been recorded on the medicine chart to administer if necessary despite having a supporting protocol and a supply of medicine on the premise to do so. The homes policy is that staff should record information on a “prn” (when required) chart but this was not always done. Staff also changed one prescribed dose from “one twice a day” to “two when required”. No written evidence from the doctor supporting this dose change could be found during the inspection. Many vitamin supplements had been purchased to administer to the service users. No confirmation that the doctor agreed with these supplements could be found. One medicine had been prescribed by the hospital to be used if the service user had an epileptic fit. The epilepsy nurse who visited the home subsequently said this would be too slow to work and an alternative would be prescribed. The home had not followed this up and no alternative had been prescribed. In addition the original medicine was still on the premise but there was no record of this on the medicine chart or the previous medicine chart when it had been received into the home. The care staff have a good understanding of the clinical needs of the service users and understand what most of the medicines were for. The management was keen to address the issues found during this inspection to bring both medication units to the same standard. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good The systems regarding complaints, concerns and protection are safeguarding service users from potential harm and keep external agencies well informed about the standard of care being provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about complaints that is provided for service users is written in a style that is suited to their communication needs and includes all that is necessary, without being too wordy or complicated. It was difficult to determine the level of understanding that service users have about how to complain, but we did observe staff constantly checking that service users were happy with the food they were eating, how they were being treated etc. Records of complaints that we saw were dealt with and written in accordance with the policy and satisfactory outcomes were reached within the specified timescales. There were only about five minor complaints, all of which were fully resolved internally. CSCI has not received any complaints about the service. The home has a file of compliments from families and professionals, which shows aspects of the service provision that are well received and seen to meet the needs of service users. All incidents/occurrences, which they need to inform other agencies about, are completed as required and we saw documentary evidence of this. A previous requirement relating to how physical interventions are recorded has been addressed. Body charts are used to show any marks that have been noticed Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 20 and these are entered on the charts in green if they were reported through the Regulation 37 notification process to show that external agencies are being kept informed about significant events that affect the well-being of service users. The records we saw relating to the management of service user monies evidenced that their interests were satisfactorily protected. Random checks are done during proprietor visits and annually by an independent, accredited firm. Training in adult protection is up to date and conversations held with two members of staff assured us that they knew what to do if a service user was harming others or was being harmed by someone else. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Quality in this outcome area is good The bedrooms we saw were personalised to the preference of the service user and the general level of décor and furnishings were to a reasonable standard, although some areas would benefit from redecoration to provide service users with a more pleasant environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there were plans for some changes to office accommodation and inevitably there was some degree of disarray, but we were impressed how quickly any records we requested to see were found. The manager explained about discussions that were taking place with regard to knocking down the old cow sheds and building a new sensory area. Currently the sensory area is housed in a portacabin, next to the old cow sheds. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 22 With service user permission we looked at a couple of bedrooms. Both of those we looked at were suitable for the needs of the service user group and were personalised to reflect the preferences and interests of the service user, which were noted in the plans we looked at when checking the service user files. One service user had several pictures of dogs in his room and the manager explained this was to help him overcome his fear of dogs, as part of a desensitising process that had been agreed and recorded in notes from his review. Although we asked the service user about what he thought of dogs he was not able to express an opinion, but he showed no distress about having the pictures in his room. The home has the services of a part time professional gardener to help keep the grounds functional and attractive and ensure that risks to service users who are likely to eat plants that may be harmful to them are eradicated. The grounds are suitable for the service user group, allowing for safe levels of supervision by staff to ensure service users come to no harm. There is also a separate sensory garden and an area where fruit and vegetables can be grown. Although not witnessed on the day of the visit we were informed that this is well used by service users. Policies and procedures we looked at cover all aspects of hygiene and control of infection matters quite comprehensively. Our observations on the day evidenced adherence to safe hygiene practice. Necessary training around infection control has been undertaken to ensure staff know how to prevent potential risks to service users, themselves and others. The laundry areas were equipped to a satisfactory standard and there are sluicing facilities. Red infection control bags are used to manage foul laundry safely. We were told that service user involvement in their own laundry care is limited. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good Safe recruitment practices ensure that service users are supported by people suitable to work with vulnerable adults. The training programme further enhances their base knowledge and skills, providing service users with staff who understand and can meet their diverse and challenging needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has achieved 50 of staff who either hold or are working toward the required NVQ award for the role they undertake, meaning that staff are achieving nationally recognised levels of competence, helping them to provide effective care to service users. Our observations of staff practice evidenced good levels of awareness and skills regarding knowledge of autism and associated difficulties, range of communication methods and dealing with difficult behaviours. Service users responded well to staff requests and guidance and staff intervention was always calm and sensitive to the individual’s specific needs. