Inspection on 10/11/06 for Merrivale Farm

This inspection was carried out on 10th November 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Merrivale Farm 28/02/06

Merrivale Farm 31/10/05

Merrivale Farm 08/02/05

Merrivale Farm 07/10/04

Merrivale Farm 26/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Merrivale Farm Eastwood Tarrington Ledbury Herefordshire HR8 2RN Lead Inspector Jean Littler Unannounced Inspection 10 November 2006 12:30 th Merrivale Farm DS0000024724.V311613.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 Merrivale Farm DS0000024724.V311613.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. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merrivale Farm Address Eastwood Tarrington Ledbury Herefordshire HR8 2RN 01531 670220 01531 670914 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) Alphagrange Limited Mrs Teresa Kate Loveridge Mrs Jacqueline Armitage Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named resident has a mental disorder in addition to a learning disability. 28th February 2006 Date of last inspection Brief Description of the Service: Merrivale Farm is situated in a rural location, on the outskirts of Tarrington village, between Hereford and Ledbury. The home is set in 20 acres of land and comprises a traditional farmhouse that has an annexe and other outbuildings. It is the only service owned by Alphagrange Ltd. There are two managers, one of whom is also one of the two company directors. The Home is registered to accommodate up to seven adults whose primary care needs are their learning disabilities. Horses are kept on the land and residents are encouraged to help with their care and other tasks in the garden. Information about the Home is available from the Home on request. The weekly fees are between £485-£714. Additional charges are made for personal items such as clothes and toiletries, and personal services such as haircuts and chiropody, holidays, some activities and vehicle costs. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine Key unannounced inspection was carried out on a weekday between 12.30pm and 6.50pm to assess the service against the Key National Minimum Standards. The managers completed a pre-inspection questionnaire to provide additional information, which was received by the Commission on 13th October 2006. Several positive questionnaires were returned to the Commission from residents and others involved with the Home. Local friends of the residents reported, ‘we are very pleased to see the residents visiting and participating in local events i.e. the village fetes, sports and dancing as well as the events they invite us to at Merrivale’. One resident said, ‘Merrivale is heaven on earth and the food is the best in the world’. A college course tutor said, ‘the two students who attend are always well presented and are encouraged to join in all our extra-curricular activities. In fact they often all join us. I have also seen groups of the residents out at events at weekends. The staff are well trained, approachable and friendly’. The responsible individual and both managers assisted with the inspection process at various times. As part of the inspection the house and new extension were toured, the medication was checked, the staff were observed interacting with the residents. Three residents were spoken with, one in private to gain his views on the service. The newest care worker was interviewed in private. A sample of records were seen and two residents’ files and care arrangements were examined. The providers have submitted monitoring reports to the CSCI following their monthly visits to the Home. These and previously know information about the service have been considered as part of the inspection process. What the service does well: The Home provides a stable and personalised service to the seven longstanding residents. Each resident has a care plan that is kept up to date. The residents take part in a wide variety of activities they enjoy and benefit from. The staff respect that the house is the residents’ home and they keep it homely and comfortable. Daily life is flexible and the residents are supported to have personalised routines, bedrooms and belongings. Residents’ health issues are taken seriously and medication is handled safely. Staff are provided with appropriate training opportunities and the team works well together to provide consistent support. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Merrivale Farm DS0000024724.V311613.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 Merrivale Farm DS0000024724.V311613.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Information about the Home is available for any prospective residents. Each resident has a contract and Terms and Conditions of Residency. EVIDENCE: A Statement of Purpose and Service User’s Guide are in place. They include information on complaints, confidentiality, privacy and the Home’s values. This information is presented in a suitable format for the residents. Keyworkers have gone through the information with each resident and they have their own pack. There are no vacancies in the Home so the packs have not yet been used to provide information to a new resident. A Terms and Conditions document is in place and this has been agreed with each resident in conjunction with the Residency Agreement. Contracts are in place between the providers and the local authorities that fund each resident’s placement. The managers are aware that a new resident should only be admitted following a full assessment being made. As none have been admitted in the last six years standard two has not been assessed in full. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 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): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents know their needs are reflected in their care plans and they are being involved more in the planning process. They may benefit from more emphasis being placed on assisting them to identify personal aims to work towards. The residents are being supported to make decisions about their lives and take appropriate risks that they benefit from. EVIDENCE: All residents have a care plan that contains clear and helpful information to guide staff. These are being kept up to date e.g. one resident’s plan reflected new arrangements for his personal care. The plans included risk assessments that had been reviewed in February 06. These covered areas such as choking from eating too quickly and being in the community without staff support. Some of the staff team have attended training on Person Centred Planning, however the care plans have not yet been developed into an accessible format e.g. with pictures and symbols. Accessible Review Reports, Health Action Plans and My End of Life Books have all been started with the residents’ involvement. Some of the information in the care files dates back to 2000 and is no longer accurate e.g. the use of bedroom door keys. This should be Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 10 archived and consideration to given to the residents keeping some of their information in their bedrooms. Staff can sit with them when it is updated to ensure their continued involvement. Daily notes are made that give a good overall picture of the residents’ wellbeing. Some charts are used to help monitor specific health needs or behaviours. The notes could link more closely to the care plan to show how specific needs are being met on a daily basis. Monthly reports are written to collate the main points and these help identify problems or progress areas. Full review meetings are being held annually with the external people involved in the residents’ lives being invited to attend e.g. college tutors. In between these, other less formal reviews are being held. A new format for reviews has been introduced that is designed to help the residents become involved and understand what is being written. The one sampled was written in clear language and covered all support areas. An additional section that detailed the resident’s personal aims and goals for the future would be beneficial. Aims were included in the care plan and these related to increasing life skills such as personal care. Some were quite general and therefore hard to monitor e.g. socialise more outside the Home. It would be beneficial if these aims were assessed in the monthly summaries and at the review meetings. Life choices are being offered regularly such as what activities and outings the residents want to take part in, the way their new rooms are being decorated and fitted, daily routines and menu options. The residents are supported to attend self-advocacy meetings and are being encouraged to voice their opinions at the regular residents’ meetings. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 11 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): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The residents have opportunities for personal development, but may benefit from a greater focus being placed on developing personal goals. The residents have regular personalised activity plans and very busy social lives. They are mixing with local people and are supported to maintain links with friends and family. Their rights are being respected and they are being provided with healthy home cooked food. EVIDENCE: On the day of the inspection the residents had all been to watch a show at The Courtyard Theatre in which one of the residents was performing. They agreed on having a fish’n’chip shop supper because they were home later than normal. All placed their orders and were enjoying their meal at the end of the inspection. The atmosphere was relaxed and homely and the group were engaging well together in conversation as they served their own meal. Before tea some residents relaxed and watched television while another used his computer to make a birthday card for another resident to give to a child of one of the managers. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 12 Around the Home the residents are involved in cleaning their rooms, bringing their laundry down, gardening, looking after the horses and dogs etc. As goals are reviewed some of these independence areas may be able to be further developed. The care records, diary and calendar showed that the residents continue to have busy and stimulating lives. They had enjoyed going to see the show ‘Oklahoma’ the previous month and were excited about a pending trip to see a Shadows tribute band. Everyone had been on a holiday this year with some choosing to go to Butlins and others preferring camping in the Forest of Dean. A trip abroad is being planned for next year. The residents have passports as they have been to Spain. There is limited local community life in Tarrington for the residents to get involved in, however they do go to church events, fetes etc. One resident won a prize at the Easter church competition and a recent trip to a ploughing match was also enjoyed. Links have been developed through regular visits to the same hairdresser and local pubs in Ledbury. As well as one off events and trips each resident attends regular activities including college and day service sessions. These have provided experiences including learning to use libraries and accessing work experience at a pizza restaurant. Other activities accessed include going on boat trips, fruit picking, visiting chapel and visiting museums. Notes showed that residents go out between five and nine times a week. Weekly timetables for each resident should be considered. Some may need the information to be provided in a visual format. The last of the residents’ quarterly meetings was held in October and this showed activitiy choices had been discussed. The residents are being given the opportunity to become more independent e.g. one resident uses public transport to return home from Ledbury. Another leaves the group when in town and spends time in the pub having a pint and a cigar. Two residents keep their own money in their room and others have their own wallets. Some residents currently lack the confidence to try taking on more responsibility. Keyworkers should encourage residents to try for trial periods to help develop their self-confidence and to allow staff to truly assess their potential skill level. As detailed above more focus should be given on developing personal goals for independence and life skills. Some of the residents’ relatives live long distances from the Care Home so contact is mainly by telephone. One resident confirmed he calls his father weekly. The staff are also supporting him, as his mother is unwell. Two other residents visit their family every other week. Socialising is being introduced and residents from another Care Home came to a summer Bar-B-Q. A return invitation has been received. They also join in with Ross-Leisure-Link activities where they meet up with friends. The food is purchased locally and cooked fresh for each meal. The residents help shop and prepare food if they want to. Some enjoy this and will help with Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 13 the regular baking sessions. The range of meals cooked are discussed at residents’ meetings and if on the day a resident does not want the meal being prepared they have the opportunity to prepare something else of their choice. Merrivale Farm DS0000024724.V311613.