Inspection on 10/09/07 for Home Farm Trust - The Elms

This inspection was carried out on 10th September 2007.

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Home Farm Trust - The Elms 13/09/06

Home Farm Trust - The Elms 07/03/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Home Farm Trust - The Elms The Elms Old Hay Lane Sheffield S17 3GN Lead Inspector Paula Loxley Key Unannounced Inspection 10th September 2007 11:00 Home Farm Trust - The Elms DS0000046512.V347183.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 Home Farm Trust - The Elms DS0000046512.V347183.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. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Home Farm Trust - The Elms Address The Elms Old Hay Lane Sheffield S17 3GN 0114 236 2292 none none www.hft.org.uk Home Farm Trust 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) Mrs Dorothea Marie Edwards Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2006 Brief Description of the Service: The registered providers, Home Farm Trust, are a nationwide provider of care services. The Elms is registered to provide care for 8 younger adults with a learning disability. The home is based in the South West area of Sheffield on the outskirts of Dore village. The Elms is a large detached house situated in extremely spacious, private and attractively landscaped grounds. All bedrooms are single and these have been individually decorated and furnished according to the personal preferences of each person. Several areas of the home have been refurbished over the last few years. This has recently included the refurbishment of the top floor flat (which can provide accommodation for two people), the downstairs bathroom and some external areas of the building. The Elms aims to maintain and develop each person’s independent living skills whilst providing them with regular opportunities to integrate with a wide range of local services and facilities. Information relating to the service, and staff support provided, can be found in the homes statement of purpose and service user guide. Each person living at the home is currently provided with 24-hour staff support with two staff covering each shift during the day and one member of staff sleeping in each night. Staff had their own sleeping accommodation with en-suite shower facilities provided. The current fees charged by the home as at 10/09/07 average £739 per week. Additional charges are made for clothing, toiletries, hairdressing, chiropody, leisure and social activities, magazines and holidays. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A visit was made to the home from 11:00am to 18:15pm. People provided with care, the manager and staff did not know that the inspection was to take place as it was unannounced. As part of the inspection the inspector met with four people who currently live at the home and five staff, including the registered manager and two newly employed staff in the process of completing their initial induction training. (Two people who lived at the home were unavailable as they were away with family). As part of this inspection all of the key standards were checked in-addition to a number of records, including two individual plans of care (PCP’s), staff recruitment and training files and a selection of the services policies and procedures. A visual check of most areas of the home was also completed. Prior to the inspection a range of information included in the ‘Annual Quality Assurance Assessment’ (AQAA), was provided by the registered manager to the CSCI. Questionnaires, regarding the quality of the care and support provided by the home, were sent to people who lived at the home and their relatives. The Commission for Social Care Inspection received seven from people who received care and five from relatives. Comments and feedback from these has been included in this report under the relevant standard. Requirements outstanding from the homes previous inspection in September 2006 were checked and any progress made has been reported on under the relevant standard in this report. Any requirements that continue to remain outstanding have been carried forward with a short timescale. The inspector would like to thank the people who live at the home who agreed to being interviewed and everyone who returned their questionnaires. Thanks also to staff for their support with the inspection process. What the service does well: People who are provided with care at the home continue to receive support from the manager and permanent members of the staff team that are experienced, skilled and committed to meeting their needs. Individuals are encouraged to develop and maintain their independence. Currently staff at the home are developing the work and social opportunities for each person as they recognise that some people who live at the home no longer want to attend some facilities or activities because this has been part of their set routine for many years. People provided with care stated ‘staff help me with what I need and I can talk to them if I am upset or unhappy with something’, ‘I like doing things with the staff that I know and it’s good because they know what I like’, ‘my key worker has helped me with lots of different things and I can talk to Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 6 her’. Relatives said ‘the manager and permanent staff are excellent’, ‘staff are always there to listen and nothing is too much trouble’, ‘all of my son’s needs are met and staff ring me regularly to keep me up to date’, ‘ I am happy knowing that my daughter is well cared for and encouraged to do things for herself and be independent’. Detailed assessments were completed prior to people moving into the home and information from this initial assessment was then used to develop the person’s plan of care or PCP (Person Centred Plan). PCP’s clearly detailed each person’s individual needs and their likes, dislikes, goals and particular methods of communication to make sure staff have all of the information they need to support people appropriately. People who received care at the home had been supported and encouraged to maintain and develop links with their local community and with family and friends. Daily routines and house rules in place at the home had been discussed and agreed with each person and details relating to this were displayed in the home. Any issues or concerns raised were discussed at ‘service user’ meetings and these were held regularly. People provided with care at the home said that they enjoyed the meals and new menu’s had recently been discussed and agreed. Each person could get involved in the preparation and cooking of meals if they wished and according to their individual levels of ability. People who lived at the home had a variety of daily activities that they attended outside of the home and this included work placements, college and social groups. Staff supported with transport as and when needed. Most people had holidays away each year or short weekend breaks if this was preferred. Some people maintained regular contact with family and friends and often stayed at home for several nights or accompanied their family on holidays. Most areas