Inspection on 19/04/07 for Harkstead Barn Residential Home

This inspection was carried out on 19th April 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harkstead Barn Residential Home 28/04/06

Harkstead Barn Residential Home 22/11/05

Harkstead Barn Residential Home 11/05/05

Harkstead Barn Residential Home 15/03/05

Harkstead Barn Residential Home 28/10/04

Harkstead Barn Residential Home 09/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Harkstead Barn Residential Home Brick Kiln Lane Harkstead Ipswich Suffolk IP9 1DF Lead Inspector Deborah Kerr Key Unannounced Inspection 19th April 2007 10:00 DS0000024402.V337082.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 DS0000024402.V337082.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. DS0000024402.V337082.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harkstead Barn Residential Home Address Brick Kiln Lane Harkstead Ipswich Suffolk IP9 1DF 01473 327380 F/P 01473 327380 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) None United Response Leonard Edward Pritchard Care Home 5 Category(ies) of Learning disability (5) registration, with number of places DS0000024402.V337082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th April 2006 Brief Description of the Service: Harkstead Barn offers accommodation and care for up to five adults with learning disabilities and behaviours that can be challenging to others. The home was converted from farm buildings into residential accommodation in 1992 and is situated in a rural position outside the village of Harkstead and seven miles from the town of Ipswich. Whilst the building is rather isolated in its location, it enables people who use the service to have maximum space and freedom. Orwell Housing Association owns the property but the business is run by United Response (Registered charity number 265429) who has many years experience in providing care for people with learning disabilities. The service user group has undergone little change since the home was opened and accommodates five men at present. An additional resource, an activities centre, was completed in late 2003, and now provides activities for people who use the service as part of their planned day programmes of activities, or as/when required. The home has a detailed statement of purpose and service users guide providing information for prospective service users issued on request. The contracts of the people using the service need to be updated top reflect their current fee and their terms and conditions of residence. The fees range from £1,117.73 to 1,320.36 per week. DS0000024402.V337082.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on a weekday lasting eight hours. This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The report has been written using accumulated evidence gathered prior to and during the inspection. This included reviewing a completed pre inspection questionnaire and four ‘Have your say about’ comment cards completed by relatives. Time was spent with one person using an inspector calls photo story book and photo survey called ‘Tell us what you think about your care’ to establish their view of how the home. Another of the men forwarded a completed photo survey to the Commission for Social Care Inspection (CSCI) following the inspection. The comments obtained from the selection of surveys are included within the report. Time was also spent with the other people living in the home, the manager and three staff. A number of records were looked at including those relating to people living in the home, staff, training, the service user guide and policies and procedures. What the service does well: What has improved since the last inspection? Staff have attended equality and diversity training which has impacted on the way they work with the people using the service. Where previously risk management strategies limited opportunities for the people using the service they have adopted a different approach, which now supports and encourages the individuals to participate in a wider choice of activities within the community promoting their independence and freedom. DS0000024402.V337082.R01.S.doc Version 5.2 Page 6 A member of staff provided examples, where previously due to behavioural patterns they avoided crowded places; two of the men are responding well to positive handling and agreed boundaries and are enjoying accessing public amenities, such as the swimming pool. A programme of maintenance and thorough cleaning has been implemented. Repairs have been made to the driveway, potholes have been filed in and the drive has been covered with shingle. The dining room, lounge, kitchen and corridors have been redecorated and a new shower has been installed. An investigation into a ‘fusty’ smell in one of the bedrooms found a leak in the roof; this has been repaired however the ceiling still needs to be redecorated. Five staff have attended training in the protection of vulnerable adults, further dates are scheduled for April and June 2007 for the remaining staff. United Response are committed to staff training, they have produced a leadership management and development diary of in house training, which covers all mandatory training. The manager has also resourced specific training to support the specific needs of the people who use the service, for example managing challenging behaviour. The complaints policy has been amended to reflect the Commission for Social Care Inspection (CSCI), replacing reference to the National Commission for Social Care (NCSC). A safer system has been developed for the management of soiled linen. Bins have been placed in bathrooms containing red dissolvable bags, these are taken to the laundry and the bags placed directly in the washing machine on a sluice programme. What they could do better: Care plans seen at the previous inspection had been person centred and for one person the plan had been designed in a format and language that they could understand. However