Inspection on 25/01/07 for Kent Farm

This inspection was carried out on 25th January 2007.

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

Kent Farm 30/11/05

Kent Farm 13/07/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Kent Farm Kent Farm Mill Street Uffculme Cullompton Devon EX15 3AR Lead Inspector Louise Delacroix Unannounced Inspection 10:30 am 25 January 2007 th X10015.doc Version 1.40 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 Kent Farm DS0000063659.V309863.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 Older People. 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. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kent Farm Address Kent Farm Mill Street Uffculme Cullompton Devon EX15 3AR 01884 840144 01884 841486 kentfarm@tiscali.co.uk 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) Ms Pauleen Rachel Maitrise Ms Pauleen Rachel Maitrise Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15), Physical disability over 65 years of age of places (15) Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Kent Farm is a residential care home, which provides a home for fifteen older people, who may have a physical disability. It is situated in the village of Uffculme and is close to the village square. It offers fifteen single rooms, ten of which have en-suite toilets. Fourteen of these rooms are situated on the first floor, and are accessed by a shaft lift. There is a homely lounge with a selection of armchairs and a bright dining room, with three tables. A visitors car park is available and rooms are styled to encourage the entertainment of visitors. The home is built on three sides of a courtyard, and residents and visitors use this in the summer. The weekly fee ranges from £280 - £410 with additional charges for hairdressing, chiropody, newspapers and toiletries. The home’s last inspection reports are well displayed in the entrance hall. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over eight hours. Seven residents contributed to the inspection, as did the manager, two visitors and three staff members. Time was spent talking to residents individually, and a medication round was observed. Prior to the inspection, surveys were sent to residents, staff members, visitors/relatives, health and social care professionals, which have been incorporated into this report. As part of the inspection, three people were case tracked, this means that where possible these people were met, and the records linked to their care and stay inspected. During the inspection, a tour of the building took place and records including fire, care plans, staff recruitment, training and medication were looked at. Prior to the inspection, the home completed a pre-inspection questionnaire, which provides the commission (CSCI) with current information about the service, staff and people living at the home. What the service does well: Before people move to Kent Farm, the manager visits and spends time with them and others involved in their care assessing the type of support they need to ensure that the home is suitable. Thorough assessments form the foundation for detailed care plans for each resident that help ensure that staff understand the support they need. During the inspection, staff were well able to demonstrate their understanding of residents’ care needs through discussion and their actions. The standard of health care is excellent with strong links with medical and health professionals, who have praised the quality of care. For example, ‘ a well run residential care home – all patients looked after exceedingly well and seem very happy’. Medication is well managed to help maintain residents’ well being. Residents were clear that their dignity is respected and that staff are skilled in their approach. The home provides an excellent range of social activities, both inside and outside of the home, and residents benefit from trips out using the home’s minibus. Visitors are made welcome and say they have good relationships with staff. There are strong links with the local community. Residents enjoy the meals served, and the quality and variety provided. Residents are confident that they are listened to and that any problems would be resolved. Staff are clear about their duty to report poor practice and their role to ensure that residents are safe. A resident said ‘being here has given me great peace of mind’. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 6 Kent Farm is clean, well maintained, and provides an attractive home for residents. The layout is accessible to all the residents and well equipped to promote residents independence. The home is appropriately staffed, and residents benefit from experienced and skilled staff, who are actively encouraged to undertake training and develop their potential. Over half the staff group have care qualifications. Mandatory training takes place, as well as additional training in specialist areas. New staff are well supported. The home is well run by an experienced manager. Staff, visitors and residents say that the manager is approachable and there is a strong sense of involvement in the way the home is run with residents feeling that their opinions are valued. The home has an excellent quality assurance system. Records and safety checks are well maintained. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from a good admission and assessment practice, which ensures that the home is able to meet their needs. EVIDENCE: Assessments were looked at for two people who have moved to the home since the last inspection. These include a pre-admission assessment, which the manager carries out either in the prospective resident’s own home or other settings, such as hospital. These records showed that a full assessment had been carried out by the manager, which recognised the range of care needs that prospective residents have, including physical, mental health and social and emotional needs. Part of the assessment includes a ‘pen’ picture of residents’ social history and acknowledges what events in their life were important to them. Identified care needs then form the foundation for the home’s care plan, which is written for each resident. For example, the assessment for one resident recorded their religious belief, which has been Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 9 incorporated into their care plan with recorded trips to the local church. Ten of the eleven residents who completed a survey for CSCI said that they had received enough information about the home to make a decision whether it was the right place for them. One person left this question blank. The home does not provide intermediate care. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff demonstrate a commitment to the health and social needs of residents, which is documented clearly in care plans. The health needs of residents are very well met with evidence of excellent multi disciplinary working taking place on a regular basis. Medication is well managed to help promote the well being of residents. Personal support is offered in such a way as to promote residents’ privacy, dignity and independence. EVIDENCE: Three care plans were looked at: these state the care needs of each resident. They are detailed and provide individual approaches for the varying needs of residents, such as personalised bath plans evidencing likes and dislikes. The care plans encompass physical, mental health and social/emotional needs of people living at the home. Through discussion and by observing practice, staff and the manager demonstrated that each area is equally important to ensure Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 11 that the residents’ sense of well-being is maintained. The plans evidenced reviews and subsequent changes to approach, which was confirmed in discussion with staff and residents. A visitor said they were involved in the monthly reviews and said this helped them keep up to date with changes. They described the care provided as ‘brilliant’. Care plans had been signed by residents showing they were consulted about the content. A relative who responded to the home’s quality assurance survey said that they were ‘particularly impressed by care plans’. Six health and social care professionals responded very positively to a survey sent to them by CSCI stating that the home communicated clearly and worked in partnership with them. All respondents felt that the staff demonstrated a clear understanding of the care needs of residents, and stated that any specialist advice that they gave was incorporated into the residents’ care plans. Nine people who live at the home said that they always received the care and support they needed, and two people said they usually did. A relative said ‘we are very satisfied that she is receiving the care and support she requires’. The manager has developed strong links with health care professionals, which staff members recognised, ‘the residents are very well looked after and provided with everything they need. The doctors work closely with the manager and ‘great care is taken over the service users’ health in meeting hospital, eye, dental appointments etc’. Four residents spoke very positively about the manager’s intervention to ensure that they had access to these services, including audiology and dental appointments. During the inspection, the manager was heard ensuring that a resident had moving and handling equipment suitable to their needs. During these telephone conversations, she showed insight into the experience of a resident with mental health needs, which affected their understanding of equipment and what it was used for. The records in the home show that residents’ weights are monitored with action taken to address concerns. For frailer residents food and fluid intake is monitored and their records show regular health reviews. Another resident said that the home’s cook always ensured that meals suited their medical condition, which they greatly appreciated. Detailed records are also kept of medical interventions, which a resident confirmed ‘I receive visits from my doctor and twice weekly visits from the district nurse’, while care plans detail what action needs to be taken to meet the health needs of residents, such as pressure care. A close friend of a resident said they appreciated being kept up to date by staff on the person’s health care, including pressure relief. They said the home provided high quality care. Staff were heard discussing and recognising signs of deterioration in a resident’s mental health, and what steps needed to be taken to support them. During the inspection, a relative of the person was kept informed about the deterioration with reassurance given by the manager. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 12 The home is proactive in trying to maintain residents’ independence and well being. This includes a regular gentle exercise class run by two trained staff. Residents spoke positively about the opportunity to exercise, records showed a high attendance and the staff members involved were enthusiastic about their roles and training. There is also a weekly music group, the musician that leads the group recognised the sense of well being that is created by singing in a group, which was evident in records for these sessions, and is backed by research in this area. A GP said in their CSCI survey that this is a ‘fantastic home, excellent care of residents, especially supervision of medical conditions and pastoral care’ another GP said ‘an excellently run home, superb management. If all homes were this good it would be a dream’. All the residents who responded said they always received the medical support they needed; one person said ‘only