of the home were well maintained following a major refurbishment programme during the last two years and people who lived at the home said they were happy with their own rooms and personal space. Medication policies and procedures in place, supported people to selfadminister their own medication if it had been assessed that they could safely do so. Reviews of medication had been undertaken when any concerns had been noted and each person’s health care needs had been addressed and staff had supported with any appointments or follow up care. Staff spoken with, were knowledgeable of the needs of the people in their care and they were keen to attend any training that could support them in their role. They confirmed that the registered organisation provided them with regular training opportunities and all permanent support staff had successfully completed NVQ level 2 in care. Staff received regular formal supervision with the manager and records of this were kept on file at the home. People provided with care were aware of the complaints procedure and it was confirmed that they had received a copy of the procedure, which included Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 7 graphics, and had it verbally explained to them by staff. Staff had completed training on safeguarding and were aware of the current procedures in place at the home. Risks associated with daily tasks and routines had been identified and assessed for each person and the appropriate systems were in place to make sure each person received the support they needed. What has improved since the last inspection? What they could do better: Although the home is well managed by the registered manager the registered organisation fail to provide her with staff that are trained appropriately and with insufficient staff resources to meet the required regulations and standards for the service. Requirements in relation to statutory training for relief staff and regarding current staffing levels that can not facilitate each person’s social and leisure needs, remain outstanding. Recently many care shifts had been covered by relief staff and this had affected the continuity of care provided to people who lived at the home. Relatives stated ‘it would be good to have more permanent staff on duty as Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 8 lots of agency staff can be unsettling for people and they don’t get the same level of care’, ‘I’m concerned that there’s so many different staff in the home and some of them don’t have the same commitment’. People provided with care said ‘I don’t like having lots of different staff around. Some don’t bother as much’ and staff commented that some relief staff did not always seem keen to support or encourage people as much as they needed. Two new staff had recently been recruited to the vacant posts. Current staffing levels do not adequately support each person with their social and leisure activities outside of the home and although extra funding had recently been approved for one person this issue remains outstanding for several other people who live at the home who are frustrated that they can not always go out when they want especially individually with staff. The inspector continues to be most concerned that a number of relief staff working regularly at the home had not completed the required statutory training prior to providing direct care and support to people. This requirement has now been outstanding since 2004 and people provided with care remain at risk. The views of people provided with care, their relatives and other professionals had not been formally sought and the manager was aware that as part of the quality assurance systems in place at the home this must be discussed further with the registered organisation With regard to the environment the shower room had a loose panel that was in need of repair and the visitors room was unfurnished and unattractive. Flooring fitted in the kitchen of the top floor flat was in need of replacement as food debris was adhering to the surface and could not be removed. 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. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 9 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 Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available written evidence seen in the personal files, and care plans, of people who live at the home and from discussions with the registered manager during a visit to this service. The care needs of each person had been assessed in detail before they had moved into the home. This made sure that the service could meet each person’s needs and that support staff had up to date information of those needs, and of their interests and personal preferences/choices. EVIDENCE: Files checked and discussions with the manager confirmed that detailed full needs assessments had been completed by the referring social worker or other appropriately trained person, prior to each person moving into the home. Copies of these were retained on individual files and information from the assessment had been used to develop the initial plan of care or PCP (Person Centred Plan). It was confirmed that people receiving care at the home and their relatives, had been involved in this process as appropriate to each person. Any restrictions imposed due to any specific risks or particular individual needs had been discussed, agreed and recorded. Home Farm Trust - The Elms DS0000046512.V347183.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 good however it is important that all support staff complete detailed daily records of the support provided and link the information to the identified goals and specific needs as documented in each person’s PCP. This judgement has been made after checking available written evidence in the daily log and two people’s PCP’s and following discussions with people who receive care at the home, support staff and the registered manager during a visit to this service. Detailed Person Centred Plans (PCP’s), including specific individual goals for each person, had been completed and this information was available for support staff. The daily records of support provided had improved since the last inspection. However as some staff were not recording sufficient information there was not enough evidence of the support provided by all staff to meet each person’s needs as detailed within their plan of care. Discussions with people who lived at the home, and information received via a number of questionnaires, confirmed that they were encouraged and supported by staff to make decisions about their lives. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 12 People who received care, and their relatives, said staff encouraged each person to maintain and develop their independence. They confirmed that staff supported them to take risks as part of their on-going development and daily life. Written risk assessments had been completed to make sure that people receiving care were safe and that any risks identified were reduced as much as possible. EVIDENCE: Two PCP’s were checked and these were very detailed and included each person’s individual needs, preferences, personal wishes and current goals. It was positive to note that they also included the person’s dislikes and details of how they may communicate that they were unhappy or distressed. People receiving care had been involved in regular informal monthly reviews of their plan of care with their key worker. Minutes of the formal annual review, with the person’s relatives and social worker also attending (as appropriate to each person), were seen on files checked. Interviews with people who received care at the home, confirmed that they were happy with the support worker who was allocated to them as their key worker and that they could discuss with them any ideas, choices or personal issues that they may have. The plans of care included graphics in-addition to the written text and it was obvious that each person had been actively involved in the development of their PCP. The manager confirmed that the plan of care was reviewed more frequently if needed. Records seen, confirmed that weekly updates, cross-referenced with the daily log, were kept in a key working log for each person. Some staff had recorded in detail how they had supported or assisted each person in working towards their current goals and there was evidence that the manager was now monitoring these records. Discussions with the manager confirmed that she was aware of the staff that needed to further improve in this area as some had regularly only recorded where the person had spent their time. Inventories of people’s personal possessions were in the main regularly updated by the key worker. People who received care at the home spoke positively of the on-going support currently provided by staff. They said they had their own monthly meetings, which staff also attended, and that they could add topics of their choice to the agenda for discussion. Minutes of these meetings were checked and items discussed included health and safety, transport and the purchase of a new car for the home, menu’s and food preparation, safety, holidays, redecoration, staffing and vacancies, employment and social trips/activities. Individual interviews with people provided with care at the home, and feedback from their questionnaires, confirmed that they were encouraged to make decisions about where they wanted to spend their time, both in and out of the home, and with whom they wished to be with. Observations of staff interaction Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 13 confirmed that people living at the home had developed positive relationships with some support staff especially those that had worked at the home for sometime that they had regular and frequent contact with. Further discussions with individuals who live at the home confirmed that two of them had been actively involved in the recent recruitment and selection of two new support staff. They said they had enjoyed doing this and newly recruited staff spoken with confirmed that it had been a positive experience. The manager confirmed that people living at the home could manage their own finances if they had the ability to do so. Records relating to each person’s circumstances, abilities and personal choices regarding their finances had been recorded. Consent forms, relating to money and the management of their finances, had been signed and were available on individual files. Regular audits of all accounts had been completed. Finance sheets and cash balances checked for two people were accurate. However it was noted that not all debits were countersigned as required or as stipulated in the registered organisations finance policy and procedures. People who received care, who had the ability to sign for their own money, had not always done so. Discussions with support staff and people receiving care at the home confirmed that each person was encouraged and supported by staff, inside and out of the home, to take risks as part of their daily routines and activities. Files checked included detailed written risk assessments and these had been regularly reviewed and updated. Risk assessments checked had been completed for individual risks associated with finances, social and leisure activities, selftravel, the use of cleaning materials and equipment, preparation and cooking of meals, independent living in the flat, self-medication, storage of items, relationships and the use of gym equipment. Further documentation seen, confirmed that support staff had provided some people who received care with more intensive individual training and support on specific risks that had been identified with personal safety, activities and self-travel. New situations had been closely monitored and supervised by staff and records relating to this had been retained on individual files. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made after checking available written evidence in two people’s PCP’s and individual files, from information provided via questionnaires and following discussions with people who receive care at the home, support staff and the registered manager during a visit to this service. People receiving care at the home confirmed that support staff helped and encouraged them to access a range of activities that they wished to participate in and in the main they were satisfied with how they spent their time. People receiving care at the home said staff supported them as they wished with maintaining and developing links outside of the home and this made sure they kept in contact with their local community. It was confirmed by relatives, and by people receiving care at the home, that staff supported each person as they wished with developing and maintaining links with their family and friends. As a result of this each person could spend time with the people they wanted to be with. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 15 Information provided by staff, relatives and people who received care confirmed that each person was aware of the daily routines and house rules that were in place at the home and that these encouraged and developed each person’s independence and individual choice. The manager and staff were continuing to work with each person who lived at the home on menu planning and on the preparation and cooking of a wellbalanced meal so that each person received nutritious and attractively presented food that they enjoyed but that also encouraged a healthy diet. EVIDENCE: Discussions with people who received care, and information provided via their questionnaires, confirmed that in the main each person could choose how they wished to spend their time. Most people said that they enjoyed having a number of different activities that they could participate in each week. One person spoken with said ‘ I don’t like to go out at night but I go out in the day with just me and staff to shops or cafes for a drink or meal’. Current activities regularly enjoyed by some individuals included music and dance, keep fit, Gym, shopping, badminton, cookery and drama. Other regular planned outings included attendance at SCOPE, Gateway, Peak Rail, Heeley Farm, church or local colleges. The manager said some people chose to have a much more active and busy week than others and that further opportunities were being developed