Inspection on 09/01/07 for Lilliputs Farmhouse

This inspection was carried out on 9th January 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lilliputs Farmhouse 05/12/05

Lilliputs Farmhouse 03/08/05

Lilliputs Farmhouse 28/02/05

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

CARE HOME ADULTS 18-65 Lilliputs Farmhouse Lilliputs Farmhouse Wingletye Lane Hornchurch Essex RM11 3BL Lead Inspector Mr Roger Farrell Key Unannounced Inspection 9th January 2007 11:30 DS0000056267.V326734.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000056267.V326734.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000056267.V326734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lilliputs Farmhouse Address Lilliputs Farmhouse Wingletye Lane Hornchurch Essex RM11 3BL 01708 620 949 TBA info@cmg-corporate.com www.caremanagementgroup.com Care Management Group Limited 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) Mr David Ward Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000056267.V326734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: Lilliputs Farmhouse is a care home for six adults who have learning disabilities situated in a semi-rural part of Hornchurch. Opened in June 2004, it shares the site with three homes for children with learning disabilities. All four homes are owned and run by Care Management Group (CMG), a large private company that operates over a hundred such care services. The Farmhouse is a 16th Century listed building that still has many of its original features. It is decorated and furnished to a high standard, meeting the needs of a modern care home whilst preserving the historic character of the fine building. The six single bedrooms are all large, with two on the ground floor and four on the upper floor. The main lounge, quiet room, kitchen, dining room, laundry and small office are on the ground floor. In addition, there is a spacious conservatory lounge, with access to the delightful large enclosed garden. The service users have free access to a large activity centre on the site, which has a swimming pool, gym, soft play area, light and dark rooms, and well equipped teaching rooms for such things as art, cookery, and music. There are also stables for the two riding horses. The Farmhouse has its own saloon car, and can use a shared minibus. There is a central administration office for all services on this site. This farmstead complex is reached by a country lane about a mile from a main road, which has a bus route into Hornchurch town centre about three miles away. The current range of fees is £1,600 to £2,300 per week. DS0000056267.V326734.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on Tuesday 9 January 2007 between 11.30am and 6pm. The inspector returned for a further three hours the following day to complete the checks of records. Originally, one main manager was responsible for all four Lilliputs’ homes. However, last June David Ward was confirmed as the registered manager for The Farmhouse. This was the home’s first inspection since he became responsible for the day-to-day running of this service, and he was present on both days to help the inspector with the checks. The two seniors of the care team were also present for parts of the inspection. The inspector gave an overview of the changes to the way care services are monitored. From this year this will include children’s homes being monitored by a different inspection agency from those who assess services for adults. Arranging for The Farmhouse to have its own manager a year ahead of this change was a sensible move. The inspector was able to advise the manager in the course of this assessment what additional steps he needed to take to make The Farmhouse a ‘stand-alone’ service. This involves taking over a few monitoring systems that currently cover all four homes, and making sure that certain procedures speak about services for adults rather than children. Another change is that from April 2007 each home will be given a ‘quality rating’ – covering a range from ‘excellent’ to ‘poor’, and that this will be published for everybody to see. The manager did an excellent job in presenting the necessary evidence that shows that his service is operating to a consistently good standard, with the top score being awarded under three headings. He showed a well-informed knowledge of the support needs of all residents, and was equally competent in presenting the practice and administrative paperwork. The inspector is grateful for the welcome he received from the six residents, and to the group of staff who met with him. Questionnaires have been sent out to relatives, and these comments will be covered in the next inspection report. What the service does well: This home is successful in meeting the needs of the six young adults. This is achieved through a combination of very good facilities, a competent manager, and a dedicated team of carers. Whilst residents enjoy the benefits of such a pleasant and well-resourced complex, good support is provided to help them take part in educational and social activities away from the farmstead. The manager and staff have a detailed understanding of each resident’s range of needs, and can demonstrate good practice standards through a thorough approach to organising care plan records. Comments from relatives include – “Just to add that the standard of care given by staff is excellent and I have only praise for them in the work they do with (my relative). I have never at any time had any cause for complaint in any respect.” DS0000056267.V326734.R01.S.doc Version 5.2 Page 6 One further comment from another relative summed up the successful conclusions set out in this inspection report - “All in all we are delighted with (our relative’s) placement at The Farmhouse. The accommodation and location are terrific, but more importantly the staff are great – both professional and caring, and we have come to feel that they are almost an extension of our family. It is obvious from (our relative’s) behaviour that she is very settled and happy…and feel I really do know that without all the care and support given we just could not manage.” 