CARE HOME ADULTS 18-65
Long Lane Farm Kellet Lane Bamber Bridge PR5 6AN Lead Inspector
Val Turley Unannounced Inspection 20th October 2006 10:30 Long Lane Farm DS0000006008.V306406.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 Long Lane Farm DS0000006008.V306406.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. Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Long Lane Farm Address Kellet Lane Bamber Bridge PR5 6AN 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) 01772 335372 01772 335372 Progress Adult Services Limited Mr Andrew Law Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home is registered for a maximum of 4 service users in the category LD (Learning Disability). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 23rd January 2006 Date of last inspection Brief Description of the Service: Long Lane Farm is one of three residential care homes run by Progress Adult Services Ltd. It provides a service for young adults who have a learning disability and present complex and challenging needs. The aim of the service is to provide the young adults with intensive positive support and experiences and to work towards reducing episodes of challenging behaviour by reinforcing and maintaining positive change. The home itself is a detached property, which is set back from the road in its own grounds. There is a large secure garden at the rear and landscaped gardens to the side and front. The home is comfortably furnished taking into account the safety and well being of the service users. The home offers accommodation to four service users who each have their own bedroom. Three of the bedrooms are situated on the first floor of one wing of the house where there is also a toilet and a bathroom. In a separate and almost self-contained wing of the house there is a fourth bedroom with en-suite bathroom and a lounge area. There is controlled access to the rest of the house from this wing. The communal areas are on the ground floor and consist of a lounge, a large dining kitchen, office and a small conservatory. There are several outbuildings with the laundry being situated in one and a staff room in another. The other buildings provided storage. Fees for the home range are £130,688 per year plus charges for any individual additional needs. Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection of a service takes place over a period of time and involves gathering and analysing written information. A site visit was also made to the home as part of the inspection process and this involved discussion, where possible, with young adults living at the home, discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. A questionnaire had been completed by the manager prior to the site visit and comment card had been completed and received from one parent and a GP and a survey had been completed by one of the young adults. These all provided information that was included in the report. As part of the inspection, the inspector used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspector to focus one of the young adults living at the home. Records relating to that individual were inspected. As the young adult had communication difficulties, discussion with him was not possible, but discussion did take place with the management team and the staff who supported the young adult. What the service does well:
The home provides a comfortable, clean, well-maintained and safe environment for the young adults who live there and the staff who support them. A thorough assessment was undertaken of any prospective new admission and a detailed and person centred care plan was developed for all residents. The care plan was reviewed on a monthly basis and support staff were encouraged to become involved in that process. Staff had a thorough understanding of the support needs of the young adults living at the home and were observed to work with them, encouraging them and supporting them to make decisions in respect of their daily routines. A variety of strategies were in place to enable the young people to do this. All activities were risk assessed with clear guidance in place for staff enabling them to support the young adults safely and appropriately. Activities were based both in the community and in the home and aimed to give the young adults a sense of achievement and security. The home had good working relationships with families and supported the young adults in their contact with them. Routines in the home were flexible and unhurried and were guided by the needs and preferences of the young adults. The health needs of the young adults were attended to with staff supporting them to a variety of appointments with health professionals. Medication was managed well in the home. The home had a comprehensive complaints policy in place and relatives were aware of who to complain to. Staff were well motivated and confident and were given access to a range of training opportunities including induction training and additional training in
Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 6 respect of specific syndromes and conditions. Of the staff team, 45 had achieved a nationally recognised qualification in care. The home was well managed with the registered manager having undertaken additional training to update his skills. There were a number of quality assurance audits in place to ensure that the home was run efficiently and in the best interest of the young adults. The home itself was well maintained with all necessary checks and services having been undertaken. . Staff received health and safety training as part of their induction and policies and procedures and appropriate risk assessments were in place. What has improved since the last inspection?
