Inspection on 08/08/08 for Holt Farm

This inspection was carried out on 8th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holt Farm 16/08/07

Holt Farm 20/12/06

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Hillview Farm

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Holt Farm Hopcrofts Holt Steeple Aston Oxfordshire OX25 5QQ Lead Inspector Delia Styles Unannounced Inspection 8th August 2008 11:10 Holt Farm DS0000067215.V369961.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 Holt Farm DS0000067215.V369961.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. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holt Farm Address Hopcrofts Holt Steeple Aston Oxfordshire OX25 5QQ 01869 347600 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) Holt Farm Care Ltd Post vacant Care Home 5 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 5. Date of last inspection 16th August 2007 Brief Description of the Service: Holt Farm is a five bedroom detached house in a rural location in close proximity to the amenities of the village of Steeple Aston which include a Post Office, shops, a pub and a church. The home is equidistant between Banbury and Kidlington. The home has good links to the city of Oxford. The home has its own transport which it can transport residents to events of their choice. The home was registered in June 2006 and is privately owned. Entry to the home is by means of a gated, electronically controlled entrance off the busy A 4260. The home has gardens to the front and rear and there is a swimming pool at the back of the home. Residents are able to walk into Steeple Aston by means of a safe footpath. The home is registered to provide accommodation and 24-hour support for five adults with either a learning disability or mental health needs. Respite care is not provided. Fees for this service range from £1,520 to £1,950 per week depending on care needs. This fee includes transport and one holiday per year. Extras include toiletries, clothes and personal items. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This is what the inspector did when she was at the home. The visit lasted for just over 5 hours on a Friday in August. The inspector met all 5 people who live at the home and was shown around so that she could see their rooms. Four people and two support workers went out for a trip and were out for most of the day so we did not have long to talk. The inspector looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. The inspector also phoned two people who visit the home and know the people who live here, to ask them what they think about how well people are supported by the home. She met some relatives who were visiting too, and talked to them about what they liked about Holt Farm. The inspector talked to the deputy manager and a support worker about what sort of things the support workers do to help people to go to college and work, and have interesting things to do. We would like to say thank you for helping us to find out what you think about living at Holt Farm. What the service does well: Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 6 The house is clean and there is plenty of space in peoples’ rooms and shared rooms in the house so that people can have quiet times or share in what’s going on in the house. People can go on outings every day with support workers, to visit interesting places and have their lunch out if they want to. What has improved since the last inspection? What they could do better: The people who run the home know that they need to do some things better and have told us how they are going to do this – like painting the house and putting in new carpets, and making a new bedroom downstairs. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 7 They need to make sure that everyone living here gets to go on outings, have time with just one or two staff, as well as in a group, to do things they like to do and to try different things. The people who live here need to have the way they like to be supported, written down or explained in ways that they can understand - like making peoples’ activity plans easier for them to use by using photos and symbols to show the things they would like to do. We know that the home is already working on some of the things that could be better and we look forward to seeing these new changes when we next visit. 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. Holt Farm DS0000067215.V369961.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 Holt Farm DS0000067215.V369961.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): 2 Quality in this outcome area is adequate. People’s individual needs and aspirations are assessed with the involvement of the individual and their family and advocates so that they can be assured, as far as possible, that the home will support them in their chosen lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been 4 people move into Holt Farm since our inspection last year and the house is now full. Health care professionals we spoke with expressed some concern that the people recently admitted had come to live here within a short space of time and had complex support needs. This has meant that staff and residents have had quite a short time in which to get to know each other and for residents to adjust to living in a new environment. According to the AQAA two of the four people living here had been admitted directly from acute hospital assessment units. The proprietor agreed that the rate of admissions had been more rapid than was ideal due to delays in funding and other priorities of safety in relation to one person. The manager of Holt Farm or of the sister home, Maytrees, had assessed all the residents before agreeing that the Holt Farm could meet their needs. We looked at the assessment information for 2 residents and this was detailed and had additional information from other social and health care professionals. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 10 One health care professional said that the homes staff had needed additional advice and support from health care professionals in order to meet their client’s specific health needs. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is adequate. Further work is needed to make sure that the service involves the people who live here in making decisions about their lives as far as possible and in planning the care and support they receive, so that they are in control of their lives and can make informed decisions. Some progress has been made in developing care plans but these do not currently accurately reflect the individual’s personal preferences and aspirations and how they need to be supported to achieve these. Personal plans need to be made available in formats that that each service user can understand. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager said she had just started the process of reviewing and improving residents’ individual plans of care. The lack of a manager on a dayto-day basis for several months has meant that documentation and recording individual goals of care and support for people has not been consistent and detailed. Health care professionals said they were concerned about the homes failure to set achievable goals and support plans with their clients. One person said that Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 12 actions that had been agreed during someone’s first review meeting, held six weeks after their admission, had not been followed up. An NHS community specialist nurse (Learning Disabilities) said that s/he would be working closely with the homes managers and staff and the local NHS multi-disciplinary team to help the home’s staff make improvements and set goals of care for each resident. The sample of personal plans seen demonstrated that the deputy manager has made a start on helping residents to better express their views about how they want to spend their time and to make choices, through the use of personal planning and health books. It is clear that a wide range of communication skills and methods are needed to help the current residents to be more fully involved in discussing what is available to them and how staff can meet their individual support needs. Little progress has been made since the last inspection, when we recommended that all materials used for sharing information with residents should be presented in formats that are accessible to each individual according to their various needs. The registered provider, Mr Wood told us that they recognise the need to improve in this area and were looking at computer-based programmes to enhance the format of written information. There were risk assessments in relation to particular activities – such as independent bathing for one person and use of the stairs by another. However, because of the range of abilities and complexity of needs amongst the people living here and the temporary management arrangements, we consider that the staffing numbers and skill mix do not consistently support and develop the independence of individuals effectively. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16 and 17. Quality in this outcome area is adequate. Limited progress has been made to improve the range of activities outside the home and in the community but staff acknowledge that more work is needed to make sure that all the people who live here have a range of opportunities to take part in stimulating and meaningful activities that suit their different needs and abilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, when there was just one service user, the home is now fully occupied. As stated earlier, the majority of the people living here have complex health and support needs. The lack of leadership and day-to day presence of a manager over recent months has meant that the development of individual opportunities for residents to be supported in a range of activities inside and outside the home, and to build up links with the local community, has been limited. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 14 The homes AQAA states that ‘it has proven a large challenge to access good quality day care for out service users, due to the area in which we are situated’. One of the health care professionals told us that they had been concerned that when they visited residents seemed to be ‘sitting around with very little to do’. The newly appointed deputy manager said she is trying to address this and has made it a priority to offer all the residents the opportunity to go on outings and shopping trips away from the home each day, using the homes own transport. On the day of the inspection visit four of out of the five residents went on an outing (to a garden centre) with two staff from late morning until late afternoon and had their lunch out. The remaining resident stayed in their room listening to music with a support worker and the deputy manager available. There were no notices displayed in the home about planned outings or activities and little evidence of equipment for leisure activities seen in the house. One person’s activity programme was included in their personal plan. A staff member said that residents could not have free access from the dining room to the patio and outdoor swimming pool because of the risk of accidents (the pool is not in use currently and is covered). The homes AQAA tells us that they plan to ensure staff are properly trained in lifeguard techniques so that the homes swimming pool can be utilised during the warmer months. Residents have access to the garden and orchard at the rear of the home and there is a safe footpath for accompanied walks for the more physically able to the nearby village of Steeple Aston. The deputy manager said she was gathering information about local services and amenities that could be accessed by people living here and hoped to introduce more age-appropriate activities such as bowling, swimming and disco outings. The deputy manager said that residents are involved as far as possible in choosing the meals. A menu plan for the week was posted on a kitchen unit door and was not visible or accessible to residents – there was no picture menu for example. Staff assured the inspector that residents were encouraged to have a balanced and nutritious diet. The majority of the residents were out for lunch on the day of the inspection so the management of mealtimes and food service was not observed in practice by the inspector on this occasion. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 15 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 and 20 Quality in this outcome area is adequate. The arrangements in place for assessing and maintaining peoples’ healthcare needs are satisfactory overall and the home has recognised areas in which it needs to improve to meet the changing health and personal support needs of the people who live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The way in which people’s personal preferences and needs about how they receive personal support is not consistently recorded in their care records – for example, some people who have come to live here recently have lived in other residential care settings and/or were already known to the manager who had assessed them prior to admission to Holt Farm. This meant there is information from their previous care environments. From conversation with the deputy manager and observation made during the inspection, it was clear that the staff on duty had a satisfactory understanding about each person’s care and support needs. However, health and social care professionals spoken with during telephone interviews said that they were concerned that there was ‘very little evidence of clear objectives having been set with individuals’ about their day to day care and support. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 16 There are plans for the home to work in partnership with local NHS community (Learning Disability) team and for staff to meet regularly with the multidisciplinary team to discuss and plan objectives for and with each resident. There was evidence that the home makes relevant referrals for residents’ health care advice and treatment. The deputy manager confirmed that residents are assisted to attend the local doctors’ surgery for appointments and that all residents will be supported to have ‘well-person’ checks this year. Support staff have had training about epilepsy to help them meet the needs of residents with this problem. The deputy manager and visiting area manager have taken action to review with medical and nursing staff the care and support needs of residents whose physical and mental health needs have increased recently. The homes systems for the safe management of medication are satisfactory overall. None of the current residents are able to manage their own medication independently. The deputy manager confirmed that she, and 5 senior carers have the required level of training in administration of medication. A ‘good practice’ recommendation is made that the home maintains a record of staff signatures and usual initials of all the staff authorised and trained to give out medicines. This means it is easier to audit records should there be any discrepancies or errors. Residents’ prescribed medicines are dispensed from the local doctors’ surgery in a monitored dosage system of individual cassettes with compartments containing the tablets for a week. The deputy manager has identified some problems with the way in which the Medication Administration Record (MAR) sheets are printed by the surgery – they cover a 28 day period only which can be confusing for staff who have to sign for medications given over a calendar month. Other changes and improvements that are needed had been noted by the deputy manager and are going to be put in place – for example, recording the amount of medication received in the home, and archiving old MAR charts and prescriptions, so that just the current records are in use to make it clearer for staff and to make regular in-house checks. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 17 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 and 23 Quality in this outcome area is adequate The homes written complaints procedure is satisfactory but needs further development to make sure that the information is available in understandable formats for the people who live here and so that they and their families and advocates can be confident that their views are listened to and acted upon. Lack of leadership and monitoring of staff practices over recent months and the complexity of care needs of the people living here means that some service users were not adequately safeguarded from potential abuse: the provider and managers now have plans in place to improve and monitor future practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was no written/pictorial information about how to make complaints seen in the house. However, information for staff about local safeguarding codes of practice and advocacy services was available in the manager’s office. The registered provider confirmed that the homes’ complaints procedure is made available in the Statement of Purpose and Service Users Guide, but agreed that limited progress has been made in making the information available to residents in a way that can be understood by them. The deputy manager said that a system of ‘key-working’ has just been started, so that each resident has a member of staff with whom they can identify and who will help them communicate any concerns and worries through individual ‘talk time’ with their key worker. The Commission for Social Care inspection has received no information about any complaints or safeguarding issues since the last inspection. When asked Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 18 about how staff would records any concerns or grumbles, the deputy manager said that the complaints forms are on the computer and would be completed by staff and sent to the registered provider. It is not clear how staff and residents would be made aware of the actions taken by the home in relation to any complaints or concerns they may have raised. A health care professional informed us that they had been ‘extremely concerned’ about a lack of knowledge about professional codes of conduct that had come to light this year when a staff member (who has since left) accepted gifts from a resident’s family member. The registered provider confirmed that action is being taken to ensure that all staff are aware of, and adhere to the homes policy that staff must not accept gifts. The health care professional is working with the homes area manager and registered provider to provide staff training in ‘ethics and moral responsibility’ to ensure that residents’ interests are always upheld. All staff receive Safeguarding of Vulnerable Adults Training. A staff member confirmed that they had had training and had been given the General Social Care Council (GSCC) codes of conduct booklet when they started working at Holt Farm. However, this person was less clear about the practical procedures for reporting suspected abuse or ‘whistle-blowing’ to the local authority. We recommend that more practical ‘scenario’ examples are included in staff training and discussion sessions. The homes system for managing and recording petty cash and individual residents’ money allowances were looked at. Residents’ have individual cash boxes kept in a locked area and accessible when they want money for shopping or trips out. The cash balance is checked daily. The deputy manager has introduced an improved recording system with 2 staff signing the balance records. Several service users have assistance with their finances from the local authority Money Management service, and this gives an added external safeguard to ensure residents’ money is correctly accounted for. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is adequate. The people who live here have a clean and spacious accommodation but work is needed to improve the décor and furnishings to create a more homely and domestic environment. Maintenance to faulty equipment and the facilities needs to be addressed promptly, so that service users are not left potentially at risk from equipment that may be unsafe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken and residents’ rooms were visited (with their permission). The communal areas of the home are clean but appear somewhat bare with few pictures, ornaments or signs of the usual social and domestic life of the home. The ground floor light coloured carpet in the lounge is marked and stained; the deputy manager said that this is going to be replaced and consideration is being given to altering the use of rooms, so that there is a quiet lounge for people who like to watch TV, and a larger room for activities. In the kitchen, a large piece of the ceiling paper was hanging down and there were signs of water damage from a leak that appeared to track near to the Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 20 ceiling light fittings. A staff member said that the provider had visited the home on the day before our inspection and that repairs to the ceiling and checks on the lighting safety were in hand. Some of the residents’ bedrooms, though roomy and bright, were also bare of ornaments and personal property; the deputy manager explained this was because of destructive behaviours and/or personal preference about the individuals’ room layout and need to see their possessions. Other rooms were more highly personalised and attractive. A ground floor shower and toilet was clean but had incontinence pads and colostomy bags on the windowsill and in a basket by the toilet. This does not support the privacy and dignity of residents and sanitary equipment should be stored more discreetly in cupboards or in residents’ own rooms. The shower base is raised up from the floor, with an unsealed wooden step to it that obstructs the access to the toilet. The registered person, Mr Wood, confirmed since the inspection that the step arrangement has been improved by providing a foldaway step. It was noted that bed linen was of a poor quality, was not co-ordinated and that two people did not have pillows on their beds. The deputy manager agreed that new bed linen was needed and said that the missing pillows were probably being laundered. She said there were spare pillows for those missing from the beds and that they would be replaced. The washing machine and tumble-drier are in what was a double garage on the ground floor. The washing machine had washing in it but was marked ‘out of order’. There has been an intermittent fault with the machine and some laundry has been taken to the provider’s other Oxfordshire residential home – Maytrees. Shortly after the inspection Mr Wood said he was awaiting contact from an engineer to correctly diagnose the fault with the machine; meanwhile a staff member had provided a washing machine until the homes own machine is repaired or replaced. Mr Wood also confirmed that the communal areas of the home are going to be redecorated and the kitchen ceiling and lighting repaired. The impression gained was that necessary repairs are not always promptly dealt with, and this results in residents and staff being inconvenienced or potentially at risk because of faulty equipment or damage to the environment. A ground floor room, formerly used as a staff room, next to the kitchen storage room, is a temporary bedroom for one resident. Mr Wood said they are still checking whether full planning permission is required to convert the garage to an en-suite bedroom. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 21 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): 32, 34 and 35 Quality in this outcome area is adequate. Lack of consistent management and leadership in the home and the complex needs of the people living here, means that although peoples’ basic needs are met, staff do not always have the experience and skills to consistently respond to residents’ individual care and support needs. The organisation has plans in place to improve staff training and liaison with external health and social care providers to improve the outcomes for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection, the newly appointed deputy manager for the home had only just completed a 2-week induction programme but had a commendable grasp of the needs of residents and some changes that need to be made to improve the organisation and running of the service. The homes manager was still on extended sick leave. The deputy manager said she has experience in caring for older people and children in residential care settings, but has limited experience in care of people with learning difficulties and mental health needs. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 22 In the absence of a manager in day-to-day charge of the home, a deputy manager from the sister home ‘Maytrees’ had been providing managerial support for Holt Farm staff, together with regular visits from Mr Wood. Health and social care workers told us that they felt the lack of leadership from a permanent manager on site had had a negative effect on the organisation and support for residents and staff alike. This was especially significant because the occupancy of the home had increased over a relatively short time, with the admission of several residents with complex support needs. They felt that things should improve with the appointment of a deputy manager and (it is hoped) the manager will be well enough to return to work soon. Meanwhile, the organisation has changed the management structure so that there is an area manager to oversee both Holt Farm and Maytrees. As mentioned earlier, there are plans for training and development of the homes staff with the input of the local learning disability team and regular review meetings to be held at the home. One professional was concerned that though the funding for their client included payment for some ‘one to one’ staff time, this did not appear to be happening. Staff numbers were depleted in the house when one person is needed to drive the transport and another to accompany residents when they go on outings together. This leaves limited flexibility and staff available to support one or two residents who may choose to do different things. A sample of staff files looked at showed that the homes’ recruitment and screening processes for new staff are satisfactory. There was evidence that new staff had attended induction training. The staff training files need updating to give a consistent and accurate record of what training has been completed by staff. The deputy manager said that recent staff training included Principles of Care, Mental