for some individuals who no longer wished to attend some activities that had been on-going for years. In the pre-inspection information provided the manager stated that the registered organisation were recruiting a fulltime ‘Supported Employment Officer’ for the Sheffield and Derbyshire services. This worker would “provide support with access to meaningful employment in the community”. However discussions with the manager during the inspection confirmed that the post had subsequently not been recruited too as it had been put on hold. It is hoped that this is only a temporary setback as the creation of this post could have provided a range of valuable contacts, links and new employment or work placement opportunities for many of the people who currently live at the home. Since the last inspection the home had purchased a new car and discussions with people who lived at the home confirmed that they enjoyed travelling by car with staff to support them with their preferred choice of outing or activity. They were able to have regular access to shops and other facilities in the local community and this included trips to the cinema, pub, restaurants, bowling, concerts or the local gateway club. Individuals who preferred to be more independent and use public transport could do so if they wished and if it had been determined that they could do this safely. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 16 Staff spoken with confirmed that they supported service users with their activities outside of the home whenever possible. This was flexible although it was dependent on the availability of staff due to the current staffing levels- for further information relating to this please refer to standard 33. Discussions with people who lived at the home, and information provided via their questionnaires, confirmed that their family and friends were encouraged to visit and that they were made to feel welcome by staff employed at the home. They said they could choose who visited and when they wished to see them. They were able to meet with their visitors in the privacy of their own rooms or in the visitor’s room downstairs. However when checked this room was unattractive and unwelcoming-please refer to standard 28 for further information relating to this. Relatives, via their questionnaires, stated that they were able to visit at any reasonable time and one relative said ‘I am always made welcome and staff are never too busy to listen or spend time with us’. Two people who lived at the home stated that they had developed positive personal relationships with partners who did not live at the home. People provided with care said they had a key for their room and it was positive to note that bedrooms were kept locked when unoccupied. Discussions with staff and people living at the home confirmed that daily routines for all household tasks, including cooking and cleaning had been developed and discussions relating to this were seen documented in the ‘service user meeting minutes’ which were available at the home. It was confirmed that each person had discussed and agreed their daily tasks and specific areas of responsibility. To avoid confusion a picture board displayed in the hall helped to remind each person of their allocated weekly tasks. Generally these had been allocated according to each person’s individual levels of ability and preferences. Details relating to this were documented in the person’s plan of care and further information regarding daily routines and the house rules were also available in the homes service user guide. The manager confirmed that records of all meals provided to each person were maintained by the home. Discussions with the manager and staff confirmed that a varied, balanced and nutritious diet was offered to each person. Details relating to this, including likes and dislikes, had been recorded in the plan of care. Since the last inspection work had been ongoing on developing new healthy menu options for each person in line with their own individual preferences and any special dietary needs. Each individual was encouraged with staff support to help prepare and cook their own meals according to their individual level of ability. People receiving care at the home were able to help with the weekly shopping if they wished and one person spoken with said ‘I like the meals and all the food. We sometimes have my favourite meals and I can help to cook it with staff’. Documentation seen in individual files confirmed that staff had provided some individuals with advice and guidance on healthy Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 17 eating or weight loss. Menu’s, cooking and food were topics regularly discussed at ‘service user’ meetings and details relating on this were seen in the minutes. Recently the manager and staff had reviewed the support provided to one person who now lived alone in the self-contained flat on the top floor of the home. Staff interviewed confirmed that discussions had taken place regarding a new four-week menu plan for this person. They looked at the issues of independent living, staff support and healthy living. The manager said new routines were now in place to make sure the person was supported appropriately and that food was prepared and cooked safely and for the required amount of time. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made after checking the medication policy, procedure and records, two people’s PCP’s, from information provided via relatives questionnaires and following discussions with people who received care at the home, support staff and the registered manager during a visit to this service. People cared for by the home said they received personal care from staff that were respectful and sensitive to their needs and situation. They confirmed that staff respected their privacy and were keen to provide them with the support they needed which encouraged and developed their independence. The physical and emotional care needs of each person who lived at the home had been regularly reviewed and reassessed and the appropriate action had been taken by staff to make sure that each person’s current healthcare needs were met. The policies and procedures in place for the recording, storage and administration of medication made sure that people who received care at the home were protected. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 19 EVIDENCE: Staff spoken with, were aware of the personal care needs and daily hygiene routines of each person they cared for. Information seen in the PCP’s clearly detailed the preferred gender of staff each person wished to support them with any aspect of their personal care. Records checked and discussions with people who received care, confirmed that staff had provided advice and guidance on skin care, clothes, personal hygiene and appearance. People living at the home were able to choose their own clothes and they were happy for staff to support them with shopping for any new clothes or personal items that they wanted to buy. A key worker had been allocated to each person and individuals spoken with confirmed that they were happy with the staff allocated to them in this role. The manager confirmed that each person who lived at the home was able to choose which GP and other healthcare professionals they wished to register with. The healthcare needs of each person had been regularly reviewed and reassessed and all information relating to this had been recorded in detail in the individual’s plan of care. Staff had supported each person with medical appointments and general advice about health issues as and when needed and details of any follow up appointments had been documented in the key worker log and healthcare section of the PCP. Specialist support or advice had been accessed for anyone who needed this and there was evidence of regular routine appointments with the dentist, optician and chiropodist for some individuals. Staff and people receiving care at the home said they could see any medical staff that visited them at the home in private. The manager confirmed in the pre-inspection documentation that the homes medication policies and procedures were last reviewed in January 2006. They included the good practice guidelines issued by Sheffield City Council. The manager and staff spoken with, and training records checked, confirmed that all permanent staff employed by the home had completed training on medication. Refresher training had recently been provided to all staff and any issues relating to the administration and recording of medication had been regularly discussed. All medication was securely stored and records were kept of any medication disposed of by the home. Records checked confirmed that the manager and responsible individual for the home were now regularly monitoring the medication administration records (MAR sheets). MAR sheets checked included all of the required information and all medication administered had been signed for as required. Staff interviewed confirmed that newly recruited staff, temporary relief or agency staff were not authorised to administer medication. Details of each person’s medication, including any allergies and known side effects, had been included in the healthcare section of their PCP. Where any concerns had been identified by staff, the GP had been contacted and a review of medication had been completed. Signed medication consent forms, for people assisted or supported by staff with their medication Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 20 were seen on file. Medication movement checklists were completed for each person when they were away from the home. The manager confirmed that people provided with care were supported to administer their own medication once it had been determined that they could safely do so. Currently one person was self-administering their own medication and staff were monitoring the situation. A detailed risk assessment had been completed. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made from information provided via questionnaires, from checking staff training records, the complaints record and policy and following discussions with people who received care, support staff and the registered manager during a visit to this service. Relatives and people who received care at the home stated that they were aware of the homes complaints procedure and that staff listened and responded appropriately if they had any complaints and this confirmed that any concerns were acted upon and addressed effectively within the set timescales. The home had the appropriate safe guarding policies and procedures in place and staff had completed the required training to make sure that service users were protected. EVIDENCE: Relatives, via their questionnaires, stated that they had been provided with a copy of the homes complaints procedure and that any complaints had been responded to quickly and dealt with appropriately. Further copies were available in the home and people who received care had signed to confirm that they had received a copy and that staff had explained it to them verbally. It was positive to note that pictures had been included with the written text to assist people living at the home with their understanding of the processes and timescales involved. The complaints record confirmed the home had received three complaints since the last inspection and the records of these detailed all Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 22 of the required information, including any follow up action taken and the outcome. There was evidence that the manager had monitored the complaints record and copies of any complaints made had been retained on individual files. No complaints had been received by the CSCI since the last inspection. Discussions with people who received care at the home confirmed that they were aware of the procedures in place and they said they were able to discuss any complaints or concerns that they may have with staff or the manager of the home. Minor issues were often discussed and acted upon following a ‘service users’ meeting. The manager confirmed in the pre-inspection documentation that the complaints procedure was last reviewed and updated in January 2006. The homes safeguarding policies and procedures included the Department of Health Guidance ‘No Secrets’ and whistle blowing and the manager stated that the policy and procedures were last reviewed and updated in March 2006. Staff training records confirmed that all staff had completed training on safeguarding, advocacy, empowerment and awareness of behaviour that challenges. The manager said it was planned for all staff to receive training and awareness on the Mental Capacity Act during the next twelve months. Staff interviewed, were aware of the different forms of abuse and they said they had been made aware of the procedures for the reporting and investigation of any allegations of abuse. One member of staff newly employed by the home, said that basic training on safeguarding issues and procedures was provided as part of the initial induction training. Discussions with the manager confirmed that she was aware that any allegations or incidents of abuse had to be reported to the CSCI under regulation 37. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 23 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, 27, 28 and 30. Quality in this outcome area is good however one area needed repairing in the shower room and the visitor’s room required furnishing. This judgement has been made after checking several areas of the homes environment, a number of records and following discussions with people who were provided with care, support staff and the registered manager during a visit to this service. Since the last inspection several areas of the home had been refurbished and redecorated and this provided people who lived at the home with a comfortable and homely environment. Toilets and bath and shower rooms provided people who lived at the home with privacy and the appropriate facilities to meet their current needs. A number of communal areas were available for people who lived at the home to use for shared activities or private use and other than the visitors room these provided comfortable, spacious and safe areas where they could spend their time. Discussions with people who lived at the home, staff and the manager confirmed that