CARE HOME ADULTS 18-65
Lilliputs Farmhouse Lilliputs Farmhouse Wyngletye Lane Hornchurch Essex RM11 3BL Lead Inspector
Ms Edi O`Farrell Unannounced Inspection 5th December 2005 12:20 DS0000056267.V270245.R01.S.doc Version 5.0 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 DS0000056267.V270245.R01.S.doc Version 5.0 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. DS0000056267.V270245.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lilliputs Farmhouse Address Lilliputs Farmhouse Wyngletye Lane Hornchurch Essex RM11 3BL 01708 620 325 TBA 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) Care Management Group Limited Carol Ann Morrell Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000056267.V270245.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: Lilliputs Farmhouse is a six-place care home for adults with severe learning disabilities, situated in a semi-rural part of Hornchurch. It opened in June 2004, and is on the same site as three other houses that form Lilliputs, a care home for children with severe learning disabilities. Care Management Group, a large private company that provides similar adult services in other areas, operates both homes. The Farmhouse is a 16th Century listed building, and many of the original features, such as low doorways, have been retained. The house is decorated and furnished to a high standard, with all equipment, fixtures and fittings being domestic in nature. All six bedrooms are single, and well above minimum standard size. Five have an ensuite toilet and shower, with the sixth having a bath/shower room nearby. Two of the bedrooms are on the ground floor, and four on the upper floor, which is accessed by stairs as there is no lift. There is a large conservatory on the ground floor, with french windows that lead onto a patio and garden, with outdoor seating. A lounge, quiet room, kitchen, dining room, laundry and small office are also on the ground floor. The service users have free access to a large activity centre on the site, which has a swimming pool, soft play area, light and dark rooms, as well as well equipped teaching rooms for such things as art, cookery, and music. They also have access to the two horses that are kept on site, and the house car, and larger vehicles belonging to the childrens home. The site is on a bus route to Hornchurch and Romford. DS0000056267.V270245.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This, unannounced, inspection took place on a weekday from midday to early afternoon. It was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits all core standards have now been assessed. Three Requirements were set at the previous inspection, and two of these have been brought forward in this report, as the timescale for action has not yet been reached. The third Requirement has been met. Some information in this report has been taken from the previous inspection, when most of the Standards were assessed in depth. What the service does well:
Lilliputs Farmhouse provides an extremely pleasant, comfortable, and safe home for the people who live there. They all have large, well-furnished, single bedrooms with their own shower and toilet. They are encouraged to have their own possessions in their rooms, and all take advantage of this. The communal space is a large and a small lounge, dining room, and large conservatory, and this means that service users can spend time with each other or alone. This is important for service users who find spending time with others to be difficult at times. Service users also use the large, and well-equipped, activity centre, which is on the same site. This has a swimming pool, soft play area, relaxation and stimulation rooms, as well as art, cookery, and music rooms. Each service user has an individual programme of educational, social and leisure activities, which include going to local collages, involvement in the running of the home, skills training, such as cookery, swimming and horse riding. They also have individual care plans, covering all their health and personal care needs, which are very person-centred. Service users are encouraged to choose their meals, and if necessary staff cook different things for them at meal times. Some nights there are takeaways, and there are also meals out at local restaurants. The staff enjoy working at the home, and have a warm and respectful relationship with the service users. The home is well managed and a lot of effort has gone into building a strong staff team since it opened. The Commission uses a scoring system of 1 to 4 when inspecting homes against the National Minimum Standards, with 4 being the highest. This is used to commend services for achieving above these standards. This home was awarded seven scores of 4 at the last inspection in recognition of the commitment to providing a high quality, and individualised, service. There have been no events since that inspection to indicate that this high standard has not been maintained, and nothing was noted during this inspection that would change these scores. DS0000056267.V270245.R01.S.doc Version 5.0 Page 6 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. DS0000056267.V270245.R01.S.doc Version 5.0 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 DS0000056267.V270245.R01.S.doc Version 5.0 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): None at this inspection These standards were not tested on this visit. However evidence from the last inspection was that service users, and their relatives, made informed choices about moving into the home, based on comprehensive assessment of need and full information about the proposed service. Service users have individual contracts. EVIDENCE: The above Standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the five Standards. At the time of the last inspection, all of the outcomes were assessed as met. These standards will be re-tested at a future inspection. DS0000056267.V270245.R01.S.doc Version 5.0 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): None at this inspection. These Standards were not tested on this visit. However evidence from the last inspection was that service users’ needs and aspirations are reflected in their individual plans, and staff support them to make decisions about their lives. They participate, as far as possible, in the life of the home, and are supported to take risks. Information on service users is handled appropriately. EVIDENCE: The above Standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the five Standards. At the time of the last inspection, all of the outcomes were assessed as met, with Standards 6 and 8 being scored as 4, commendable. These standards will be re-tested at a future inspection. DS0000056267.V270245.R01.S.doc Version 5.0 Page 10 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): None at this inspection. These Standards were not tested on this visit. However evidence from the last inspection was that service users lead very active and