Inspection on 27/04/06 for Hall Farm House Care Home

This inspection was carried out on 27th April 2006.

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 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

Hall Farm House Care Home 26/04/07

Hall Farm House Care Home 30/11/05

Hall Farm House Care Home 08/08/05

Hall Farm House Care Home 24/01/05

Hall Farm House Care Home 25/11/04

Hall Farm House Care Home 26/02/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Hall Farm House Care Home Gainsborough Road Everton Nottinghamshire DN10 5BW Lead Inspector Jayne Hilton Unannounced Inspection 27th April 2006 10:00 Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 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 Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 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. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hall Farm House Care Home Address Gainsborough Road Everton Nottinghamshire DN10 5BW 01777 817 431 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) Voyage Limited Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Hall Farm House is an adapted older property located in a quiet village and whilst somewhat isolated, a minibus is provided to accommodate for service users travel needs. The home accommodates 6 people with learning disabilities who have challenging behaviour. The home has a large garden and an adjoining field with a variety of animals, and which service users are involved with care of the farm area along with a specific worker. There is a choice of communal spaces for service users. All bedrooms are single and decorated according to individuals choice. One bedroom provides for independence training and has its own en suite bathroom. Information about current fees were obtained on 28/4/06 are as followscurrent fees range between £975.94-£1,319.98 per week Additional charges are to be agreed within the terms and conditions for the contribution to travel costs and which is based on service users Disability Living allowance. Those on the lower rate contribute £35.00 per month; those on the higher rate contribute £100 per month. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Jayne Hilton undertook the unannounced inspection on 27th April 2006. The inspection commenced at 10am and was completed at 3.30pm. The focus of the inspection was to assess if the previous requirements set had been met and also focussed on the key standards. The methodology used included examination of three service users development plans and associated documentation, examination of five staff member’s personal files and recruitment documentation. Training records, financial records, risk assessments and a sample of policies and procedures were examined. Observation was made of staff practices and interaction with service users. Two service users were spoken with and eight staff was involved in discussions at varying intervals and within a staff meeting, which the inspector participated in. A part tour of the building and discussion with the temporary manager were also part of the inspection process. The home has recently had some difficulties, which have resulted in some staff changes, and the inspector’s decision to attend the staff meeting was made with this knowledge and partly used as evidence gathering within the assessment and evaluation of outcomes for the service users living at Hall Farm. What the service does well: Service users generally know, their assessed and changing needs and personal goals are reflected in their individual plan and that they can make decisions about their daily lifestyles and participate in all aspects of life within the home. Service users generally benefit from effective risk management strategies that promote their independence and rights, Service users rights are respected in all aspects of their daily lives, their relationships and within the community. Prospective service users have the information they need to make an informed choice about where they live. Their needs and wishes are fully assessed. Complaints procedures are in place and satisfactory systems are in place to protect service users from abuse neglect and self-harm Service users live in a homely comfortable and clean environment, which provides spacious indoor and outdoor and personal space. Service users Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 6 bedrooms reflect their individual styles and although there is adequate toilet and bathing facilities, service users would benefit from washbasins in their bedrooms. Service users generally benefit from well-supported and supervised staff. Service users are protected by good recruitment practices and induction and training programmes support the staff to provide an appropriate and quality service. Staffing levels appear satisfactory. A service user reported that he would be attending a dance in Lincoln on the evening of the inspection and enjoyed visiting another home and cream cakes. One service user was watching TV and informed the inspector he had a free view box. Another was seen playing football with a member of staff and another filming staff and the inspector with a camcorder. One service user had returned to relatives for a visit stay that morning and a service user informed the inspector that he had gone along with the service user and staff for the ride out. Holidays are planned at the organisation’s caravan in Bridlington and a camping holiday in Devon is arranged for three other service users. There was evidence that service users are assisted and supported with friendships and relationships. Relatives may visit at any reasonable time and most service users visit their relatives for periodic weekends. Restricted visiting arrangements are written within an individuals development plan should this be necessary. Counselling for sexuality and relationships can be arranged and supported, alongside well person sessions. Service users have varying needs and varying types of friendships, with others who may have a learning disability or also may not. Equality and Diversity is promoted within the home. There are ‘Agreed Handling Guidelines’ being introduced into the development/care plans and which are compatible with the strategies for crisis intervention training [SCIPr- [UK] and risk management strategies and physical intervention. Care Plans are also in place for positive reinforcement for appropriate behaviour. The health and safety of service users is generally promoted and protected and quality audit systems are in place. The health and safety of service users and staff is overall maintained. What has improved since the last inspection? Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 7 Recent breakdowns in continuity of the homes philosophy are being re-built and re-structured currently. Policies and procedures for the safe management of medication were overall satisfactory. Risk assessments for transport have been reviewed and appear to be appropriate. The organisation and the home now have voice mail facilities for contact details in case of an emergency. Some areas of the home have been decorated and new furniture, bedding and curtains have been purchased. Training has been carried out in infection control. What they could do better: The policy of the home is to encourage service users to be involved in the day to day running of their home wherever able, including, shopping, menu planning and daily household tasks. Support for service users in these areas had lapsed and there were plans to re-structure the daily lifestyles and routines with the individual service users needs and goals. Service users also need to have more opportunities for personal development and to take part in activities, which are appropriate and wide ranging. Mealtimes appear to be enjoyable and a review of the menus and aspects of food and nutrition will provide more choices for service users to make informed choice decisions. Up to date training is needed to ensure service users needs are fully met. Update Training in SCIPr-[uk] must be arranged at once. Further development work is needed to ensure service users physical and emotional health needs are fully met and that they receive personal support in the way they prefer and require. A certificate for electrical circuit testing must be provided. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 8 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. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 9 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 Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3, 5 Prospective service users have the information they need to make an informed choice about where they live. Their needs and wishes are fully assessed. Up to date training is needed to ensure service users needs are fully met. Individual contracts need to be in place. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed Statement of Purpose and service user guide which is service user friendly and includes picture symbols to aid communication. An assessment of needs is undertaken for any new service users, prior to admission and compatibility with the existing is considered. Copies of both the homes assessment documentation and social worker assessments were seen on the service users files examined. Service users and staff appeared to be relaxed in each others company and the staff members on duty interacted well and included service users in conversations. The home provides support for service users with complex challenging behaviours and all staff undertake Scipr [uk] [Strategies for crisis intervention and prevention [revised] UK training.] –Some of this training has been delayed for new staff and for refresher training, due to a change in Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 11 trainers. This training was still outstanding and a requirement set in relation to this. New staff undertake comprehensive inductions, which is detailed in a handbook and monitored and evaluated regularly by the home manager. Although training has been delayed over the last twelve months or so due to difficulties and changing managers, this now appears to be back on track with much training being planned and arranged. Contracts [terms and conditions] documentation was not evident but the manager stated that, as these were to be included within the service user guide. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Service users generally know, their assessed and changing needs and personal goals are reflected in their individual plan and that they can make decisions about their daily lifestyles and participate in all aspects of life within the home. Recent breakdowns in continuity of the homes philosophy are being re-built and re-structured currently. Service users generally benefit from effective risk management strategies that promote their independence and rights. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three Development plans were examined. The temporary manager is currently introducing a new system and improvements to the pre existing systems were noted. The development plans contain clear instruction for staff in how service users needs will be met. The development plans seen, on the whole were appropriate but were in the early stages and further development to the plans is needed in relation to healthcare, medication profiles and service users social and recreational needs. Because the development plans were new they were not due for review. Service users had not yet signed the new development plans, but there was evidence that service users were involved in decision Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 13 making and had signed individual declarations about decisions they had made against staff advice. Daily notes were completed and food charts are in place. [see standard 17] Service users would benefit from life story books as there was evidence that some important information staff knew about individuals had been archived or not documented. The policy of the home is to encourage service users to be involved in the day to day running of their home wherever able, including, shopping, menu planning and daily household tasks. Support for service users in these areas had lapsed and there were plans to re-structure the daily lifestyles and routines with the individual service users needs and goals. A service user was observed peeling potatoes for the evening menu The development plans contained risk assessments and individualised strategies for promoting independence and achievement. Risk assessments for the use of transport have been reviewed and updated. Service users are offered monthly meetings and any issues highlighted are addressed and fed back. Minutes of these meetings were not available for inspection, as the member of staff responsible had taken these home. Copies of the minutes should be kept in the home both for reference and inspection. Service users would benefit from an individual copy of the minutes. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 14 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): 12, 13, 15, 16,17 Service users need to have opportunities for personal development and to take part in activities, which are appropriate and wide ranging. Service users rights are respected in all aspects of their daily lives, their relationships and within the community. Mealtimes appear to be enjoyable and a review of the menus and aspects of food and nutrition will provide more choices for service users to make informed choice decisions. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” EVIDENCE: There was evidence that service users are assisted and supported with friendships and relationships. Relatives may visit at any reasonable time and most service users visit their relatives for periodic weekends. Restricted visiting arrangements are written within an individuals development plan should this be necessary. Counselling for sexuality and relationships can be arranged and supported, alongside well person sessions. Service users have varying needs and varying types of friendships, with others who may have a learning disability or also may not. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 15 Service users generally have a say, which key worker supports them, but a consistent and structured plan of care may mean that this is not always possible. The same gender staff provides Personal Care and there is always a male rotered on each shift. Bedtimes are flexible and a service user confirmed this. Development plans contained information to support service users to achieve goals and aspirations. These sometimes need to be structured within a context of managing challenging behaviour. Any limitations on freedom are noted within the development plan and evidence of this was seen. The arrangements for meeting the social and recreational needs of service users had deteriorated but the temporary manager was addressing this. Staff reported that some college placements had broken down however there did not appear to have been any analysis within the team of the possible reasons for this in the past few months. Staff were observed to be somewhat negative in approach in what they couldn’t provide, rather than being innovative and motivated with ideas about what they could provide in the way of opportunities for individuals. Some staff had important information about service users experiences, which was not within the care plan and clearly increased exchanges of communication between staff are necessary to ensure that service users needs are fully met. The manager is addressing the identified areas for development and working with the identified strengths within the staff team to promote quality lifestyles for the service users. Life Story books or social activity scrap books/projects may be useful for developing skills and interests of staff and service users in partnership. A service user reported that he would be attending a dance in Lincoln on the evening of the inspection and enjoyed visiting another home and cream cakes. One service user was watching TV and informed the inspector he had a free view box. Another was seen playing football with a member of staff and another filming staff and the inspector with a camcorder. One service user had returned to relatives for a visit stay that morning and a service user informed the inspector that he had gone along with the service user and staff for the ride out. Holidays are planned at the organisations caravan in Bridlington and a camping holiday in Devon is arranged for three other service users. A menu is provided and is devised over a four-week cycle. The choice offered at lunchtime was always sandwiches or soup and a roll and no choice was evident for the main meal. A service user spoken with was not aware of what meals were planned for the day and had not made a choice from the menu at the time of being asked. The menus are to be developed to address these identified issues and the manager has asked staff to plan and organise shopping around the menu plans. It is recommended that the area of food and nutrition in general is developed with the staff and service users in partnership and that it may be useful for particular staff members to undertake training in this area and oversee the development of it within the home on a daily basis. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 16 Food charts are kept for all service users and there was evidence that a service user’s individual needs in relation to food/condition had been monitored and appropriate investigation initiated. There was also evidence that another service user had refused some meals in the recent days prior to the inspection, but the manager had not been made aware of this. This was also of concern to the inspector as the service user was complaining of not feeling well. The inspector questioned weight records for another individual and the temporary manager asked to look into the issue. Staff was clearly not using the systems/tools in place appropriately and this is an area, which clearly requires improvement. A requirement is set in relation to this. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19,20 Further development work is needed to ensure service users physical and emotional health needs are fully met and that they receive personal support in the way they prefer and require. Policies and procedures for the safe management of medication were overall satisfactory. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users at Hall Farm House do not require any specialist equipment and any involvement of specialist therapists are recorded in the development/care plans. Voyager employ the services of a Consultant Psychiatrist who can be used as needed but the people at Hall Farm House generally use the psychology services, area Community Learning Disability Teams. The development plans are currently being developed. More evidence is required within the documentation about service users healthcare needs and how these are being addressed. Work is to be actioned to ensure that the staff team are consistent in supporting service users, as they require. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 18 Systems for the management of medication were examined. The home has changed pharmacy support since the last inspection but the temporary manager informed the inspector that there are plans to change back to Boots. Medication is supplied in blister packs for the home and medication is stored in an appropriate cabinet. Training for staff appeared appropriate and the system for key holding, however there were formal medicines policies in place and which includes guidance for staff in the event of medication errors and selfadministration. The home does not store any Controlled Drugs or drugs that need cool storage facilities currently. There was evidence of GP authorisation in individual development plans for homely remedies Sample staff signatures were evident and photographs of service users with medication record charts. Medication records were sampled and this evidenced an entry key of ‘F’ on one service users record which contained details of four prescription items, two were clearly identified as ‘as required’ medications. Staff reported that the ‘F’ signified that the medication had not been given. PRN medication only needs an entry of a signature or when given. Two prescribed medications also had the entry of ‘F’, which indicated that the medication had not been given. One prescription item did not have the instruction details stating ‘as prescribed by GP’ the medication itself carried the same instruction on the label, which is not satisfactory. Prescriptions or record sheets stating this should not be accepted by the home. All prescribed medication use din the home should contain the dosage details and how this should be taken. As there had been some changes within the team and no information pertaining to why the service user had been prescribed the said medication had been located, staff had made enquiries with the individuals GP, who had arranged a medication review in the next week to resolve this. Despite the problem with the medication information and labelling overall the system for the management of medication had been improved since the previous inspection. The inspector did not observe any medication being dispensed on the day. There were now clearer records of attendance to or by GP’s chiropodists, dentist and optician or annual health checks within the service users personal files. Service users wishes for the end of their life were well documented. Development plans should include medication profiles and a section for health and well being, including weight monitoring and evaluations Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 A complaint procedure is in place-further work is needed to ensure any complaints are documented. Systems are in place to protect service users from abuse neglect and self-harm Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information seen in the home on the day of the inspection indicated that there had been no complaints documented since 2004.It was unclear whether there were any other records in relation to complaints. Safeguarding adults issues were documented and had being dealt with appropriately. The inspector has been informed of outcomes to recent Safeguarding Adults investigations The manager has been advised to look at developing systems to embrace grumbles and concerns expressed by service users. Where service users are at risk of self harm-appropriate risk assessments are in place. There are ‘Agreed Handling Guidelines’ being introduced into the development/care plans and which are compatible with the strategies for crisis intervention training [SCIPr- [UK] and risk management strategies and physical intervention. Care Plans are also in place for positive reinforcement for appropriate behaviour. