CARE HOME ADULTS 18-65
Long Lane Farm Kellet Lane Bamber Bridge PR5 6AN Lead Inspector
Val Turley Unannounced Inspection 23rd January 2006 09:30 Long Lane Farm DS0000006008.V264909.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 Long Lane Farm DS0000006008.V264909.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. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 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.V264909.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 4 service users in the category LD (Learning Disability). The service should, at all times, 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. 8th August 2005 3. 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, staff room, office and a small conservatory. There are several outbuildings with the laundry being situated in one. The other buildings provide storage. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in January 2006 by one regulation inspector. The inspection took 71/2 hours The inspection involved discussion with and observation of the young adults who lived at the home and also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection? Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 6 Since the last inspection the organisation had appointed a member of staff who had taken on the role of quality assurance. This role included the review of all policies and procedures to ensure as far as possible that good working practices were developed and maintained. The home had been decorated throughout providing a comfortable and pleasant living and working environment. Work with the individual young adults had continued and they had been further supported to personalise their rooms, allowing their interests, hobbies and personalities to be reflected. 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.V264909.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 Long Lane Farm DS0000006008.V264909.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): 2 This standard was not assessed at this inspection as no new young adults had been admitted to the service since the previous inspection. EVIDENCE: Long Lane Farm DS0000006008.V264909.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 of these standards were assessed at this inspection. EVIDENCE: Long Lane Farm DS0000006008.V264909.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): 15 and 16 The homes policy regarding contact with families and friends did not give support staff sufficient information or guidance potentially leaving young adults without the support required to maintain relationships with family and friends. The daily routines within the home gave the young adults opportunities to make choices and decisions in terms of their privacy and dignity. EVIDENCE: Standard 15 was partly assessed at this inspection. At the previous inspection it had been required that the homes policy regarding contact with families and friends must be extended to reflect the emphasis the home places on these relationships. This could possibly leave the young adults without the necessary support to maintain relationships with family and friends. This policy was still in the process of being reviewed and so the requirement remained unmet. During the course of the inspection the support staff were observed to be courteous towards the young adults and to respect their rights in terms of privacy and dignity. Support staff talked to and interacted with the young adults. The young adults were observed to be confident and relaxed in the company of the staff and able to turn to them for guidance and support. The young adults were able to spend time alone if they wished in the privacy of their bedrooms. Staff were observed to support the young adults in this and
Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 11 information within care plans gave guidance as to the support the young adults needed in these situations. This approach provided the young adults with a structured routine and a sense of security but also the flexibility that allowed them to make choices within that routine. With a view to maintaining their independence skills, wherever possible young adults were supported to become involved in housekeeping tasks and again guidance regarding this was included within care plans. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 12 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 The support staff had a good knowledge of service users preferences and personal care needs and provided personal support sensitively and in accordance with their wishes. The staff worked hard to ensure that the health needs of the service users were being met however additional work could be undertaken to ensure as far as possible that their health was being monitored and any concerns addressed. The management of medication within the home could be strengthened to further safeguard the young adults. EVIDENCE: The file of one of the young adults was examined to determine if the personal care provided maximised the young adults privacy, dignity, independence and control. The care plan outlined the young adults preferred routines when receiving personal care and specified the support he required and the tasks he was able to undertake himself. On the day of the inspection it was noted that the daily routines for the young adults were flexible with the young adults being able to determine for themselves the time for getting up and the activities they wished to participate in. The young adults were also able to make some decisions as to who provided them with support during the course of the day and again this was observed during the inspection. The home had a key worker system with support staff applying for these posts and providing evidence that they had a commitment to supporting the young adult.
Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 13 Standard 19 was partly assessed at this inspection. At the previous inspection it had been recommended that health action plans be developed for each of the young adults to ensure as far as possible that their health needs were fully met. Some work had commenced to develop these but it was recommended that the home consult with the community learning disability team for advice and support in respect of this. The management of medication at the home was inspected. The home had clear protocols in place and in general the medication was well managed. Some recommendations were made with a view to safeguarding the young adults and the support staff. These were the need for two members of staff to sign and countersign any handwritten additions on the Medication Administration Record (MAR) sheets and the provision of guidance for staff as to ‘when required’ (PRN) medications should be administered. The service users consent to medication should be also recorded within the care plan. Where it is not possible to obtain consent then this should be recorded plus any guidance for support staff as to how individual young adults may indicate they do not wish medication to be given. MAR sheets must remain at the home. Any periods of absence away from the home e.g. home leave, must be recorded as such on the MAR sheet and a separate record may be kept of medications administered by family and relatives. Accredited training in the administration of medication had been arranged to be delivered by an external agency and this was to be made available to all members of staff with a view to strengthening the homes management of medication and safeguarding the young adults. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 14 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 The homes policies dealing with the protection of vulnerable adults could be strengthened to give staff clear guidance of their responsibilities to ensure that the young adults are protected as far as possible. EVIDENCE: The homes policies and procedures in respect of the Protection of Vulnerable Adults were examined. These provided appropriate information and guidance although it was agreed that these could be strengthened to provide clearer directions to staff as to the action they should take if they suspected the young adults were being abused in any way. To further protect the young adults, the policy dealing with the management and handling of their monies and possessions, must be amended to ensure that an inventory of the young adults valuables is maintained. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 15 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, 28 and 30 The home must undertake additional work to ensure that a safe environment is provided for the benefit of both the young adults and support staff. A pleasant, comfortable and clean environment was provided for the benefit of the young adults and support staff. EVIDENCE: Standard 24 was partly assessed at this inspection. A requirement made at the previous inspection had been acted upon and the home had been decorated and outstanding repairs had been attended to providing a clean, pleasant and comfortable environment for both the young adults and support staff. The grounds were spacious and pleasant, however the organisation should continue in its efforts to ensure that improvements are made to the drive and other concreted areas to the rear of the premises. These are very uneven and as such present a health and safety risk to the young adults and the staff. This requirement remains outstanding. The laundry was situated in an outbuilding. The team leader stated that laundry was carried through the front door and round the back of the house to the laundry to ensure that it was not carried through any areas where food is prepared or eaten. However discussion with staff indicated that these guidelines were not always followed. Policies and procedures were in place for the control of infection and the disposal of clinical waste and these must be amended to make it clear that laundry should not be carried through any areas
Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 16 were food is stored, prepared, or eaten unless carried through in an appropriate laundry bag with a view to further improving infection control measures. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 17 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 Appropriate training and support was provided for staff to help ensure that the needs of the young adults were being met. The homes recruitment procedure was not always followed precisely leaving young adults potentially at risk. EVIDENCE: During the course of the inspection the staff were observed supporting the young adults. They were observed to communicate well with the young adults and to support them sensitively in a variety of situations. The young adults were comfortable in the presence of the staff and turned to them for support and guidance. From discussions with both established and recently appointed members of staff and an examination of training files, it was evident that the staff were well supported by the management team and that the induction training and subsequent training gave them the necessary skills to support the service users in an effective and meaningful way. The organisation was continuing to work towards having 50 of its work force achieve a relevant qualification in care additionally staff were encouraged to apply for external training courses. Training and development was discussed staff within individual supervision meetings. The management team had recently received training in undertaking staff appraisals. The files of three members of staff were examined to determine if the selection and recruitment procedures of the organisation were thorough and robust to ensure the protection of the service users. All the necessary documentation on two of the files was found to be in order with the relevant checks having been
Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 18 undertaken prior to the staff commencing work within the care home. However the third member of staff had commenced work, providing support within the home, prior to a second written reference being received. This arrangement potentially placed the young adults in a position of risk. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 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 37 39 and 42 The registered manager had the appropriate qualifications and experience to manage the home for the benefit of the young adults and the support staff. Quality assurance processes in the home needed to be strengthened to ensure that the young adults are provided with a relevant and appropriate service. EVIDENCE: The homes registered manager had qualifications and experience relevant to his role and was working towards the registered managers award. He had a clear view as to how the home should be run and how he hoped to continually improve the support provided to the young adults. Since the last inspection the home had appointed a member of staff to take on the responsibility of quality assurance within the organisation. As a result of this a number of policies and procedures were being reviewed. Monthly monitoring visits were made to the home to ensure that the service provided was satisfactory and reports were submitted to the Commission for Social Care Inspection. The registered manager undertook a number of regular checks to make sure that all documentation in the home was in place and up to date and that the
Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 20 environment was safe for both the young adults and the staff. The home had achieved the Investors in People Award which is a quality assurance award accredited by an outside body. Care planning meetings were held monthly to review the support provided to the young adults and make any necessary changes. Although the home was in regular contact with the families of the young adults and they were encouraged to play an active part in reviewing the care approach, their views, and where possible the views of the young adults should be sought about the services provided. The results of this survey should be published and made available to interested parties. The views of involved health and social care professionals should also be sought. Standard 42 was partly assessed at this inspection. A requirement made at the last inspection had been acted upon and the fire risk assessments had been reviewed and refresher fire training had been arranged. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 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 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 3 X X X 2 X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 2 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 2 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Long Lane Farm Score 3 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X 3 DS0000006008.V264909.R01.S.doc Version 5.0 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA15 Regulation 16(m) Requirement The homes policy regarding contact or communication with families and friends must be extended to reflect the emphasis the home places on these relationships. (Previous timescale of 31/10/05 not met) A record must be maintained of all valuables and held at the home on behalf of the young adults. The external grounds should be suitable and safe and appropriately maintained Unnecessary risks to the health or safety of the service users must be identified and as far as possible eliminated. The registered person must not employ a person to work at the home unless the necessary checks have been made. Consultation must take place with the service users and their representatives with a view to improving the service provided. Timescale for action 31/03/06 2 YA23 17(2) Schedule 4 23(2)(o) 13(4)(c) 31/03/06 3. 4 YA28 YA30 31/03/06 31/03/06 5 YA34 19 28/02/06 6 YA39 24(3) 30/04/06 Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 4 5 6 7 8 Refer to Standard YA19 YA20 YA20 YA20 YA20 YA23 YA32 YA39 Good Practice Recommendations The young adults should be offered minimum annual health checks. Consent to medication should be obtained and recorded in the individual plan. Hand written entries on a Medication Administration Sheet should be signed and counter-signed by two members of staff. Medication Administration Records should remain at the home with a separate record kept of families administering any medication. Guidance should be provided for staff as to ‘when required’ (PRN) medication should be administered. The homes policy dealing with the protection of vulnerable adults should be strengthened to ensure that staff are provided with clear guidelines. The home should continue to work towards 50 of its work force achieve a relevant qualification in care. The views of health and social care professionals should be sought as part of the homes quality assurance audits. Long Lane Farm DS0000006008.V264909.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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