the contents of the care plans seen on this occasion were variable. They were difficult to follow, containing a lot of information, in no particular order and did not give a plan that focused on the individual. Each plan did have a morning, evening and night routine, however in the case of one individual these focused on their ‘mood’ rather than the positive aspects of their abilities and personality. Care plans need to be developed with the individual, which focus on the individual’s strengths, personal preferences and changing needs. Reactive management plans have been developed guiding staff to the known triggers, interventions and guidance techniques, however if all of these actions fail, (only trained staff) are instructed to follow the breakaway and restraint techniques. There is no explanation of what these techniques are and how they are to be managed. DS0000024402.V337082.R01.S.doc Version 5.2 Page 7 Each of the people using the service have a contract/individual agreement between them and United Response in place, however these contracts have not been reviewed or updated since 1995-1998 and do not reflect current fees. Contracts need to be agreed, signed and dated by the individual and the manager of the home. Where the individuals lack the capacity to agree and sign the terms and conditions between themselves and the home, support from family or an independent advocate must be obtained to act in their best interests. 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. DS0000024402.V337082.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000024402.V337082.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, People who use the service experience good quality outcomes in this area. Should the situation arise where there is a vacancy, United Response has a detailed process in place for people considering moving into the home, however individual contracts need to be updated to reflect the current peoples fees and terms and conditions of residence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an established group of people living at the home with no new admissions to the service for a long time. It is therefore difficult to assess these standards. United Response has produced a manual of policies and procedures relating to the care and support of the service users called “Getting it right”. This includes a detailed procedure for new people to move into the home. Prospective candidates will have a full assessment of their needs with a multi disciplinary team. Following this a short planned visit would be arranged for the person to meet the other people living in the home. If all was well further planned visits and an overnight visit would be arranged, followed by a weekend stay and then a moving in date agreed. DS0000024402.V337082.R01.S.doc Version 5.2 Page 10 The home has a corporate statement of purpose provided by United Response, with additional information directly related to Harkstead Barn. A further leaflet called ‘Support for people with learning difficulties in Suffolk’ has been produced specifically for Harkstead Barn, which provides people with information about the service. Each of the men has a copy of a service user’s charter and individual charter. These documents have been produced by United Response and are in a picture and word format. The service user’s charter states what the home will provide and the individual charter states the terms and conditions of living in the home and reflects that Orwell Housing association owns the building. However, the contracts and individual agreements between them and United Response have not been reviewed or updated since 1995-1998 and do not reflect current fees. These need to be signed, agreed and dated by the individual and the manager of the home. Where the individuals lack the capacity to agree and sign the terms and conditions between themselves and the home, support from family or an independent advocate must be obtained to act in their best interests. DS0000024402.V337082.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, People who use the service experience good quality outcomes in this area. However, care plans need sorting out to ensure they are person centred and focus on the strengths, preferences and changing needs of the people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans seen at the previous inspection had been person centred and for one person the plan had been designed in a format and language that they could understand. However, the contents of the care plans seen on this occasion were variable. They hold a lot of old information, which means sifting through the plan to ascertain the individual’s current needs. Daily routines of the individuals are split into morning, evening and night, however these are descriptive providing information for staff to deliver their care, rather than being written in the first person to indicate that these are their preferences and choices. DS0000024402.V337082.R01.S.doc Version 5.2 Page 12 In the case of one individual their daily routines focused on the person’s ‘mood’, which determines their activities, rather than focusing on the positive aspects of their behaviour. One of the care plans does have a front sheet called ‘All about Me’, which identifies the individuals preferred name and guidance about their needs written in the first person, for example “I like you to” and “ If I do not want to” which reflects the person’s involvement in writing the plan and the control they have over their own life. All staff have attended management of challenging behaviour training, which was specifically designed for the people living in the home. As a result of the training a reactive management plan has been developed for each of the men. These plans give guidance on the individualised procedures, which highlight the known triggers, interventions, and guidance techniques, however if all of these actions fail, (only trained staff) are instructed