Inspection on 28/04/06 for Harkstead Barn Residential Home

This inspection was carried out on 28th April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harkstead Barn Residential Home 19/04/07

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 Seddon Unannounced Inspection 28th April and 4th May 2006 10:00 Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 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.V290940.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 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. The home has a detailed statement of purpose and service users guide providing information for prospective service users issued on request. Each service user has a contract; these are in the process of being reviewed and fees renegotiated with Suffolk Social Care services. The fees range from £798.06 to £1129.06 per week. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The first day of the inspection was unannounced. The manager was attending training on the 28th April and was not present for the inspection, therefore the inspector was unable to access staff files and arranged with the manager to continue the inspection on the 4th May. 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 the home’s statement of purpose and other documents required under the Care Homes Regulations. These documents were previously supplied to the Commission for Social Care Inspection (CSCI) by the home. Additionally a number of records held at the home were looked at including those relating to service users, staff, training, the service user guide and policies and procedures. Time was spent with all five service users, the manager, three staff, one agency and a relative. What the service does well: What has improved since the last inspection? What they could do better: Some of the décor in the home is looking a little tired and worn requiring some decoration and maintenance. Parts of the home could do with additional cleaning for example; the carpet in the lounge is dirty and stained in places. Staff supervision and appraisals need to happen on a more regular basis. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 6 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.V290940.R01.S.doc Version 5.1 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.V290940.R01.S.doc Version 5.1 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): 1,2,3,4,5, Should the situation arise where there is a vacancy, United Response has a detailed process in place for prospective service users to move into the home. Existing service users can expect to be consulted on who moves into their home. EVIDENCE: The home has a corporate statement of purpose provided by United Response, with additional information directly related to Harkstead Barn. A leaflet called ‘Support for people with learning difficulties in Suffolk’ produced specifically for Harkstead Barn provides service users with information about the service as required in the service users guide. There is an established service user group living at the home therefore there have been no new admissions to the service for a long time. 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 service user admissions to the home. The manager described the process, which involved informing social services they had a vacancy. Once a prospective candidate had been found a full assessment of their needs with a multi disciplinary team would take place. Following this a short planned visit would be arranged for the service user to visit the home and meet the other service users. 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. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 9 Each of the service users has a contract/individual agreement between them and United Response. All contracts had not been reviewed or updated since 1995-1998 and did not reflect current fees. Evidence was seen in the service users care plans that their had been recent correspondence from Suffolk County Council sponsoring authority with regards to service users current rate of top up fees. The manager contacted the fees department and area manager who confirmed that the current fees ranged from £797.71 to £798.06 per week, plus individual top up fees of £331 for four of the five service users. United response is in the process of renegotiating service users individual fees. The manager informed the inspector that the contracts are in the process of being updated and will be completed in a format and language that service users will be able to understand. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10, Service users can expect to have detailed plans identifying the level of support they need and be fully consulted on all aspects of their lives using appropriate means of communication. EVIDENCE: The home has full and comprehensive care plans and personal files in place, which cover all areas of the service users lives. The care plans of two service users were tracked during the inspection. The care plans were divided into sections identifying the level and support service users needed to achieve their daily routines, intimate and personal support plan, medical profile, communication summary, and ‘my behaviour guidelines’ giving details for staff of the steps to take. These had been written and agreed with the service user. Evidence was seen that care plans are developed using the person centred planning approach. Two independent person centred planners linked to the health authority had been involved in the implementation of one service users care plan resulting in a plan that identified their long and short term goals. Through observation and talking to staff these objectives were being implemented. A package had been negotiated with Social Services for funding for two care staff to be employed to meet the service users day care needs. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 11 The service user attends a day centre in Ipswich, where the new day care arrangements have been implemented. They were involved in the recruitment of two staff to share their day care hours from Monday to Friday. The service user has 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. Care plans have been developed using formats that are understandable by the service users, with symbols, pictures and words. One service user has a hearing impairment and their care plan has been formatted with pictures and signs for them to read. All staff are learning British Sign Language (BSL) to ensure that they are able to fully communicate with the service users. Staff have received help and support from the speech and language therapists to support other service users communication needs. One service user with limited speech uses objects of reference as a means of communicating, for example the service user is shown the coffee and tea containers so that they can choose which drink they prefer. Service users are supported to manage their own finances wherever possible. United Response is corporate appointees for each of the service users. The manager, deputy and acting deputy are all signatories for the service users bank accounts. The service users are encouraged to be present when making withdrawals. The manager is responsible for managing service users benefits and ensures these are paid into the service users account. The home keeps a cash float for the service users, each have a separate money tin locked in the safe. Each service user has a ledger with a record of all transactions of cash purchases and withdrawals from the bank. The ledgers and balance of two service users were checked and found to be accurate. Information relating to service users is held in the office, which is kept locked when not in use. Service users have access to their files with the support of staff and their designated key worker’s. Although the care plans are very detailed they hold a lot of old information, which means sifting through the plan to ascertain their current needs. The manager told the inspector that they are in the process of sorting through and archiving old information. In addition to the care plan each service user has a pen picture with a current photograph and a positive interaction record of current support issues. The manager explained this is used for new staff and agency to obtain a brief overview of the service users needs. These folders contain risk assessments relating to the individual for daily activities, for example, using transport to and from the home and accessing healthcare appointments. Evidence was seen that these are very detailed, current and being reviewed on a regular basis as the needs of the service users change. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 12 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): 11,12,13,14,15,16,17,18, Service users can expect that they will have their rights respected and 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. EVIDENCE: Service users are encouraged to undertake practical life skills. The inspector was invited to join two of the service users having lunch and observed one of the service users clearing away the plates and cups following lunch. Each service user has objectives in their care plans of tasks they need to do to contribute to the day to day running of the home and the level of support and encouragement to achieve the task. The home has it’s own allotment, providing fresh vegetables for the home. Service users and staff maintain the allotment. The inspector saw a photograph of the allotment, which is a well-kept plot with a shed and table and chairs so that service users and staff can have picnics. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 13 Service users attend a variety of day care services. One service user has a work related day service placement at a unit called ‘Growing places’. The unit grows and sells vegetables and fruit. The service user attends Monday through to Friday helping to dig, plant and sell the produce. Two of the service users had their day funding stopped a few years ago, however the home negotiated funding for the service users to attend a day care service set up on the premises at Harkstead Barn. This service was opened as an additional resource in 2003, and now provides activities for these two service users Monday to Friday. A separate staff team is employed to facilitate the day care and offers the service users daily programmes of planned activities. One of the day service staff told the inspector that regular activities include swimming, ten pin bowling, walking, going out for meals, going to the cinema, clothes and food shopping, using the computer and the play station. The day service has musical equipment, one service user was observed playing the drums, a tambourine and triangle. The day service is also used by the other service users evenings and at weekends to play pool, table tennis and table football as well as listening to music. The day service is run completely on money obtained by fund raising. A relative spoken with during the inspection runs a community organisation arranging events to fund the day service. These events include Bingo sessions, which are held in the village hall and attended by some of the service users. Other events have included fetes and a valentine dance. All service users have regular contact with their families. A relative told the inspector they are kept fully involved in the care of their sibling. The service user has their own vehicle and their relative uses this to take them home every weekend. They have funding arranged to have staff support either side of the weekend to enable the service user to access the community, to go shopping and to places of inertest, most recently to Abbey