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, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being supported with their personal care in a way they prefer and require. Arrangements are in place to meet their health needs. All referrals for external health support should be made in a timely manner. The staff are safely managing medication. Some residents may benefit from becoming involved in the process. EVIDENCE: The member of staff spoken with said male staff did not assist the female resident with personal care and that where possible male staff support the male residents. He reported that the residents choose when to bathe and that their privacy is always respected. The resident spoken with in private felt staff supported him in a respectful way. The care records are being written in an appropriately respectful way and staff were observed to interact with the residents in a pleasant manner. The daily routines are flexible and where possible they are given choices. Self-help skills are being promoted and support is only provided with personal care if the residents cannot do the task themselves. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 15 The two residents whose care was tracked have both had regular health check ups such as dentals. Their weight is being regularly monitored. Input is accessed from some health professionals. One resident had seen the psychiatrist in November to support him through an unsettled period. One resident has continence needs but a referral had not yet been made to the continence nurse. The managers reported that they were assessing the situation and what aides were needed before doing this. Professional input should be requested when needs are identified as changing, as there may be some delay in receiving the input due to resource limitations. Accidents are being logged and summarised. There were only five recorded for 2006 and the majority of these related to epileptic seizures. One resident has been restrained since the last inspection. This incident was reported to the Commission and discussed prior to the inspection. The physical intervention was needed to prevent one resident hurting another resident after an altercation. Staff spent time talking to the residents afterwards and they provided appropriate first aid. The medication is stored in a metal lockable cabinet and the key held securely. The medication is mainly supplied in a monitored dose system. Other medication was stored in named plastic containers to help prevent errors. The months records were comprehensive, up to date and showed that doses had been administered as prescribed. Hand written entries on the chart should be signed by two staff to show the author and who checked the accuracy of the instructions. Some medication is only given ‘as required’. In one case staff could offer the resident one or two tablets. A protocol should be in place to guide staff about when these medicines should be administered and in what doses. The supplying pharmacist had audited the system in June 06 and had raised a few minor issues. Staff are all experienced at administering medication and all but one have attended an in depth training course. There are plans for the other worker to attend this in December. The residents have signed a form to say they do not want the responsibility of self-medicating. Consideration should be given to encouraging some of them to become involved in small steps as their restistance maybe because of a lack of experience and confidence. Merrivale Farm DS0000024724.V311613.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, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are systems in place to support residents or their representatives to raise concerns. A framework is in place to help protect residents from abuse. EVIDENCE: A complaints procedure is in place that has been written in a clear format with some visual images to aid residents’ understanding. No complaints have been received by the Home or the Commission since the last inspection. The residents have relatives and keyworkers who can advocate on their behalf. They take part in residents’ meetings, which provide opportunities for them to raise any concerns they have. A brief and clear ‘Abuse’ policy is in place. This makes clear reference to the local multi-agency procedure for dealing with ‘Vulnerable Adult’ concerns. A ‘Whistle Blowing’ policy is also in place that states staff will be protected if they report a concern. No adult protection issues have occurred since the last inspection. The managers attended a conference on Adult Protection in 2004 and are aware of the legislation in place to protect vulnerable adults. All new staff cover abuse and protection in their induction and foundation. Refresher training on Adult Protection has recently been provided for all staff and managers by the Herefordshire adult protection manager. Records’ relating to how residents’ money is being spent need to be clearer to demonstrate that expenditure is appropriate. Merrivale Farm DS0000024724.V311613.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, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being provided with a clean and homely environment. They are excited about the developments which will significantly improve their home. EVIDENCE: The house has seven single bedrooms, a lounge, a dining room, a kitchen with table and chairs, a laundry area and a large garden. One resident’s bedroom is in a self-contained area that he accesses through his own front door. An extension has been built to provide this resident with his own self-contained house comprising of a ground floor kitchenette and lounge and a first floor bedroom with en-suite bathroom. It is hoped he will move in before the end of 2006. The development will also provide a ground floor bedroom with en-suite toilet, a first floor bedroom with en-suite bathroom and a ground floor disabled access shower room. In addition the staff sleeping in facilities have been improved, the laundry area is being refurbished and a new boiler has been fitted but not yet commissioned. A new fire alarm system has been fitted throughout the old and new premises. Once two residents have moved into the new bedrooms the two smallest bedrooms will be knocked into one to create a larger room and some of the residents will move to the bigger rooms that become vacant. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 18 The hall, stairs and landing have been redecorated recently. This has repaired the damage to the ceiling caused from a leek. Other redecoration and new carpeting is planned once the building work is finished. Work continues in the garden and the residents are being encouraged to grow flowers and vegetables. The Home was clean, comfortable and homely. The residents have been supported to personalise their bedrooms. One resident showed the inspector his room and the new stereo cabinet he put together from a flat pack with some staff help. He liked his room but is considering moving into the new ground floor room. His mattress was very soft and the springs could be felt. This needs to be replaced but if he is going to move into a larger room he should be offered the choice of a bigger bed as he is a large man and he has epilepsy. Infection control arrangements are in place in the kitchen such as covering and dating food in the fridge, and staff have attended food hygiene training. The Home is now managing one resident’s continence needs. Suitable arrangements seemed to be in place and protective clothing is being provided for staff. The new laundry has been designed with one sink so it needs to be made clear to staff that this is for hand washing and not for laundry. The infection control policy should be updated to reflect the changes in the premises and in the care needs being met. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 19 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, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being supported by a small team of staff who are appropriately trained and who work the hours needed to enable them to attend health appointments and activities. Appropriate recruitment arrangements are in place, however one shortfall was noted. The staff are supported by the managers, however formal supervision should be increased. EVIDENCE: Two staff have left since the last inspection. One new worker started in May 06. The team is made up of five support staff, two managers and the responsible individual. There is usually two staff on at peak times but there is a good degree of flexibility to accommodate activities and outings. The recruitment records showed that appropriate checks had been carried out before the new worker had started with the exception of a PoVA First check. Records provided good evidence that the CRB application was lost by the CRB, which caused a significant delay. The applicant had been known by the providers for many years and was able to provide a CRB from his current employer. The providers did contact the Commission and discuss the delay. The worker started five weeks before the CRB was returned, however he did not work unsupervised during this time. There was no evidence on the file that Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 20 a PoVA First check was received prior to the worker starting although it was reported that this was obtained. A copy of the email should be printed and held on file along with a risk assessment to show how the decision to start the worker early had been made and what the exceptional circumstances were. The induction records showed the worker had been given copies of essential policies such as the Health and Safety and whistle blowing policy, as well as the GSCC code of conduct. Protective clothing had also been given out ready for working in the garden e.g. steel toecap boots. Staff training continues to be improved. The last three staff employed have all been supported to work through the Learning Disability Award Framework (LDAF) that includes all the core safety training. In the last year training has been provided for autism awareness, 4 day first aid qualification, safe handling of medicines, person centred planning and positive approaches to challenging behaviour. The responsible individual is working towards gaining an NVQ award and it is hoped that the newest worker will go on to gain this once he has completed the LDAF. Currently none of the care staff are qualified, however both managers are qualified and they work care shifts regularly. Some staff have attended epilepsy training and it is planned that the other staff will attend in the coming year. One worker still needs to attend the medication training but a date is booked. The newest worker has attended physical intervention training and the annual refresher for the other staff is planned for February. The newest worker was interviewed in private. He reported that he has been well supported and has found the training appropriate and helpful. He has only had one formal supervision session in the seven months since starting. Although he works regularly with one of the managers and found her approachable, formal supervision should still be provided at least six times a year to formalise the management and feedback processes. The worker felt valued and has been delegated specific responsibilities. Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 21 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, 38, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are benefiting from a well run home with a positive ethos. Arrangements to monitor the quality of the service have been improved and it is planned that this will include feedback from residents and their representatives. The residents’ best interests are being safeguarded by the home’s record keeping systems. Some other policies need to be written to ensure the staff work consistently in line with the Home’s values. The residents’ health, safety and welfare are generally well promoted. EVIDENCE: The management arrangements have not changed since the last inspection. Both managers have relevant qualifications including the NVQ 4 in Care. One also holds the Registered Managers Award. The management team are proactive and since taking over the Home they have worked hard to improve the standards in all