to follow the breakaway and restraint techniques. However, there is no explanation of what these techniques are and how they are applied, managed, recorded and reported. Discussion’s held with a person living at the home confirmed that they are consulted about the day-to-day running of the home and that they had been involved in making decisions on the recruitment of new staff. People using the service are supported to manage their own finances wherever possible. United Response is corporate appointees for each person. The manager, deputy and acting deputy are signatories for the individual’s bank accounts. The home keeps a cash float in a separate money tin locked in the safe and a ledger with a record of all transactions of cash purchases and withdrawals from the bank for each person. The ledgers and cash balance of two people were checked and found to be accurate. A placement social worker has been seconded to work with the people at Harkstead Barn. They are currently undertaking work to help and support people to make decisions about developing and maintaining personal and family relationships and how to deal with bereavement issues. They are also working with another of the people using the service to complete an assessment to evidence a need for additional one to one day care funding. DS0000024402.V337082.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): 12,13,14,15,16,17, People who use the service experience excellent quality outcomes in this area. People using this service can expect that they will be supported to take part in appropriate leisure and work related activities within the local community and have the opportunity to mix with other adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Various day care facilities provide opportunities for people using the service to access activities of their choice. Two of the people from the Barns own day care unit were accompanied to Thetford Forest for a walk and picnic. One of the other men attends a day centre in Ipswich, where they have the support of two staff, as part of an agreed care package with social services. They have been supported to purchase their own vehicle, which is kept at the day service during the week and is solely used for their day care activities. Another of the men continues to attend a work placement at a unit called ‘Growing places’, which grows and sells vegetables and fruit. They attend Monday through to Friday helping to dig, plant and sell the produce. DS0000024402.V337082.R01.S.doc Version 5.2 Page 14 One person remained at Harkstead Barn whilst the others were taking part in activities. Their reactive management plan stated that a trigger likely to initiate challenging behaviour was a lack of structure in their day. It was noted that their behaviour changed when the others went out on their trip. This was discussed with the manager who confirmed that the individual had been offered to go to Thetford Forest with the others but that they had declined. However the manager did acknowledge that they were in the process of undertaking an assessment to liaise with social services on behalf of the person to obtain additional funding to provide one to one day care. A separate staff team is employed to facilitate the day care on the premises and offers the people a programme of planned activities. The staff obtained a brochure completed as part of a community project for places easily accessible for people with impairments and/or disabilities out and about in Ipswich. They have used the brochure in discussion with the people to plan activities of their choice. The men have taken part in a range of leisure activities, which include attending a nightclub called ‘Betty’s Disco’, Pleasure Wood Hills entertainment park, swimming, sailing, horse riding, ten pin bowling, going to the local pubs to play snooker or for a meal, going to the cinema, clothes and food shopping. As the home is set in the countryside the men enjoy going for long walks. They also use the Barns own day care facilities in the evenings and at weekends for their own entertainment. There is a range of musical instruments, including a full set if drums, a computer and play station, a pool table, table tennis and table football. People living at the home are supported to maintain relationships with their families and often spend the weekend at their parental home. One of the men had gone to visit their parents following their day care. The remaining men were offered the opportunity to take a trip to Felixstowe for the evening and have a fish and chip supper. Harkstead Barn has it’s own allotment, which is currently situated in Ipswich. Due to other activities they have not been able to visit the allotment on a regular basis. The home has been awarded a grant from a well-known DIY store and through consultation with the people using the service they have decided to use the money to relocate the allotment to the grounds at Harkstead Barn. This will enable the men to have access to the allotment at any time. One of the men told the inspector that they have enjoyed taking part in digging and preparing an area for the shed and a patio area. The idea is for the allotment to provide fresh vegetables for the home. People using the service have the cost of a week’s holiday contracted into their fees. One of the people using the day care service showed the inspector their holiday photographs of a trip to Amsterdam and talked of going to Portugal this year. Another of the men is going to Turkey. The day care staff acknowledged that two of the men benefit from shorter local brakes. Last year they had enjoyed a trip to the Lake District, accompanied by a relative as well as the care staff. One of the men through positive encouragement made a real achievement climbing a mountain up to the top of 2,000 feet. DS0000024402.V337082.R01.S.doc Version 5.2 Page 15 The men are encouraged to contribute to the day to day running of the home, which includes keeping their rooms clean and tidy, and helping to prepare the table for mealtimes and clear away afterwards. They were observed moving freely around their home spending their time as they chose and enjoying the companionship of two pet cats called Sylvester and Gizmo. A member of staff has designated responsibility for the menus to ensure the people using the service have healthy balanced diets. The men are encouraged to take part in choosing the menus; which are discussed at the beginning of the week. If however they choose to have an alternative a good range of food was seen stored in the freezer and refrigerator. One of the men was observed preparing himself a snack on return from their day care activity. Generally the men have packed lunches to allow spontaneity depending on the weather for outing and picnics and have a cooked meal at night. DS0000024402.V337082.