Inspection on 30/11/05 for Hall Farm House Care Home

This inspection was carried out on 30th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 27/04/06

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 30th November 2005 10:30 Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 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 Mr Scott Scully Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 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. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Jayne Hilton undertook the unannounced inspection on 30th November 2005. The inspection commenced at 10.30am and was completed at 2.45pm. The methodology used included examination of four service users development plans and associated documentation, examination of six staff member’s personal files and recruitment documentation. Training records, financial records, risk assessments and a sample of policies and procedures were examined. Observation of staff practices and interaction with service users. The focus of the inspection was to assess if the previous requirements set had been met and also focussed on the remaining key standards not assessed at the earlier inspection in August 2005 and areas in relation to a number of regulation 37 notifications received by the Commission. Two service users were at home when the inspector arrived and were observed to be making Christmas Cards. The inspector did exchange communication with both service users during the inspection, however the service users had planned to go out for a pub lunch and therefore they were not interviewed. Service users and staff were spoken with at the previous inspection. An inspector had tried to make contact with the home on one occasion that all service users and staff had gone out. There were no voicemail facilities either at the home or when trying to contact Voyage out of office hours. Voyage need to address these issues should the home or organisation needing to be contacted in an emergency What the service does well: Service users benefit by the home being overall well managed and by a staff team who are guided by strong leadership. The health and safety of service users is generally promoted and protected and quality audit systems are in place. Prospective service users have the information they need to make an informed choice about where they live. Their needs and wishes are fully assessed and the home appears to meet the service users needs very well. Individual contracts are in place but these need to be changed to Voyage. Service users 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 have opportunities for Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 6 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 will provide more choices for service users to make informed choice decisions. Service users physical and emotional health needs are generally well met and they receive personal support in the way they prefer and require. Service users wishes for the end of their life are well documented 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 benefit from well-supported and supervised staff. Service users are protected by generally good recruitment practices and induction and training programmes support the staff to provide an appropriate and quality service. What has improved since the last inspection? What they could do better: The current systems in place for adult protection are not robust and they must be revised to ensure they protect service users from abuse, neglect and selfharm. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 7 Urgent reviews are required in relation to risk assessments for use of transport as the health and safety of service users and staff could be compromised in relation to this. The acting manager must submit an application with the CSCI. Policies and procedures for the safe management of medication were not satisfactory and an immediate requirement is set in relation to this. Improvement is required in relation to recruitment documentation. Recommendations are made for the following: Service users would benefit from washbasins in their bedrooms. Policies and procedures are in place but these need reviewing and to ensure that all the required documentation is in place. Service users surveys would improve the quality monitoring systems. The organisation and the home should have voice mail facilities for contact details in case of an emergency. 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.V269826.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 and the home appears to meet the service users needs very well. Individual contracts are in place but these need to be changed to Voyage. EVIDENCE: The home has a detailed Statement of Purpose; this has been amended/updated with manager and staffing and CSCI details. 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. The Lavigna Willis assessment tool is also completed within the first month of placement. 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 trainers New staff undertake comprehensive inductions, which is detailed in a handbook and monitored and evaluated regularly by the home manager. Although Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 10 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 is being updated to the current organisation. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8,9 Service users 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, however urgent reviews are required in relation to risk assessments for use of transport. EVIDENCE: Four Development plans were examined. A new system is currently being introduced by, the new acting manager and improvements to the pre existing systems were noted. The development plans seen, on the whole were appropriate, however one service user had no plans in place for epilepsy or for a recent health issue diagnosis. The acting manager reported that these were almost completed. Development plans were reviewed up to date. The development plans in place otherwise were well detailed and give clear information to staff in how to meet the service users needs and wishes. Service users sign their development plans. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 12 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. The development plans contained risk assessments and individualised strategies for promoting independence and achievement. On scrutinising the risk assessments in relation to the use of transport, these were found to be inadequate and in urgent need of review, particularly in relation to recent incidents. Service users are offered monthly meetings and any issues highlighted are addressed and fed back. Minutes of these meetings are kept. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Service users 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 will provide more choices for service users to make informed choice decisions. 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. Service users generally have a say, which keyworker 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. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 14 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. Some service users attend college and certificates of achievement were kept in service users personal files. It was evident within the files tracked that service users are offered a wide range of activities and are encouraged to pursue their own interests and hobbies. Some service users attend the local village sports events, to support the local cricket and football teams. A new menu has been devised, which appears to be varied and nutritious. A second choice is now offered for the main meal of the day. Two service users were at home when the inspector arrived, but went out for lunch to the local pub. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 15 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, 21 Service users physical and emotional health needs are generally well met and they receive personal support in the way they prefer and require. Policies and procedures for the safe management of medication were not satisfactory and urgent action is required to rectify this. Service users wishes for the end of their life are well documented EVIDENCE: Service users generally have a say, which keyworker 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. The manager was aware of how to obtain cultural support for one service user if needed. 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 manager reported that service users are able to advocate who attends their care reviews Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 16 Systems for the management of medication were examined. Boots currently supply blister packs for the home and medication is stored in an appropriate cabinet. The storage temperatures of medication were not being monitored and therefore a requirement is set in relation to this. There was no evidence available for the receipt of medication, although there was a record for medication that had been returned to the pharmacy. The BNF [British National Formulary] was just over twelve months old and it is recommended that a newer version be obtained. Training for staff appeared appropriate and the system for key holding, however there were no formal medicines policies in place, apart from a brief aide memoir for staff devised by the current acting manager. 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 that could be used for that individual but no homely remedies policy. Sample signatures were evident, but the manager reported that the list required updating as more staff now have authority to administer medication. There was no policy for self-medication, neither was there a policy in place for the event of a drug error. The manager reported that this was currently being developed. There was not a copy of the Royal Pharmaceutical Societies guidance for medicine administration in Care Homes and this is advised. In view of the lack of policies and procedures in place for the recording, handling, safekeeping, safe administration and disposal of medicines, an immediate requirement was set and these must be completed as specified by the Medicines Act and in conjunction with the Royal Pharmaceutical societies guidance manual by 30th December 2005 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. Service users mental health needs and the evaluation of this are included in their individualised development plans. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The current systems in place are not robust and they must be revised to ensure they protect service users from abuse, neglect and self-harm. EVIDENCE: A number of incidents had occurred recently which had resulted in the organisation discussing the need to improve policies and procedures. There was evidence of the new updated Adult Protection Guidance and most staff have now undertaken training in abuse awareness. The acting manager and staff member had not followed the correct procedures recently under the Protection Of Vulnerable Adults Policy Guidance and the Registered Person and the acting manager need to ensure that appropriate referrals are made to Social Services as the lead agency for adult protection investigations. In accordance with ‘No Secrets’ the local Social Services Authority is the lead agency with responsibility for co-ordinating the interagency framework for the protection of vulnerable adults. Every reported incidence of abuse or suspected abuse must be taken seriously and assessed and treated with the necessary level of urgency. It is the responsibility of the Registered Person to ensure the safety and protection of service users under Regulation 13[6] of The Care Home Regulations 2001 and develop relevant policies and procedures for the protection of vulnerable adults and whistle blowing in line with the Public Disclosure Act and the DOH guidance. Social Services must be contacted in every instance. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 18 Extra support for the staff and a mentor for the newly employed manager has been provided by an experienced manager in the organisation, who will also be providing training for the staff in de-escalation tactics prior to Christmas. The acting manager has introduced de-briefing sessions in team meetings to evaluate practice and how this can be further improved. Voyage provide helpline cards “I am worried please contact me” which can be sent by post to Voyage. It is recommended that this system be reviewed and envelopes be provided for privacy and security of information that may be written on them. 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. A sample of risk assessments were examined in detail in relation to the inspectors concerns regarding recent incidents, particularly in relation to use of the homes transport. There is a general policy for the use of the homes transport, regarding its overall use, authority to drive and maintenance of the vehicle. The inspector noted that there was no written guidance that linked into the individual risk assessments of service users, regarding how many staff should be present on the transport when service users are travelling on it. It was noted that on at least one occasion, a driver only was present, with five service users who all had varying risk elements for travel, challenging and unpredictable behaviour and one who was funded for one to one support. It was evident that the risk assessments in place were not adequate and that they had not always been followed in relation to the transporting of five service users with specific needs. Service users, staff and others had clearly been put at risk by staff not following the guidance within the documented risk assessments. An urgent review is needed to ensure that practices by staff minimise any risk posed to the service users and others. A full discussion on the issues was held between the acting manager and the inspector. The acting manager reported a commitment to ensuring that this will be addressed urgently. The policy folder index contained reference to a policy for dealing with ‘Violence and Aggression [under review]’ but this policy was not contained in the policy folder. The manager explained that this was, currently being developed by the organisation. The lack of this policy leaves no guidance for staff or management to follow. Interim guidance should be provided in the meantime and should include clear guidance for staff and should include details of when other agencies need to be involved/informed, i.e. The Police, Social Services etc. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 19 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 two signatures and receipts, the system needs to be improved to ensure financial procedures are robust and service users are protected from financial abuse. The system for the daily handover of cash amounts appears appropriate, however receipts should be numbered and all cash amounts accounted and receipted for, even if the service user keeps part of the cash amount themselves. 