Inspection on 10/10/05 for Ivy Cottage

This inspection was carried out on 10th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ivy Cottage 26/06/06

Ivy Cottage 07/03/06

Ivy Cottage 31/01/05

Ivy Cottage 20/07/04

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

CARE HOME ADULTS 18-65 Highlands Farm Woodchurch Ashford Kent TN26 3RJ Lead Inspector Sally Gill Announced 10/10/05 at 09:30hrs The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Highlands Farm Address Woodchurch, Ashford, Kent, TN26 3RJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01233 861493 01233 860433 Canterbury Oast Trust Registered Care Home 16 Category(ies) of Adults with a Learning Disability 18-65 registration, with number of places Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31/03/05 Brief Description of the Service: Highlands Farm (Holly, Ivy, Jasmine & Rock Cottages) is registered to provide accommodation for up to 16 adults with a learning disability and admits people with low to medium dependancies. The company Canterbury Oast Trust owns the business. There are two Managers (one with responsibility for Ivy, Jasmine & Rock and the other for Holly) a new manager for Holly has been appointed but as yet has not started, neither is registered with the Commission although one has an application with the Commission. Highlands Farm has four separate purpose built units with accommodation on one level. Jasmine is a unit accommodating 4 residents in self-contained apartments with their own bed sit, kitchen and shower/toilet. Rock accommodates 2 residents with their own bed-sits and they share a kitchen and bathroom. Holly and Ivy each accommodate 5 residents in single rooms and both have a shower/toilet, bath/toilet, toilet, laundry, kitchen and lounge/diner.Highlands Farm is a wellknown tourist attraction in a rural area on the outskirts of Woodchurch. A short drive will take you to the towns of Ashford and Tenterden, approximately 3 miles away is Hamstreet train station. Within the village of Woodchurch there is the local GP’s surgery, post office, church and two pubs. The Cottages have transport, which can be used for the residents and a local bus service passes the farm. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which took place on Monday, 10th October between 9.20am and 4.35pm. Additional time was spent in preparation and report writing. During the inspection the Inspector spoke to 5 residents and briefly spoke to/met 4 others both in company and in private. Also, she spoke to one Manager, the team leader and 3 other staff. Surveys were received back from ten relatives, which all indicated that they are generally satisfied with their care at Highlands Farm. Comments included ‘ my X is very happy at X, ‘the standard of care is excellent’, ‘we are more than satisfied with care’, ‘we can see X receives excellent care always’. There was some negative feedback on staffing levels within Rock/Jasmine, the independent living houses. All residents confirmed during the inspection and on surveys that they are happy with the care received. Comments included ‘I like it here it is nice’,’ I have a nice apartment’, the house is nice and the staff are wonderful and helpful and we have wonderful surroundings’. The care of two residents was case tracked and others looked at in parts. The Inspector examined various records including care plans, risk assessments, resident’s finances, Medication Administration Record (MAR) charts and accident reports, menus, minutes of residents meetings, the fire safety logbook, health and safety records, complaints record, staff files and training records. The Inspector accessed the communal areas of Ivy and Holly cottage and by invitation the bed-sits in Rock and three other bedrooms also by invitation. After discussion during the inspection those that live at Highlands Farm will be referred to in this report as residents. The Inspector would like to thank all residents and staff for their help and assistance during the inspection. What the service does well: Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 6 Residents are clearly involved in the day to day running of the home with the emphasis on inclusion and choice. The Home provides a comfortable, homely and relaxed environment in which there is a high level of mutual respect. There is wide range of educational, practical work experience and leisure opportunities available to everyone. Each person has an individually tailored day plan and the residents spoken to say they are happy with their chosen activities. Care and support plans have been written specifically to describe individual needs containing good detail of skills and support required in order that any needs can be met. The staff team are positive and committed to providing and improving quality of life for residents with an emphasis on independence wherever possible. What has improved since the last inspection? The statement of purpose and service user guide, which has been tailored to specifically reflect the home is now in place and all residents have received a copy of the service user guide for their information. Further work to promote independence has been achieved with one resident now self-medicating. Daily records also show involvement in developing independent living skills. Residents have been involved in adopting the new format care plans, which have now been completed for all residents giving good detail of their skills and needs. Policies and procedures were not seen, but have been reviewed centrally. An ongoing consultation process is in place to offer policies in draft form for comment before they are made firm. The quality assurance system has been reviewed and as well as the views of residents also seeks the views of families and professionals who have contact with people living at the home. Written agreements have developed and signed and agreed by residents. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 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. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 4, 5 Existing residents have had their needs assessed prior to moving into the home. Prospective residents have copies of the home statement of purpose and service user guide, which contain detailed information enabling an informed decision about admission to the home. Residents have written agreements in place. EVIDENCE: The home has produced three different statement of purpose and service users guide reflecting individual cottages and existing residents have received a copy of the service user guide for their information. Information within these documents reflects a thorough admissions procedure is followed. Local authority funds all residents and the Inspector is aware that the Trust did obtain a copy of the Care Managers assessment prior to admission however these are no longer held on file. Where new admissions/transfers are taken these documents must be held on file within the home this was discussed with the Manager in relation to a planned admission. The Manager also undertakes her own assessment using the Trusts own format. The Inspector is aware that this format does not ensure all areas of 2.3 are covered by the assessment so the Manager would need to take this into account and make adjustments when completing it, however the outcome for existing residents is met. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 10 Written contracts have been developed and agreed with residents a copy is held on their files. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10 There is a clear and consistent care planning system in place, which provides staff with the information they need to meets the residents, needs and promote independence. The systems for resident consultation are good and residents feel their opinions count. Assessments are in place and describe the actions that reduce risks to enable people to maintain/develop independence. Records are stored safely and securely. EVIDENCE: Residents have been involved in the completion of new type format care plans. These show good detail of all skills and needs to ensure staff adopt a consistent approach to support and also promote independence where possible. Risk assessments and strategies for risk management are in place. All residents spoken to confirmed that they feel involved in the running of the home and are able to through a variety of opportunities have a say which is acted upon. Residents felt that they are able to make decisions about their day-to-day lives. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 12 Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 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 standard(s) 11, 12, 13, 14, 15, 16, 17 Resident’s personal development and independence is encouraged. There are a wide variety of regular opportunities for educational, work/training and leisure activities and access to the local community for residents. Resident’s relationships and friendships are supported and encouraged by staff. EVIDENCE: Each resident has been supported to develop a timetable of weekly activities/opportunities of their choice. Opportunities include college, work/training activities, leisure activities, volunteer work placements and time to develop independent living skills. Family indicated that they are always made to feel welcome. Records and discussions evidenced many friendships, which are encouraged by staff. Residents either cook their own individual meals or participate in preparation and cooking in each house. Menus are varied with an emphasis on healthy eating. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 14 Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Care plans detail the way the resident prefers to be support with personal care. Health care needs are monitored and addressed. Improvements are required to ensure the medication system does not pose a risk to residents. EVIDENCE: Independence with personal care is encouraged and achieved wherever possible. Care plans are specific to the individual and makes clear where and what sort of support is needed. Physical and mental health needs are all monitored and referred or addressed appropriately; all contact with health care professionals is documented. Where possible residents are encouraged to self medicate and since the last inspection the number of residents self-medicating has increased. The medication system was examined in Holly Cottage however the Managers should ensure the same standards are adopted for all. Where a resident is self medicating or part self medicating (creams) there must be a risk assessment undertaken and recorded which includes the issuing of medication, the safe storage, any records and any support required by staff. All medication issued for self-administration must be recorded with the date and quantity, which should be signed, by the resident and staff member. Any medication that is prescribed for as and when required must have written instruction for staff Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 16 which includes what the medication is, what its for, the times and frequency it can be administered and what authorisation if any is required to administer. All handwritten entries on the MAR chart must be signed by two staff and dated (this is different from recording the quantities received). Information recorded on the MAR chart must not be obscured when incorrect, there should be a clear audit trail of information. The MAR charts should reflect up to date information and any inaccuracies should be addressed with the pharmacy. One house had medication competency checks held on staff files and the other although staff felt they had completed them were not held on file. The competency check should include at least one observation of drug administration. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 There are shortfalls in the protection of residents from abuse. Residents feel their views are listened to and acted upon. EVIDENCE: One complaint has been received since the last inspection, which is still under investigation. There are shortfalls in the recruitment practice, which leaves residents at risk of abuse (see standard 34). Some staff have received adult protection training. Staff spoken to demonstrated a good knowledge of how and where to report any suspicions of abuse. Staff were observed to treat and speak to residents in a respectful way, and offered opportunity for decision-making using at times good humour but protecting resident’s dignity. There is a good system for handling resident’s finances however one balanced checked highlighted a minor shortfall in cash. The Manager advised this would have been highlighted at handover when balances are checked and the shortfall even though very minor investigated and resolved with no detriment to the resident. The Inspector was advised later that the 5p was found. The outstanding recommendation to expand the policies to ensure they include information regarding benefiting from and witnessing of wills/documents remains outstanding. The Inspector is aware that the Trust has plans to address this. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 28, 30 The standard of the environment within this home is very good providing residents with a clean, safe, attractive and homely place to live. EVIDENCE: The home continues to be a well maintained with ongoing maintenance and planned improvements. Since the last inspection five apartments in Rock and Jasmine have been painted, three re-carpeted and one has new kitchen flooring. Ivy has redecorated their kitchen, laundry room, hallway and one bedroom. Holly has decorated two bedrooms and two have had new carpets. Bedrooms are very tidy, clean and highly personalised. Residents in Jasmine are accommodated in their own apartments. Residents in Rock have a bed-sit with shared kitchen and bathroom. Residents in Holly and Ivy have their own bedrooms with a spacious lounge/diner and a kitchen. The home is clean and hygienic throughout. Residents all have access to garden areas and a new patio area has been laid between Holly and Ivy. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 There is an experienced and competent staff team who are committed to working positively with residents to improve their whole quality of life. Residents are at risk from the homes recruitment practice and induction training could be improved. EVIDENCE: Staff are clear about their roles and responsibilities and demonstrated a commitment to supporting the aims and values of the home. The home is just short of meeting the 50 target of staff qualified or undertaking their NVQ level 2 although it is hoped that further new appointments will undertake NVQ. The Inspector examined staff files one of which highlighted that a member of staff had commenced employment and is still working without appropriate and valid reference checks. This practice puts residents at risk. The Trusts own flexi bank staff covers shortfalls in rota cover. Several comments by relatives on surveys indicated that they felt there is not always sufficient staff on duty although this was entirely focused to Rock/Jasmine which accommodate residents that are suitable for more independent living and therefore a minimal of staff support. The Inspector is aware that the Trust Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 20 is in negotiation with residents and their families regarding required support and long term plans which the Inspector acknowledges can be unsettling for those involved. Since the last inspection further staff have been trained both in core and specialist subjects. The induction of two members of staff was discussed with the Manager and team leader. The information regarding induction courses is confusing. In one case although management felt staff had undertaken induction there is no evidence within the home. Another case the staff member had undertaken the course externally although there appeared to be no evidence of a competency check either whilst on the course or later by the home. Induction courses run by the Trust do not appear to be flexible to meet the timescales when new staff are starting. The new standards for induction and timescales were discussed with the Manager. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 40, 41, 42, 43 The home is well organised, run in the best interest of the residents with a relaxed atmosphere but with clear leadership direction. There should be some improvement in records to ensure resident’s best interests are safeguarded. Residents views underpin the self-monitoring and development of the home. The home does not have a full set of policies and procedures, which fully safeguard the residents. The health and safety of all is promoted and protected. EVIDENCE: The management approach within the home creates an open, positive and inclusive atmosphere. Staff commented that they felt well supported by the Manager and Area Manager (until recently the second Manager) both showed listening skills and had the ability to make both residents and staff feel valued and were able to make decisions and show clear leadership. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 22 Two types of quality assurance questionnaires were in place for residents one would benefit from simplification of some questions, the other has been developed and in the Inspectors opinion more appropriate. One house is already using questionnaires for relatives and care managers the other is not. See previous standards relating to shortfalls in records for medication and staff recruitment and induction. The Trust has reviewed several policies centrally and as an interim implemented draft policies however there are still one area (see standard 23), which is to be addressed by the Trust. Health and safety of all people living and working in the home is well supported. The home is well supported by a development plan and management structure, which has systems (which although at times appear slow) to ensure the effectiveness of the home. Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Highlands Farm Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x 3 3 2 2 3 3 H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 20, 41 23, 34, 41 Regulation 13(2) 19 Schedule 2 Requirement The home to have a safe system for medication and address all areas highlighted in text Review recruitment practice to ensure that residents safety is protected Timescale for action 10/11/05 15/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 23, 40 32 36 Good Practice Recommendations Expand the gifts policy to include benefiting from wills and witnessing documents 50 of staff qualified to NVQ level 2 or above Staff to receive annual appraisals Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Highlands Farm H56-H05 S23447 Highlands Farm V245434 101005 Stage 4.doc Version 1.40 Page 26 - 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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