Since the last inspection the home has benefited from input from a psychological service that has provided advice and guidance in respect of any management challenging behaviour presented by the young adults. Person centred planning had also been introduced to the home and it was hoped that this would improve the support that the staff provided to the young adults. A number of policies and procedures had been reviewed, extended and updated, including the Protection of Vulnerable Adults, the policy dealing with contact with families and friends and the management of young adults monies held at the home. The recruitment processes in the home had also improved with all of the necessary checks and references being in place prior to a new member of staff commencing work in the home. Additional training in the management and administration of medication had been introduced. Improvements had been made to the environment with the renewal of some carpets and furnishings. Plans were also in place to make the uneven area to the rear of the home safe. Additional safeguards had been introduced in respect of infection control in relation to the movement of laundry around the home. Consultation had also taken place with the service users representatives with a view to improving the service provided at the home. A number of recommendations had also been acted upon. The young adults had been offered an annual health checks. Some improvements had been made to the management of medication in the home. The consent of the young adults to medication had been obtained where possible, and if this had not been possible then this had been recorded. Hand written entries on the Medication Administration Sheets had been signed and countersigned by two members of staff. Procedures had been introduced to ensure that families were provided with a means of making a record of the medication they administered to the young adults when they made a home visit. Guidance had been developed for staff in respect of medication that is to be administered ‘when required’ (PRN) Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission process was in sufficient detail to ensure that prospective young adults supports needs are fully assessed before admission. EVIDENCE: There had been no new admissions since the last inspection; therefore it was not possible to assess this standard fully. However previous inspections have indicated that the home have thorough processes in place when new admissions are being considered, with a detailed assessment being undertaken before a decision is made to admit a new service user. The homes statement of purpose gave a clear outline of the assessments and processes the home would follow should a prospective service user be identified. Long Lane Farm DS0000006008.V306406.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a positive and effective approach to meeting the individual support needs of the young adults. EVIDENCE: The care of one of the young adults at the home was tracked. The documentation included a great deal of detail of his support needs including some of his preferred routines. The care plan was updated on a monthly basis and discussions with the key worker indicated that the staff had a thorough understanding of his needs. Discussion with staff outlined how the young adult was encouraged and supported to make decisions about his daily life and this information was also recorded within the care plan. Staff were observed to involve the young adult in the decision making process as far as he was able and to respect any decisions that he made. The young adult used signs to help him communicate his feelings and decisions. A questionnaire completed by another of the young adults at the home indicated that he was supported to make decisions about the activities he got involved in both during the week and at the weekend. Any activities that the service user was involved in were risk assessed and the staff were provided with guidance as to how best manage situations and
Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 11 protect both the young adult and themselves. The young adults day was structured to provide an atmosphere and environment that he felt as safe as possible in. The home had links with the local advocacy service, which they were able to call on if their involvement was needed. The home had started to introduce Person Centred Planning with a view to improving the support that staff provided for the young adults. It was hoped that this would ensure that preferred routines and any goals or ambitions that the young adults may have, would be accurately reflected within the care plan. Long Lane Farm DS0000006008.V306406.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The support staff encouraged the young adults to make decisions and choices in their daily lives and supported them in these, taking into account any health and safety issues. EVIDENCE: As far as possible the young adults were encouraged to take part in a range of activities. These included attending the local leisure centre for activities, college courses and the use of local shops and facilities. Activities were carefully thought through to ensure as far as possible that they were safely managed and enjoyed by the young adults. The knowledge that the support staff had of the young adults individual needs helped them to organise these activities successfully. Activities were also arranged within the home taking the young adults interests and needs into consideration. One of the young adults was being successfully supported in a work placement and it was hoped that this approach could be extended with other work placements being considered. He was able to discuss this work and explain how proud he was of his achievements. The home had good working relationships with the families of the young adults and supported any contact the young adults had with their families ensuring as
Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 13 far as possible that any contact was positive for both parties. The homes policy in respect of contact and communication with families and friends had been reviewed and extended since the previous inspection providing clearer and more detailed guidance and information for staff. The staff spoken to on the day of the site visit spoke to the service user sensitively and respectively. They spent time talking and interacting with the service users and respecting their choice to spend time alone when they wished. Care plans included details of the young adults dietary needs and preferences. One of the young adults said that he ate healthy food and that the staff supported him to do this. One of the young adults was observed helping to prepare a meal. The meals were unrushed and arranged around the young adults routines. Long Lane Farm DS0000006008.V306406.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place to assess the personal care needs of the young adults they supported and worked appropriately and sensitively to ensure that their health needs were met. EVIDENCE: The care plan examined included detail of the young adults preferred routines and the specific support he required in terms of personal care. This detail was confirmed in discussion with the management team and the key worker who was clear what support he required in this area. There was evidence that the young adult had his health needs met appropriately. Documentation on his file indicated that he had been supported to attend the GP’s surgery for an annual health check, hospital appointments and the opticians. On the day of the site visit a dentist visited the home to attend to one of the young adults. Concern was also expressed by staff with regard to the health of one of the young adults and discussion took place amongst them as to the advisability of making an appointment for him with the GP. A comment card received from a GP expressed his overall satisfaction with the service that the home provided and his relationship with them. The company that ran the home employed a speech and language therapist who was available for advice and consultation. The services of a psychological
Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 15 service were also available to provide guidance and advice in respect of the management of challenging behaviour in the home. The home managed its medication well and recommendations in respect of medication at the previous inspection had been acted upon. Additional training had been introduced for all staff in the management and administration of medication and staff were provided with additional support and guidance by the company nurse and management team. Long Lane Farm DS0000006008.V306406.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 at least once during a 12 month period. 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. The home had good policies and procedures in place to ensure as far as possible that the young adults were protected. EVIDENCE: The home had comprehensive policies and procedures in place in respect of concerns, complaints and protection. These were available within the home. No complaints had been made to the home. A comment card received from a relative indicated that they were aware of how to make a complaint and a survey completed by one of the young adults indicated that he was also aware of how to do this. Training in the protection of vulnerable adults was on going with all new staff being given training in the induction period and existing staff receiving refresher training. The home had an inventory of the young adults personal possessions and valuables on their file and had also introduced new procedures within the home for managing the young adults monies. The new procedure had introduced new safeguards by reducing the number of people who could access the money. Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable and provided a pleasant and safe environment for both the young adults and support staff. EVIDENCE: The home was clean, comfortable, well maintained and decorated. Furnishings were chosen carefully with the safety of the young adults being a consideration in this process. The company had its own maintenance team enabling repairs to be carried out quickly and efficiently. The young adults bedrooms were decorated were their interests and personality in mind. The home had been recently redecoration and some of the furnishings and carpets had been replaced. A requirement made at the last inspection was reviewed. This was in respect of the uneven garden area to the rear of the home. The home was able to provide documentation that there were plans to clear this area in the very near future and so reduce any risks to the young adults and staff. The laundry facilities at the home were located in an outbuilding. The equipment provided here was sufficient to meet the needs of the home. Staff spoken to at the time of the site visit stated that soiled laundry was not carried through the kitchen area of the home and that laundry bags designed to minimise the spread of any infection were utilised for carrying other laundry.
Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a robust recruitment process and provided staff with good training opportunities with a view to protecting the young adults as far as possible. EVIDENCE: The staff spoken to on the day of the site visit were well motivated and keen to continue to improve the lifestyles of the young adults who lived in the home. They had received training appropriate to their role and were confident with the responsibility that they had. The young adults appeared relaxed in their company and one said that he liked the staff very much. Progress was being made to reach the target of having 50 of the staff team achieve a nationally recognised qualification in care. The home had a thorough recruitment process in place to safeguard the young adults with records indicating that staff only commenced work with the young adults once all the necessary references and checks had been received. All staff were subject to a probationary period before being confirmed in post. The training matrix indicated that the home provided good training opportunities and this was confirmed by the staff spoken to. All mandatory training was provided and the staff team were encouraged and supported to attend external courses. Additional training was provided in respect of specific conditions and syndromes were this was appropriate.
Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed with the best interests of the young adults being promoted and safeguarded. EVIDENCE: The registered manager of the home was continuing to work towards his NVQ 4 in Care and Management. There was evidence that he was committed to the aims and objectives of the home and had updated his skills with additional training. The home had a number of quality assurance systems in place to ensure that the home was run efficiently and in the best interests of the young adults. These included a monthly monitoring visit by a senior member of the company, a daily report by the registered manager, and daily checks on the environment, medication and documentation. The home had achieved the Investors in People Award, which is a quality assurance award accredited by an outside body. A survey of the views of relatives and social care staff involved in the home had been undertaken and it was recommended that this be extended Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 20 to health professionals providing a service to the young adults living in the home. The home was well maintained with all necessary checks and services having been undertaken. Staff received health and safety training as part of their induction and policies and procedures and appropriate risk assessments were in place. Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA32 YA39 Good Practice Recommendations The home should continue to work towards 50 of its work force achieve a relevant qualification in care. The views of health care professionals should be sought as part of the homes quality assurance audits. Long Lane Farm DS0000006008.V306406.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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