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 audit 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. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 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. EVIDENCE: Hall Farm House appears comfortable and has a homely atmosphere. The furniture and furnishings are domestic in character. The acting manager reported that new furniture is to be purchased in the near future. Radiators were being provided with safety covers, prior to the winter on a priority basis. The development plans now identify if a service user wishes to have a key or is identified through a risk assessment not able to. It is recommended that an authorisation/agreement signature be added. The bedrooms are spacious and individually personalised. Furniture and equipment lists were seen in the development plan files and a table to write at is now provided. 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. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 21 The home has 3 bathrooms all with toilets and a separate toilet downstairs. All bathrooms are lockable. 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. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Service users benefit from well-supported and supervised staff. Service users are protected by generally good recruitment practices and induction and training programmes support the staff to provide an appropriate and quality service. EVIDENCE: A sample of six staff member’s staff personal files were examined. The inspector saw evidence of Criminal Records disclosures but only one contained the complete document, neither was there evidence that POVA register checks had been carried out. The Guidance for CSCI regulated services is that Disclosures should be kept for up to twelve months or more to enable CSCI inspectors to see a sample at the next inspection. Not all of the staff files contained photographs as required by schedule 2 of the regulations. New guidance states that copies of birth certificates need not be now kept. The registered provider must ensure that appropriate records are in place for inspection, in relation to recruitment of staff. The acting 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 acting manager Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 23 reported that this was to be further supplemented with another workshop on epilepsy. There was still no evidence of training in infection control. 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. Evidence was seen of formal staff supervision. The acting manager stated that training would be provided for team leaders for further improve this system. Further training is to be arranged for refresher SCIPr-[UK] and de-escalation techniques. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 Service users 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 could be compromised in relation to the inadequate risk assessments in place for transport. The acting manager must submit an application with the CSCI. EVIDENCE: There was evidence that overall the management systems within the home were being improved since the new acting manager had been in post. He has recently been interviewed for the position of permanent manager and will need to register with the commission as soon as possible. The acting manager is currently undertaking the Registered Managers award and hopes to complete by the end of 2005. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 25 There was evidence of some conflict within the staff team regarding consistency of approach with service users, which the acting manager is currently addressing and working with staff to further develop good practices. The policy folder was examined and found to contain comprehensive policies and procedures, but there was evidence of missing policies for dealing with violence and aggression and missing persons. A review of the policies sand procedures is recommended. There were no policies for the safe handling of medicines [Standard 20], which constitutes a breach of regulation. 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 were observed to be preparing food wearing aprons and there were improved practice noted in relation to food safety. Training for staff in infection control is outstanding. The farm is now using the old pottery shed outside. Previous issues are now no longer relevant. There are some issues in relation to inadequate risk assessments for the use of the homes minibuses. Service users and staff members’ health and safety need to be protected in relation to their use. Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X 2 Standard No 22 23 Score X 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 1 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hall Farm House Care Home Score 3 3 1 3 Standard No 37 38 39 40 41 42 43 Score 2 3 3 1 X 2 X DS0000008686.V269826.R01.S.doc Version 5.0 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1 2 Regulation Requirement Timescale for action 30/12/05 30/12/05 YA9YA23YA42Y 12, 13 3 Urgently review the service users risk assessments and policies in relation to the use of transport YA20YA40 13,16,17 The Registered Person must ensure that appropriate systems are in place for the recording, handling, safekeeping, safe administration and disposal of medicines. Immediate YA23YA40YA42 12, 13, 17 Ensure appropriate systems are in place to Protect service users from abuse. Ensure appropriate reporting and referral of incidents/allegations/suspected/potential abuse 30/12/05 4 YA34 5 6 YA37 YA42 Ensure robust financial procedures. 7,9,19 The registered person must ensure that appropriate records are available for inspection in relation to CRB disclosures and POVA register checks 8 The acting manager must submit an application to be registered 12, 13, 18 Provide all staff with training in infection control. Outstanding 30/12/05 30/12/05 08/11/05 Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3. Refer to Standard YA5 YA6 YA20 Good Practice Recommendations Obtain the new organisation terms and conditions and ensure that service users or their representative’s signature for agreement to the terms and conditions. Ensure development plans include epilepsy and healthcare/mobility needs of individuals. Obtain the Royal Pharmaceutical guidance for administration of medicines in care homes and an up to date BNF. [British National Formulary] Develop medication profiles within the service users development plans Provide washbasins in service users bedrooms. When the washing machine is in need of replacement, purchase a type with an integral sluicing programme/facility. Implement service user surveys within the framework of quality monitoring. Review the policy files and ensure policies are in place for dealing with violence and aggression and when service users go missing. Review the ‘I am worried’ cards regarding confidentiality The organisation and the home should have voice mail facilities for contact details in case of an emergency. 4. 5. 6 7 YA26 YA30 YA39 YA40 8 *RCN Hall Farm House Care Home DS0000008686.V269826.R01.S.doc Version 5.0 Page 29 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.V269826.R01.S.doc Version 5.0 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!