CARE HOME ADULTS 18-65
Hft - Falstaff House 12 Victoria Road Bidford On Avon Warwickshire B50 4AS Lead Inspector
Catherine Mundy Unannounced 26 August 2005 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 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 Stationary 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. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hft - Falstaff House Address 12 Victoria Road Bidford On Avon Warwickshire B50 4AS 01789 490526 01789 772790 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Home Farm Trust Mrs Carolyn Margaret Manktelow Care Home 8 Category(ies) of Learning Disability (8) registration, with number of places Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 30 November 2004 Brief Description of the Service: Falstaff House is situated in Bidford On Avon. It is part of the Home Farm Trust group, which owns 14 homes nationwide and provides a day service separate but close to this home. People who live here usually attend HFT day services. It is a large traditional, detached property with a large, wellmaintained garden. People who live here receive personal care, 24-hour supervision and accommodation. The home can accommodate 8 people in 2 ground floor and 6 upper floor single bedrooms. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th August 2005 between the hours of 7.50am and 2.30pm. During this time the inspector had the opportunity to meet all of the residents residing in the home, examine care plans and other documents relevant to the running of the home, tour the premises and observe the interactions between the residents and staff and their environment. Three members of care staff were on duty, and participated fully with the inspection. The Registered Manager was not present during this inspection. What the service does well: What has improved since the last inspection?
Of the ten requirements made at the last inspection, four have been met in full and two are part met. Since the last inspection the home has updated the residents contracts to reflect more fully the terms and conditions of residency within the home. The kitchen has been refurbished, new work surfaces, and cabinets have been provided. The staff advised that most of the staff have been provided with training in food hygiene, the remaining staff are to receive this training on 20th September 2005. A certificate confirming the safety of the gas boiler and central heating has been provided.
Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 6 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.
Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4 and 5 Prospective residents are not provided with sufficient information to enable them to make an informed decision as to whether to accept a placement in the home. The home cannot demonstrate that the residents needs and aspirations can be met. EVIDENCE: The home has produced a Statement of Purpose and Service Users Guide to the home. Contracts detailing terms and conditions of residency are also available. These documents have been examined at previous inspections, where it was identified that they are acceptable. Examination of the file relating to a resident who had moved into the home, four weeks prior to the inspection, provided no evidence that the Statement of Purpose, Service Users Guide or contract had been provided to her. The staff member seemed unsure as to when or if the documents had been provided, but thought that they would most likely be provided once the resident had made a final decision to move in to the home at the three month review of the placement. The residents file contained a full and detailed assessment of need completed by a social worker employed by the organisation. There is evidence in the file that the residents own social worker and community nurse have been involved in collating this information.
Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 9 There is no evidence that the home has completed its own assessment as to whether the residents identified needs can be met. Care plans detailing how the needs, identified in the organisations assessment, are to be met were not available. There is no evidence that referrals to the relevant professionals, as detailed in the needs assessment, have been made. There is evidence that the resident was invited to visit the home prior to making a decision to move in. This included visits for the day, overnight stays and a weeks trail. There is also evidence that the other residents were consulted as to whether they wanted this resident to move in. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 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 standard(s) 6, 9 and 10 The residents care plans do not detail sufficient information to enable the staff to meet the residents identified needs effectively. Personal information relating to the residents care needs is not always stored securely in the home. The residents cannot be sure that their confidentiality is maintained. EVIDENCE: A sample of two residents files were examined. As detailed earlier in the report a comprehensive plan of care has not been provided for the resident who has most recently moved into the home. The staff stated that the home was in the process of collating information relating to the residents in order that a plan of care can be devised. There is evidence that this process is being completed, however as noted earlier the resident does not have a plan of care which addresses the needs identified in the organisations assessment of need. The other residents have been provided with a plan of care which has been devised in conjunction with the adult reviewing team. These are subject to regular review.
Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 11 The care plan provided for one resident following a review on 15th March 2005, states that with regard to the residents epilepsy, ‘there is a need to identify and minimise risk of harm’ and to ‘address seizures and seizure behaviour’. Risk assessments and risk management strategies relating to this were not available in the residents file. Behaviour management guidelines were also not available. Risk assessments that were available were generic and included the use of the kitchen, damage to clothing whilst using the laundry and strangers entering the home. Information relating to the residents is stored securely within the home. This is with the exception of guidance relating to individual residents, provided by the speech and language therapist, which is prominently displayed on the notice board in the kitchen. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 16 and 17 The residents are supported to choose from a broad range of valued and fulfilling activities which they enjoy. The meals provided by the home reflect the residents choice and provide a varied and balanced diet, however it is of concern that the special dietary needs of one resident are not being met. EVIDENCE: All of the residents attend a structured day placement on weekdays. This is provided by Home Farm Trust at the near by Arden Vale site. Some of the residents access this placement on a part time basis. Daytime activities are provided in the home on the days that the residents do not attend the centre. An activity timetable is displayed in the residents bedrooms, this is provided in a format that is more accessible to the residents. Activity records seen, discussions with staff and observations of the facilities available in the home confirm that the residents continue to participate in abroad range of valued and fulfilling activities which they enjoy, both in and out of the home.
Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 13 The residents are supported to make choices regarding their everyday lives. Observations of the interactions between staff and residents confirmed that the staff use appropriate means of ascertaining the residents wishes, using a variety of communication aids and techniques. The staff respected the choices made by the residents, during this inspection. The residents are also supported to make broader decisions regarding the running of the home. These include décor of the home and purchasing of garden furniture. The residents opinions were sought, through the residents meeting, as to whether new residents should move in to the home. The menu plans available in the home reflected that the residents have a varied and balanced diet. Food stocks within the home confirmed that the home use fresh produce to prepare ‘home cooked’ meals. The staff confirmed that the residents are involved in planning the homes menus, pictorial aids are available to support this activity. It is also confirmed that an alternative meal is provided at the residents request. Observations of the interactions between the staff and residents at breakfast and lunchtime confirmed that the residents are supported to make choices regarding their meals and drinks. The residents preferences and dietary requirements are recorded in their individual files. It is detailed in the needs assessment of one resident that a referral to a dietician is required. There is no evidence that this referral has been made. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 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 standard(s) 18, 19 and 20 Personal support is provided in a sensitive manner which promotes the residents privacy, dignity and independence. This is enhanced by the positive relationships that are evident between the residents and staff. The health needs of most of the residents are met with evidence of multidisciplinary working taking place on a regular basis. The system in place for the management of the residents medications are good, with clear arrangements in place to ensure the residents medication needs are met. EVIDENCE: The residents preferred daily routine is detailed in the residents plans of care. This is provided in a pictorial format. Observations of the interactions between the staff and residents confirmed that the residents are supported in a manner which enables the residents to make decisions, promotes their independence and respects their privacy. The residents health care needs are met with the support of the relevant healthcare professional. Records are retained of any medical contact and of the outcome for the resident. As noted earlier in the report referrals to the relevant health care professional have not been made for the resident who has most recently moved into the home.
Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 15 On the day of the inspection the staff supported one resident to attend the GP surgery for routine screening. The staff supported this resident in a manner which reduced the residents anxiety and enabled a positive outcome for the resident to be achieved. The residents needs are such that the responsibility for the management of medication is retained by the home. Discussions with the staff and examination of the storage arrangements and records relating to medication administration confirms that the home continues to adopt good practices. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 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 standard(s) 22 and 13 The residents are supported to make complaints or raise concerns and there is evidence that the views expressed are listened to and acted upon. The home takes appropriate action to protect the residents from abuse. EVIDENCE: The staff confirmed in discussion that in the event of a complaint being made appropriate action would be taken. It is advised by the staff that there have been no complaints made since the time of the last inspection. This could not be verified as a complaints log was not available in the home. The staff stated that a form is completed detailing the nature of the complaint, it is passed to the manager who in turn passes the details on to the main office at the Arden Vale site. The home keeps a log of any comments that have been made by the residents, this also details any positive comments made regarding the home. The residents are provided with several forums in which to air their views, the home operates a key worker system, and facilitates residents meetings on a regular basis. One resident has a befriender and others have family to support them. All of the residents spend time away from the home and have other professionals involved in the provision of their care. The complaints form is provided in a format that is more accessible to the residents. The staff confirmed in discussion that appropriate action would be taken in the event of suspected abuse. The financial records relating to a sample of residents were examined. These confirmed that the residents monies are managed appropriately. Receipts are retained to confirm any expenditure.
Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 17 A requirement was made, at the previous inspection, to provide the Commission with full details of the most recent arrangements for an independent audit of the finances of the residents for whom a representative of the organisation acts as an appointee. The action plan provided by the home confirmed that financial audits has take place annually in March. Further details were not provided. Evidence that this audit had taken place was not available during the inspection. Staff stated that they believed that this information would be retained in the office at the Arden Vale site. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 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 standard(s) 24 Whilst the home has taken action to provide a comfortable and homely environment, further action is required in order to ensure the safety of the residents and staff. EVIDENCE: A tour of the home confirmed that the residents live in a clean, comfortable and homely environment. The home has been decorated and furnished to reflect the residents needs and personal preferences. The staff stated that there is a plan in place to enhance this further with the provision of redecoration throughout the home and refurbishment of the bathroom. To improve access to the home ramps and rails are to be provided. The requirement to refurbish the kitchen, made at the last inspection, has been met. Some of the residents bedroom doors and the door to one of the lounges were propped open with door wedges. These are fire doors. This practice compromises the safety of the residents and staff in the event of a fire. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: The standards within this section were not inspected during this inspection. Other than to note that the requirement made at the last inspection to provide all staff with food hygiene training is part met. The staff advised the inspector that the remaining staff members who had not received this training are to undertake this training on 20th September 2005. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The home does not take sufficient action to promote and maintain the health and safety of the residents and staff. EVIDENCE: There are insufficient rubbish bins. Rubbish could not be stored appropriately. In addition to this being unsightly, this may after a period of time emit a foul odour and present an increased risk of infestation. Food is stored in a room off the main kitchen. This room also has an external door, this is used by the staff and residents to access the garden and laundry area and to dispose of rubbish. The exterior door was left open throughout this inspection. Some of the food items were not stored in sealed containers. Action was taken by the staff to address this during the inspection. Food storage temperatures are recorded daily. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 21 Records available confirmed that the home completed regular monitoring of fire safety equipment, including alarms, extinguishers, escape routes and emergency lighting. A fire safety risk assessment is available, this was last reviewed in January 2004. As noted previously in the report some of the homes fire doors are propped open, compromising the safety of the residents and staff in the event of a fire. Portable electrical appliances are safety checked (PAT testing). This check was last completed in August 2002. A requirement has been made at the previous two inspections of the home to ensure a safety check of electrical wiring is completed. At the last inspection the home was required to advise the commission of the date of the check and of the outcome. This information has not been provided and was not available in the home at the time of this inspection Water temperatures are tested weekly. Thermostatic controls are not fitted to the taps. Provision of these would reduce the risk of scalding. Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 22 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 2 3 2 3 2 Standard No 22 23
ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 2 2
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 3 3 x x x 3 3 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hft - Falstaff House Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 1 x E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1, 5 Regulation 4 5 Requirement All residents are to be provided with a copy of the Statement of Purpose, Service Users Guide and a contract, detailing terms and conditions of residency. The Registered Manager must complete her own assessment, as to whether the identified needs of a prospective resident can be met, prior to offering a placement in the home. The Registered Manager must ensure that all residents are provided with a detailed plan of care which meets their identified needs. The Registered Manager must ensure that referrals are made to relevant healthcare professionals, in order to ensure residents needs are identified and met. Risk assessments and risk management strategies must be completed to address the residents identified needs. Information relating to the residents is to be stored securely. A complaints log is to be available in the home. Timescale for action 30/9/05 2. 3 14 30/11/05 3. 3, 6 12 13 15 12 13(1)(b) 15 7/10/05 4. 3, 17, 19 7/10/05 5. 9 12 13(4)(c ) 17(1)(b) 17(2) Schedlue 7/10/05 6. 7. 10 22 30/9/05 30/9/05
Page 24 Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 4.11 8. 23 13(6) 20(3) Full details of the arrangements in place for external audit of the residents monies, is to be provided as part of the action plan to this report. This requirement has been made at previous inspections. The home must continue with the planned refurbishment of the home. Visits to the home under Regulation 26 are to take place on a monthly basis. Copies of the reports made following these visits are to be provided to the Commission. (this requirement has been made at previous inspections) The home must continue with the plan to provide all staff with food hygiene training The home must provide appropriate door closing devices which will allow doors to close in the event that the fire alarm is activated. (This requirement has been made during previous inspections) The home must provide sufficient storage for household rubbish. The home must ensure food is stored in line with current guidance. The external door to the kitchen must not be used as a main access to the laundry and rubbish bins. The fire risk assessment must be reviewed and updated annually. Portable electrical appliance safety tests (pat tests) are to be completed annually. The home must confirm, as part of the action plan to the report, 7/10/05 9. 10. 24 39 23(2)(b) 26 30/11/05 31/10/05 11. 12. 35 42, 24 13(3) 13(4) 18(c )(i) 23(4) 30/7/05 31/10/05 13. 14. 15. 42 42 42 13(3) 16(2)(k) 23(2)(l) 13 (3) 13(4)(a ) 23(2)(a ) 23(5) 23(4) 13(4)(a)2 3(4)(a) 13(4)(a ) 7/10/05 26/8/05 30/9/05 16. 17. 18. 42 42 42 30/9/05 31/10/05 7/10/05 Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 25 19. 42 13(4)(a ) whether electrical wiring safety checks have been completed. Evidence of the outcome of this check is required. (This requirement has been made at previous inspections) The home must provide thermostatic controls to water outlets. 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Hft - Falstaff House E53 S4243 HFT Falstaff House V246383 260805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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