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 20 Risk assessments for transport have been reviewed and appear to be appropriate. A member of staff had escorted two service users and the driver on the trip organised for the morning of the inspection. There was no evidence of a policy for dealing with ‘Violence and Aggression There was no evidence of a policy or procedure in place for missing persons. Service Users at Hall Farm House are their own appointees, however records are kept as appropriate. A sample of records were examined and although these carried signatures and receipts, the system could be further improved if two signatures are used, one may be the service user and receipts to be filed with the relevant record sheet. The system for the daily handover of cash amounts appears appropriate. It is recommended that receipts are kept attached to the record sheet or in an envelope for each month’s transactions and which can be easily audited trailed. Policies and procedures are needed to inform staff of the appropriate practice and to include that they must not benefit from making purchases on behalf of service users, for example the law in relation to the use of bonus point or advantage schemes. The manager reported that she was aware that this was company policy. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,29 Service users live in a homely comfortable and clean environment, which provides spacious indoor and outdoor and personal space. Service users bedrooms reflect their individual styles and although there is adequate toilet and bathing facilities, service users would benefit from washbasins in their bedrooms. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hall Farm House appears comfortable and has a homely atmosphere. The furniture and furnishings are domestic in character. New furniture has been purchased recently. Radiators were being provided with safety covers, prior to the winter on a priority basis. The development plans did not identify if a service user wishes to have a key or is identified through a risk assessment not able to. The bedrooms are spacious and individually personalised. Service users bedrooms although spacious did not have washing facilities apart from one having en-suite provision. Service users would benefit by these facilities being installed. One service user said he would like a privacy blind and Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 22 it recommended that this issue be explored with all service users. New bedding has recently been purchased and some service users have new curtains The home has 3 bathrooms all with toilets and a separate toilet downstairs. All bathrooms are lockable. The bathroom/shower room washbasin hot tap was not working on the day of the inspection. Toilets are currently being redecorated. The bathroom/shower room would benefit from some refurbishment The home has a large dining room, a large kitchen and 2 lounge areas. The home is surrounded by, a very large garden and additional field. There are plans to redesign the garden with a water feature, herb garden and vegetable patch. Work has commenced on this. New sofas and dining room furniture has been purchased and provides a much-improved environment for service users. The home was clean and free from any malodour. The manager reported that discussions are in place regarding moving the laundry facilities and then to replace one of the washing machines with a type that has a sluice facility. The laundry room would benefit from a facelift and tidy. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33 34, 35,36 Service users generally benefit from well-supported and supervised staff. Service users are protected by good recruitment practices and induction and training programmes support the staff to provide an appropriate and quality service. Update Training in SCIPr-[uk] must be arranged at once. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of five staff member’s staff personal files was examined and were satisfactory. Rotas were examined and found to be satisfactory. The temporary manager is currently reviewing staff members training needs to bring the training programmes up to date. Some training has been postponed due to circumstances with trainer. Training records confirmed staff had undertaken induction, fire safety training, first aid, food hygiene, manual handling, health and safety training, SCIPr-[uk]. Epilepsy management had been covered within the first aid training, however the manager reported that this was to be further supplemented with another workshop on epilepsy. Infection control training had been carried out in March 06. Some staff have undertaken training in autism and abuse awareness. care planning, medication, and a high number of staff are currently studying NVQs or are due to enrol/start. Team meetings were evident and minutes are kept of these. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 24 Evidence was seen of formal staff supervision but not all staff had records in place for this. The temporary manager is prioritising staff supervision to ensure that all staff are up to date. Further training is to be arranged for refresher SCIPr-[UK] and de-escalation techniques. There has been a delay in this training. As there have been a number of issues, which have identified that the updates are needed, a requirement is now set for this. It was also noted that some staff had failed to attend training in the past and that measures were in place to address this. Training is booked for Health and Safety 22/5/06 Food Hygiene 26/5/06, Manual handling 23/5/06,first aid, 24/5/06, medication management, 30/5/06, 9th and 12th May 2006 Behaviours and epilepsy. Induction booklets were evident for most staff. All staff has a training and development plan in place. Copies of certificates are kept in staff personal files. The temporary manager has just commenced the Registered Managers award. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 There has been some instability in the staff team due to some in house changes however this is being addressed and service users currently benefit by the home being well managed and by a staff team who are guided by strong leadership. Policies and procedures are in place but these need reviewing and to ensure that all the required documentation is in place. The health and safety of service users is generally promoted and protected and quality audit systems are in place. The health and safety of service users and staff is overall maintained. An electrical safety circuit test certificate must be provided however. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence that overall the management systems within the home were being improved since the temporary manager had been in post. The temporary manager is currently undertaking the Registered Managers award. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 26 There was evidence of some conflict within the staff team regarding consistency of approach with service users, which the temporary manager is currently addressing and working with staff to further develop good practices. The policy file could not be located to provide evidence of missing policies for dealing with violence and aggression and missing persons. Audit systems are in place including regulation 26 visits. Service user meetings are held. There is currently no service user survey used and this is recommended to meet the standard fully. Fire risk assessments were seen and a file containing generic risk assessments was evident in the home. Staff was observed to be preparing food wearing aprons and there were improved practice noted in relation to food safety. Training for staff in infection control has been complete. Systems are in place for the prevention of legionella and water outlet tests are documented. There was evidence of a gas safety check but not a five-year electrical circuit safety certificate. Portable appliance records were up to date. Accident and incident records were seen. There were some issues raised by the manager and staff in relation to cleaning schedules and how this is to be delegated and recorded. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 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 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 2 X Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 28 No 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 YA17 Regulation Requirement Timescale for action 27/06/06 2 YA19 3 4 5 YA3 YA35 YA42 12,13,14,15,16 Ensure systems are in place which ensure the monitoring and evaluation of service users nutritional needs 12,13,14,15,16 Ensure systems are in place which ensure the monitoring and evaluation of service users nutritional needs 14,15 Ensure all staff receive updates in SCIPrUK training urgently 14,15 Ensure all staff receive updates in SCIPrUK training urgently 16,23 Provide evidence of a five year electrical safety check 27/06/06 27/06/06 27/06/06 27/05/06 Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 29 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 Good Practice Recommendations YA5 Obtain the new organisation terms and conditions and ensure that service users or their representative’s signature for agreement to the terms and conditions. YA6 Ensure development plans include epilepsy and healthcare/mobility needs of individuals and that service users have greed to them Improve verbal and written communication within the staff team to ensure the health and social needs of service users are fully met and that they receive support, as they require. Further promote daily living skills within the service user group. 4 YA8 Improve verbal and written communication within the staff team to ensure the health and social needs of service users are fully met and that they receive support, as they require. Further promote daily living skills within the service user group. 5 YA16 Improve verbal and written communication within the staff team to ensure the health and social needs of service users are fully met and that they receive support, as they require. Further promote daily living skills within the service user group. 6 YA18 Improve verbal and written communication within the staff team to ensure the health and social needs of service users are fully met and that they receive support, as they require. Further promote daily living skills within the service user group. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 30 2. 3 YA7 7 8 9 10 YA12 YA13 YA17 YA20 Staff should be more innovative and creative in providing opportunities for activities and personal development of service users. Staff should be more innovative and creative in providing opportunities for activities and personal development of service users. Improve the arrangements for food and nutrition. Ensure prescription labels are accurate on receipt of medication. Ensure medication charts are completed appropriately for PRN medication Develop medication profiles within the service users development plans 11 12 13 14 YA22 YA23 YA24 YA26 Look at ways to embrace grumbles and complaints that may be made by service users Further improve the system for service users finances Ensure the identified hot water tap is fully operational and working Provide washbasins in service users bedrooms. Ensure the provision/option of door keys and lockable facilities is fully operational and documented within development plans. Where service users wish to have privacy blinds these should be provided 15 YA30 When the washing machine is in need of replacement, purchase a type with an integral sluicing programme/facility. Revamp and tidy the laundry 16 YA39 Implement service user surveys within the framework of quality monitoring. Ensure copies of minutes of service user meetings remain in the home 17 YA40 Review the policy files and ensure policies are in place for dealing with violence and aggression and when service users go missing. Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Hall Farm House Care Home DS0000008686.V290626.R01.S.doc Version 5.1 Page 32 - 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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