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 24 The two staff files we examined in some depth provided evidence of good recruitment practices. There were three other files that were checked less rigorously but reinforced what we found in the other two. The application form requires employment gaps to be explained, Criminal Records Bureau (CRB) information that is meant to be kept is on file, staff photos are present, there is evidence of at least two references, terms of conditions of employment are signed and dated and there is evidence of Protection Of Vulnerable Adults (POVA) checks being carried out. We saw evidence that staff are issued with the General Social Care Council (GSCC) code of practice and we found the staff files to be very well organised. These recruitment practices ensure that everything possible is done to employ staff who are safe to work with vulnerable adults. As identified in the lifestyle outcome area the staff team is well balanced in terms of gender, age and ethnicity reflecting the diversity of the service user group. The assistant manager who is responsible for overseeing induction and training has a well organised database clearly showing which staff have completed training, when courses are scheduled, cancellations with reasons why and dates for refresher training. The assistant manager talked us through the induction programme being provided to staff and we were satisfied it meets Skills for Care requirements and provides newly appointed staff with the necessary skills and knowledge to provide service users with a level of care that is respectful and safe. The AQAA identifies that training in anti-racist practice and cultural awareness is being developed and the database we saw shows there are proposed plans for this to happen in the not too distant future, further enhancing staff awareness and knowledge of diversity issues. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good There is a competent and motivated management team who are always seeking to improve the level of service they offer. There is a desire to continuously improve the outcomes for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA identifies that the registered manager holds her NVQ 4 and Registered Managers Award (RMA) and has 7 years management and supervisory experience. To support this the manager and her assistant undertook an eight day management and leadership course in 2004 run by Cameleon Training, which still provides relevant and valid evidence of competence. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 26 In the main office area we saw certificates showing the level of insurance cover that the home has. This meets regulatory requirements and gives service users and their relatives confidence that in the event of poor practice or an occurrence resulting in harm or damage the home can meet its’ obligations. Both the manager and the assistant manager explained how keen they were to develop practice and improve standards and they explained how they actively seek advice. One example of this was the autism accreditation report we looked at, which identified areas for improvement and also confirmed that the home provides a good standard of care to the service users. The “Are we doing a good job?” comment cards completed by service users, often with assistance from staff, gives the home some indication of how service users feel about the standard of care they receive. We saw a file that contains letters and representations from family and professionals and the manager explained how she uses these to identify what the home does well and how they help her focus on what needs to improve. All necessary health and safety related checks are being carried out and we looked at the health and safety files as confirmation of this. We are satisfied that service users and staff are protected from identifiable harm resulting from cross contamination or poorly maintained equipment. Health and safety and training records we saw provided evidence that the home carries out its’ responsibilities to keep safe living and working environments. We were able to confirm that checks are carried out and recorded properly. While checking the records in bungalow one we were unable to find the up to date Care of Substances Hazardous to Health (COSHH) records and the member of staff was unable to find them either. We were presented with a very comprehensive COSHH file a few minutes later by the member of staff given responsibility for health and safety matters but it would be helpful if all staff were able to put their hands on COSHH data sheets quickly to properly safeguard service users who might accidentally or deliberately ingest a dangerous substance. The COSHH file we were shown by the health and safety designated member of staff was well constructed and had all the data sheets associated with products being used by the home. Even though we were unable to find the information as quickly as we would have liked the staff on duty knew which products they used, how to keep them stored safely and the potential harm if they were used for anything other than the intended purpose. We saw records that confirm fire alarms are being tested weekly to confirm that fire could be responded to quickly, allowing time to get service users to a safe place. A comprehensive fire risk assessment needs to be completed for each area of the premises, especially as some changes and building work are taking place and/or being planned. The most recent one we could find was dated August 2006 and the member of staff responsible for this area of practice confirmed this to be the case. To continue safeguarding service users from the risk of fire this should be done as quickly as possible. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 27 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 3 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 x 34 4 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The medicines must be administered as prescribed at all times. This includes medicines prescribed on a “when required” basis Medicines purchased for homely remedies must be administered against a homely remedy policy that has been endorsed by the prescribing doctor. Timescale for action 19/08/08 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 alternative solutions are found for sending medicines out of the home for social leave. If no alternative solution can be found clear robust procedures for secondary dispensing must be written and all medicines must be labelled in compliance with the labelling regulations (as amended) The purchase of a locked medication refrigerator is DS0000004534.V365898.R01.S.doc Version 5.2 Page 29 2. YA20 Gorse Farm 3. YA42 required to ensure that medicines requiring refrigeration are stored in compliance with their product licences A comprehensive fire risk assessment should be completed without delay to ensure service users continue to be protected from risks associated with fire, especially following the planned building works. Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gorse Farm DS0000004534.V365898.R01.S.doc Version 5.2 Page 31 - 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. 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