areas of the service. All are in the Home on almost a daily basis and the residents are very comfortable with them. The residents spoken with over several inspections consistently say they feel able to tell any of these Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 22 three people any problems they have. Residents’ and staff meetings are both held regularly. All records requested were available and these are being held securely. Some areas of the record keeping system for residents’ money need to be improved so they demonstrate fully how this is being used. The managers recognised the areas that needed to be improved and agreed to review the system. The responsible individual has been completing monthly monitoring reports and forwarding these to the Commission. It is positive that a policy has been developed on how the quality of the service is going to be monitored. A quality monitoring system has been purchased and the managers have attended a briefing on this. The system is linked to the national minimum standards and it consists of a series of audits that should identify any areas for improvement. The management team are aware that each review period needs to include consultation with the residents and other stakeholders and should lead to an action plan and a report that is shared with those who contributed and the Commission. There is a business plan in place for the period of 200408. The aims in this could be reviewed with the residents and staff team and development plans for the next year agreed. The management team have worked hard to develop a set of policies and procedures. Some that are outstanding were mentioned in the last inspection report, however these have not been developed over the last year. These are important policies and developing them should now be made a priority. They include sexuality and personal relationships, continence promotion, moving and handling, aggression towards staff, referral and admissions. The managers provided evidence that equipment was being serviced and health and safety checks are being carried out regularly e.g. hot water and fridge temperature checks. The arrangements for First Aid training have been improved with staff now obtaining a full qualification over four days and not the one-day course. Staff were provided with fire safety training in March 06 and they are taking part in periodic drills with the residents. Routine checks of the alarm system are being carried out and service records were seen. It is positive that the electrical wiring certificate for the house was issued in July 06 as the last one was 1997. The COSHH data sheets are being changed as new cleaning products are now being purchased. The last inspection report noted that an overall risk assessment needed to be completed to show what arrangements for the residents are considered safe in regards to storage and use of chemicals. This has not been completed and a bottle of toilet descaler was in a bathroom accessed by the residents. It was reported that this does not pose a hazard to the residents however the managers need to evidence this decision in a risk assessment. The building work for the new extension is fenced off and is not affecting the inside of the main house. Development in one area on the first floor has meant Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 23 that access has been needed through the main house. This seemed to be being managed effectively with no obstructions seen. Risk assessments have not always been written down and this should be done in future to evidence that safety has been properly considered at each stage of any works. Merrivale Farm DS0000024724.V311613.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 X 3 X 4 X 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 3 12 4 13 4 14 4 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 2 2 2 3 X Version 5.2 Page 25 Merrivale Farm DS0000024724.V311613.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard YA6 YA11 Good Practice Recommendations Continue to develop the person centred work that has already been started and extend this to include the care plans. Support the residents to further develop their personal aims. Make these more measurable and include them in the care pans. Assess progress in monthly summaries and at review meetings. Further develop the use of new technology to make information more accessible e.g. weekly activity programmes that include symbols, pictures or digital photographs of the resident doing the activity. Develop a protocol to guide staff about when any ‘as required’ medication should be offered to the residents and in what doses. The protocols should be held with the administration charts. Consider if some residents would benefit from a trial Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 26 2. YA6 YA12 3. YA20 4. YA25 involvement with managing their medication. Ensure mattresses are checked regularly and replaced as needed. The residents should be provided with the option to buy double beds when replacements are needed even if they pay the difference between these and the single the home would normally provide. If a worker starts employment before a satisfactory CRB check is returned evidence that a PoVA First check was obtained prior to them starting must be kept on file and a risk assessment should be completed to show what the exceptional circumstances were that led to the decision to start them early. Increase the number of care staff who hold an NVQ qualification in Care. Provide all staff with at least six formal supervision sessions each year. Develop service aims for the year ahead with the residents and the staff team. Implement the new quality assurance system. Develop the remaining policies from those listed in the NMS for Adults Appendix 2. Review the infection control policy to reflect the changes in the home and the care needs being met. Ensure records of residents’ monies are clear and demonstrate how their money is being used. Complete a risk assessment about where cleaning chemicals are stored in the Home and who has access to them. 5. YA34 6. 7. 8. YA35 YA36 YA39 9. YA40 10. 11. YA41 YA23 YA42 Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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 Merrivale Farm DS0000024724.V311613.R01.S.doc Version 5.2 Page 28 - 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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