Inspection on 16/10/06 for Hill Farm

This inspection was carried out on 16th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hill Farm 17/07/09

Hill Farm 23/07/08

Hill Farm 07/03/06

Hill Farm 22/06/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hill Farm Hill Farm 15 Keycol Hill Sittingbourne Kent ME9 8LZ Lead Inspector Graham Cummings Unannounced Inspection 16th October 2006 09:30 Hill Farm DS0000063115.V315586.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 Hill Farm DS0000063115.V315586.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. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hill Farm Address Hill Farm 15 Keycol Hill Sittingbourne Kent ME9 8LZ 01795 841220 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) Forward Care (Residential) Ltd Gary Greening Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: The Home offers services for people with learning disabilities who have challenging behaviour/high dependency needs. Services are tailored to meet the needs of the individual aiming to offer opportunities, choice, to facilitate experience, enhancement of self-esteem and to enable service users to manage their lives with support & assistance. The Home is a detached property with accommodation on two floors. Accommodation is provided in 9 single bedrooms, some of which are located on the ground floor, all of which have call bell points & T.V points. There is a shaft lift providing wheelchair access to the first floor. The fees range from £900.00 to £3000.00 per week depending on need. The overall quality of the service provided is good. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was carried out as the final part of the home’s first Key Inspection. The Inspector had looked at previous inspection reports, the completed Pre Inspection Questionnaire, informal discussions with Service Users, the House Manager and Registered Manager. The Inspector also had a tour of the home and viewed paperwork. On the day of the inspection 3 Service Users were getting ready to go out for the morning and the Inspector observed some medication being dispensed. The home presently has a full occupancy of 9 Service Users, there were 6 staff on duty. The House Manager informed the Inspector that the home provides 24 hour residential care where the aim is to support individuals to live as independently as possible with dignity and respect. The home is out in the community as much as possible. The home has 2 mini buses to use for trips out and appointments. Evidence seen by the Inspector supports the comments of the House Manager. The staff are presently doing the cooking as the cook recently left and a new one has not been appointed, wherever possible Service Users help in the preparation and cooking of the meal, this is risk assessed. The menu included a choice of meals for both lunch and dinner. The home has carried out a lot of training. Some of this has been through watching videos and then answering a questionnaire at the end. This is mainly used for introduction and induction purposes. External training has also taken place. The home had 2 requirements from the last inspection relating to training, 10 staff have attended a course on infection control, however they have not yet managed to locate an Autism Awareness Course and this will remain as a Requirement. Since the last inspection the home has purchased a new cooker, 3 piece suite, settees, chairs, nursing bed, bathroom suite, dining table and chairs, flooring, boilers, commercial washing machines and tumble dryer. It is hoped that the kitchen will be refurbished in the near future. The staffing ratio is good with 6 staff to 9 Service Users, this means that any vacancies put a lot of pressure on existing staff to increase their hours to cover. The Registered Manager during conversation confirmed that they monitored the number of hours staff were doing and ensuring they had time off so that when on duty they were able to provide quality care. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 6 The home was interviewing prospective candidates for employment on the day of the inspection. Recent work on the installation of new boilers has left exposed hot water pipes and these need to be boxed in as soon as possible to prevent any possibility of burns. At the last inspection 7 Requirements were made, of these 5 have been completed. The 2 outstanding Requirements relate to staff training in Mental Health and Autistic Spectrum Disorders and the Manager not having the recognised qualifications. What the service does well: What has improved since the last inspection? What they could do better: Recent work on the installation of new boilers has left exposed hot water pipes and these need to be boxed in as soon as possible to prevent any possibility of burns. Training in Mental health and Autistic Spectrum Disorders needs to be carried out. The Manager of the home must gain the qualifications in NVQ level 4 and the Registered Managers Award. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 8 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 Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective Service Users have the information required to make an informed choice. Prospective Service Users have the opportunity to visit the home and each individual has a written contract. EVIDENCE: There have been no admissions since the last inspection in March 2006. The Inspector had a discussion with the house manager regarding the process the home uses following the receipt of an enquiry for a new placement. The information given was in line with good practice. The Inspector looked at 2 Service User files and both contained a written contract. The Inspector was given a copy of the home’s updated information flyer that is given to prospective Service Users, family members and care managers. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users changing needs are assessed and they make choices with assistance. Service Users participate in aspects of life in the home and are supported to take risks wherever possible. EVIDENCE: The Inspector looked at 2 care plans and found that they contained good information regarding the individuals likes and dislikes about how they received the care to be given. There was evidence that the care plans were being evaluated at regular intervals of 3 months. Service Users are involved in the writing of the care plan wherever possible. Information from the care managers and families is also considered and 6 monthly care managers reviews are held. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 11 Risk assessments are in place for behaviours and activities and Service Users wherever possible are involved in the making of these. There was also evidence that the assessments are being evaluated. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users have the opportunity for personal development and take part in age appropriate activities. Service Users are part of the local community and most enjoy family visits. Service Users are respected and offered a healthy and nutritious diet. EVIDENCE: The inspector saw an activity rota that included aromatherapy, art therapy, music and movement, physiotherapy, beauty therapy, cooking, gardening, sensory room, horse riding, seaside, café and restaurants. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 13 Most of the activities are on a 1-1 basis but not all. The home has 2 minibuses that are in constant use with small groups of Service Users going out with staff. The inspector had seen that risk assessments were in place for the individual Service Users with strategies to minimise risks to both Service Users, staff and public. About 5 of the Service Users have support and visits from family members whenever possible. During the inspection the Inspector noted several interactions between staff and Service Users that were positive and done with dignity and respect. Presently the staff were doing the cooking as the cook left, an advert is out and applications received. A new kitchen has been fitted and when being given a tour of the home it was clean and tidy. The menu seen was nutritious and healthy. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users receive personal support in the way they prefer. Service Users can be confident that their health needs will be met. EVIDENCE: Wherever possible, Service Users’ personal support is given in the way they prefer and is written in their individual care plans. All of the Service Users are registered with a G.P., Optician and Dentist in the local area. The home also has access to a number of therapists to help meet individual Service Users. No Service User self medicates, the home does have a written policy on self medication in the event that any new admission is capable of this. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users and their families can be confident that they will be listened to wherever possible. Service users are protected from abuse by the home’s policies and procedures. EVIDENCE: Due to the Service Users needs it is not always possible to ascertain their views, however the home does involve family members and care managers in all aspects of their care and lifestyle. All staff watch a video as part of their induction entitled ‘Abuse in the Care Home’ and ‘Managing Challenging Behaviour’, this has a questionnaire that is answered after the video has been watched. In 2006 13 staff have attended external training in Adult Abuse Protection, 4 have attended NAPPI training and 4 have completed Understanding Challenging Behaviour. The home has a complaints policy. At the time of the inspection and there was an on-going Adult Protection issue that was being investigated and a disciplinary hearing was due to be held.. The home had acted appropriately throughout this issue. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users live in a homely, comfortable, clean, hygienic and generally safe home. Service Users bedrooms suit their needs and promote independence. Service Users have ample toilets and bathrooms to provide privacy. Shared space complements Service Users individual rooms. EVIDENCE: The Inspector toured the home and found it to be homely, spacious, light and clean. It was evident that a lot of work had been carried out since the last inspection. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 17 The bedrooms were well furnished and decorated with Service Users personal belongings. One of the bedrooms had just been decorated in a colour of the Service Users choice and it was planned that another bedroom was to be redecorated in the near future. The kitchen had been redecorated and a new cooker purchased, it was fresh, clean and in very good order. Since the last inspection the company have bought a new 3 piece suite for the lounge, dining tables and chairs, wardrobes, commercial washing machine, commercial tumble drier and flooring. On the day of the inspection workmen were completing the fitting of new boilers. The Inspector was concerned that the hot water pipes running around the home were not boxed in, this needs to be rectified as soon as possible. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users benefit from a competent trained staff team who have a clear understanding of their roles and responsibilities. The home’s recruitment process protects Service Users. The care of service users is enhanced because staff are well supported and supervised. EVIDENCE: The Inspector looked at 2 staff files and found that they contained information set out in Schedule 2 including job descriptions, job specifications, induction, interview notes and telephone notes confirming references received. The Inspector also saw supervision notes were in place that had been signed and dated by both parties involved. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 19 The training matrix was seen, this showed that staff training is available, this gives them the skills and knowledge to carry out their job well. The Inspector noted that the requirement from the last inspection for training in Mental Health and Autism has not been carried out, this is going to be addressed and will remain as a requirement. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users benefit from a well run home with competent management where their best interests are safeguarded by the home’s policies and procedures. Service Users can be confident that their views, wherever possible, or those of their family will be listened to and acted upon. Service Users can be confident that their health, welfare and general safety is promoted. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Inspector spoke at length to the Registered and House Managers and they were able to show a good knowledge and understanding of the Standards and Regulations. The Inspector, through discussion, viewing paperwork and observation was of the opinion that the home is run in the best interests of the Service Users. On the day of the inspection several trips out were taking place into the local community. The inspector witnessed numerous conversations that showed Service Users were offered choice and treated with dignity and respect. The home’s record keeping was clear and easy to follow and the House Manager was able to provide the inspector with all the information requested. Due to communication difficulties the inspector was not able to gather direct information, however, staff were able to communicate to Service Users who I was and why I was visiting. The Inspector was told that Service Users wherever possible were included in the daily decision making of activities, meals and the clothes they wore. The health and safety of Service Users was at some risk due to hot water pipes being accessible. This has occurred due to the installation of 3 new boilers in the cellar, this work was still in progress but almost complete. All of the hot pipes need to be boxed in to prevent any chance of injury to both staff and Service Users as soon as possible. The House Manager told the Inspector that this would be completed as soon as the boiler works had been completed. The home has recently completed a quality assurance survey, the results have been looked at and wherever possible acted upon. However, the results, which were positive have not been collated or distributed to interested parties such as CSCI, families or care managers. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 X 4 3 5 3 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 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 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 3 2 3 Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 YA42 Regulation 13(4)(a) Requirement The Registered person shall ensure that (a) all parts of the home to which the Service Users have access are as far as reasonably practicable free from hazards to their safety. The registered person shall ensure that all staff have qualifications suitable to the work that he is to perform, and the skills and experience necessary for such work; specifically training in mental health needs and other specialist needs such as autism. A person is not fit to manage a care home unless he has the qualifications, skills and experience necessary for managing the care home. Timescale for action 31/01/07 2. YA35 19(5)(b) 31/01/07 3. YA37 9(2) 31/01/07 Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 24 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 YA39 Good Practice Recommendations That the quality assurance survey that has recently been carried out is collated and the results given to Service Users/ families/ CSCI and care managers. Hill Farm DS0000063115.V315586.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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