Inspection on 18/07/06 for Homeleigh Farm

This inspection was carried out on 18th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Homeleigh Farm 16/02/06

Homeleigh Farm 02/08/05

Homeleigh Farm 03/02/05

Homeleigh Farm 10/08/04

Homeleigh Farm 25/02/04

Homeleigh Farm 08/05/02

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Thorndene

Insight - Eastchurch

Southfields

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33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Homeleigh Farm Dungeness Road Lydd-on-sea Kent TN29 9PS Lead Inspector Lisbeth Scoones Unannounced Inspection 18th July 2006 09:45 Homeleigh Farm DS0000023452.V299479.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 Homeleigh Farm DS0000023452.V299479.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. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homeleigh Farm Address Dungeness Road Lydd-on-sea Kent TN29 9PS 01797 321506 01797 322134 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) Parkcare Homes Limited Mr Michael Christopher Britton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 2006 Brief Description of the Service: Homeleigh Farm is owned by Craegmoor Healthcare and provides residential care for 6 male residents with learning difficulties some of who may present with behaviours that challenge. The home comprises a domestic style extended bungalow, situated on the South Kent coast, approximately one mile from the small town of Lydd. It has extensive gardens on all sides, a large part of which is used for growing vegetables and housing chickens and geese as well as a greenhouse and outhouses. Residents are encouraged to be involved in gardening tasks and looking after the chickens and geese. The home produces all its own vegetables, some fruit and eggs, the surplus of which is for sale. Car parking is provided. There are local shops, churches and pubs in the small town of Lydd nearby. Other amenities such as swimming pools, cinemas and colleges are within half an hours drive. All but one of the residents currently living at the home have needs requiring one to one staff support. The home has no other facilities on site but residents are accompanied if they wish to make use of facilities elsewhere. The home has the use of two vehicles. Residents have access to general and specialist medical services either through the local primary care team or through consultants employed by the company. Fees currently range from £1781 to £2311 per week. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started at 09.45 and finished at 15.15. During this time, the inspector met with all the residents, the manager Michael Britton, deputy Alex Hill, the team leader and support staff on duty. A tour of the premises and grounds was made, a meal shared with residents and staff and documents examined. These included care plans, medication records, accident records, training matrix and staff files. Prior to the inspection, comment cards were received from 2 GP’s, a member of the mental health team and a CPN who are involved with the medical care of the residents. All commented favourably on the service provided. One comment read: “ I am very pleased with the overall care that my client receives and the manager’s and staff’s understanding of my client’s needs.” All residents, with staff support, completed a comment card. “They care for me”, “ They give the best care” and “I am always supported in whatever I do”. What the service does well: What has improved since the last inspection? What they could do better: No requirements or significant recommendations were made at this inspection. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Prospective residents’ individual aspirations and needs are assessed prior to the decision being made that the home would be suitable. Each residents has an individual and signed contract outlining the terms and conditions. EVIDENCE: The home currently has one vacancy. The manager is expecting this to be filled in the very near future. From discussions with the manager and samples of other pre-admission assessments seen, it is ascertained that a comprehensive process is followed. Every resident’s file contained a contract signed by the manager and the resident. The contract sets out in detail what is included in the fee, the role and responsibility of the provider and the rights and obligations of the resident. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 9 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, 9 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. The care planning system is clear and provides staff with the information they need to meet the residents’ needs. Residents are provided with the information and support they need to make decisions about their life. Staff make sure that residents are fully included and encouraged to participate in all aspects of life in the home. Residents are supported to take responsible risks taking into account their safety, that of others and staff. EVIDENCE: Residents are encouraged to be involved in their plan of care. A sample of care plans was examined. Care plans provide detailed, comprehensive and regularly reviewed information about all aspects of residents’ care including the views of the residents. Nutritional assessments are carried out and supported by dietary guidelines when a weight problem has been identified. Other information included are monthly goal charts, risk assessments Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 10 (reviewed 6 monthly) covering everything from outings to the use of the swimming pool, “ABC charts” for the recording of incidents of aggression or inappropriate behaviour and point charts with reasons for gaining and loosing points as well as charts for behaviour in the community. Copies of annual care reviews were seen. In respect of one resident who has made good progress, it was suggested that the section entitled “my book and my way forward”, completed by the resident on admission was updated. Comprehensive daily records are maintained several times a day. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 11 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, 17 The quality in this outcome group is excellent. This judgement is based on information available at the time, which includes a visit to the service. Residents are provided with opportunities for personal growth and are enabled to take part in a range of appropriate leisure activities. Residents are encouraged to be part of the local community and to maintain contact with their families. Residents rights are respected and staff encourage the residents to take responsibilities for their daily lives. Residents are provided with an excellent choice of healthy, some homegrown, food and are encouraged to take part in the growing, harvesting and preparation. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 12 EVIDENCE: Residents are encouraged to take part in daily domestic chores as e.g. cleaning their rooms, hanging out the washing and preparing vegetables for their meals. Two residents regularly help in the kitchen. A resident said, “I like making chocolate sponge”. Residents would be paid therapeutic earnings for their participation in looking after the vegetable garden and the chickens and geese. Staff accompany the residents to any suitable activity of their choice on a one to one basis. Prior to such events or outings, a comprehensive risk assessment is undertaken. This year two holidays to Centre Parcs have been enjoyed and very recently residents and staff went on a daytrip to Thorpe Park. A resident said, “I went on all the rides twice.” Other activities include clothes and food shopping, swimming (recently a large swimming pool was purchased the cost of which residents contributed to). Trips to the cinema and local pubs are organised. Such events are recorded in residents’ care plans. In line with a resident’s goals, a college place is being considered for September as well as a possible work placement. Recent leisure developments include a badminton patch, golf and a pool table in one of the outhouses. It is evident that residents enjoy seeing their families. A resident said, “I love my Mum and tell her so when I see her.” The home keeps relatives informed of residents’ progress. Menus demonstrate that good nutritious meals are provided using fresh and homegrown products. Residents are involved in collecting eggs, harvesting vegetables (a good cauliflower crop) and picking fruit. Staff and residents eat their meals together, sometimes outside when the weather is good. On the day of the inspection, it was too hot to eat outside. The lunch time session was unhurried and residents interacted with the staff in a pleasant relaxed manner. A resident said, “I like the puddings”, another, “I like the second helpings”. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 13 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, 20 The quality in this outcome group is excellent. This judgement is based on information available at the time, which includes a visit to the service. Residents receive personal support in the way they prefer and need. Residents’ physical and emotional health needs are met. Good medication administration systems are in place. EVIDENCE: Residents were well dressed in clothes chosen by them. It was observed that residents felt comfortable with the staff who supported them in a sensitive manner with due regard for residents’ lifestyle, privacy, dignity, independence and control over their lives. A chiropodist regularly sees residents and dental appointments are arranged. All residents have a medical consultant. The difficulties in ensuring a rapid and constant service were discussed in detail. Following such difficulties, a resident has recently been referred to the Enhanced Mental Health Team and a CPN has now been assigned. A resident has regular group counselling. Residents are Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 14 seen by their GP’s when needed. All medical professional input is recorded in residents’ care plan. Each resident has a medication file. Good medication procedures are in place including risk assessments and a pictorial consent form signed by each resident. It was recommended that the printed medication list be dated for auditing purposes. A “homely remedies” procedure in place signed up for by the GP’s. It was evident that residents’ medication is regularly reviewed and reduced as much as possible. MAR charts are well maintained and staff have regular medication training. See also standard 35. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Residents are confident that their views are listened to and acted upon. Residents are protected for abuse. EVIDENCE: It was evident while talking to the residents that they feel comfortable to express their views. In response to the question “do you know who to speak to if you are not happy”, two residents replied, “ I would talk to the manager, Alex, or the other staff”, another “I would speak to my key worker” and another, “staff always listen”. One resident said, “I don’t understand how to make a complaint.” Residents’ views are formally requested every six months through questionnaires and regular resident meetings. A complaint procedure was seen on display and a pictorial one available for the residents. It was observed that staff deal with residents’ concerns in a positive and supportive manner trying to resolve the situation. Annual Adult Protection training is provided for all staff. A recent AP alert was investigated and concluded satisfactorily. Prior to appointment all staff have an enhanced CRB and POVA check. Team leaders deal with residents’ financial issues. The company recently carried out a financial audit at the home and achieved a 5 star rating. Some residents have lockable boxes in their rooms for the safe keeping of small amounts of money. The staff are actively working with a resident to gain independence in money management. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Residents live in a homely, well maintained, comfortable, clean and safe environment. EVIDENCE: It is evident that the home is well maintained. Since the previous inspection, the bathroom and shower have been upgraded and a painting and decorating programme is ongoing. Several residents’ bedrooms were seen, were well personalised and in good order. A resident showed the inspector his new bed. Regulation 26 visit reports comment on the standard of the maintenance and health and safety issues. The large garden is well mainaryined and a gardener is employed for one day a week. The vegetable gardens are cared for by staff with assistance from the residents. There is a pleasant furnished patio area and a conservatory used as a smoking room. The home is clean and hygienic. Night staff are responsible for cleaning and residents are encouraged to participate in domestic tasks during the day. All Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 17 staff are trained in health and safety, COSHH and infection control. Hand wash facilities are available in the garage for staff and residents’ use following gardening duties and caring for the animals. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Residents know that their needs will be met by adequate numbers of staff who are competent, well trained, qualified and aware of their role and responsibilities. Residents are protected by the home’s recruitment procedures and staff are well supported and supervised. EVIDENCE: Staffing has been stable and there has been little changeover since the previous inspection. In anticipation of the arrival of an additional client, the home is currently advertising. Duty rotas confirm that there every shift is covered by a team leader and three or 4 support workers. At night there are two members of staff, one waking, one sleeping. The manager and deputy’s hours are supernumerary. Staff demonstrated a good awareness of their roles and responsibilities and the home’s aims and values. They confirmed that they are well supported and that good training opportunities are given. The deputy manager said that the company is pro-active and staff training has improved. Specialist training is Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 19 now more easily available. The training matrix confirmed that in addition to statutory training, staff are provided with “understanding of challenging behaviour”, “understanding ADHD”, Crisis Prevention and Intervention, sexual awareness and adult protection training. The team leader on duty confirmed that she was supported to obtain NVQ level 3. All support workers are encouraged to undertake level 2. The deputy said he had been given an opportunity to undertake level 4. The home’s induction and foundation training, based on LDAF principles, is currently being reviewed to comply with Skills for Care standards. A sample of staff files was examined and demonstrated sound recruitment procedures. The files evidenced that CRB and POVA checks and references are carried out prior to employment. Files contained training records and supervision notes. The company operates in accordance with a Personal Performance Agreement, which incorporates performance management, training and career development. Each member of staff has an individual annual performance record in which 6 supervision sessions are recorded. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The quality in this outcome group is excellent. This judgement is based on information available at the time, which includes a visit to the service. Residents live in a well managed home and benefit from the ethos and leadership approach. The company has introduced a comprehensive quality assurance system, which includes residents’ views. Residents’ and staff’s health, safety and welfare are promoted and protected. EVIDENCE: Michael Britton manages the home. He has a NVQ level 4 in management and many years of experience in the care of people with a learning disability. Residents and staff said they feel well supported by him and his deputy Alex. In turn Mr Britton said he is well supported by the company. It is evident that Mr Britton has an open and inclusive management style. During the Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 21 inspection, residents walked in and out of the office with queries, comments or just for a chat. Residents meetings are held monthly and minutes kept. Recently the company’s has sharpened and extended its quality assurance systems. Mr Britton showed the inspector the new QA file with evidence of audits, Regulation 26 visits and satisfaction surveys. Relatives are invited to take part in care reviews to ensure that they are fully aware and involved with their relative’s care. The home provides a safe environment. All staff have health and safety training and comprehensive risk assessments are carried out. Accidents and incidents are well recorded and reported to the CSCI in accordance with Regulation 37 criteria. Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 4 x LIFESTYLES Standard No Score 11 x 12 4 13 3 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 x 4 x 4 x x 3 x Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Homeleigh Farm DS0000023452.V299479.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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