CARE HOME ADULTS 18-65
Harkstead Barn Residential Home Brick Kiln Lane Harkstead Ipswich Suffolk IP9 1DF Lead Inspector
Helen Fontaine Unannounced Inspection 22nd November 2005 03:30
22/11/05 Harkstead Barn Residential Home DS0000024402.V268256.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 Harkstead Barn Residential Home DS0000024402.V268256.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. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Harkstead Barn Residential Home Address Brick Kiln Lane Harkstead Ipswich Suffolk IP9 1DF 01473 327380 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 Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th May 2005 Brief Description of the Service: Harkstead Barn offers accommodation and care for up to five adults with learning disabilities and challenging behaviour. The home was converted from farm buildings into residential accommodation in 1992 and is situated in a very 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 service users to have maximum space and freedom and offers spacious accommodation to a relatively small service user group. Orwell Housing Association owns the property but the business is run by United Response (Registered charity number 265429) who have many years experience in providing care for people with learning disabilities. The service user group had undergone little change since the home was opened and accommodates five young men at present. An additional resource, an activities centre, was completed in late 2003, and now provides activities for service users as part of planned day programmes of activities, or as/when required. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of Harkstead Barn took place over two and a half hours and was the second statutory inspection visit in the inspection year for 2005/6. Over the course of the two visits, all core standards have now been assessed. Two requirements and one recommendation were set at the previous inspection and the home has complied with all of the required action. No further requirements or recommendations were identified at this inspection. The manager was present during the inspection and their support was very much appreciated. A tour of the home and the kitchen was undertaken, most areas of the home were seen and a resident’s room with their permission was also seen. All the residents were spoken to during the tour and they were fully involved with the whole process. What the service does well: What has improved since the last inspection?
The previous inspection identified two Requirements Recommendation, all of these were all found to be met. and one The resident’s files were looked at and there is now a copy of the minutes of the decision from the most recent review. Not only were there the minutes, there was a summary of the last Person Centred Plan and the new schedule of daytime activities. The second Requirement around the visits of the provider
Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 6 under Regulation 26, now includes details of the records have been examined. It also now covers evidence of interviews with residents and staff. The home has taken on board the Recommendation of the last inspection report to consider including a section on reviewing the placement plan for each resident on its agenda for internal review. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 Admissions to the home are well planned and service users have an opportunity to visit and look at the facilities on offer. EVIDENCE: The inspector looked at the area around prospective service users moving into the home and the manager produced the home’s policy and procedure. No resident has moved into the home since 1996/1997 and therefore the home has not had to use these policies. The document seen under Section 3 headed assessment, documents that the manager will make contact with the individual within seven working days of the referral. The manager will have undertaken a full assessment before the person visits the home for the first time. The assessment will include all information and the Care Planning Approach meetings, if there has been one. Section 4 of the policy is around the introductory visits of the person concerned, to meet existing residents and staff. It states that prospective new Service Users to be offered the opportunity to visit meet existing Service Users and staff. The planned visits are then over night and can establish the compatibility between the proposed and existing residents. The policy states that each resident should receive an individual charter, which details what the proposed Service User can expect when they move into the home. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 9 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): 7 Service users have a comprehensive care plan and are assisted to access community health services. EVIDENCE: One of the resident’s of the home had recently had a Person Centred Plan and the inspector saw documentation around this process. The Person Centred Plan had been undertaken with those the resident had chosen and key people in their lives. The Person Centred Plan document was divided into columns; the first had who was present. The next column was where the service user is now and this documented that they are stuck too much at the day centre and not getting out. Next was documented that there needed to be more staff at the day time activity, increased joint working at the home to look at flexi staffing and to get a mobility car for the resident. There was then a full review of the resident and again documentation and conversation with the resident confirmed their full involvement in the process. The resident, said and the manager confirmed, how much they liked to go out and do activities. The new care plan reflected this with a plan that will include swimming, canoeing, conservation work in the local park, long walks and horse riding. All of this will be accessed through the employment of 2.1 staff, especially appointed for this
Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 10 resident. The manager said that these staff will be employed and paid for by the Local Authority and there is a possibility that some of the home’s part time staff might apply. The resident will be part of the interview of the staff and take part in the decision making process of who is appointed to the post. During this inspection a tour of the home was undertaken and a resident showed the inspector around the home with the manager. The resident showed the inspector the chart of household tasks the residents all undertake and the resident said that they did the hoovering. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 11 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): 17 Residents can expect a health and balanced diet, with a choice of foods in a setting that is suitable. EVIDENCE: During the inspection the home’s fridges and freezers were looked at and found to be well stocked with food. The home’s transport came back from shopping in Ipswich during the tour and residents had gone along to help out. One of the residents when asked said they very much like sausage and chips with peas and another resident said they liked chicken and vegetables. Both of these were on the menu that was displayed in the kitchen and on the evening of the inspection the residents were having Lasagne. The kitchen area was quite large, making it an area where the residents could take part in all the aspects of preparing the meal. The dining room was next door and all the meals are eaten in this area. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 12 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): 20 Residents are protected by the homes policies, procedures and practices around the issues of medication. EVIDENCE: Medication was looked at during the inspection and the manager said that none of the residents self medicated, as they all had high care needs. The medication is all kept in bubble packs and the medication sheets seen during the inspection had a photo of the resident and all the sheets were completed appropriately. The policies and procedures for the use of medication were looked at and on the front of the front of the sheet was a list of staff that could administer medication. The policy was then headed the promise, that the home where possible will encourage the self-administration of medication. The policy then had that staff should understand the purpose and the likely affects of medication and that all staff will receive training. The policy also stated that before any medical intervention is given the consent of the resident will be sought first. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 13 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 Residents are protected from abuse by the staff and can expect to be protected from self-harm and neglect. EVIDENCE: The home has the Local Authorities adult abuse procedure, the manager felt that all but one of the residents would have an understanding enough to say they had been abused. However the staff and the manager know the residents so well, that any change in behaviour or mood would be noticed and acted upon. One resident spoken to said that they would know if someone had been unkind to them and when asked what they would do, they said they would tell the staff. The manager was able to show the inspector the training and half of the staff had been on Adult Abuse training. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 14 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): 28 The communal facilities are of a high standard and service users are able to personalise their own bedroom. EVIDENCE: The home has been converted from a barn and was specially designed for the use of the residents, living in the home. Each of the residents has their own room, which is of a size that allows them to have their own possessions and space to use their room for private time. In the rooms are on two sides of the lounge, dining room, kitchen and entrance. There are two rooms on one side with the homes office and three the other sides, with a toilet and bathroom for each side. The lounge is very large with a high ceiling and very comfortable furniture, the space allowing residents to move around without getting under each other’s feet. There is then a door to the kitchen and another to the dining room. The dining room again is large and has a large table for the residents to eat their meals in the company of the staff. The kitchen as mentioned previously is large and open to the entrance lobby, allowing the staff and the residents to take part in all the kitchen activities. It was noted during the inspection, that the staff and the residents spend most of their time in the evening around the kitchen area.
Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 15 The other three bedrooms have the staff toilet; sleep in room and a laundry area. It was noted during the inspection that all the residents accessed all the areas of the home and joined the manager and the inspector in the office during the inspection of documents. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 16 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 and 36 Staff are competent and qualified to do their jobs and are supported and supervised. EVIDENCE: The home has a very stable workforce, which greatly benefits the residents of the home, as they know and understand their needs. The home is in the position of not having to use bank staff, as they have enough that work in other areas that can step in when needed. The manager has a large chart in the office of all the training for the staff and the manager showed this to the inspector. Training consisted of, challenging behaviour 1,2 and 3, as well as challenging behaviour refreshers. All the staff but two had been on medication training and all but one had done, first aid, food hygiene, health & safety, manual handling, epilepsy and prevention from harm. Five members of staff had done National Vocational Qualification two, one member of staff had done National Vocational Qualification four and two members of staff has done National Vocational Qualification three. There was also training that bad been booked for the newest member of staff and booked was, first aid, food hygiene and medication. One member of the staff is the home’s coordinator with Local Authorities total communications group and has a certificate for this. This member of staff
Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 17 gives talks to the other staff in the home at team meetings and signs for the residents to keep them informed of issues around communication. Staff files looked at showed that all the member of staff had supervision and the manager was also able to produce a supervision chart. The manager said that they did not have a deputy manager and up to the present they had to undertake all the supervision. This has resulted in the past to staff not receiving the supervision as regularly as the manager would have liked, but the staff are well supported and the manager felt they would come for support if they needed it. However two seniors have now had supervision training and they are now starting to give regular supervision, which is greatly supporting the manager. The manager was asked about their supervision and support and they said they receive regular supervision and felt very well supported. Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 18 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): 42 People who use this service can expect to live in a home that is well managed with policies and procedures that protect their health and safety. EVIDENCE: During the tour of the building there was nothing that was seen as not meeting the National Minimum Standards. No fire doors were wedged open, the weekly water temperatures were seen and these were in the homes diary, to remind staff when they needed doing. The weekly chart showed that each of the resident’s basins in their rooms was at 40ºC, the showers at 38ºC and 39ºC for the other water facilities. The home had a mini bus and there was a chart of areas to check and as an example one of the areas to check each month was the coolant levels. The home had a document that noted the checks on the fuse box and electrics, the last fire drill was on the 29th October 05 and the last night time fire drill was this time last year. All of the maintenance side of the home was kept in a folder of their own, with dates in the homes diary for checks and when certificates needed renewing.
Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 19 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 X X X 3 X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X 2 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X X X 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Harkstead Barn Residential Home Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000024402.V268256.R01.S.doc Version 5.0 Page 20 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Harkstead Barn Residential Home DS0000024402.V268256.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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