got to ask and aid is given’ and another stated ‘very good if unwell’. A third resident confirmed this saying that the staff were caring in the way they supported them when they were ill, while a relative in response to the home’s quality assurance said that ‘residents are treated as people not objects’. Six health and social care professionals said that residents’ medication was appropriately managed, which was observed during a medication round where a member of staff was seen reassuring people, checking that they had taken their medication before the staff member signed the records, checking pain relief and ensuring residents had control over pain management as well as following the advice given in one resident’s care plan. All of these elements evidence good practice. Records were appropriately kept. For example, changes to the medication administration records were double signed. Drugs are correctly stored and disposed of, including controlled drugs, which are accompanied by clear records, which could be easily audited during the inspection. The manager described how the medication stock is checked and the steps she has taken to try and improve the home’s current system. She spoke about working in partnership with the home’s linked pharmacist, and this equal relationship was borne out by a positive report by the pharmacist. In response to a CSCI survey, all the respondents who live at the home said that staff listened to them and acted on what they said. One person said ‘the management and staff are very kind and helpful’. Another described the sensitive support they received from staff when they had health problems. They said that their dignity was not compromised during these interventions and staff were sensitive in their approach. This respect of dignity was seen throughout the inspection. For example, staggered mealtimes for those people who need more support. This support was offered by a staff member sitting beside the person and included gentle encouragement. The language of care plans showed respect for the respects, as did the wording of daily notes and the discussions with staff members. All rooms have lockable storage space to Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 13 help residents’ to store items privately. The manager is clear about creating an atmosphere where ageism is not tolerated, and residents are valued as individuals. This was evidenced in the increased sense of well being of one resident, who has increased confidence and a sense of role within the community of the home. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The range of social activities is excellent providing daily variation and interest for residents, who are also supported and encouraged to maintain links with the local community. Residents make decisions about their lives. Meals at the home are good, cater for the individual likes of residents, and provide a varied diet. EVIDENCE: The manager and staff with the support of residents have worked hard to ensure that the activities and social opportunities within the home meet the residents range of interest and ability. A person living at the home explained that residents been consulted about trips that they would be interested in. They said that these had taken place, and spoke enthusiastically about their experiences on a number of trips. The manager has invested in a minibus, which residents were positive about. One person said in their survey, ‘Pauleen has done many things for us. We now have a minibus and go for nice rides and places. We also celebrate religious days and all other events and holidays, this all helps cheer us up…so all in all Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 15 I’m very happy here’. Photographs around the home showed that a mix of residents went out on the trips and the social records for one person who was casetracked showed they were supported to go to a local church and attend communion held at the home. Trips have included the seaside, a trip to Longleat, a visit to a cafe at a garden centre, a meal at a restaurant and trips around the countryside to enable residents to revisit places special to them. Two residents spoke enthusiastically about the opportunity to go back to these special places. A member of staff said ‘the activities and the outings are very beneficial to the staff and residents. And we all have a great time when we go out. All the outings and activities have been put in to place since Pauleen came to manage Kent Farm’ and another staff member commented ‘they are treated to outings and parties, open days, which they didn’t get before’. Another staff member’s comment was, ‘social activities for service users have improved’. Discussions with residents, staff and completed care records show that there is a range of internal activities, including musical sessions for which musical instruments have been bought, craft, quizzes, and reminiscence sessions. During the inspection, one person living at the home said ‘I had such a lovely day yesterday’. They explained this was because they had taken part in a flower-arranging event, which they had really enjoyed. The flowers were on display in the dining room. Another person said ‘love doing the activities the home has to offer – both indoors and trips out in the home’s minibus’. All sessions are written up, which provide a good overview of the success of the event, who took part and help monitor the general well being of residents by their responses and interactions with one another and staff. One visitor said that their relative was not always able to take part in some of the activities but ‘is always included in the company’. Another relative noted that an ‘increase in entertainment, creative activities and outings for the residents is outstanding’. The staff group also provides regular one to one sessions with residents, which