since the last inspection new daily cleaning routines were in Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 24 place at the home to make sure that the home was kept clean and to protect people who lived and worked there from infection. All areas of the home checked during the inspection were clean. EVIDENCE: It was positive to note that since the last inspection several areas of the home had been refurbished and redecorated. This included the top floor selfcontained flat that had equipment replaced in the bathroom and a new shower installed over the bath, new kitchen worktops, cabinets, cooker and extractor in addition to redecoration and new carpets and blinds. Staff confirmed that the person living in the top flat had purchased a new bed, settee, wardrobe, carpet and curtains of their choice for the bedroom that was spacious and personalised. Work had been completed on removing the moss and excess water from the external fire escape to make sure that anyone evacuating the building by this route could do so safely. Records checked confirmed that all equipment had been checked and serviced as required and any repairs or faults required had been actioned. People provided with care said they liked living at the home and that they were pleased with the work that had been done recently and the new equipment that had been purchased. They had been involved in decisions regarding the purchase of new furniture and furnishings. The furniture was domestic in style and most areas of the home were attractively decorated and personalised. The manager confirmed that further work was to be undertaken on the external areas of the home and that this included resurfacing the driveway and erecting railings to the side and rear garden areas. Since the last inspection the downstairs bathroom had been refurbished and a walk in shower with seat and Mira shower had been installed. Walls had been retiled and new lighting, blinds and an extractor fan had also been provided. People who lived at the home also had a separate bath and shower room on the first floor available for them to use. All equipment provided was in working order and the appropriate locks had been fitted. The inspector discussed with the manager the possibility of personalising the shower and bathroom’s as they appeared clinical and less homely than other areas of the home. The manager said that this would be difficult as one person living at the home would not tolerate this and would remove any items placed in these rooms. The inspector suggested that this issue was discussed with everyone that currently lived at the home as there were six other people’s views and preferences to consider. An access panel leading to pipe work, fitted underneath the sink in the shower room, was in need of repair as it had loosened and could cause injury to someone accessing the sink. People provided with care at the home confirmed that they could choose how and where they wished to spend their time in the home. The accommodation Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 25 provided sufficient communal space for them to be able to spend time alone, outside of their own room, if they wished. All kitchen equipment was domestic in style and adequate laundry facilities were fitted in the laundry room in the lower basement. Staff covering the sleep in duty had comfortable accommodation provided with the recent conversion of one room to a staff bedroom with en-suite shower facilities provided. The downstairs visitors room was unattractive and unwelcoming and all of the furniture had been removed. All areas of the home checked were clean, tidy and free of offensive odours. Discussions with staff confirmed that since the last inspection new cleaning routines had been developed and these had been discussed and agreed with the people who currently live at the home. Details of this could be seen displayed in the hallway and specific tasks had been designated each week for each person. The cleaning and maintenance of the top floor flat was the responsibility of the person who lived there but staff spoken with, and the PCP checked, confirmed that staff also supported with this and were to monitor the flat each day. People provided with care said that they knew what tasks they had to help with each week. One person said they liked some tasks more than others but were aware that they ‘took turns with the jobs to make sure it all gets done and the place gets cleaned up’. Staff spoken with said each person helped with tasks that were appropriate to their individual skills and capabilities and that any potential risks had been identified, assessed and documented in the risk assessments. The flooring in the kitchen in the top floor flat appeared dirty. Staff confirmed that the wrong type of flooring had been fitted as it was only suitable for bathrooms and especially not for food preparation and cooking areas as any food debris adhered to the surface of the flooring and was extremely difficult to remove. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 26 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, 33, 34 and 35. Quality in this outcome area is good, however staffing levels must be reviewed to ensure that people provided with care at the home can access their preferred leisure and social activities as they wish and as documented within their PCP. This judgement has been made after checking a number of staff records, from information provided via questionnaires and following discussions with people who were provided with care, support staff and the registered manager during a visit to this service. Records checked and discussions with staff and the manager confirmed that all permanent staff had completed a range of training including NVQ level 2 in care and as a consequence of this people who received care were in the main supported or assisted by staff that were qualified, experienced and competent. Discussions with staff and the manager confirmed that since the last inspection the agreed staffing levels had generally been maintained. However there was evidence that the current staffing levels were not always sufficient to provide each person who received care at the home with the appropriate support to facilitate their preferred social and leisure activities outside of the home. Detailed staff recruitment and selection policies and procedures were in place at the home and the required documentation had been retained on staff files to make sure that people provided with care were protected. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 27 Generally the registered organisations commitment to staff training made sure that people provided with care were supported most of the time by staff that were appropriately skilled and trained to meet their needs. EVIDENCE: Since the last inspection all support staff employed on permanent contracts at the home had successfully completed NVQ level 2 in care and one person had previously achieved NVQ level 3. Discussions with staff confirmed that they were committed to further training and that the organisation provided them with regular opportunities to attend a range of training courses relevant to their role at the home. A number of staff had many years of valuable experience of working with young people with a learning disability in a care setting and they continued to be committed to meeting the needs of each person in their care. Observations of staff interaction with the people who lived at the home demonstrated that staff were supportive and had the appropriate skills to communicate effectively with each person. Discussions with people who received care at the home confirmed that they were comfortable with staff. Two people spoken with said they could easily talk to staff who they knew would listen to what they had to say and positive relationships had been developed with the member of staff who was allocated as their key worker. Relatives, via their questionnaires, stated ‘the support worker rings me every fortnight and they are always helpful and supportive’, ‘the staff understand my son and enable him to live a life which is fulfilling according to his abilities’, ‘permanent staff are excellent’ and ‘the staff cater for all my daughter’s needs’. Support staff employed to work at The Elms are also employed to work at a supported living scheme adjacent to the home. The manager confirmed that since the last inspection the agreed staffing levels of two staff on duty throughout the day from 7.45 am to 15.15 and 15.00 to 22.30, had been maintained on all but one occasion. During the last few months there had continued to be a high use of relief bank staff (employed by the organisation) or agency staff to cover staff vacancies. The manager stated that relief/agency staff had covered 204 hours over a three-month period. It was positive to note that the home had recently recruited two new staff to the vacant posts who at the time of the inspection were completing their induction training. The manager said that she hoped the home could now achieve a period of stability and consistency of care as the need to use relief staff would reduce once new staff had completed their induction. Relatives, via their questionnaires, had raised concerns about the frequent use of relief staff and the unsettling effect that this had on the people who lived at the home and who needed continuity of care from staff that they knew well and had developed positive relationships with. People provided with care said ‘I like it best when it’s the staff I know because they know me and what I like’, ‘I don’t like lots of different staff Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 28 coming and going and some don’t bother as much as others or help us as much- there’s too many’. The manager confirmed that extra funding had been agreed to purchase additional staff resources for one person currently provided with care at the home. This funding would provide extra staff hours to support the person with a range of social, work or leisure activities outside of the home. The manager was aware that this was needed for a number of other people who receive care at the home as the current staffing levels do not always facilitate each persons needs particularly in relation to social activities, outings or day trips. Relatives, via their questionnaires, stated ‘more permanent staff are required and then people can get out more’, ‘staffing levels mean regular outings or trips don’t happen often enough for some’. People provided with care at the home when spoken with, or via their questionnaires, said ‘we can’t always go out when we want because there are not enough staff to take us’, ‘unless lots of us want to go somewhere together we can’t always go’, ‘staffing does not always allow one to one activity or outings’. It is important that this is addressed as it has been an issue for sometime now and one relative spoken with said ‘what’s the point having all these meetings for PCP’s and plans if what people have said they want to do can’t happen because there are not enough staff on duty to support them. It undermines the whole process of doing the plan in the first place’. The inspector discussed this issue at length with the manager and suggested that staff rotas were reviewed to determine if there could be any further flexibility with the staffing on some days to facilitate each person’s social needs as they wanted and preferred. The staff recruitment and selection policies and procedures in place at the home had been reviewed and updated in November 2006 and these were detailed and comprehensive. It was confirmed that staff were not recruited to work with people provided with care at the home until all of the required checks had been completed including a CRB check at the enhanced level, two written references, including one from their last employer, a health check and evidence of proof of identity and qualifications obtained. Copies of the required documentation were available on files checked and one support worker recently recruited to work at the home said they had completed an application form and attended a formal interview prior to being provisionally offered the post. Staff files were stored securely as required and some of the information was retained at head office. It was positive to note that people who were provided with care at the home had been actively involved in the recent recruitment and selection of new staff. The manager confirmed that all staff had a personal training and development plan. Support staff spoken with confirmed that the registered organisation encouraged and supported them with regular training opportunities and that their training needs were discussed regularly in supervision. Since the last inspection staff had completed a range of training and this included safeguarding, personal care, risk assessments, autism, challenging behaviour, Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 29 epilepsy, loss and bereavement, dementia and dental health. One newly recruited support worker stated during interview that the induction training was extremely comprehensive and supportive. It included the first week shadowing experienced staff on shift followed by a three week rolling programme. This included three days induction at the office covering equal opportunities, diversity, risk assessments, manuals and policies, health and safety and care plans. Details of the induction were clearly documented and signed off when completed by the staff member and their manager. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 30 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 and 42. Quality in this outcome area is adequate however relief staff employed to work at the home must undertake the required statutory training before they provide support and direct care to people who live at the home. This judgement has been made after checking a range of documentation including staff training records and relatives questionnaires and following discussions with support staff and the registered manager during a visit to this service. The registered managers experience and training benefited people who were provided with care at the home. The views of people who lived at the home had been sought via ‘service user’ meetings and the registered organisation had recently conducted a survey of staff. However the views of relatives, friends or any professionals involved with the service had not been formally sought and therefore effective quality assurance and monitoring systems were not fully in place at the home. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 31 The majority of the records checked contained the required information and were well ordered and up to date which confirmed that the rights and best interests of people provided with care at the home were safeguarded. Detailed health and safety policies and procedures were in place at the home and the manager confirmed that staff had been made aware of these. However concerns remain regarding the continued lack of statutory training provided to many of the organisations relief bank staff that work regularly at the home providing direct care and support to the people who live there and who as a consequence of this are not adequately protected. EVIDENCE: The manager has a wealth of experience of working in a care setting and had successfully completed NVQ level 4 training in care, the A1 Assessors award and the Registered Managers Award (RMA). Discussions with her confirmed that she is aware of her roles and responsibilities and is keen to see people who are provided with care at the home further develop their independence and achieve the goals that they have set for themselves particularly in relation to work, social and leisure opportunities. She is committed to further training for herself and all staff employed at the home. Staff spoken with stated that the manager was supportive and that they could discuss any ideas, issues or concerns that they may have with her. People provided with care said that they were happy to talk to the manager who was often around in the home. One relative via their questionnaire stated ‘The Elms has improved over the last three years- good manager and several good permanent members of staff’. The manager said that the registered organisation had conducted a staff satisfaction survey in 2006 however the results had not been published and a report on the findings had not been provided to the CSCI. ‘Service user’ meetings were held monthly and people who lived at the home said they could choose if they wished to attend and could add items to the agenda for discussion. The manager said that staff were consulted on the development of the service and were supported to involve the people who live at the home. She confirmed that there was an annual development plan for the home however the views of people who lived at the home, relatives, friends and other professionals had not been formally sought and therefore no report was available on the findings. The manager said this was something she would discuss with her line managers. Records checked were securely stored, up to date and contained most of the required information. Monthly regulation 26 reports were available. These were detailed and a copy had been forwarded each month by the responsible Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 32 individual to the CSCI. It was noted that visitors to the home had not always signed in and out in the visitors book and the minutes of staff meetings did not always include details of who was responsible for taking any follow up action on a particular issue or if any agreed action had been completed. Any issues found in relation to other records have been reported on elsewhere in this report under the relevant standard. Staff training records confirmed that the majority of permanent staff employed at the home had now completed the required statutory health and safety training including refresher training. Written risk assessments had been completed and these had been regularly reviewed and reassessed and staff had signed to confirm they had been made aware of these. Records checked confirmed that all equipment had been checked and serviced as required and this had included PAT testing of all electrical appliances and equipment. Safety procedures that could be easily understood by people who lived at the home were displayed throughout the home and everyone who lived and worked at the home had been included in fire instruction sessions and regular fire drills. The inspector was deeply concerned that the staff training records confirmed that a number of relief staff recently working regularly at the home, and involved in direct care and support of people who lived at the home, had not completed the required statutory training on food hygiene, moving and handling, first aid or infection control. This requirement has been outstanding since April 2004. Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 33 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X 3 2 X Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 34 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 17 Requirement Daily records of the staff support provided to each person must include details of the action taken by staff to facilitate each individual’s needs and goals as identified within their individual plan. (Previous timescales of 31/03/05, 30/06/05,30/04/06 and 31/10/06 not met). The loose access panel below the sink in the upstairs shower room must be repaired. The visitor’s room must be adequately furnished and decorated. The flooring fitted in the kitchen in the top floor flat must be replaced. The current staffing levels must be reviewed to ensure that sufficient staff are on duty at all times to facilitate the preferred daily leisure and social activities as identified within their individual plan. (Previous timescales of 30/06/06 and 15/12/06 not met). The views of service users families and friends and other DS0000046512.V347183.R01.S.doc Timescale for action 31/10/07 2 3 4 5 YA27 YA28 YA30 YA33 23 23 23 18 31/10/07 31/10/07 31/12/07 31/01/08 6 YA39 24 31/01/08 Home Farm Trust - The Elms Version 5.2 Page 35 7 YA42 18 professionals involved with the service should be sought and the results of any service user satisfaction surveys must be published and made available to service users, their representatives and the CSCI. (Previous timescale of 31/01/07 not met). All staff employed by the home 31/01/08 (including relief, bank and agency staff) must complete statutory health and safety training. This includes regular refresher training as appropriate. (Previous timescales of 01/04/04, 31/10/04, 31/05/05, 31/07/05, 30/06/06 and 30/11/06 not met). 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 YA7 Good Practice Recommendations All financial transactions involving service users money should be countersigned as stipulated in the organisations finance policy and procedures. Service users who have the ability to sign for their own money should do so. Bath and shower rooms should be personalised. Staff meeting minutes should include details of the person responsible for taking any follow up action and should record if this has been completed. All visitors to the home should sign in and out in the visitors book. 2 3 4 YA27 YA41 YA41 Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Home Farm Trust - The Elms DS0000046512.V347183.R01.S.doc Version 5.2 Page 37 - 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. 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