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): 18,19,20,21, People who use the service experience good quality outcomes in this area. People living in the home can expect to have their physical and emotional health needs meet and have personal support provided in a way that maximises their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individuals have an intimate and personal support plan, which identifies what they can do to meet their own personal care needs and the level of support they need to achieve this, which can be either physical help, encouragement, observation or prompting. Medical profiles identify current medication, conditions, allergies, a record of vaccinations and a monthly record of the service users weight. The men are supported to access routine healthcare appointments, such as the dentist, opticians, doctors and other specialist healthcare providers where required. These profiles were being updated in conjunction with the person’s annual review. DS0000024402.V337082.R01.S.doc Version 5.2 Page 17 Due to the high and complex needs of the individuals none of the men self medicate. Medication is kept locked in the office. At the front of the MAR charts folder is a copy of the homes policies and procedures for administering medication. The policy covers the arrangements for the safe ordering and returns of unused or soiled medication. The home does not currently hold any controlled drugs, but do have a lockable cabinet with in the medication cupboard. Both are locked at all times. At the front of each individuals Medication Administration Record (MAR) chart is a photograph of the individual for identification and where identified established guidelines for administering PRN (as and when required) medications. Evidence was seen that PRN medication to manage an individual’s behaviour when being verbally and physically aggressive was being administered in line with the guidelines. The few occasions recorded in their daily progress notes and on the MAR chart reflected that individual’s behaviour is being managed through the reactive management process and not by medication. The MAR charts for all the people living in the home were checked; these had been recorded, signed and dated appropriately. A statement recorded by staff in an individuals care plan confirmed that staff have a basic knowledge of the individuals prescribed medicines. They had identified an error in the individual’s prescription, which had increased to double the dose of their usual prescription and had checked with the pharmacy prior to administering medication. This was investigated by the pharmacy and through discussion with the consultant a decision was made to revert back to the original dosage. The home has policies and procedures for dealing with death and bereavement. These issues have been discussed with the individuals and their relatives, and where agreed a pre paid funeral agreement plan has been purchased, which clearly states their wishes in the event of the individuals death and dying. DS0000024402.V337082.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23, People who use the service experience good quality outcomes in this area. People who use this service are supported to express their concerns and have access to a complaints procedure in a format they are able to understand and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person is provided with a copy of the United Response complaints procedure in a format incorporating symbols and pictures to guide them should they wish to make a complaint. The complaints log was seen, which confirmed there have been no complaints made about the service since 2005. Policies and procedures are in place to protect the service users from neglect and absue. United Response has a detailed policy for the prevention of harm, which identifies the actions staff should take if an incident of abuse is discovered or reported to them. A previous requirement was made for staff to recieve training for the protection of vulnerable adults. Five staff have attended training, further dates have been set for May and June 2007. The manager has put in a request to the training manager for United Response for further training for the management of challenging behaviour. All staff recieved specialised training in 2005. The restraints book seen, confirmed there have been no recorded incidents of restraint since the previous inspection in April 2006. Prior to this date there had been three occasions in 2005 where restraint had been used and one entry for March 2006. A full account of these incidents had been recorded. DS0000024402.V337082.