health awareness, First Aid, Communication Skills, Health Promotion and Safeguarding of Vulnerable Adults (SoVA). Some staff have attended ‘Physical Intervention’ sessions and senior staff have attended a course about the ‘Learning Disability Workers role’. Most staff work 12-hour shifts (0800 – 20:00), which gives continuity of care and support to residents. During the day there are 3 support workers and the deputy manager or senior support worker. Overnight there are two waking support staff and a senior staff member or manager on call. If the homes own staff cannot cover absences, agency staff from one agency are used: the agency supplies staff who have the relevant experience in supporting residents with similar needs to those of people living at Holt Farm. Mr Wood said that it is ‘some time ago’ that he asked the agency to confirm that all the staff they supplied to Maytrees care home had current CRB and PoVA checks in place. He should request that the agency confirms in writing Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 23 that all staff supplied at Holt Farm have the appropriate clearances to work with vulnerable people. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 24 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, 38, 39 and 42 Quality in this outcome area is adequate. The temporary day-to-day management arrangements in place whilst the manager has been off sick have been unsatisfactory resulting in a lack of leadership and lapses in the homes practices and procedures that could potentially put residents health and safety at risk. However, the recent appointment of a deputy manager and an area manager has had some positive effects on the organisation and running of the home so that there is some evidence that the quality of the service is improving. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated earlier, it is evident that the home has lacked effective day-to-day leadership for a period of approximately 5 months. As a result, some routine policies and procedures have not been consistently followed. For example, a staff member said that fire drills have not been routinely taking place, but that the deputy manager is now making sure that the fire alarms are Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 25 tested weekly. However, there is a fire safety logbook that all staff sign to indicate that they have checked around the home to make sure that there are no obvious fire hazards each time they start their shift. This is good practice and involves all staff in taking responsibility for fire protection in the home. There was no evidence that staff have attended, or are up to date, in food hygiene training. This was discussed with the deputy manager and Mr Wood who said that this would be checked and training and/or updates provided for all support staff. It was noted that the window opening restrictor chains in a first floor bedroom had been unhooked, so that the windows opened wide and could pose a potential hazard of falls or accidents to the resident. The deputy manager took immediate action to re-attach the device and to check other windows at first floor levels. There are regular staff meetings to discuss how the home is running and any concerns. The deputy manager said she is planning to hold a meeting on her return from annual leave. There appear to be no formal systems for getting the views of residents, their families or representatives, about the home. A visitor spoken to during the inspection said that s/he was very pleased with the care and attention received by her relative since they have been at Holt Farm. Mr Wood said that now that Holt Farm is fully occupied, he intends to use the same independent audit company that has provided quality assurance reports about the sister home, Maytrees. The monthly registered provider visit reports (required under Regulation 26 of the Care Standards Act) were checked during the inspection but there were no copies available in the home since January 2008. Mr Wood has since confirmed that he had visited and completed reports but that recent reports were still on the computer. The registered person (Mr Wood or his representative) is required to visit the home ‘unannounced’, at least every month to inspect the premises, its record of events and records of any events, and to talk to residents and any visitors, and staff in order to get view about the standard of care provided in the home. He must then ‘prepare a written report on the conduct of the home’ a copy of which must be made available to the manager and the Commission. These ‘provider visits’ are an important part of the way in which the registered person can evidence that the standard of care and facilities provided in the home is meeting residents’ needs and expectations and that any concerns are followed up and resolved. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 26 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 3 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 2 2 X X 2 X Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 15 Requirement Care plans must be written in a format that service users can understand and must set out how their personal and social support will meet current and changing needs and aspirations and achieve goals. Staff must support service users to make use of services, facilities and activities in the local community in accordance with individuals’ assessed needs and individual care plans. Supply a copy of the complaints procedure in a format that is accessible and suitable for each service user. The registered provider must have in writing confirmation that the agency has obtained the information and documentation in respect of each agency worker supplied to work at the home. The registered provider must make available at the home the written reports of the unannounced visits made by him, to the Commission and other persons responsible for the management of the organisation. DS0000067215.V369961.R01.S.doc Timescale for action 30/11/08 2. YA13 16(m) 30/11/08 3. YA22 22 30/11/08 4. YA34 19 31/10/08 5. YA39 26 31/10/08 Holt Farm Version 5.2 Page 28 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 YA20 Good Practice Recommendations Maintain a record of the usual signatures and initials of all staff authorised to administer medication in the home. Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone 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. Extracts may not be used or reproduced without the express permission of CSCI Holt Farm DS0000067215.V369961.R01.S.doc Version 5.2 Page 30 - 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. 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