Gardens in Bury St Edmunds. The service user, their relative and the activities staff were preparing to go shopping the afternoon of the inspection. Each of the service users has a week’s holiday contracted into their fees. The relative spoke of accompanying their sibling on holiday last year to Devon. The relative was in addition to two staff. The manager has a budget for service users holidays if there is money left over from each service user’s holiday it is pooled and additional weekends or days out are arranged for all the service users. Service users take part in choosing the menus; these are discussed at the beginning of the week. A member of staff has designated responsibility for the menus to ensure service users have healthy balanced diets. The menu for the week of the inspection was seen. A range of meals included roast chicken and vegetables; lamb chops with vegetables, scotch egg salad, tuna and sweet corn in jacket potatoes, oven fish and chips and shepherds pie or spaghetti bolognaise or chilli. All service users had packed lunches to allow spontaneity depending on the weather for outing and picnics. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 14 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, 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. Service users are protected by the home’s procedure for administering medication. EVIDENCE: Each service user has an intimate and personal support plan, which identifies what they can do to meet their own personal care needs. The plan describes the level of support they need to achieve this, which can be either physical help, encouragement, observation or prompting. The plans are written in consultation with the service user and in the first person, for example “I need help with…”. These plans are supported by the service user’s daily routine plans which identify their routines for morning, evening, night and weekends, detailing the preferred times the service user wishes to get up and go to bed. Evidence was seen in the service users care plans that they are supported to access routine healthcare appointments, such as the dentist, doctors and other specialist healthcare providers. Medication profiles identify current medication, conditions, allergies, a record of vaccinations and a monthly record of the service users weight. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 15 The profiles reflect specific health related issues, for example one service user if stung by a bee or wasp is likely to suffer an anaphylactic shock. The plan gave details of the steps staff should take to reduce the risk of this happening. The plan was supported by a detailed risk assessment. Due to the high and complex needs of the service users none of them self medicate. The medication is kept in blister packs locked in the office. 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. The front of each medication administration record (MAR) chart had a photograph of the service user for identification and all the MAR charts checked were signed and dated appropriately. At the front of the MAR charts folder was a copy of the homes policies and procedures for administering medication. A list of staff and their signatures were recorded reflecting who was authorised to administer medication. The policy covered the arrangements for the safe ordering and returns of unused or soiled medication. The policy also stated that before any medical intervention is given the consent of the resident will be sought first. Evidence was seen in the care plan of one resident where a consultation meeting had taken place to support them to attend a hospital appointment. The home has policies and procedures for dealing with death and bereavement. Evidence was seen that one service user and their relatives had taken out a pre paid funeral agreement plan with the funeral planning authority, which clearly stated their wishes in the event of their death. The manager informed the inspector they had arranged for a solicitor specialising in drawing up Wills for people with learning disabilities to visit the home to speak with service users and their families, should they wish to make a will. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 16 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): Service users can expect to have their views listened to and to be supported to express their views about the home, including any complaints. Service users are supported and protected from abuse, neglect and self-harm by the homes policies and procedures, however staff need up to date training. EVIDENCE: The home has a detailed complaints procedure developed by United Response included in the statement of purpose. Additionally each service user’s care plan has a copy of the complaints procedure in a format incorporating symbols and pictures to guide them should they wish to make a complaint. However the contact details were incorrect directing complainants to previous inspectors and the National Care Standards Commission (NCSC) these need updating to read the Commission for Social Care Inspection (CSCI) including the address of the Suffolk area office. The complaints log was seen. There has been one complaint about the home, which was made in July 2005. Details of the complaint were forwarded to the Commision for Social Care Inspection (CSCI). The complaint was fully investigated by the manager, which was unresolved due to a lack of information provided by the complainaint. There have been no further allegations made to substantaite the complaint. At the back of the complaints compliments had been made manager. A relative had written for the hard work and forward hospital visit. Harkstead Barn Residential Home log was a section for compliments. Several by relatives and a United Response area conveying their deep appreacation and thanks planning to support their