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. DS0000056267.V326734.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000056267.V326734.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved looking at how assessments would be carried out. This service is good at presenting information, including using pictures and symbols to make some matters more easily understood. This includes the main service user guide, and how to make complaints. EVIDENCE: Care homes must have two main documents that describe how they can meet the support needs of the service users they are registered to care for by the Commission. The ‘statement of purpose’ was republished last year. It is well presented in the clear standard style used by the company. It makes strong commitments to providing a high standard of service, including guaranteeing residents’ rights. It covers all areas asked for in the regulations, and crossreferences entries with the company’s policies and procedures. It also has a copy of the company’s standard form of contract/resident’s agreement. There are some errors that need to be corrected before the next print run – such as calling the home ‘Lilliputs House’, instead of ‘Lilliputs Farmhouse’; and saying there is a ‘highly experienced and skilled deputy’ when there is no such post in the staffing budget. Further, it is a good idea to include accurate details of the staff complement, and describe the normal pattern of cover. The ‘service users’ guide’ has also been revised. This should be aimed at service users and also act as an information brochure for prospective DS0000056267.V326734.R01.S.doc Version 5.2 Page 9 residents. The company has done a good job at presenting this information handbook in a way that helps understanding by using pictures, signs and simple words. This includes how to make a complaint. There was a signed copy of the ‘resident’s agreement’ on the individual care plan files seen by the inspector. There was also a copy of the pictorial ‘residents’ charter’. The home was set up nearly three years ago for young adults. Three of the residents had lived in the neighbouring children’s homes. All six residents moved in soon after the home opened; are in their early twenties; and consider this to be their permanent home. This group of standards covers how new residents are helped move in. The manager outlined how the selection process would be carried out in the unlikely event of there being a vacancy. The company have a standardised assessment form and referral procedure. The inspector looked at a recent example used for one of the neighbouring houses. Covering twenty-pages, this had a comprehensive range of headings completed in good detail. Such an approach would match the range of headings set out in Standard 2.1 of the National Minimum Standards. The ‘information files’ kept in the main administration office have ‘carried forward’ information, such as the ‘LAC forms’, still useful in such areas as recording a person’s immunisation record. In the early days a person was admitted as ‘an emergency’ for two weeks. However, the manager said that any future move-in would be planned and phased, with compatibility with the other residents being fully considered. DS0000056267.V326734.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved hearing about each person’s main support needs and how staff provide help. This team are successful in the way they keep personal information, such as the care plan files. They are given the top ‘excellent’ score for the way they arrange and keep these files up-to-date. They are able to prove the ways in which they respond to residents’ individual choices and care needs. EVIDENCE: The manager gave the inspector an overview of each resident’s history, support needs, how each person communicates, and their family and social networks. The inspector looked at a sample of service users’ files. This included the ‘care plan files’, that include the day-to-day notes; the ‘medical files’; the ‘risk assessment files’; and the ‘information files’. Overall, they represent a satisfactory support planning, monitoring, and review record system. The care plan files have good personal details and profiles, including ‘life pictures’; good practical instructions on support tasks and individual needs; and consideration of personal choices, such as ‘likes and dislikes’. Attention to detail is very good, such as assistance with personal hygiene and monitoring more difficult behaviours. All residents have had a review within the last year with their funding authority represented, though the manager said that he has had to DS0000056267.V326734.R01.S.doc Version 5.2 Page 11 push to make sure these took place. The two examples of review records seen – one from Havering Council and the other from Wandsworth Council - were satisfactory and covered good detail. Based on the range and quality of the two ‘care plan files’ checked in detail, the top ‘excellent’ score is award. DS0000056267.V326734.