Inspection on 13/09/06 for Home Farm Trust - The Elms

This inspection was carried out on 13th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Home Farm Trust - The Elms 10/09/07

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 13th September 2006 09:45 Home Farm Trust - The Elms DS0000046512.V308716.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.V308716.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.V308716.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.V308716.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 7th March 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 private and attractively landscaped grounds. All bedrooms are single and are individually decorated and furnished according to the personal preferences of each service user. During the last two years, several areas of the home have been refurbished and this has included the replacement of the windows, some rewiring, refurbishment and redecoration of the upstairs bathroom, installation of vanity washbasins in bedrooms and the redecoration of several areas of the home including service users bedrooms. The Elms aims to maintain and develop service users 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. Service users are provided with 24-hour staff support with one member of staff covering the sleeping in shift each night. The current fees charged by the home are £699.25 per week. Additional charges, paid individually by each service user, are for clothing, toiletries, hairdressing, chiropody, leisure and social activities, magazines and holidays. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out from 9:45am to 18:15pm. Two service users, one relative and four staff, including the registered manager, were spoken to as part of the inspection process. (Six service users were unavailable, as they had gone on a day trip with SCOPE to Stoke). A wide selection of records, including two service users plans of care, three staff files and a selection of the services policies and procedures, were checked. A visual check of several areas of the home was also completed. Questionnaires, regarding the quality of the care and support provided by the home, were sent to service users and their relatives. The Commission for Social Care Inspection received seven from service users and five from relatives. Comments and feedback from these has been included in this report under the relevant standard. Requirements outstanding from the previous inspection in March 2006 were checked and the progress made has been reported on under the relevant standard in this report. Any requirements that remain outstanding have been carried forward with a short timescale. The inspector would like to thank the service users who agreed to being interviewed by the inspector and everyone that returned their questionnaires. Thanks also to staff for their help and support with the inspection process. What the service does well: The manager and permanent staff team employed at the home are committed to meeting the needs of the service users and they have a range of skills, knowledge and abilities that are appropriate to the service within which they work. Relatives, via their questionnaires, confirmed that support staff were approachable and supportive. One relative stated ‘ I could not be more satisfied, the staff have been excellent’ and another said ‘I am extremely satisfied with the high standards of care that our child receives’. The recent refurbishment has provided service users with a homely and comfortable environment in several areas of the home and this has included the redecoration and refurbishment of six of the eight bedrooms. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 6 Service users and their relatives had attended review meetings and detailed care plans had been developed for each service user within the ‘person centred plan’ (PCP) format. Observations made during the inspection and discussions with service users confirmed that staff encouraged each individual to develop and maintain their independence. Service users had a key worker allocated and positive relationships had been developed. Service users said staff were approachable and that they could talk to them about any issues or concerns that they may have. Service user meetings had been held regularly and minutes of these meetings confirmed that a variety of topics were discussed. Routines were flexible and the manager confirmed that service users were being encouraged to develop their social and leisure activities and it was hoped that this would provide service users with greater opportunities as identified within their individual plan. Staff interviewed, were well informed and knowledgeable of each service users needs and personal preferences. Any risks had been identified and assessed and the appropriate systems had been put in place to ensure that service users received the support they needed. Service users said that they enjoyed shopping for food and that they could choose what they wished to eat. Staff had provided advice about healthy eating and supported some service users with the preparation and cooking of meals. What has improved since the last inspection? Since the last inspection a number of records had been updated and many of the issues found in relation to records had been addressed. Staff had completed training on adult protection awareness and staff interviewed were aware of the procedures for the reporting and investigation of any allegations. Staff had accessed a range of training since the last inspection and this had included equality and diversity, statutory health and safety training, personal care, medication and NVQ level 2 in care. A number of staff had training courses planned for later in the year. Service users now had access to a room on the ground floor where they could meet with their visitors in private and this room had been redecorated and new furniture and carpets had been purchased. Staff recruitment files had been updated to include all of the required information. The homes finance policy and procedures had been reviewed and updated and all records of service users financial transactions had been countersigned as required. It was positive to note that some service users were signing their own records. The regulation 26 reports, completed monthly, were available within the home and they contained all of the required information. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Home Farm Trust - The Elms DS0000046512.V308716.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 Home Farm Trust - The Elms DS0000046512.V308716.