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,30, People who use the service experience good quality outcomes in this area. The physical layout and design of the home enables people to live in a safe and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Harkstead Barn provides accommodation, which has been specifically designed, for the people who live there. The home is safe and accessible by all the men and meets their individual and collective needs in a comfortable, homely and friendly environment. A previous requirement was made for a schedule of maintenance and thorough cleaning of the home to ensure all parts of the home are reasonably decorated, maintained and clean. A tour of the home confirmed that the dining room, lounge, kitchen and corridors have been redecorated and a new shower has been installed. Investigation into a ‘fusty’ smell in one of the men’s bedrooms found a leak in the roof, which has been repaired however the ceiling still needs to be redecorated. Due to the length of time taken to resolve the problem the housing association has compensated the individual with some vouchers from a well-known high street store. DS0000024402.V337082.R01.S.doc Version 5.2 Page 20 Repairs have been made to the driveway by filing in the potholes and covering the whole drive with shingle. The men’s rooms are nicely decorated reflecting their individual personalities. Additionally there is a range of communal areas consisting of a lounge, dining room and kitchen/diner. The cushions covers on the armchairs and sofa in the lounge were coming off and need attention to replace or repair zip fasteners; also the carpet needs a thorough clean to remove tea stains. A comment received in a questionnaire was that “the lounge would improve with a bit more furniture and individual’s bedrooms would be improved with the provision of new curtains”. There are three bathrooms each with a bath, shower and toilet. The bathroom near to the manager’s office needs redecorating and the radiator is rusty. A new toilet has been fitted. There is a separate staff toilet. Orwell housing undertake a yearly inspection of the premises and hold quarterly Joint Advisory Group (JAG) meetings to discuss the maintenance and upkeep of the home. The manager provided the inspector with a copy of the minutes and an action plan from a recent inspection of the home, which identifies further work to be undertaken to redecorate parts of the home. This confirmed plans to complete the decoration to the ceiling and refurbishment of the bathroom and replacement flooring in the hallway outside the bathroom where water had leaked. A courtyard style garden is central to the house and day care facilities. This area is maintained by the men and the staff and provides a range of seating areas. There are ample parking facilities and additional gardens. The gardens are surrounded by fencing, which deters the men from leaving the home without the staffs knowledge. An area of the grounds has been sectioned off to relocate the allotment to develop and grow fresh vegetables. The home was found to be generally clean and tidy with no unpleasant odours. A previous requirement was made for the home to consider an alternative method of handling of soiled linen. A member of staff confirmed that they have changed the procedure for dealing with soiled linen. When attending to the personal care needs of an individual any soiled linen is placed in bins, which contain red alginate dissolvable bags. These are then taken to the laundry and placed directly into the washing machine and put through a sluice cycle minimising direct contact with the soiled items and the risk of spreading infection. A comment card received made reference to more care could be taken with the laundry of clothes. DS0000024402.V337082.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36, People who use the service experience good quality outcomes in this area. There is sufficient staff in the home who are trained and have the skills to support the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Harkstead Barn has a total of ten staff who work full and part time hours, plus three activities staff. Between them they provide 24-hour care based on the individual needs of the people living in the home. Observation and discussions with staff confirmed that they have a good understanding of needs of the men. The manager felt that the long standing staff team has helped to create stability in the service and created positive relationships between the men and staff. However, three staff have recently resigned and are moving on to further their careers. The manager is in the process of trying to recruit new staff, with minimal disruption to the lives of the people living in the home. DS0000024402.V337082.R01.S.doc Version 5.2 Page 22 United Response has developed a programme of mandatory training and specific training to meet the needs of the individual services. The manager produced a copy of the Leadership and Management Development Diary, which reflected a list of training events for April 2007 to March 2008. These included health and safety, protection of vulnerable adults, fire safety, moving and handling, medication, first aid, food hygiene, working with diversity and the way we work. All staff are expected to attend these training courses on a rolling programme to ensure they have the competencies, skills and experience to meet the needs of the people using the service. Other training specific to the individuals has consisted of Suffolk total communication, British Sign language (BSL), and health action planning and epilepsy awareness. Individual staff have the opportunity to attend ‘train the trainer’ courses so that they can cascade in house training within their service to staff, for example moving and handling of people. Additionally the manager has requested further three day training in challenging behaviour, which relates directly to the people at Harkstead Barn. Training certificates in staff files and information provided in the pre inspection questionnaire confirms that 50 of the staff has achieved a National Vocational Qualification (NVQ) 2 in care. New staff are provided with an employee induction and a training and development port folio. The induction pack covers the six core principles of the Skills for Care Common Induction standards. The new employee is required to attend two induction training days