again are clearly recorded. These are based on the individual wishes of people living at the home and vary from hand massages, trips to the post office, attending church, watering plants and looking through photographs. From the comments made by relatives in response to the home’s quality assurance, care records, observation during the inspection and discussions with people living at the home and staff, it is clear that the home works closely with residents’ families and friends. Residents said that they could see visitors in private; all the rooms seen during the inspection had room for two comfy chairs to help this happen. One resident said in their CSCI survey,’ When any friends and relations wish to visit they are always made very welcome, irrespective of their race, religion or the colour of their skin’. During the inspection, staff appeared confident and welcoming to visitors; visitors to the home said that ‘staff are always cheerful and polite and recognise you’ and ‘staff are a pleasure to meet and chat to’. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 16 The manager spoke about plans to hold a coffee morning in the town square, which would enable residents from the local area to meet up with friends and enable the local community to find out more about the home. The residents’ meeting minutes for January 2007 evidence the discussion that took place about this plan. Photographs evidenced many of the residents, including frailer people, with happy expressions during carol singing sessions from a local school and pre-school group. People living at the home were clear that they could exercise choice. For example, whether they joined in with activities, what they ate and where they ate meals. For example, ‘I am a plain eater and if I don’t care for the meal on offer, I am given an alternative’. Some people said they preferred spending times in their rooms only coming down for meals and chosen activities; others said they enjoyed the communal life of the lounge. Residents were heard being asked about their choice of how they wished to vote, and voicing their decisions. Residents’ files show that they were given the choice regarding a lock on their door. Some bedroom doors had locks on them. In response to the CSCI survey, three residents said they always liked the food, five said they usually did and two said sometimes. One person said ‘the food is good with an excellent choice of menus’ and another person said ‘ I like all the meals’. The manager said during the inspection that this mixed response had already been recognised as part of the home’s quality assurance system and as a result changes had been made. She showed the new menus based on residents’ preferences. Staff and residents confirmed that the new menus were due to start next week. The atmosphere of an observed meal was calm, relaxed and unhurried. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ are confident that they are listened to and their requests acted upon. Staff have a good knowledge and understanding of their role to ensure that people living at the home are protected from abuse. EVIDENCE: The home’s pre-inspection questionnaire states that no complaints have been received by the home. None have been received by CSCI or by the six health and social care professionals surveyed by CSCI. Residents in their CSCI survey response stated that ten people always knew who to speak to if they were unhappy. While one person said they usually knew. One person said ‘the girls are very good, and Pauleen. If I’m upset I’ve only got to say’ and another said ‘very good. No adverse comments’. Nine people knew how to make a complaint, one said they usually knew and one survey was left blank. Four residents who contributed to the inspection said they felt comfortable approaching either Pauleen or for one person a senior staff member, while a visitor said they could always see the manager, Pauleen if they had a worry. Another person in response to the home’s quality assurance said ‘when a problem or concern has arisen it has been dealt with quickly…nothing seems too much trouble’. Staff who were interviewed were clear what they needed to do if they received a complaint from a resident or visitor. The complaints policy is clearly on display in the dining room. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 18 Three members of staff were asked about their understanding of their role to safeguard vulnerable adults. All were clear about their responsibilities, their duty to report poor practice to either their manager or external agencies, such as CSCI. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This is a well cared for home, which provides residents with an attractive, clean and homely place to live. There is a commitment to provide an environment that is accessible to all residents demonstrated by a broad range of equipment and well thought out layout. EVIDENCE: The manager continues to ensure that the home is well maintained to a high standard. This includes external and internal décor. During the inspection, work was being carried out on the guttering, and since the last inspection the external walls have been painted, including the courtyard area, which is attractively arrayed with potted plants. The grounds are easily accessible, and residents spoke about using the external areas of the home during warmer months. Currently there is a small porch with seating for smokers. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 20 The manager spoke about a rolling programme of maintenance, which will include re-decorating the downstairs communal bathroom and the stairwells. There are plans to refurbish residents’ bedrooms, if they wish, and re-carpet if necessary. Minutes from a residents’ meeting confirm this. Recent work has included the re-decoration of the dining room and the lounge, which residents spoke positively about, plus insulation to the roof and a shower fitted in one room. The communal areas of the home are attractively decorated and homely in appearance with a range of suitable lighting, and armchairs arranged in small groups. The home is very well equipped to meet the needs of people with a physical disability, which helps ensure that everybody has equal access and that where possible people’s independence is maintained. For example, there is a shaft lift between the two floors of the home for good accessibility. There are grab rails throughout the building, both in communal and individual residents’ rooms. There are two assisted baths, rooms have ceiling tracks hoists in place and the home is fitted with a portable call bell system. Pressure relieving equipment was seen being used around the home, and the manager evidenced through the inspection her knowledge of individual residents’ needs and was heard ensuring that equipment was suitable to meet these. All areas of the home are accessible to people using wheelchairs, including the courtyard. Staff and residents confirmed that there are hoists, including a stand aid, which is jointly hired by the resident and the home. Individual residents have hired some items of equipment, such as a nursing bed. The home was clean and odour free on the day of the inspection. In response to the CSCI survey, ten residents said the home was always fresh and clean, and one person said it usually was. A resident who said that they were very pleased with the cleanliness of their room confirmed that the home was kept clean. Residents’ rooms are fitted with paper towel dispensers. Liquid soap is provided, and staff spoke about the protective clothing available. These measures help prevent cross infection. Rooms have cleaning checklists in place, and care staff explained that currently cleaning is part of their duties. One staff member in their survey said that they thought the home would benefit from a cleaner ‘as we have very little time to carry out cleaning duties as more things are introduced’. However, the manager said this role had been raised in a staff meeting and that the plan was to employ a cleaner for five days a week, which was raised at a residents’ meeting and included in the minutes. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from having skilled, experienced and friendly staff who have a good understanding of their needs based on good communication and training. A change to the recruitment process would make it more robust as one aspect has the potential to put residents at risk. EVIDENCE: During the inspection, residents and staff were observed to have positive and caring relationships with staff adapting their approaches to meet the needs of individual residents. On the day of the inspection, there were two carers on duty, one of whom was a senior. The manager, the cook and the administration assistant were also on duty. All of the social and health care professionals visiting the home, and who responded to the CSCI survey said that a senior member of staff is always on duty to confer with and that they were satisfied with the overall care. Rotas showed that staffing levels in the mornings has changed to two carers for the main part of the morning. However, the manager said that the night staff stayed until 9am in order to provide help with residents’ personal care, and she felt that the employment of a cleaner would help. A staff member also commented that ‘if we are short Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 22 staffed Pauleen will always help us’ and a resident said in their survey, ‘since Pauline took over, I have seen great improvements in the running of the home and Pauleen being ‘hands-on’ helps give a good impression’. In response to the CSCI survey, all residents said that staff are always available to them when they needed them, and this was confirmed by residents during the inspection. Residents were aware that there had been some problems recruiting night care staff and in response to the CSCI survey some staff had raised concerns about having to cover night shifts and there being ‘enough staff’. The manager felt that new staff had now helped ease this problem, which staff confirmed, and that only one night currently needed to be covered. A resident was very positive about how new staff were introduced, which helped them feel safe. One of the GPs commented in the CSCI survey that ‘management and staff alike are very caring, professional and very much put the service users needs foremost. They are every good at responding to patients’ needs and problems. Communication is good’. This level of professionalism is reflected in the promotion of training within the home. The home’s pre-inspection questionnaire states that that over fifty percent of the staff have an NVQ ( a formal qualification) in care, which was reflected in the staff files and confirmed in discussion with staff. Three staff recruitment files were looked at. POVA First is the first stage of a Police check (CRB) to help ensure that staff are appropriate people to work in a care setting. Evidence of good practice was seen by POVA and CRB checks being in place before staff started working at the home, as well as suitable forms of identification. The manager has chased references that have not been returned as confirmed by a copy of a letter on one file. However, two references must be in place before staff start working at the home, and this was not the case in two files. The manager explained that gaps in employment are followed up in interview. Within a few days of the inspection, the manager has provided evidence that references are being ‘chased up’. In the CSCI staff survey, one respondent said ‘I feel I have good training in all areas of my work, and training/induction now given to new members of staff is much better’. All