CARE HOME ADULTS 18-65
Higher Keason Farm St Ive Liskeard Cornwall PL14 3NE Lead Inspector
Mike Stokes Unannounced Inspection 19th May 2006 03:00 Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Higher Keason Farm Address St Ive Liskeard Cornwall PL14 3NE 01579 383137 01579 383137 linda.olver@ssmail.neet 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) Mr Andrew Charles Hambly Mrs Linda Rose Olver Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to be 35 - 65 yrs of age upon admission Date of last inspection 30th November 2005 Brief Description of the Service: Higher Keason Farm is registered for 3 Adults with learning disabilities. The home is run as a family home with all the care and services delivered by the two registered persons. Each service user has their own single bedroom, with bathing facilities on the same floor as their bedroom. Communal space includes a lounge/dining room and a spacious conservatory. Access to the house is via a long drive where car parking is available. The home is situated in a rural position with pleasant views over the open countryside. The home is close to public transport routes for access to the facilities of Liskeard and Callington. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The registered person was unaware that this inspection was going to happen and it was planned to arrive unannounced to review the care provided to people living there. I arrived at 3.00pm and the inspection process was completed through a second visit on 25/05/06. During the inspection I spoke to Mrs Olver who is one of the registered persons, met 2 service users and discussed welfare issues with a relative of another service user by telephone. What the service does well: What has improved since the last inspection? 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. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 6 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 Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 7 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 and 3. These standards are met as the registered person understands the need for pre-admission assessments and has produced information to assist prospective service users in choosing a home. EVIDENCE: The registered person has produced the statement of purpose, service users guide and assessment process for inspection. 2 service users have lived at the home for 7 years and another for 3 years. There are no plans for other admissions. The provider stated that she has discussed the documents with service users to ensure they have appropriate information about the home. The registered person has amended the complaints information to include the name of The Commission for Social Care Inspection and the contact telephone number. A copy of these updated documents has been provided to each service user and where appropriate, their advocates. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 8 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 and 9. Service users are living in a stable and supportive environment. The service users are involved in decisions affecting their lives and enabled to participate in chosen activities. EVIDENCE: 2 service users were met together in the communal lounge area and a discussion occurred about the various aspects of living at the home. The 2 service users have a supportive relationship and choose to participate in shared activities in the community. These service users stated that they attend ‘Link into Learning’ activity at Callington and described how they use public transport independently to access community facilities at Callington and Liskeard. The plan of care has been developed regarding a service user experiencing seizures and how the supporting service user would request emergency services or contact the registered person if necessary. The risk assessment regarding community access should be shared with the care manager for these service users. Another service user requires more supervised activity and attends a day centre during the week. The relative of this service user expressed approval of the care provided and stated that he keeps his dog at the home and can enjoy short walks in the area.
Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 9 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. The service users have opportunities for socialising with others in community settings. The dietary needs of service users are catered for by the provision of food that meets their tastes and choices. EVIDENCE: The home is situated in a quiet rural area. Two service users access community facilities as required by public transport. The registered person stated that their transport is also used to assist service users in leisure activities, attend Gateway club, occasional visits to a relatives and day care and educational opportunities are organised. There are no special dietary needs and within this small family setting, meals are provided with the Knowledge of likes and preferences. The registered person stated that advice is offered regarding dietary needs and fruit and snacks are available. The service users expressed their approval of roast dinners and other meals provided at the home. The registered provider is advised to record meals provided at the home for service users. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 10 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 and 20. The health needs of service users are met with evidence of multi disciplinary working taking place. EVIDENCE: Service users are registered with General Practitioners in Liskeard and have on-going consultation with the Consultant Psychiatrist and Learning Disability Team at Bodmin. Service users are assisted with their medication needs and the registered person maintains records regarding the ordering and administration of prescribed medication. The registered person has completed training in ‘the safe handling of medication’ and the medication is appropriately stored and administered. A service user was pleased that he has an appointment to visit the eye infirmary and the registered person confirmed this referral was organised. The service users are mainly self-caring and receive prompts and encouragement from the registered person to maintain personal hygiene and health care. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 11 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): 22 and 23. These standards are met with the registered person exhibiting appropriate knowledge and understanding of Adult Protection issues that protect service users from abuse. EVIDENCE: A discussion occurred regarding Adult Protection procedures and the registered person is attending training in September 2006 to maintain appropriate procedures. The registered person has a complaints policy and procedure, with the amended complaints information provided to service users and advocates. The service users maintain contact with relatives occasionally through telephone calls and the home gives assistance and encourages visits where possible. Service users stated that they feel safe at the home and the registered person speaks well to them. A telephone conversation occurred with the relative of one service user who confirmed that the registered persons are trying to help their relative as much as possible. The registered provider has complied with a requirement to maintain records that provide a clear audit of service users financial accounts and procedures. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 12 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, and 30. Service users live in a homely, comfortable and safe environment with evidence of maintenance and improvement. EVIDENCE: A tour of the home occurred and it presented as clean and hygienic. Service users have single rooms that are comfortable and individually decorated. The service users bedrooms and those of the registered person and family are on the first floor. The bathroom on this level has been refurbished and decorated to provide bathing, shower and toilet facilities. The communal areas available to service users on the ground floor include a large conservatory and a lounge with dining area. The 3 service users will all be 65 years during 2006 and the registered person is advised to consider future needs regarding mobility, access arrangements and assessments that may be required to provide for service users welfare. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 13 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. The registered person has appropriate experience and provides care in a stable and homely environment. The registered person is the predominant carer for service users and has been attending training opportunities to maintain appropriate skills. EVIDENCE: The registered person does not employ other carers and is the main carer for service users within a homely and stable environment. The registered person has attended training in medication procedures and food safety. Training courses are arranged for health and safety, first aid and protection of vulnerable adults procedures. A requirement is made regarding the need for CRB checks, POVA First and recruitment procedures if staff are employed or volunteers used. The registered person has currently been providing day care for visitors to the care home. A recommendation is made for the registered provider to submit an amended statement of purpose to this Commission regarding these details, to ensure that appropriate supervision is provided to existing service users at all times; and that consultation occurs with existing service users and that their opinions are respected and recorded. Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 14 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, 39, 42 and 43. The registered person benefits from daily contact and Knowledge of service users to provide appropriate services in a small family environment. The introduction of periodic review procedures demonstrates that service users are formally consulted on issues affecting their lives. EVIDENCE: The registered person has an appropriate policy and procedures manual available for inspection. The registered person has produced a survey in response to a previous requirement to introduce quality assurance systems and review care provided at the home to demonstrate service users involvement in decision-making regarding their welfare. Fire precautions are maintained at the home and a requirement is made to ensure the smoke detectors are always operational at the home. The registered person is required to provide a copy of the public liability insurance cover – reference standard 43(5). The registered person is experienced and registered on NVQ level 4 and the RMA. The registered person is recommended to inform the Commission of proposals to progress with this training.
Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 15 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 2 Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 16 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 YA34 Regulation 19 Requirement The registered person must operate a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users with the need for CRB checks, POVA First and recruitment procedures if staff are employed or volunteers used. The registered person must ensure fire precautions are maintained at the home and a requirement is made to ensure the smoke detectors are always operational at the home. The registered person must provide a copy of the public liability insurance cover – reference standard 43(5) to demonstrate financial viability and accountability of the home. Timescale for action 31/07/06 2. YA42 12 and 13 31/07/06 3. YA43 25 31/07/06 Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 17 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 YA33 Good Practice Recommendations The registered person should submit an amended statement of purpose to this Commission regarding the development of day-care services, to ensure that appropriate supervision is provided to existing service users at all times; and that consultation occurs with existing service users and that their opinions are respected and recorded. The registered person should inform the Commission of proposals to progress with the NVQ 4 and RMA training. 2. YA37 Higher Keason Farm DS0000009038.V293513.R01.S.doc Version 5.2 Page 18 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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