relative to attend a DS0000024402.V290940.R01.S.doc Version 5.1 Page 17 Policies and procedures are in place to protect the service users from neglect and absue. United Response has a detailed policy in the ‘getting it right’ manual for the prevention of harm, which identifies the actions staff should take if an incident of abuse is discovered or reported to them. This includes details of the whistleblowing procedure. The policy gives details of persons to be contacted of any concerns or allegations of neglect or abuse, which include the Commission for Social Care Inspection (CSCI) and Customer first in line with the Suffolk inter agency policy for the protection of vulnerable adults. The training matrix reflected that three staff had not taken part in prevention of harm training, two staff had attended training in 2005, other staff had attended training in 2003/4. The manager informed the inspector that the area manger for United Response has recently attended a train the trainer course for protection of vulnerable adults and will be delivering training in house. The manager had attended a piolot training session, further training sessions for all staff are to be fitted into the homes training programme. All staff attended a three day training course understanding challenging behaviour in 2005. The manager has arranged for the company to deliver a fourth day of training scheduled for June 2006. The manager has discussed a package with the trainer who is currently developing a programme specific to the needs of the service users at Harkstead Barn. Physical and verbal aggression by service users is well managed by the home. Evidence of this was seen during the inspection. Individual behavioural mangement plans were in place with clear guidelines for the steps staff should take if the service user became physically or verbally aggressive, causing concern for the safety of the other service users. These plans had been implemented with the service users agreement and consent. The plans referred to restaint of the service user only in extreme circumstances. The restraints book was seen, which reflected three occasions in 2005 where restraint had been used and one entry for March 2006. Evidence was seen that staff had used techniques in line with training and the service users plan. A full description of the occasion had been recorded, signed and dated by the staff involved, including follow up support given to re-assure the service user. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30, Service users can expect to live in a home that meets their individual and collective needs in a safe and homely atmosphere, however some areas of the home could do with redecoration and thorough cleaning. EVIDENCE: Harkstead Barn was purpose built converted from farm buildings into residential accommodation in 1992. It is owned by Orwell Housing Association but run by United Response. The barns are 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. The home has it’s own minibus and two of the service users have their own cars to enable them to access the community. The inspector made a tour of the building and grounds. Each of the service users has their own room fitted with a wash hand basin and windows with views out into the garden. The rooms were nicely decorated reflecting the service users personalities with personal items and furniture. Additionally there is a range of communal areas accessible to all service users consisting of a lounge, dining room and kitchen/diner. Three bathrooms are shared between the five service users each with a bath, shower and toilet. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 19 There is a separate staff toilet. The home is safe and accessible for all the service users meeting their individual and collective needs in a comfortable, homely and friendly environment, however some areas of the home were beginning to look a little tired and in need of redecoration and maintenance. One bathroom shared between two service users had paint peeling off the walls and around the base of the toilet. The radiator was rusting. The manager informed the inspector this room was in the process of being decorated. In one service users bedroom the curtains were hanging down with missing hooks and a rug was worn and frayed, creating a potential tripping hazard. In another service users bedroom the wardrobe had a door missing. The lounge carpet and chair covers were looking stained and dirty. One of the service users rooms although clean and tidy had a smell that indicated poor incontinence management and another service user’s room had a musty smell, which the inspector was informed, is being investigated. The manager showed the inspector a programme of maintenance scheduled for June 2005 to 2006, which reflected that some decorating had taken place. The home has a courtyard style garden, which has been well maintained by the service users and the staff providing a range of seating areas. There are ample parking facilities and additional gardens. The gardens are surrounded by fencing, with a lockable gate, which deters vulnerable service users from leaving the home without the staffs knowledge. The inspector was shown an area of the grounds, which has been sectioned off to create an additional garden area for the service users. The home is in the process of applying for a grant to fund this development. Each service user will be given a section of the garden to develop as they choose. The service users living at the home are physically able to move around the home without the need of aids and equipment, however to meet the needs of the service user with a hearing impairment and those with limited communication skills the home has developed a safe system for alerting service users to fire. Around the home there are flashing lights as well as audible alarm bells that raise the alarm