staff responding to the CSCI survey said they received time and funding for relevant training. Two members of staff on duty, who spoke about their own personal development under the current manager, confirmed this. They were able to recognise their own areas of expertise and areas where they wished to develop further. They felt well supported by the manager. These qualities were also recognised by the manager in discussion, and she spoke about future proposals for training including palliative care and further knowledge on the mental health needs of older people. Staffing records show that training in first aid, medication and moving and handling has been provided. A resident confirmed that staff were competent Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 23 with using the stand aid and a staff member felt that they were confident using this piece of equipment, recognised the importance of reassuring residents, and had received a moving and handling update. Induction records are in place for new staff and are signed off by the member of staff and the manager or senior. A staff member acknowledged that records and staff induction procedures have much improved due to the support from their manager. The minutes from a residents’ meeting show that they are asked their opinion on the work of new staff, which demonstrates that the manager values their views on care workers suitability. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This home is very well run and managed, with an ethos which promotes residents’ involvement in the life of the home. EVIDENCE: The manager has many years of experience in working in residential settings and has recently become involved in a county wide training initiative. She has shown a commitment to making positive changes within the service since buying the home. She recognises the importance of acting as a role model for staff, and encourages both residents and staff to fulfil their individual potentials. Residents spoke positively about the impact she has had upon the home. One person said, ‘under new management it has become a professionally run home’ and another said the manager was ‘highly efficient’. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 25 While a staff member said ‘Pauleen manages the home very well. A number of things have been improved and been introduced which helps to deliver better care to our residents. She has also spent a lot of time to make sure we all understand what we have to do’. Another staff member commented, ‘Pauleen has done great things and I am sure she will continue to do so’. Staff files show that staff are provided with the General Social Care Council code of practice, and the manager spoke about promoting professionalism within the role of care workers. A GP commented that ‘the home is very well organised and staff are very loyal and caring’. The home is run in the best interest of the people living there. This is evidenced by discussions with residents who are well informed and clearly feel valued. One person commented in their survey that ‘we have residents’ meetings…at which we can raise any matters we wish, and as Pauleen makes a point of seeing everyone in their room individually, and encourages one to speak frankly with either praise or blame. This promotes a very open atmosphere and consequently a very happy one…I look forward to many more years at Kent Farm’. Several residents confirmed that regular residents’ meetings took place, which they valued, and copies for the last two meetings were seen, which showed the meetings were well attended and covered a broad range of topics. Residents and staff were well informed about the role of CSCI and the purpose of inspection, which was backed up by easily accessible inspection reports for the home. Staff commented that, ‘Communication with both residents and staff have improved since the present owner has arrived’ and another person said ‘Everyone communicates well, between staff, communicating well with residents and relatives. Also written communication’. Staff benefit from regular meetings, supervision and updates, which they discussed during the inspection. In response to the CSCI survey, two people said there are ‘monthly staff meetings and also our residents have a monthly residents’ meeting’ and ‘I work with my senior who carries out supervision so they see how I work. We have team meetings once a month’. The manager explained that the home does not hold personal allowances for residents instead extra costs are invoiced, for example, hairdressing. Record keeping is up to date, well managed and kept securely. Fire records were up to date, and staff training was generally within timescales with external and internal training provided. The home’s pre-inspection questionnaire shows that safety checks and annual services have taken place within the recommended timescales. Spot checks during the tour of the building showed that window restrictors are in place and radiators are protected to help protect the safety of residents. Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 4 x x x 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 x N/A x x 3 Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No. 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 OP29 Regulation 19 Schedule 2 Requirement The registered person shall not employ a person to work at the care unless he/she has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. (Staff must not start working at the home until the required information i.e. two written references are in place). Timescale for action 28/02/07 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 Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kent Farm DS0000063659.V309863.R01.S.doc Version 5.2 Page 29 - 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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