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that checked on how residents spend their time. Even though there are some excellent facilities on the site, residents get good help to join in educational and social activities away from the Lilliputs complex. Good contact is maintained with families, including asking them about what they think of the service provided. Arrangements for meals are satisfactory, including residents going food shopping and using fresh ingredients. EVIDENCE: The inspector was provided with a good range of information to help judge these headings as satisfactory. This included each resident’s ‘overview of activities’ sheet setting out the main daily activities; and a synopsis of social events and outings over the last six months from the main diary. This has included trips to the seaside and zoo, and going to London – as well as social gatherings and parties held on-site. In addition, day-to-day notes record regular activities such as bowling, going to the cinema, and shopping trips to Romford. There is also a programme for the prestigious on-site activity centre - which includes swimming, soft play in the gym, cookery, art, and horse riding. DS0000056267.V326734.R01.S.doc Version 5.2 Page 13 These show that residents are well supported in taking part in individually chosen educational, social and leisure pursuits. This includes some residents attending other resource centres, college courses, places of worship, and local evening clubs. Two residents were due to go to Disneyland Paris the following month as part of their ’21st Birthday’ celebrations, with the main holiday for all at Butlins booked for September. In one file checked by the inspector there was a good review from that resident’s main resource centre, which the manager had attended. The ‘risk assessment files’ have a worthwhile range of completed sheets covering activities. One resident needs to use a wheelchair away from the home. Two staff are ‘approved drivers’ for the shared minibus that is adapted to take wheelchairs. Nearly all other staff can drive the home’s own car. The manager’s overview for each resident included their contact with family. Most residents have regular contact, including three who visits their family homes regularly, that for two includes staying overnight. The team have taken steps to maintain links with one person’s family who make very little contact. Entries in the main diary show that residents have been supported to attend the company’s Forums held in Croyden. The inspector looked at a sample of menus based on a six-week cycle, and saw the arrangements for lunches and a main evening meal. Staff were responsive to individual preferences, and have a clear idea about each person’s likes and dislikes. There was good use of fresh ingredients – with good stocks of fresh vegetables and a well-filled fruit bowl. The inspector sampled the main meal on the first inspection day and this was well prepared and presented. There were good stocks of food and residents do help with the main weekly shopping. Views on the quality of diets are included in the questionnaires sent out to relatives, with positive responses. DS0000056267.V326734.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that checked on help with day-to-day living and medical care. Based on the examples used below, residents and their families can be confident that there is a caring and vigilant approach. Again, the detailed way the staff keep notes shows a thorough approach. EVIDENCE: As stated earlier, care plan details covering personal support are very good. These have well expressed instructions, with attention to detail, such as – night care arrangements; taking shower temperature readings; specific risk assessments; oral hygiene; weight charts, and so on. Separate ‘medical files’ have recently been set up, and again these are completed in good detail. This includes the well designed ‘my health booklet’ used by CMG, that has advice on how to help with particular physical needs, and a ‘health action plan’. Symbols are used to help explain matters to the residents. The manager described particular mental and physical health needs. There is a good level of satisfaction with the main GP practice used by four residents. This is also the case for the two people who have remained with their established family doctors. There are visiting dental and chiropody services, and good links with a local optician. There is helpful guidance material in individual files – such as explaining particular syndromes. There are the necessary range of monitoring sheets, such as recording seizure frequency and DS0000056267.V326734.R01.S.doc Version 5.2 Page 15 patterns, and guidance on the emergency use of medication. Training was due to take place on the use of a less intrusive drug used for prolonged seizures, all staff having previously done training on rectal procedures. There were some gaps in the medication notes, such as in the medical tracking sheets, but the manager showed the inspector the additional ‘medical file’ that had a report for each type of consultation. Staff also need to be reminded to date sections when they are updated. In line with the home’s ‘stand-alone’ status, it is now time to consider holding the ‘information files’ at the home rather than in the administration office. The manager gave an overview of the medication system. Drugs are supplied by Boots in their monitored dose cassettes, with printed recording sheets. Supplies are held in a locked trolley that is anchor locked in an alcove. There is the same good standard of clear records as with other sections of the residents’ files. The supplying pharmacist provides training, and staff explained how they then ‘shadow’ for a period as part of establishing their competence to give out drugs. There have been no known errors with medication since the last inspection. The manager needs to check if there is a ‘community pharmacy contract’ with their supplying chemist – this is normally the case when they provide training. If so, the pharmacist should be invited to visit to do periodic checks on the medication arrangements. The manager is also aware that the Commission has pharmacy inspectors who can offer advice, and occasionally carry out audits. DS0000056267.V326734.