CARE HOME ADULTS 18-65
Merrivale Farm Eastwood Tarrington Ledbury Herefordshire HR8 2RN Lead Inspector
Jean Littler Unannounced Inspection 28th February 2006 10:20 Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 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.V285175.R01.S.doc Version 5.1 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.V285175.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Merrivale Farm Address Eastwood Tarrington Ledbury Herefordshire HR8 2RN 01531 670220 01531 670941 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 Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named resident has a mental disorder in addition to a learning disability. 31st October 2005 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. It is registered to accommodate up to 7 adults whose primary care needs must be due to learning disabilities. Some animals are kept and service users are encouraged to help with their care and other tasks in the garden. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out on a weekday between 10.20am and 12.30pm. The managers and responsible individual were both off duty but came in to assist with the inspection. The member of staff on duty and the three residents at Home all spoke to the inspector and were all positive about the service. The focus of the inspection was to see the progress being made with the extension and to cover some of the standards not assessed at the last inspection. The providers monthly visit reports that are sent to the Commission, and other communication with the Home since the last inspection were also considered as part of the assessment process. What the service does well: What has improved since the last inspection? What they could do better:
The way the providers monitor the quality of the outcomes of the service for the residents, their relatives, staff and other stakeholders needs to be further developed. Staff training arrangements for Adult Protection and Medication Management could be improved. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 6 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.V285175.R01.S.doc Version 5.1 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.V285175.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not assessed. No new residents have been admitted and there are no current vacancies. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 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): 10. Suitable arrangements are in place to keep service users’ personal information confidential. EVIDENCE: Personal information about the residents is being kept in the office, which is locked when not in use. The member of staff spoken with was aware of the need to keep service users’ personal information confidential and had seen the policies relating to how sensitive information needs to be managed. One of the managers is taking the lead in the introduction of Person Centred Care Planning. She is starting a course to become a facilitator for this process and once trained will trial the process with a resident who shows an interest. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 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): 11, 12, 17. The residents are benefiting from the opportunities provided for personal development and from trying new activities. They are being provided with a healthy diet of fresh homemade food that they enjoy. EVIDENCE: The range of activities the residents are accessing continues to be increased. As an example, one resident has become very good at ceramics at a day centre and now attends a community ceramics group on a Saturday morning. She is also enjoying making stage scenery for shows, attending church and going swimming regularly. The manager reported that these experiences have led to increased self-confidence. This resident now gives her opinion freely when issues are discussed in the Home. A recent residents’ meeting had been held to discuss holiday plans for the year. Small group holidays are being arranged based on each resident’s preference. One resident has also chosen to go on holiday with a group from a club he attends.
Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 11 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 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.V285175.R01.S.doc Version 5.1 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): 20. Medication is being safely managed. EVIDENCE: The medication is stored in a metal lockable cabinet and the key held securely. The months records were comprehensive, up to date and showed that doses had been administered as prescribed. The supplying pharmacist had audited the system in October 05 and made four recommendations that were being addressed. Staff are all experienced at administering medication and some have attended an in depth training course. There are plans for the rest of the team to attend this training in the near future. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 13 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. Appropriate procedures are in place regarding adult protection. Staff training in this area should be arranged. EVIDENCE: No complaints have been received by the providers or the Commission since the last inspection. Policies are in place covering complaints, abuse and whistle blowing. The member of staff spoken with was aware of these and was clear she would report any concerns promptly. Both managers attended a briefing on Adult Protection in 2004. Staff have not yet attended specific Adult Protection training. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: These standards were not assessed, however the house was clean and homely. Work on the extension is progressing well with the windows and doors due to be fitted soon. This new part of the Home will provide a good sized flat for one resident, new larger bedrooms for two, and possibly three, other residents. The changes will also provide a shower room and an improved laundry area, and will allow the two smallest existing bedrooms to be knocked into one. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 15 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): 33, 35. Suitable staffing levels are being provided by an appropriately trained team. EVIDENCE: The team had recently attended refresher training for Physical Intervention. The providers have taken the decision to upgrade the level of First Aid training provided to staff when they next need a refresher course. This will ultimately mean a qualified First Aider will be on duty at all times. It is positive that one of the managers is going to become a LDAF mentor. Both of the newer staff successfully completed the LDAF foundation award and went on to start an NVQ award. Unfortunately one worker is now leaving. The team has remained very stable and this is the only change in over two years. A new worker has been appointed and is due to start when all the recruitment checks are received and approved. Staffing levels remain the same with one worker being on duty at all times and a second worker helping when needed with transport and outings. The new worker has been signed up for a one day induction course as well as being taken through the in-house induction process. He will then complete the LDAF and go on to NVQ. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 40, 41. Appropriate systems are in place for the management of records. Policies and procedures are in place to guide staff and help protect the residents’ best interests. EVIDENCE: All records requested were available and had been kept up to date. As detailed under Standard 10 records are being appropriately stored and kept confidential. Over the last two years a great effort has been made to develop a full set of policies and procedures for the service. These are now in place and are readily accessible to the staff. Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 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 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 X 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 x X X X 3 3 X x Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 18 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 YA35YA23 Good Practice Recommendations Arrange for all staff to attend adult protection training with the local Adult Protection manager. Arrange for the remaining staff to attend accredited medication training. Further develop arrangements for quality assurance. 2. YA39 Merrivale Farm DS0000024724.V285175.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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