in the event of a fire. For safe evacuation the home have produced procedures in picture and symbol formats to support written procedures guiding service users to fire exits. The home has a laundry situated to the side of the building with a door that opens into the garden. Evidence was seen that the home had good systems in place for dealing with the service users laundry, however some consideration must be given to the handling of soiled linen to reduce the possible spread of infection. Any soiled linen is placed in bins when dealing with the service users personal care in their room or bathroom and then taken to the laundry where it is transferred into a second bin with other soiled linen. This is then transferred to the washing machine and put through a sluice cycle. A discussion was held with the manager about soiled linen being placed directly in to a red alginate dissolvable bag, which is placed directly into the washing machine. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 20 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): 31,32,33,34,35,36. Service users can expect to be supported by a staff team that provides continuity and stability in their lives and that the staff are trained and available in sufficient numbers to meet their needs. EVIDENCE: Harkstead Barn provides 24-hour care on a roster basis. The roster was seen and it was difficult to work out who was actually on duty. The roster did not have the full names and designation of the staff or a clear reflection of who was in charge of the home in the absence of the manager. This was discussed with a senior member of staff on the first day of the inspection. When the inspector returned on the 4th May a new roster had been implemented to reflect these requirements. The inspector was showed a separate roster for the activities staff as these hours are worked out on a separate budget. The home has 10 full and part time staff, plus the 3 activities staff. The manager has developed a system where they calculate staff’s hours and allocate shifts accordingly to meet the needs of the service users. The home uses agency on occasions to cover staff sickness and holidays. An agency staff working in the activities was spoken with and told the inspector this was only their sixth shift at the home. They had experience of working with adults with learning difficulties and had been given information and support to meet the needs of the service users at the home. A relative spoken with confirmed that agency is not used on a regular basis. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 21 Service users benefit from an experienced and stable workforce, which has changed little since the home opened. Observation and discussions with staff during the course of the inspection reflects that the staff know and understand the service users needs well. The manager felt that the stability of the team has helped service users build up confidence in them and creates a positive relationship between the service users and the staff. Harkstead Barn recognises the importance of training and staff development. They have a programme of statutory training and specific training to meet the needs of the service users. A training course list for April 2006 to March 2007 was shown to the inspector, which showed a rolling programme of courses, and dates, which included health and safety, fire safety, moving and handling, medication, first aid and food hygiene. Additionally the manager has arranged for specific training in challenging behaviour, which relates directly to the service users at Harkstead Barn. Staff receive job coaching and direct support from suitable trained staff in understanding how each service user likes to be supported. For example, a member of staff recently qualified to be the communications co-ordinator has responsibility for overseeing and implementing training to meet the communication needs of the service users. Staff files seen showed that training is taking place and dates had been entered on the roster and in the diary of forthcoming training, which included first aid, food hygiene, medication and health and safety. The manager attended training with United Response for equality and diversity. This is a course that is being piloted and introduced to the rolling programme of training. All staff will be scheduled to attend. The manager informed the inspector that two staff had nearly completed their NVQ level 2, three staff have just enrolled on level 2, two staff hold level 3 promoting independence and the manager is currently undertaking level 4 health and social care. Two staff have completed their D32/33 NVQ Assessor awards. The files of two staff were seen all appropriate checks had been taken up prior to them commencing employment. However, there was little evidence to suggest that supervision and performance and development appraisals are taking place on a regular basis. This was discussed with the manager who informed the inspector that their deputy manager had been seconded and then on a period of sick leave and agreed that as a result supervision had not taken place as often as it should, however staff spoken with felt they were well supported by the manager. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 22 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, People living in the home can be assured that the home is well managed and run in their best interests. The home’s policies, procedures and regular safety checks protect the service users health, safety and welfare. Service users are encouraged to take calculated risks as part of maximising their independence. EVIDENCE: The current manager has been in post since June 2002. They have a National Vocational Qualification (NVQ) level 4 in management and are working towards completion of their NVQ level 4 in health and social care. They have eight years experience of working with United Response and previous experience of working with people with learning disabilities. The manager demonstrated that they had a clear sense of direction for the service and had worked hard to obtain additional funding to enhance the lives of the service users. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 23 Evidence was seen that the manager facilitates regular staff meetings, the minutes for the last meeting were seen for January 2006 which confirmed that issues of the day to day running of the home, service user issues, fund raising events, medication and health and safety issues were discussed. A discussion took place with the manager about the systems for quality assurance monitoring and seeking the views of people connected to the service to measure how the home meets its objectives. The manager and inspector discussed the process of quality assurance and providing questionnaires to seek the views of service users, their relatives, social workers and health professionals. The manager showed the inspector a survey, which was last sent out in 2003 to relatives and service users. They will update these and re-issue to all relative persons connected to the service users and collate the feedback to provide an audit of the service. They assured the inspector they would publish the document making it available to service users and their relatives and forward a copy of the audit to the Commission for Social Care Inspection (CSCI). The area manager for United Response visits the home on a monthly basis and sends a copy of their report to CSCI. A requirement was made at the inspection in May 2005 for these reports to include what records were examined and evidence that that they spent time with service users, relatives and staff to obtain an opinion of the standard of care being provided at the home. These reports have been amended to reflect this, giving more detail of how the home is meeting the standards. Evidence gathered from these reports prior to today’s inspection referred to all risk assessments being updated as an ongoiong process and in line with risk adversion. The inspector spoke with the manager to clarify this process. The manager explained that United Response has their own health and safety manager who audits the individual services. As a result of their audit they found that homes are producing far to many risk assessments with the adverse affect of discouraging people from taking appropraite risks. Although reducing the number of written risk assessments staff are ensuring that they discuss with service users minor risks in day to day activities. The home is well managed and service users health, safety and welfare is protected by the home’s policies and procedures. manual. A selection of these were looked at in the the United Reponse ‘getting it right’ manual covering prevention of harm and missing persons. The risk management manual was seen providing evidence that there are systems in place for testing fire fighting equipment and alarm systems, management of infection control and the management of food hygiene relating to the Hazard Analysis of Critical Control Points (HACCP). Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 24 The fire log book showed that the alarm system had been serviced in December 2005 and the fire fighting equipment had been serviced in January 2006. Regular fire drills were taking place. There was also evidence that the hot water temperatures were being tested and recorded daily for all basins and bathrooms and temperatures were within the recommended temperature between 38.2 and 43.3 degrees centigrade. A certificate was seen to show that the home had had all their electrical portable appliances tested in March 2006 and an annual loft ladder inspection and maintenance completed in January 2006. The home undertakes monthly hazard inspections identifying where there are areas of the home that need repair and maintenance to ensure the saftey of the service users. The last inspection was undertaken in March 2006, with recommendations to replace a glass panel in the kitchen and a light fitting in one of the service users bathrooms. These had been completed. The registration certificate was displayed in the entrance hall; both parts were shown and had the correct information. The home’s insurance policy also on display expires in March 2007. The health and safety law poster was seen on display in the staff office. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 3 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 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 X 3 3 Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA22 Regulation 22 (7) Requirement The complaints policy in service users care plans refers to the National Commission for Social Care (NCSC) and must reflect the correct name, address and contact number of the Commission for Social Care Inspection (CSCI). All staff must receive adult protection training and guidance on the procedure for referring allegations of abuse. A schedule of maintenance and thorough cleaning must be in place to ensure all parts of the home are reasonably decorated appropriately maintained and clean. A safe system of dealing with soiled laundry must be introduced to minimise staff contact with soiled items and the potential to spread infection Timescale for action 30/06/06 2. YA23 13 (6) 31/08/06 3. YA24 23 (d) 31/08/06 4. YA30 13 (3) 30/06/06 Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 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. Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 28 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 © 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 Harkstead Barn Residential Home DS0000024402.V290940.R01.S.doc Version 5.1 Page 29 - 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!