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved speaking to a group of staff about what would happen if something were wrong. The manager has a good understanding of the steps that must be followed if there is a complaint or concern. Staff said they are committed to responding if they became aware of any concerns. EVIDENCE: Information on how to make complaints is readily available. This includes simple guides using pictures and symbols in the ‘service users’ guide’, with a copy on each person’s main file that includes how to speak to an inspector. There is also a ‘complaints procedure file’, giving details of the company’s commitment to take all complaints seriously and respond within set timescales. There are set complaints forms, but no formal complaint has been logged since the home opened. The inspector looked at a sample of ‘next of kin’ survey questionnaires returned last year. The redecoration of a bedroom raised by one relative had been carried out as requested. An explanation was also given as to why a bath was not replaced due to a structural limitation. In their meeting with the inspector staff gave adequate answers regarding prevention of abuse, including knowing their responsibilities in line with the ‘whistle blowing’ expectation. They confirmed that training on this matter is provided within a short period of starting. All staff have been given a copy of the main national ‘code of practice’, but were vague in their understanding of the role of the General Social Care Council, including the phased programme of registering. A recommendation has been made on this matter. The manager was familiar with the legal expectations regarding responses to suspicions or allegations of abuse, including having a copy of the main DS0000056267.V326734.R01.S.doc Version 5.2 Page 17 guidelines called ‘No secrets, and a copy of the company’s ‘Pova’ procedure. He did not have a copy of the local council guidelines that he would have to follow, but had ordered a copy for the home when the inspector returned for the second day. There have been no alerts regarding abuse or neglect since the home opened. DS0000056267.V326734.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved checking all areas. Both The Farmhouse, and the Lilliputs site overall provides an excellent standard of facilities. Residents have the benefit of safe, spacious and tastefully maintained accommodation. Additionally there is ready access to a well-equipped activity centre, and delightful garden and grounds. There is a good range of vehicles, as well as staff using their own cars to make sure residents get to use local community facilities. EVIDENCE: The inspector looked at all parts of the building, including bedrooms. There is a description of the facilities in the ‘statement of purpose’, saying how these comfortably exceed the minimum space standards for a care home. The boast that this Grade 2 listed building meets safety standards whilst preserving the historical character of the buildings, including the decorative style, is fully justified. The manager described the improvements that have been carried out over the last year, including installing new boilers and fitting better control valves on radiators. Many areas have been fitted with new carpets, three bedrooms have DS0000056267.V326734.R01.S.doc Version 5.2 Page 19 been redecorated taking into account the resident’s choice; and the lounge and hallway have also been repainted. The manager said he was satisfied with how the company maintain the buildings, saying they respond promptly to any problems. The main maintenance manager visited during the inspection to carry out checks. There are two full-time handypersons based on site who tackle minor defects quickly. All parts of the home were found to be clean and safely arranged at this unannounced visit. DS0000056267.V326734.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved looking at staff vetting; their skills; and training. This is undoubtedly a dedicated team that appreciate their manager. However, there needs to be an improvement in the training, including supporting staff do the main NVQ qualifying awards. This is the only area where the service scores below the ‘good’ rating. EVIDENCE: The staffing complement is: manager; two senior support workers; 5 support worker; 4 night support workers – all full-time, though currently six people cover the night shifts. The normal pattern of cover is four staff on during the day (7am to 7pm), excluding the manager; with two staff on the evening/waking night shift. It is said that staff have a preference for these longer 12-hour shifts, working ‘three days on four days off’ on a six-week repeating rota. There are no overlap periods between shifts, but it is said that staff do arrive about 15 minutes early for their shifts to allow for an information handover. As said earlier, there are a number of references to a deputy, but there is no such post. There is a good record of staff retention, with some staff moving from, or transferring to other on-site services. DS0000056267.V326734.R01.S.doc Version 5.2 Page 21 Currently there an agreement and extra funding for one resident to have extra ‘one-to-one’ support every evening between 7 and 10pm. This is cover by two regular agency workers. The inspector checked a sample of staff files. These have a handy front index checklist. This confirmed that the company are still carrying out the required vetting, including getting two references; taking copies of personal documents that prove identity and permission to work; having a recent photo; and obtaining a CRB certificate. Files also have a copy of application forms with details of work history, and a job description. The only advice offered by the inspector at this visit was to ask for verification, such as a company stamp or letterhead, when a standard reference response is used. The most recent joiners said they were led through the induction programme topic by topic, saying they sign only when each topic has been suitably explained. One of the seniors keeps good log of courses and who attended each session. Training was the main topic discussed with the group of staff. They confirmed that they attend training in six main areas within a reasonable time of starting, covering – care planning; food hygiene; back care; communication including Makaton; protection guidelines; and epilepsy. The inspector was also sent a ‘training matrix’ showing when each person attended training on the