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 at least once during a 12 month period. 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 service users files and following discussions with the registered manager. Service users care needs had been fully assessed prior to their admission to the home. This ensured that the service was appropriate to meet each individuals identified needs and that staff had the relevant information relating to those needs. EVIDENCE: Service user 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 the individuals admission to the home. Copies of these had been retained on individual files and the information contained in the assessment had been used to develop the initial service user plan of care. Service users and their relatives had been involved in this process as appropriate to each individual. Any restrictions imposed due to any specific risks or special individual needs had been discussed, agreed and recorded. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good however the information recorded in care plans must be improved to ensure that all sections are up to date and that there are full details of the staff support provided to facilitate service users identified needs. This judgement has been made after checking the available written evidence in service user files and following discussions with service users, staff and the registered manager. Detailed care plans, that included individual goals, had been completed for each service user. However the daily records of care did not contain sufficient information or evidence of the support provided by all staff to meet each persons needs as specified within their care plan. Service users spoken with, and via their questionnaires, confirmed that they were encouraged and supported by staff to make decisions about their lives as needed. Service users said staff encouraged them to maintain and develop their independence. They confirmed that staff supported them to take risks as part of their on-going development. Written risk assessments had been completed to ensure the safety and protection of service users. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 11 EVIDENCE: Two care plans were checked and these clearly detailed the individual needs of each service user. They had been developed within a ‘person centred plan’ (PCP) format and service users and the manager confirmed that these had been regularly reviewed. Service users confirmed that they had attended their review meeting with their parents. It was positive to note that care plans included graphics in addition to the written format. Service users had a key worker allocated and two service users interviewed said they were happy with the staff linked to them in this role as they could easily talk to them about any issues or concerns that they may have. The manager confirmed that the care plan would be reviewed more frequently if staff indicated that they had any specific concerns. Documentation seen in service user files confirmed that weekly updates, cross-referenced with the daily records, were recorded on each key working log. Individual goals were updated monthly and these focused on finances, health, inventory of personal possessions and health and safety. PCP reviews were held at six monthly intervals and notes of these meetings had been retained. Some staff had recorded how they had supported or assisted individual service users. Not all inventories seen had been updated as required and the daily log had not always been completed daily. The current system in place required staff to record on the key working log and/or on the daily log but it was confusing as some days had no entries made on either, and some of the records were disorganised. The daily log appeared to only record any activities attended or it stated ‘had relaxing day’, ‘have seen around Elms, upstairs-kept to self, alright’, ‘been to village, seems well’. The manager confirmed that she thought there were problems with the current recording systems and that she had been discussing this with her senior manager. The daily records and key working log did not always include details of the support provided by staff to facilitate the individuals needs in relation to their identified goals. It was not clear if weight charts were being used as one only had two entries made for May 04 and June 05. Service users spoke positively of the support provided by staff and they confirmed that they were encouraged to make decisions about how they wanted to spend their time and whom they wished to spend it with. It was obvious from the discussions that positive relationships had been developed with some support workers, particularly the permanent staff that they had regular contact with. Service users had accessed a range of facilities and were being supported by staff to further develop this as appropriate to the wishes and preferences of each person. The manager confirmed that service users could manage their own finances if they had the ability to do so and records relating to each individuals circumstances, abilities and personal choices had been recorded. Consent forms, relating to money and the management of their finances, had been signed by service users and were available on individual files. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 12 Discussions with service users, and documentation seen in individual files, confirmed that service users were supported by staff inside and out of the home to take risks as part of their daily routines and activities. Detailed written risk assessments had been completed and the manager confirmed that these were updated annually or when any concerns were highlighted. Assessments, seen on files checked, had been completed for individual risks connected with finances, activities and self- travel, the use of cleaning materials, preparation and cooking of meals, being unsupervised in the flat, self-medication, storage of items, relationships and the use of gym equipment. It was positive to note that there was written evidence of specific training given by staff to individual service users where risks associated with personal safety had been identified. Home Farm Trust - The Elms DS0000046512.V308716.