CARE HOME ADULTS 18-65
Higher Morris Farm 595 Preston Road Clayton Le Woods Lancashire PR6 7EB Lead Inspector
Val Turley Unannounced Inspection 23 and 25th January 2006 09:30
rd Higher Morris Farm DS0000005967.V264957.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 Higher Morris Farm DS0000005967.V264957.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. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Higher Morris Farm Address 595 Preston Road Clayton Le Woods Lancashire PR6 7EB 01772 324515 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) Progress Adult Services Limited Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of up to 5 service users to include: Up to 5 service users in the category LD (Learning Disability). The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines, which may be issued through the Commission for Social Care Inspection. 1st September 2005 Date of last inspection Brief Description of the Service: Higher Morris Farm is one of the three homes operated by Progress Adult Services Ltd, which is a company caring for young adults whose severe learning disabilities are compounded by severe challenging behaviour. The service aims to provide an individualised, integrated service within which, communication therapy and high quality care, combine to reduce challenging behaviour and reinforce and maintain positive changes. The home is a detached property with a large enclosed secure garden to the rear, and parking area to the front and side of the property. The home offers accommodation to five young adults who each have their own bedroom. There are two bedrooms located on the ground floor, which are adjacent to a bathroom. On the first floor there are three bedrooms with one service user having sole use of an adjacent bathroom. The remaining two rooms having access to a second bathroom also on the first floor. In addition, the home has three lounges over the two floors, a dining room, kitchen, and two staff offices/sleeping accommodation and bath/toilet facilities. The outbuildings provide an activity room for the use of one of the young adults and a laundry in another. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days in January 2006. The inspection took 71/2 hours The inspection involved observation of the young adults who lived at the home and also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. What the service does well:
The young adults were supported by a motivated staff team who had received the appropriate training to ensure that they could meet specific personal and social needs of the young adults. They were supported to get involved in a variety of activities that were selected to meet their needs and interests. The young adults were comfortable and relaxed in the presence of the staff and turned to them for support and guidance. Information within the individual care plans gave good guidance to the staff in terms off the support needs. The daily routine within the home was observed to be flexible and revolve around the needs and choices of the young adults. Meals were varied and nutritious and were prepared and provided with individual needs and preferences in mind. The health care needs were addressed and health and social care professionals involved as necessary. The home was clean and hygienic and provided a comfortable environment for both the young adults and the support staff. The homes complaints procedure was comprehensive and this plus the close and regular contact with the families, provided opportunities for any concerns about the care provided to be raised. Monthly care planning meetings were held and these too gave opportunities to raise any views or concerns regarding support needs to be raised and acted upon. The individual communication needs and techniques of each of the young adults were documented and guidance was provided for staff to enable them to communicate effectively giving them opportunities to express their feelings and wishes. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 6 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 Morris Farm DS0000005967.V264957.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 Higher Morris Farm DS0000005967.V264957.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): None of these standards were assessed at this inspection. EVIDENCE: Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this inspection. EVIDENCE: Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 10 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, 16 and 17 The young adults were supported to take part in activities that were age, peer and culturally appropriate. The young adults were provided with balanced and varied meals with their specific dietary and cultural needs being taken into account. EVIDENCE: Discussion with the staff and documentary evidence indicated that the young adults were supported by staff to become involved in a range of meaningful activities, some of which were based in the community. The activities included leisure centre activities, college courses, music workshops, local shopping trips, cooking, playstation games, videos, books and craft activities. On the day of the inspection one of the young adults had enjoyed a trip to Blackpool. Staffing at the home was arranged to ensure that there were sufficient numbers of staff on duty to support the young adults to participate in these activities. Activities were arranged to suit the needs and interests of the young adults and these were fully risk assessed to ensure as far as possible the safety of the young adults. Bedrooms were personalised to reflect the interests and taste of the individual young adults. Holidays were arranged and again these were risk assessed to ensure the safety of the young adults with staff support being provided as necessary.
Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 11 The young adults were observed to be comfortable in the presence of the support staff, turning to them for support and information. The support staff interacted with the young adults, involving them in discussion, utilising sign language where this was appropriate. The young adults were observed to be supported to spend time alone if they wished and guidance within the care plans outlined how this support should be provided. The young adults were provided with a varied and nutritious meals that were based on their individual preferences, dietary and cultural needs. Evidence to support this was available within individual care plans and discussions with staff confirmed their knowledge of young adults needs. Where a young adult presented any specific challenges in terms of mealtimes and dietary intake, the care plans outlines any strategies that were implemented for each individual to help ensure that their nutritional needs were met as far as possible. The young adults were weighed on at least a monthly basis to help in the monitoring of their health and well-being. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Health and personal care needs are met in a caring and sensitive way ensuring individual needs are met and young adults are safe. EVIDENCE: The care plans for the young adults included details of the individual’s needs and preferences in terms of their specific personal care needs. These details included information regarding their preferred morning and evening routines. Discussion with staff indicated that they were aware of these routines. From observation daily routines were seen to be flexible and revolved around the needs and choices of the young adults. Information on the young adults files and discussion with staff indicated that the young adults received specialist support and treatment from appropriate health and social care professionals. The home had a key worker system with staff being encouraged to apply for these posts and in doing so demonstrate an interest in and commitment to supporting the young adult. Accredited training in the administration of medication had been arranged for staff with a view to safeguarding both the young adults and the support staff.
Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Procedures in the home made sure the young adults were protected from harm and their views respected. EVIDENCE: The home had a comprehensive complaints policy and procedure, which contained all of the detail as outlined within the National Minimum Standards. Monthly care planning meetings and regular contact with family and friends provided the young adults with support that would enable any concerns or views to be recognised and acted upon. Written comments from one of the parents stated that the staff were ‘very helpful and co-operative’ and maintained ‘a close contact’. The individual communication needs and techniques of each of the young adults was documented and guidance was provided for staff to enable them to communicate effectively with the young adults, giving them opportunities to express their feelings and wishes. From discussion with the staff during the inspection it was clear that there was an intention to approach the community learning disability team for additional advice and guidance regarding the management of challenging behaviour with a view to ensuring that the approaches adopted by the home were most appropriate to the needs of the service users. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The home was clean and hygienic with procedures in place to control the spread of infection. EVIDENCE: The laundry was situated in an outbuilding and was equipped appropriately for the needs of the young adults. Staff carried laundry through the home without taking it through any area where food was stored, prepared or eaten. The home had comprehensive policies and procedures in respect of the control of infection, ensuring as far as possible the health and well being of both the young adults and the support staff. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 Staff were competent and skilled but the homes recruitment procedure was not always followed precisely leaving young adults potentially at risk. EVIDENCE: During the course of the inspection the staff were observed supporting the young adults. They were observed to communicate well with the young adults using sign language were appropriate, to support them sensitively in a variety of situations. The young adults responded well to the staff demonstrating confidence in the support that they received. From discussions with both established and recently appointed members of staff and an examination of training files, it was evident that the staff were well supported by the management team and that the induction training and subsequent training gave them the necessary skills to support the service users in an effective and meaningful way. The organisation was continuing to work towards having 50 of its work force achieve a relevant qualification in care; additionally staff were encouraged to apply for external training courses. The files of three members of staff were examined to determine if the selection and recruitment procedures of the organisation were thorough and robust to ensure the protection of the service users. All the necessary documentation on two of the files was found to be in order with the relevant checks having been undertaken prior to the staff commencing work within the care home. However the third member of staff had commenced work, providing support within the
Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 16 home, prior to a second written reference being received. This arrangement potentially placed the young adults in a position of risk. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 17 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 and 39 Quality assurance processes in the home needed to be strengthened to ensure that the young adults are provided with a relevant and appropriate service. EVIDENCE: The home did not have a registered manager in post. The acting manager was being supported by the management team to ensure that the home continued to be effectively run until arrangements could be made for a registered manager to be appointed. Since the last inspection the home had appointed a member of staff to take on the responsibility of quality assurance within the organisation. As a result of this a number of policies and procedures were being reviewed. Monthly monitoring visits were made to the home to ensure that the service provided was satisfactory and reports were submitted to the Commission for Social Care Inspection. The acting manager undertook a number of regular checks to make sure that all documentation in the home was in place and up to date and that the
Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 18 environment was safe for both the young adults and the staff. The home had achieved the Investors in People Award which is a quality assurance award accredited by an outside body. Care planning meetings were held monthly to review the support provided to the young adults and make any necessary changes. Close contact was maintained with families and a family member wrote that if she had ‘any concerns or questions there is always someone I can speak to and I don’t feel uncomfortable doing this’. Although the home was in regular contact with the families of the young adults and they were encouraged to play an active part in reviewing the care approach, their views, and where possible the views of the young adults should be sought about the services provided. The results of this survey should be published and made available to interested parties. The views of involved health and social care professionals should also be sought. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 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 X 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 X 2 X 2 X X X X Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 Requirement The registered person must not employ a person to work at the home unless the necessary checks have been made. The registered person must ensure that a manager is appointed to the home and an application submitted to the Commission for Social Care Inspection. Consultation must take place with the service users and their representatives with a view to improving the service provided. Timescale for action 28/02/06 2 YA37 8(1) 31/03/06 3 YA39 24(3) 30/04/06 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 2 Refer to Standard YA32 YA39 Good Practice Recommendations The home should continue to work towards 50 of its staff achieve a relevant qualification in care. The views of health and social care professionals should be sought as part of the homes quality assurance audits. Higher Morris Farm DS0000005967.V264957.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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