main core topics, but this had quite a lot of gaps. Overall staff expressed a positive view about learning prospects, and satisfaction with the company trainers, who use the ample training suite in the activity centre. However, one comment was – “Although I think they are quite good and I have benefited from (the training) I have attended that has really been quite good, they have been a bit sluggish when it comes to following through on promises regarding NVQs.” Other than the manager and two seniors, only one of the team has an NVQ award – though the two members of the team who qualified had moved to other company services during last year. Three current staff are signed up to commence on NVQ schemes. Consequently, improving on their record of training, both in core topics and NVQ qualifications emerged at this inspection as the only significant shortfall in this service. Consequently, the requirement on this matter is carried forward. DS0000056267.V326734.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved checking how it well it is being run since it got its own manager. The clear conclusion is that this is an effectively operated service, with the registered manager having earned the respect and appreciation of his team. All evidence considered at this visit shows there is strong leadership from a person, who in turn, works well within the company’s systems. This positive outcome includes good quality control monitoring, including overseeing safety arrangements. EVIDENCE: Establishing a manager post for The Farmhouse has been a success. David Ward has over thirty years experience in public service, in addition to running a home for older persons for over ten years. He has worked at the Lilliputs complex since November 2004, and in effect has managed this home since August 2005, with his registration being confirmed in May 2006. He holds the main national qualifications for managing care services. DS0000056267.V326734.R01.S.doc Version 5.2 Page 23 In addition to the competent and efficient way in which he responded to this service assessment, comments by staff were consistently positive. They talked of strong leadership qualities, fairness, and a good level of involvement in dayto-day care. During the inspection he showed a detailed understanding, and caring approach to supporting residents and guiding staff. Comments from team members included – “I know that we work with a really good manager… he is very ‘hands-on’.“; “We all get on. You can have a moan if necessary, but we all get on with the job…we have confidence in David and he knows he can trust us to do things right.”; “Yes, we all do get on together. It helps when you have a manager that says ‘thank you’…its important to know you are appreciated.” This theme of good teamwork was stressed by a number of staff, including one relatively new person saying – “I knew early on that I had joined a good team that work well together…. And I haven’t seen anything that has changed my mind.”; One further comment being – “There is good diversity such as different ages. It is one group, and we get on really well. New staff are helped to fit in. People get on with what needs doing…they know what needs doing and will always step in to help you when needed.” There was also agreement that staff meetings are productive, and supervision helpful. There is a good system of delegating lead responsibilities, such as keeping a check on the car, ordering household products, and some safety monitoring. The inspector explained the increased emphasis on registered providers carrying out quality control and assurance monitoring. The efficient way in which the manager and team now arrange monitoring systems is a good indicator of their ability to prove accountability. Equally, there are a number of company systems, such as regular ‘monthly reports’ using a good checklist and comment report. Last year a satisfaction survey was carried out, with questionnaires sent to relatives and care managers. A copy was sent to the friend of the resident who has little family contact. The manager was able to describe the action taken to the limited number of issues of concern raised in the responses. The inspector asked to see a range of health and safety records and certificates. This included the fire log of in-house checks, drills and equipment maintenance; electrical, gas and water safety certificates; and in-house health and safety routines. These were all satisfactory, being neatly arranged in appropriate files. The last reports following visits by a fire safety inspector, and an environmental health officer gave satisfactory conclusions. The manager is ensuring that this building achieves the necessary ‘stand-alone’ documentation that was previously held for the site overall. Good use is made of standardised company proformas, such as the good fire log book. The top score is awarded for this good record of safety monitoring and recording. DS0000056267.V326734.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 4 3 DS0000056267.V326734.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes. The requirement covering the qualification target is carried forward. 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 YA32 Regulation 18 Requirement Develop a plan that supports staff to undertake appropriate qualifications. The expected target is that 50 of the tem have NVQ at Level 2 or above. Within a reasonable time of commencing, provide all care staff with training in core skills training. Timescale for action 01/04/07 2 YA34 18(1)(c) 01/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA31 Good Practice Recommendations Provide staff with guidance on the role of the General Social Care Council, including the phased programme of enrolment. DS0000056267.V326734.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000056267.V326734.R01.S.doc Version 5.2 Page 27 - 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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