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good however the staff support available to service users with the planning, preparation and cooking of their meals needs to be improved. This judgement has been made using available written evidence and following discussions with service users, relatives, support staff and the manager. Service users confirmed staff supported them with accessing appropriate activities, college courses or voluntary employment that they wished to participate in and this ensured that they were fulfilled. Service users confirmed that they were encouraged and supported by staff to participate in activities in the local community according to their personal wishes and preferences. Service users were effectively supported by staff to ensure that they developed and maintained links, inside and out of the home, with their family and friends, as appropriate to the needs and wishes of each individual. Service users confirmed that their rights were respected and that their daily routines encouraged and developed their independence. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 14 Generally service users were provided with nutritious food that they said they enjoyed. However staff and two relatives were concerned that some service users did not receive the appropriate support with the preparation and cooking of their meals and therefore the health and wellbeing of service users could not always be ensured. EVIDENCE: Service users spoken with said they could choose how they wished to spend their time each week and that they enjoyed having a range of activities that they could participate in. The manager confirmed that further opportunities were being developed with each service user regarding their preferred leisure and social activities. One service user said she liked her week to be flexible and that she enjoyed shopping, cooking, keep-fit and drama. Activities currently enjoyed by other service users included music and dance, SCOPE and attendance at various colleges or membership at local gymnasiums/fitness centres. Service users confirmed that staff supported them with transport to facilities in the local community if they needed this. Service users could use public transport if they preferred and if it was appropriate for them to do so. Records checked and discussions with service users and staff confirmed that some service users enjoyed going out in the evening to the pub, cinema, local gateway club or bowling. One service user said by choice they ‘stayed in each evening as they found the dark frightening and preferred the safety of the home’. Staff confirmed that they supervised service users with their activities outside of the home and that this was flexible and included the daytime, evenings and weekends. Concerns were raised that a number of planned outings had been cancelled recently when the required staffing levels had not been maintained. Service users spoken with, and via their questionnaires, confirmed that their friends and family were encouraged to visit and that they were made to feel welcome by the staff at the home. They said they could choose when they had visitors and whom they saw. They could meet with their visitors in the ‘visitors room’ downstairs or in the privacy of their own rooms. One service user interviewed said she liked to meet regularly with her boyfriend and that they enjoyed spending time together. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 15 Service users confirmed that they had been provided with keys for their rooms and that they kept their rooms locked when they were unoccupied. Service users interviewed said staff only entered their rooms with permission and one service user said ‘staff are allowed into my bedroom once a week to help me with the cleaning and sorting out of my room’. Daily routines for domestic tasks, including cooking and cleaning had been established and service users spoken with were aware of their responsibilities in relation to this. A picture board in the hall helped to remind each person of their daily task and individual tasks had been allocated according to each person’s individual levels of ability. Service user meeting minutes confirmed that the daily routines and household tasks were regularly discussed. Details of each individual’s responsibilities had been documented in their care plan and further information was available in the service user guide. Records of meals were maintained. Service users, the manager and staff confirmed that a reasonably varied and healthy diet was offered. Individual preferences and any special dietary needs were catered for. Details relating to this, including likes and dislikes, had been recorded in the service user plan. Service users interviewed said staff had provided service users with advice and guidance regarding healthy eating and they confirmed that their parents had often been involved in these discussions. Service users stated that in the main they were happy with the choices offered and that they could help with the food shop if they wished. One service user said ‘I like to shop for my own food and I help the staff if I can to make my favourite meal which is a curry’. Two relatives were concerned that the menu plan that had been developed was not always adhered to and that on occasions there did not seem to be sufficient stocks of food available to cook the planned meal. Staff and relatives said they thought that some service users did not always get the appropriate support with the planning, preparation and cooking of their meals and they thought that in the long-term this could have health or safety implications. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good however some of the medication procedures need to be improved. This judgement has been made after checking a range of documentation, including service user plans and medication administration records, and following discussions with service users and staff. Service users confirmed that they received personal support from staff that was flexible and sensitive to their needs and situation and this made sure that their privacy, dignity and independence were promoted. Service users physical and emotional care needs had been regularly assessed and the appropriate action had been taken by staff to make sure that each individual’s current healthcare needs were met. The homes policies and procedures for the recording, storage and administration of medication had recently been updated however the current procedures for the recording of medication received did not ensure that service users were fully protected. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 17 EVIDENCE: Service users spoken with said that staff supported and encouraged them with their personal care and daily hygiene routines. Care plans clearly detailed the gender of the staff they wished to support them with any aspects of their personal care. Records checked confirmed that staff had provided advice and guidance to service users regarding their personal hygiene and appearance. Service users said they could choose their own clothes and they were happy that staff had helped them to shop for any new items that they wanted to buy. Service users were able to choose which GP and other healthcare professionals they wished to register with. Information seen recorded in care plans confirmed that the healthcare needs of each individual had been clearly assessed and staff had supported service users with medical appointments and general advice about health issues as and when needed. Specialist support or advice had been accessed for anyone who needed this and service users had regular dental and optical checks. Service users said that they were able to see any medical staff that visited them at the home in private. The homes medication policies and procedures had recently been updated to include the new guidelines issued by Sheffield City Council. Staff interviewed and staff meeting minutes confirmed that staff had been made aware of the revised procedures. Issues relating to the administration and recording of medication had been regularly discussed and documentation checked confirmed that the manager had monitored the medication administration records (MAR sheets). Any discrepancies found on the MAR sheets had been investigated by the manager, and the staff responsible had been suspended from administering medication until further training had been given. Medication was securely stored and detailed records were kept of medication disposed of by the home. Staff confirmed that they had been trained to administer medication and refresher training had recently been provided for all staff by the registered organisation. Staff spoken with, confirmed that temporary bank or agency staff employed by the home, were not authorised to administer medication to service users. Care plans included details of the service users medication and of any possible side effects that may occur. Where any concerns had been identified by staff, the GP had been contacted and the service users medication had been reviewed. Medication consent forms for service users assisted or supported by staff with their medication, had been signed by service users and retained on individual files. It was positive to note that details relating to the administration of prescribed creams and shampoo had been provided to one service user in picture format as well as written text. One item of medication had not been recorded as being checked in when received. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 18 The general record for the receipt of medications had been signed to confirm they had been received but did not list in detail the items received. Two MAR sheets checked had hand written alterations recorded on the MAR sheet that related to the administration of prescribed creams. The inspector was concerned that there were no details of who had authorised these changes, when or why. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available written evidence in the complaints record, staff training and service user files and following discussions with service users and staff and from feedback via relative’s questionnaires. Service users said they were aware of the homes complaints procedure. They confirmed that staff listened and responded appropriately if they had any complaints and this made sure that any concerns were acted upon and addressed. The home had the appropriate adult protection policies and procedures in place and staff had completed the required training to ensure that service users were protected. EVIDENCE: The complaints procedure was available within the home and service users had signed to confirm that they had received a copy and that it had been explained to them. Pictures had been included with the written text to assist service users with their understanding of the processes and timescales involved. Service users spoken with said they could discuss any concerns that they may have individually with staff or at the service user meetings that were held regularly. Relatives, via their questionnaires confirmed that they had been made aware of the procedures and that any complaints had been handled appropriately and responded to quickly. The complaints record contained all of the required information and had been monitored regularly by the manager. No complaints had been received by the home or by CSCI since the last inspection. The inspector noted that the guidelines for using the complaints Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 20 procedure, which were available in the complaints file for service users and staff, were dated September 1997 and there was no evidence that they had been recently reviewed. The homes adult protection policies and procedures included the Department of Health Guidance ‘No Secrets’ and whistle blowing. Staff interviewed, were aware of the different forms of abuse and of the procedures for the reporting and investigation of any allegations of abuse. The staff training records confirmed that all staff had now completed the appropriate training. The manager confirmed that the records of any allegations, and the subsequent investigation, were retained for confidentiality at the registered organisations head office. These would be made available upon request as required. Since the last inspection there had been no allegations of abuse reported. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 and 30. Quality in this outcome area is adequate. Several areas of the home continue to need refurbishing and the standards of hygiene particularly in the flat are poor. This judgement has been made following observations of several areas of the homes environment and after discussions with a service user, staff and a relative. The areas of the home that had been refurbished and redecorated provided service users with a comfortable and homely environment. However several other areas of the home continue to be in need of refurbishment as the comfort and safety of service users cannot currently always be guaranteed. Toilets and bathrooms ensured the personal privacy of service users. However not all bath and shower rooms had the appropriate facilities to meet the needs of the service users currently living at the home. A range of communal spaces, were provided for service users shared activities or private use and these ensured that service users using these rooms were comfortable and safe. The manager confirmed that cleaning routines were in place at the home. Several areas checked however were in need of cleaning to prevent infection and to promote the health and safety of service users as currently this could not be guaranteed. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 22 EVIDENCE: Several communal areas of the home, a bathroom and service users bedrooms had been refurbished and redecorated during the last eighteen months. All equipment and appliances had been checked and serviced as required. Service users said they were pleased with the improvements and confirmed that they had been involved in choosing the new decoration and soft furnishings for their rooms. The two bed-roomed flat at the top of the house, currently shared by two service users was in need of extensive refurbishment and redecoration as it appeared neglected and was poorly maintained. The external fire escape appeared un-safe as pools of water had collected on the steps that were slippery and covered in moss. The handrail was inadequate and the inspector was concerned that the edges of the steps may not be clearly seen by one of the service users who currently occupied the flat whom was registered blind. Further aids and adaptations were required in the flat to make sure that the service users could be appropriately supported with maintaining and developing their independent living skills. Discussions with the manager confirmed that work, on refurbishing several areas of the home, including the flat, was due to start on the 18th of September this year. This was to include the resurfacing of the drive, the renewing of two showers (one in the flat), the replacement of the oven and hob in the flat, the redecoration and carpeting of the top flat, a new front porch, the installation of an en-suite to the staff sleeping in room and the relaying of garden paths. As a consequence of the planned maintenance and renewal programme, requirements in relation to most of the environment issues have not been made. The inspector will continue to closely monitor the renewal programme planned for the premises. One bathroom had been recently refurbished to a high standard, however the shower room, the downstairs bathroom and the bathroom in the flat were in need of refurbishment or redecoration. The manager confirmed that work was to start on refurbishing the shower room and the bathroom in the flat. Toilets and bathrooms had the appropriate locks fitted. Service users said they were happy with the furniture that had been purchased for the communal areas of the home and they confirmed that they could choose where they wished to spend their time. One room, previously used as the staff sleeping in room, had recently been converted into a private area for service users to use with their visitors. New furniture and curtains had been purchased and this had made it more comfortable. Service users confirmed that they helped with the daily household tasks and with the cleaning of their rooms. Staff spoken with said service users helped with tasks that were appropriate to their individual skills and abilities and any potential risks had been identified and assessed. The lounge, dining room and kitchen were clean and tidy. The hall and landing areas upstairs were dusty and cobwebs needed removing from lampshades and ceilings. Several Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 23 communal areas seen in the flat, including the kitchen and all appliances, bathroom and hallway, were in need of thorough cleaning. The inspector was concerned about the poor standards of hygiene around the food storage, preparation and cooking areas and it was obvious that the service users were in need of further support from staff to maintain the areas adequately and prevent infection. One relative said they were concerned about the cleanliness of the flat and that the appropriate staff support was not always provided. Staff confirmed that they had concerns about the service users in the flat and that they were not always getting the staff support they needed. The inspector is aware that the service users currently living in the flat are keen to maintain and develop their independent living skills. However the poor standards of hygiene seen in the flat suggest that the current levels of staff support (see also standard 33) are often inadequate and can’t always guarantee the health and safety of the service users who live there. The bathroom downstairs smelt of stale urine. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is adequate. This judgement has been made following discussions with service users, staff and relatives and from checking available written evidence in staff training and recruitment files, staff rotas and minutes of staff meetings. Discussions with staff and records checked confirmed that staff had completed a range of training including NVQ level 2 in care and this ensured that service users were supported by competent and qualified staff. Records checked, and discussions with staff, confirmed that the agreed staffing levels had not always been maintained and as a result of this service users needs, both in and out of the home, had not always been met. Also service users did not always receive consistency and continuity of care. Appropriate staff recruitment and selection policies and procedures were in place and the required documentation had been retained on staff files making sure service users were protected. In the main, the organisations commitment to staff training ensured that service users were supported by staff that were appropriately skilled and trained to meet service users changing and complex needs. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 25 EVIDENCE: Staff spoken with appeared competent and knowledgeable of the needs of service users. Many of the staff had several years of valuable experience of working with young people with a learning disability in a care setting and they were committed to meeting the needs of the service users in their care. 50 of the staff team had completed NVQ level 2 training in care and four staff had recently enrolled for this training. One staff member interviewed was keen to develop this further and enrol for level 3 now that level 2 had been achieved. Staff had a range of skills and abilities and observations of staff interaction with service users confirmed that staff could communicate effectively with each individual. Discussions with service users, a relative and staff and documentation checked, including staff rotas and the pre-inspection questionnaire, confirmed that the agreed staffing levels for The Elms had not always been maintained. Currently staff employed to work at The Elms are also employed to work at a supported living scheme adjacent to the home. It had been agreed that service users at The Elms required a minimum of two staff to support them with their needs throughout the day, with one member of staff covering the sleep in. One member of staff, as identified on the rota, has to cover the supported living scheme. During the last few months there has been an extremely high use of bank and agency staff to cover two staff vacancies, annual leave and training. The manager confirmed that in-addition to the use of the organisations own team of bank staff agency staff had covered 465 hours of direct care with service users over an eight-week period. A number of shifts had been operated with only two staff to cover both at The Elms and the supported living scheme. The inspector was concerned that service users at the home were not receiving continuity or consistency of care. Discussions with staff and service users indicated that some agency staff did not work as effectively in meeting service users needs as identified within their individual plan. Service users had not always received the support they required and staff employed permanently by the home had concerns about this. It was confirmed by staff that throughout the summer a number of planned outings had been cancelled and this had frustrated service users and staff. One service user interviewed said ‘I’m not happy having lots of different staff around that I don’t know very well. If I’ve got any problems or I’m upset I’ll wait for the staff I know, or my key worker because I know they will help me. Some staff are not bothered, and so I don’t have much contact with them. They leave us to it in the flat’. Staff time was regularly taken from The Elms to support with medication and other tasks with a service user at the supported living scheme. The current situation of staffing the residential care service and the supported living scheme with one staff team is not ensuring that service users are supported as required. It is not acceptable that service users living at The Elms do not always receive consistent and reliable staff support, or for planned activities and outings to be cancelled, because of staffing issues within the supported living scheme. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 26 The staff recruitment and selection policies and procedures in place at the home were comprehensive and confirmed that staff were not recruited to work with service users until all of the required checks had been completed including a CRB check at the enhanced level. Copies of the required documentation was available on the files checked and staff interviewed confirmed that they had completed an application form, had attended an interview and had provided two written references, including one from their last employer. Staff files were stored securely as required. The manager confirmed that any documentation relating to staff recruitment would be made available upon request. Discussions with the manager and staff confirmed that staff newly employed by the home completed detailed induction training and records of this had been maintained. Since the last inspection staff had completed training on abuse awareness, food hygiene, personal care, equality and diversity, moving and handling, medication induction and refresher, and fire. Staff confirmed that the registered organisation encouraged and supported them with regular training opportunities and that their individual needs were discussed regularly in supervision. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. Quality in this outcome area is good however statutory health and safety training for staff must be improved. This judgement has been made following discussions with the manager, staff and service users and from checking available written evidence and documentation in care plans, risk assessments, staff training records, service user meeting minutes and regulation 26 reports. The registered managers skills and training benefited the service users. The views of service users, families or friends and any professionals involved with the service had not been formally sought and therefore it could not be confirmed that effective quality assurance and monitoring systems were fully in place at the home. In the main the records checked were up to date, well ordered and contained the required information. This ensured that the rights and best interests of service users were promoted. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 28 The appropriate health and safety policies were in place and staff were aware of the procedures. However the health, safety and welfare of service users could not always be guaranteed as some staff had not completed statutory training as required. EVIDENCE: The manager had successfully completed NVQ level 4 training in care and management and she has a wealth of experience of working in a care setting. Discussions with her confirmed that she is committed to the further development of the service and she said she is keen for service users to develop their daily activities and leisure pursuits. The manager is aware of her roles and responsibilities and she undertakes periodic training to ensure that her skills and knowledge base are kept up to date. Staff and service users spoken with said the manager was approachable and supportive. Staff confirmed that they could discuss any ideas, issues or concerns with her. Regular service user meetings were held each month and topics discussed included activities and exercise, daily routines and household tasks, daytrips, views of the service provided, health and safety issues, medication, nights out, caring for each other, pets, equipment and a family barbeque. Minutes of these meetings had been maintained and service users said they could choose if they wished to attend the meetings. The manager confirmed that there was an annual development plan for the home however the views of service users, families, friends and other professionals had not been formally sought via user satisfaction questionnaires and therefore no report was available on the findings. The manager confirmed that this was something she could develop in the future. Records were securely stored and in the main they were up to date and contained most of the required information. Requirements found on the last inspection, relating to records, had been addressed. Service users finance sheets had been countersigned as required and the finance policies had been updated to reflect current practice. Monthly regulation 26 reports were available and they contained all of the required information. Copies of these had been provided to CSCI each month. It was noted that where issues were recorded on the service user meeting minutes it did not include details of who was responsible for actioning the requests. Issues found in relation to care plans and other records checked have been reported on elsewhere in this report under the relevant standard. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 29 Most staff had completed the required statutory health and safety training including refresher training. Detailed written risk assessments had been completed and these had been regularly reviewed. Records checked confirmed that equipment had been checked and serviced as required. Safety procedures that could be easily understood by service users were seen at the home and service users were included in fire instruction sessions and drills. The fire alarm was triggered accidentally during the inspection and it was positive to observe that service users evacuated the building very quickly to meet with staff at the agreed meeting point outside. The inspector was concerned that the training records checked confirmed that not all bank staff used regularly by the home, including two staff who had been employed since 2005, had completed the required statutory training on moving and handling, first aid or infection control. This requirement had now been outstanding for over two years. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 30 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 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 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X 2 2 X Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 31 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 Timescale for action 31/10/06 2. YA6 17 3 YA6 17 4 YA17 16 Daily records of the staff support provided to each individual must include details of the action taken by staff to facilitate service users needs as identified within their individual plan. (Previous timescales of 31/03/05, 30/06/05 and 30/04/06 not met). Service user inventories retained 31/10/06 on individual files must be kept up to date. (Previous timescales of 31/03/05, 30/06/05 and 30/04/06 not met). The manager must ensure that 31/10/06 the daily records of staff support provided to service users are regularly monitored. All staff employed by the home, including bank and agency staff, must adhere to the recording systems in place at the home. Service users must receive the 31/10/06 appropriate staff support with the preparation and cooking of their meals. Agreed menu plans must be adhered to unless the service user requests an alternative. Sufficient stocks of DS0000046512.V308716.R01.S.doc Version 5.2 Home Farm Trust - The Elms Page 32 5 YA20 17 6 YA22 17 7 YA24 16 8 YA24 16 9 YA27 23 10 11 YA30 YA30 16 16 food must be available to ensure that planned menu’s can be facilitated. Detailed records must be maintained of all medication received by the home and staff must sign to confirm that they have been checked. The MAR sheets must accurately record the times and the frequency for the administration of each item prescribed. Any hand written changes must include details of who authorised the changes, the date and the signature of the staff member recording the entry. The guidelines available for service users and staff on complaints must be regularly reviewed to ensure that the information is up to date. The appropriate aids and adaptations must be provided in the top flat to ensure that service users are adequately protected and that their independence is maintained. The fire escape leading from the top floor flat must be made safe and the moss and excessive water must be removed to ensure that the steps are not slippery. A handrail, and other appropriate aids or adaptations, must be provided to ensure the safety of all service users, including those who are visually impaired. The downstairs bathroom with damaged plaster and paintwork must be redecorated. (Previous timescale of 30/06/06 not met). All areas of the home must be kept clean and free of offensive odours. Service users living in the flat DS0000046512.V308716.R01.S.doc 31/10/06 30/11/06 15/12/06 31/10/06 15/12/06 13/09/06 31/10/06 Page 33 Home Farm Trust - The Elms Version 5.2 12 YA33 18 13 YA33 18 14 YA33 18 15 YA33 18 16 YA39 24 must receive the appropriate staff support to ensure that all areas of the flat, especially food storage, preparation and cooking areas, are kept clean and that reasonable standards of hygiene are maintained at all times. Staff must agree with service users the nature of the support that is to be provided and this must be clearly recorded in the service user plan. 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 timescale of 30/06/06 not met). The agreed staffing levels for the home must be maintained. Until further notice CSCI must be notified immediately of any shifts not covered as required. The manager must ensure that all staff employed to work at the home work consistently and actively support service users with there identified needs as documented within their care plan. The registered organisation must review the current staffing procedures and day to day operations to ensure that service users care and staff support at the home is not compromised by the needs of the service users at the supported living scheme adjacent to the home. The views of service users families and friends and other professionals involved with the service should be sought and the results of any service user satisfaction surveys must be DS0000046512.V308716.R01.S.doc 15/12/06 30/09/06 31/10/06 15/12/06 31/01/07 Home Farm Trust - The Elms Version 5.2 Page 34 17 YA41 17 18 YA42 18 published and made available to service users, their representatives and the CSCI. Service user meeting minutes 31/10/06 must include details of any follow up action to be taken and the name of the person responsible for this must be recorded. All staff employed by the home 30/11/06 (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 and 30/06/06 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 YA27 Good Practice Recommendations Bath and shower rooms should be personalised. Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Home Farm Trust - The Elms DS0000046512.V308716.R01.S.doc Version 5.2 Page 36 - 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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