and further training to assist them to complete their induction workbook. The home has good recruitment practices in place. The files of three staff confirmed that all appropriate checks had been taken up prior to them commencing employment. United Response has a corporate agreement with the Commission for Social Care Inspection to maintain the original Criminal Records Bureau (CRB) disclosures at their head office. The manager contacted personnel who were able to confirm the details of the CRB’s for the staff. One of the men living in the home confirmed that they are involved in the recruitment process and their opinion is sought on the suitability of the potential employee. Staff files confirmed that supervision and performance and development appraisals are taking place, however these are not on a regular basis or in accordance with the National Minimum Standard (NMS) of six sessions a year. Staff spoken with confirmed that they felt there was sufficient staff on duty to meet the needs of the people living in the home and that they were supported to do their job and received regular training. One member of staff commented “ I am still really enthusiastic about my job, it is a really nice place to work”. DS0000024402.V337082.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42, People who use the service experience good quality outcomes in this area. They can be assured that the home is well managed by a competent manager and is run in their best interests. People can be assured that their health, safety and welfare is protected through robust safety checks, policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current manager has been in post since June 2002. They have a National Vocational Qualification (NVQ) level 4 in management and is currently working to achieve NVQ level 4 in health and social care. They demonstrated that they has a clear sense of direction for the service in line with United Response aims and objectives. DS0000024402.V337082.R01.S.doc Version 5.2 Page 24 Feedback provided in the comment cards received by the Commission for Social Care Inspection (CSCI) confirmed that the service is run in the best interests of the people living in the home. Comments included, “The home provides care for my relative and see to their needs the best they can, I cannot ask for anything more” and “The manager and staff work hard at what ever they are doing, we are very happy with the care” and “The standard is good and my relative appears to be very happy there, we find the management very approachable and staff work hard to obtain additional funds to ensure the people have a good standard of living and we appreciate everything they do”. The manager confirmed that a quality assurance exercise has been completed by the home. Relatives and other people associated with the home have been asked to complete questionnaires to seek their views of the service provided at Harkstead Barn. This information is currently being analysed and a copy of the outcomes of the survey will made available to people on request and a copy forwarded to the CSCI. People’s health, safety and welfare is protected by the home’s policies and procedures contained in the United Reponse ‘getting it right’ manual. The Pre Inspection questionaire confirms that these policies and procedures are being reviewed and updated on a reagular basis. The fire log book showed that the alarm system and fire fighting equipment had been serviced in December 2006 and that regular fire drills are taking place. Health and safety checks include vehicle checks and hot water temperatures. Tests are carried out weekly and records kept of adjustments and repairs. A six monthly test of the thermostatic water mixing valve outlets was undertaken in March 2007 where the valves were tested and adjusted. Temperatures in bathrooms and toilets were checked and found to be within the recommended temperature of near to 43 degrees centigrade. A certificate was seen to show that the home had had all their electrical portable appliances tested in February 2007 and an annual loft ladder inspection and maintenance completed in January 2007. The home undertakes three monthly hazard inspections identifying where there are areas of the home that need repair and maintenance to ensure the saftey of the people living in the home and staff. The last inspection was undertaken in April 2007, making recommendations that internal decoration was required to the corridors, lounge, kitchen and dining area. These have been completed. DS0000024402.V337082.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 2 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 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X X 3 X DS0000024402.V337082.R01.S.doc Version 5.2 Page 26 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 YA5 Regulation 5 (b) Requirement Each of the people using the service have a contract/individual agreement between them and United Response in place, however these contracts have not been reviewed or updated since 19951998 and do not reflect current fees. Care plans need to be developed with the individual, which focus on the individual’s strengths, personal preferences and changing needs. The reactive management plans need to explanation what the breakaway and restraint techniques are and how these techniques managed, recorded and reported. Timescale for action 15/06/07 2. YA6 15 (1) 15/06/07 3. YA6 15 15/06/07 DS0000024402.V337082.R01.S.doc Version 5.2 Page 27 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 YA36 Good Practice Recommendations Supervision sessions should be undertaken with a proper agenda providing an opportunity for staff to discuss their work role, any concerns they may have, future development and training needs. These sessions should be recorded and take place at least six times a year. DS0000024402.V337082.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. 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