Inspection on 22/06/05 for Hill Farm

This inspection was carried out on 22nd June 2005.

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 no outstanding requirements from the previous inspection report, but made 1 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 16/10/06

Hill Farm 07/03/06

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 15 Keycol Hill Sittingbourne Kent ME9 8LZ Lead Inspector Sally Hall Unannounced 22 June 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. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hill Farm Address 15 Keycol Hill Sittingbourne Kent ME9 8LZ 01795 841220 nil nil Forward Care (Residential) Ltd 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) Gary Greening Care Home 9 Category(ies) of Learning Disability - 9 registration, with number of places Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection nil 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. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 22nd June 2005. The inspector was helped with this inspection by the acting senior carer, Mr. George Dixon. It found that many of the National Minimum Standards had been met or partially met and that the overall quality of care provided was good. In some instances the judgment of compliance was based solely on verbal responses given by those spoken with. Not all the standards were assessed at this inspection, but these standards were met during the last inspections. What the service does well: What has improved since the last inspection? What they could do better: The home could ensure that service users are encouraged to choose what they want to eat, particularly for the main meal of the day. Staff need to document what service users eat through the day on a regular basis. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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 Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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) 2-5 The homes in depth process of introductory visits ensure any new service user is matched well with other service users and the homes environment. The robust assessment procedures adopted by the home ensure that all new service users individual needs can be met. Service users are not all supplied with completed contracts/terms and conditions of their stay. EVIDENCE: Six Service users files were reviewed at time of inspection. The assessments were easy to understand and gave a good picture of the service users complex needs. The home’s senior carer confirmed that a comprehensive assessment is prepared prior to admission. In the service users files sampled there were plans of care and risk assessments that had been formulated from the assessments. The daily care notes cross-reference with the care plan and behavioural guidance notes. This indicates that the service users care needs are being met. The senior carer was able to explain how a prospective service user goes through the assessment and matching process. The home sees this as a very important period of time in their bid to ensure they can meet the needs of the new service user and ensure that they will fit in well with the existing service users. Before they become permanent a review is held with care management, the family and any other involved professionals. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 9 Examples of service users contract and terms and conditions were seen in the files. These have been reviewed since the last inspection and now include the room number and fee as identified as missing in previous reports. Not all of the contracts had been drawn up or signed by the relevant parties. This is currently being addressed. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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) 6,7,8,9, Service users assessed needs are reflected in the individual care plan. Service users are encouraged to make choices within the limits of their own capacity. Service users are assessed to ensure that any potential risks are minimised. EVIDENCE: Service users files each contained a plan of care and behavioural guidelines that had been formulated from the assessment. These documents identified areas where the service users are to be encouraged to maintain their independence and where assistance is needed. It also indicated realistic goals for the service users which staff encourage and enables service users to attain. The behavioural management guidelines, described certain aspects of the service users life in which the service user is using inappropriate behaviour; it detailed the way staff should encourage more acceptable behaviour. The daily care report does now carry more detail and does cross-reference better with the plans of care and behavioural guidelines. The Inspector indicated to the senior carer how the daily care notes showed little evidence of choice by service users; but conversations between staff and service users during the day did evidence choice. If the service users’ rights have to be limited it is detailed in their service user plan, following a multidisciplinary review. These decisions are then reviewed on a regular basis. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 11 Service users staying at the home at this time are unable to handle their own finances so a small amount of personal money is kept safe in the Home. A check of these accounts was not made during this inspection. The risk assessments in the files sampled, detailed the perceived risk that had been identified from the assessments and the action required by staff to minimise that risk. It was evident that as far as possible the staff action recommended was not there to restrict the life of the service user more to guide and encourage appropriate behaviour. It was evident that some risk assessments had associated training implications for staff. The home has recognised this and have recently achieved Investors in People. An award which means they are able to recognise the skills required to help locate the required training for the staff. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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) 11,12,13,14,15,16,17. Service users do have the opportunity for personal development. Appropriate activities are available for all service users on an individual basis. Service users integrate well into the local community. Service users are encouraged and enabled to maintain family links. Service users are offered a healthy balanced diet, but a choice needs to be available in the evening for the main meal. EVIDENCE: Staff at the home reaffirm appropriate service user behaviour. The behavioural guidelines seen show how service users are to be encouraged to develop social and emotional skills to enable them to be integrated into the community. Life skills can be limited by service users’ abilities, but the encouragement of good behaviour was seen during the inspection. Goals were seen documented and reviewed in the service users files, outcomes were also recorded. Some service users who are able are encouraged to do more practical life skills. These include keeping their bedrooms clean and tidy with help and encouragement from staff. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 13 Due to the service users level of learning disability, education and/or employment are not appropriate at this time. The home keeps this under review on an individual basis. The daily care notes indicated that service users go out on an almost daily basis to a variety of venues. One service user told of their visit to the coast. During the day of the inspection a small group of service users went to the coast for the afternoon. Other service users spent much of the afternoon in the garden where staff encouraged them to play ball and relax in the warm sunshine. Some service user bedrooms have lighting systems designed to relax and soothe them. A physiotherapist comes into the home and encourages individual service users with aspects of their mobility. This is done in a way that has become a one to one activity for them. The staff arrange transport for service users to go and visit relatives. Some service users find it hard to speak on the phone but the facility is available for those who can. Due to the communication difficulties of the service users the group do not go to local clubs etc. However, to ensure they meet others and have the opportunity to make friends outside the Home, the organisation integrates the service users from their other Home on occasions. The senior carer explained that the daily routine of the home is flexible and set up to meet the needs of the individual service user. Staff knock on service users doors and wait before going in. Staff open the mail for service users who are likely to rip up letters and inform them of the contents. This is recorded in the service users plan. Staff interact well with service users on an individual basis and have learnt to understand their unspoken language. Staff asked the service users who were able to indicate a choice, what they wanted for lunch. The lunchtime meal was arranged in an appetising way. The cook had been recording what service users have to eat. This has not been the case since the cook left. No entries were found from the 8th June 05. There is still no choice being offered to service users for the main meal of the day. This needs to be addressed and was an outstanding issue from the last inspection. The service users files recorded their likes and dislikes regarding food. Menus seen offeed a varied and balanced diet but are not being adhered to. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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) 18-20 The service users receive a high level of personal support as agreed in their care plan. All the service users health issues are monitored closely. The robust systems in place for the administration of medication ensure service users have the medication prescribed. EVIDENCE: Personal hygiene needs are recorded in the service users plans and the required staff action is detailed, whether this is by prompting or by hands-on care. Help given was seen recorded in the daily care notes. Staff were seen treating service users with respect and sensitivity during the Inspection. The level of personal hygiene was high. All service users have their own GP. Staff accompany doctors when they visit to give reassurance to the service user. Health professionals visits take place in the privacy of service user bedrooms. Health needs are monitored on a daily basis and examples were seen of this in the daily record. The Home facilitates hospital appointments and always sends an escort. Chiropody, dental and optical treatments are also arranged for service users as needed. Evidence of this was seen in the service user files. Staff designated as being competent administer medication. Service users resident at the Home at this time are not able to take responsibility for taking Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 15 their own medication, but this is reviewed during the routine reviews held for each service user. The Medication Record Sheets showed that all medication is being checked into the Home each month and signed for. The Medication Record Sheet has been fully completed with the details of the service user and staff have signed to show that service users have taken their medication or indicated a reason if they have not. There was evidence in the plans of care that not all service users might actually take their medication, but hide it to get rid of later. Staff are required to check that these service users have taken the medication. Evidence was seen that medication reviews take place regularly for each service user. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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) 22,23 The home has a robust complaints procedure. EVIDENCE: The homes complaint procedure is easy to follow; it has realistic time scales, and forms for staff to complete when a complaint is made. The senior carer confirmed that the home had not received any complaints since the last inspection. There were none recorded in the file seen. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 17 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) 24-30 The home provides service users with a homely and safe environment in which to live. The bedrooms are individually furnished and in some cases decorated to meet the individual need of the service user. The home has sufficient bathroom and toilet facilities for the numbers of service users living at the home. Service users have a choice of shared space in the home and this includes a quite area. The home has ensured that any specialist equipment needed by service users is available. The home is kept very clean and free from odour. EVIDENCE: The home is very well maintained. The service users rooms are large and personalised. Each room has a wash hand basin. The type and amount of furniture in service users’ rooms was suitable for them. There is a lift so that those less mobile can access the first floor. The home has a maintenance man that works through a rolling programme of works and attends to day-to-day maintenance needs. The upstairs windows are restricted and the home has a risk assessment in place regarding the building. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 18 All the service users rooms are a good size, and there were different areas of communal space where the service users could choose to sit. One of the areas is kept as a quiet area, for those service users who cannot tolerate a lot of noise. All areas are well furnished and have a homely feel. The floor spaces in the Home meet the standard. Service users have access to a cordless telephone. Service users’ bedrooms are lockable, and they are given a key on request. The home has it’s own physiotherapist who can advise on the adaptations needed in the home. Specialist equipment was evident during the tour of the building. There are sufficient bathrooms and toilets in the Home, with 1 bath, shower and two toilets on the first floor and 4 toilets and 1 bath on the ground floor. The Home was clean and odour free. The flooring in most service users rooms is washable and this has reduced the risk of odour with in the Home. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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) these standards were not inspected but were met during the last inspection. Not inspected on this occasion. EVIDENCE: Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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) 40-43 Services users rights and best interests are safe guarded by the homes policies and procedures and it’s record keeping. The health and safety of the service users is promoted and protected in the most part. The service users benefit from accountable management and proactive ethos of the service. EVIDENCE: The relevant policies and procedures are in place and staff were aware of where these were kept. The policies and procedures had been reviewed with in the last year. Records required for the efficient running of the home were found to be well maintained and up-to-date. The senior carer confirmed that service users can have access to their records and the information about them if they so wish. Records pertaining to staff and service users were kept securely within the home. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 21 The senior carer was able to locate the COSHH file and said all staff are made aware of this file and it is used during induction. Staff indicated that most of the training needed to meet health and safety had been received. However one newer member of staff who started 4 months ago had not done a moving and handling course. The home has achieved IIP, Investing In People award recently. The fire log was up to date but there was no evidence of a recent fire drill. A copy of the health and Safety poster was displayed and showed names and addresses of the responsible people. Maintenance certificates were not seen during this visit but were in order during the last visit in January 05. One of the owners spoken with on the phone on the day of inspection; confirmed that the home remains viable. There was nothing during the inspection to indicate otherwise. It appeared that the home continues to invest heavily in providing high standards of care and environment. Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 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 x 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 2 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hill Farm Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x 3 3 2 3 H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 23 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 YA17 Regulation 16(2)(m) Requirement The registered person must ensure that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements; that meals are taken in a congenial setting, at flexible times, OFFER A CHOICE and a record is kept of meals taken by service users on a daily basis. Timescale for action 1 July 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 YA05 Good Practice Recommendations Service users should be provided with a contract/terms and conditions which indicate the fee and who is responsible for payment. signed by the service user or family if not appropriate. All staff should have the appropriate training regarding health and safety to protect the service users and the staff member. 2. YA42 Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent, ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hill Farm H56-H06 S63115 Hill Farm V234750 220605 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!