varied lives, which encourage personal development and learning. Their rights are respected, and they are encouraged and supported to take responsibility for their actions. Contact with families, friends, and access to the community are given a high priority. EVIDENCE: The above Standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the seven Standards. At the time of the last inspection, all of the outcomes were assessed as met, with Standard 17 being scored as 4, commendable. These standards will be re-tested at a future inspection. DS0000056267.V270245.R01.S.doc Version 5.0 Page 11 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): 20 in part. Staff are now fully following correct procedure in relation to medicine administration, offering protection to service users. The remaining Standards were not tested on this visit. However evidence from the last inspection was that service users receive personal support the way they prefer, and their physical and emotional health needs are met. EVIDENCE: In response to a Requirement set at the previous inspection staff are now signing when handwriting prescriptions onto the medication administration cards. They are also recording all stock taken forward at the start of each prescription cycle. This means that it is possible to carry out a medication audit. The other three Standards were not specifically checked on this visit, as there were no other outstanding Requirements. At the time of the last inspection, all of the outcomes were assessed as met. These Standards will be re-tested at a future inspection. DS0000056267.V270245.R01.S.doc Version 5.0 Page 12 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): 23 Some additional training in adult protection needs to be arranged, so that all staff understand how to protect service users from potential abuse. This training needs to identify the differences between child protection and adult protection. EVIDENCE: A Requirement was set at the last inspection that all staff must have adult protection training. As the timescale for this has not yet been reached this has been brought forward as Requirement 1. DS0000056267.V270245.R01.S.doc Version 5.0 Page 13 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): None at this inspection. These Standards were not tested on this visit. Evidence from the last inspection was that service users live in an extremely homely, comfortable, and safe, environment. Their bedrooms suit their needs, and promote independence. The shared space, including the use of the activity centre and outdoor space, complements and supplements their individual rooms. The home is clean and hygienic, and any specialist equipment that is needed to maximise independence is provided. EVIDENCE: The above Standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the seven Standards. At the time of the last inspection, all of the outcomes were assessed as met, with Standards 24 to 27 being scored as 4, commendable. These standards will be re-tested at a future inspection. DS0000056267.V270245.R01.S.doc Version 5.0 Page 14 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): 34 & 36 The company has a robust recruitment procedure, but interview panels need to check application forms more thoroughly, in order to offer full protection for service users. Service users benefit from well supported and supervised staff. EVIDENCE: The manager reported that the deadline of 31/12/05 for at least 50 of staff to achieve NVQ level 2 or above would not be met. Requirement 2 has been set taking account of this. Staff files were examined in depth, and in each case there were at least two references, proof of identity, and proof that CRB checks had been carried out. The latter are held at the company head office, and a letter sent through to inform the Registered Manager that one had been received. At a recent inspection of the children’s home a Requirement had been set that this letter must inform the manager if the CRB check had been satisfactory or not. This has now been implemented across the whole of the site, with the letter having been changed to include this point. Proof of permission to work is in place where required. In some cases the application forms had not been fully completed, for example giving the name and address of schools attended, but not dates, and not including dates of previous employment, or reasons for gaps in employment. The Registered Manager must be able to evidence that
DS0000056267.V270245.R01.S.doc Version 5.0 Page 15 they have explored all gaps in each potential staff member’s employment history before they offer employment. This is Requirement 3. DS0000056267.V270245.R01.S.doc Version 5.0 Page 16 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): 39 A quality assurance system needs to be put in place, which includes seeking the views of service users and their representatives. The remaining six Standards were not tested on this visit. However evidence from the last inspection was that the home is run in the best interest of the service users; it is well managed, with a good quality of leadership. The home’s record keeping, and policies and procedures safeguard service users’ rights and best interests. EVIDENCE: Requirement 4 has been brought forward from the last inspection as the timescale has not yet been reached. The remaining six Standards were not specifically tested on this visit, as there are no outstanding requirements. At the time of the last inspection all of the outcomes were assessed as met. These Standards will be re-tested at a future inspection. DS0000056267.V270245.R01.S.doc Version 5.0 Page 17 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 X X X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X Standard No 37 38 39 40 41 42 43 Score X X 2 X X X X DS0000056267.V270245.R01.S.doc Version 5.0 Page 18 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. 1. Standard YA23 Regulation 13 (6) Requirement All staff must have training in the protection of vulnerable adults. This must include clarity as to each staff members responsibility to report any potential abuse, and the differences between child and adult protection policies and procedures. 50 of care staff, including agency staff, must achieve NVQ2, or above. The Registered Manager must be able to evidence that all gaps in the employment history of prospective staff members have been explored. A Quality Assurance system must be in place. This system must include seeking the views of service users and their representatives, about the service. A copy of the report must be forwarded to the Commission, and be made available to service users, and their representatives. Timescale for action 31/12/05 2 3 YA32 YA34 18 19 31/03/06 28/02/06 4. YA39 24 31/12/05 DS0000056267.V270245.R01.S.doc Version 5.0 Page 19 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 DS0000056267.V270245.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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