Inspection on 18/01/08 for Old Barn Close (4)

This inspection was carried out on 18th January 2008.

CSCI found this care home to be providing an Adequate service.

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

Old Barn Close (4) 12/01/09

Old Barn Close (4) 22/02/07

Old Barn Close (4) 17/07/06

Old Barn Close (4) 15/02/06

Old Barn Close (4) 27/09/05

Old Barn Close (4) 15/03/05

Old Barn Close (4) 13/07/04

Old Barn Close (4) 23/02/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Old Barn Close (4) Gawcott Bucks MK18 4JH Lead Inspector Mike Murphy Unannounced Inspection 18th January 2008 11:00 Old Barn Close (4) DS0000023095.V356066.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 Old Barn Close (4) DS0000023095.V356066.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. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Barn Close (4) Address Gawcott Bucks MK18 4JH 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) 01280 821006 01280 821006 4oldbarn@nildram.co.uk Hightown Praetorian & Churches Housing Association Ms Dawn Mayhew Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ms Mayhew is to have completed her NVQ Level 4 / Registered Managers Award by the 1st January 2007. 22nd February 2007 Date of last inspection Brief Description of the Service: 4, Old Barn Close is situated in a quiet residential area of the village of Gawcott. This village is a short distance from the town of Buckingham, which has a variety of shops and other local amenities. Gawcott is served by infrequent local bus services, with more extensive transport accessible in Buckingham. The home is part of the Hightown Praetorian Housing Association. 4, Old Barn Close is a modern bungalow, which is home to 4 male service users with behavioural problems, learning and communication difficulties. The home has an enclosed garden, which provides service users with a safe external area in which they can walk unhindered and in safety. The garden contains swings for service users, and is planted with flowers and shrubs. Entry to, and exit from, the home, has to be facilitated by staff, and an alarm alerts staff if the door is opened at other times. All service users are accommodated in single bedrooms, which possess washbasins. A separate shower and bath are present in the home, as well as a kitchen, laundry, staff sleep over room, dining and lounge areas. All service users are registered with a general practitioner, and access to other healthcare professionals, such as community nurses and dieticians, is through direct contact by staff, or through GP referral. The home currently has one vacancy. Fees range from £2031.33 to £2140.30 per week. Information supplied by the manager at the time of inspection. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by one inspector in February 2008. The inspection included a visit to the service, discussion with the registered manager and staff, interaction with service users, observation of practice, examination of documents (including care plans), consideration of information supplied by the manager before the inspection visit and of CSCI survey forms. The home is a detached bungalow located in a quiet close just off the High Street in the village of Gawcott, Buckinghamshire. Gawcott is just under 4 miles from Buckingham and about 15 miles from the centre of Milton Keynes. The home provides a comfortable and safe environment for four residents. It had one vacancy at the time of this inspection. The home has a pleasant garden which includes a vegetable patch. The home has good systems in place for assessing the needs of prospective residents. These include contact with the prospective resident, his or her family and current carers. They also include consideration of whether the home can meets the person’s needs, a match with current residents and of issues relating to equality and diversity (in which staff have received training). A support plan is in place for each resident. Support plans are comprehensive but are not in a form which facilitates the involvement of residents in the process. The manager said that the home is working towards developing a person-centred approach and intends to address this more actively throughout 2008. While the format of support plans could be improved their content is generally good. Attention to some details is required but the plans support the provision of care appropriate to the needs of each resident. The home liaises with health and social care agencies as required. The home has its own vehicle for outings. Residents regularly attend an arts and crafts centre in Winslow and staff and residents have numerous outings together. There are thorough systems in place for dealing with complaints and for safeguarding vulnerable adults. The latter however, need to include a review of monitoring arrangements by the home in conjunction with other agencies. Overall, although there is a need for management attention to some matters of detail, this inspection concludes that the home provides a pleasant, comfortable and safe environment for residents. Residents receive appropriate support and care and their healthcare needs are met in liaison with their GP and other services. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Develop a system of care planning which supports the participation of residents in the process. Review adult safeguarding procedures so that monitoring arrangements do not unnecessarily compromise the dignity or well being of the person. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Old Barn Close (4) DS0000023095.V356066.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 Old Barn Close (4) DS0000023095.V356066.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. 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 needs of prospective residents are carefully assessed before admission to ensure the home can meet the person’s needs. EVIDENCE: The service has not had a new admission since the last announced inspection although a referral had been received and was at an early stage of consideration. Although there was not sufficient information to provide evidence of conformance to the standards, the manager outlined the process to be followed. Before admission the person, their family and the care manager are provided with information about the home. The referral, together with supplementary information such as existing care plans and risk assessments, is assessed by the service manager and the home manager. A series of personal contacts are established. The referring care manager visits the home. Members of the prospective resident’s family visits the home to view its facilities and meet current residents and staff. If the referral continues to be progressed the manager visits the prospective resident at their current place of Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 10 residence to continue carrying out the assessment of needs and come to a view on whether the home can meet those needs. Arrangements are then made for the prospective service user to visit the home, accompanied by family members, an advocate, the care manager and perhaps a current carer. If it is decided to continue to progress the referral then arrangements are made for a trial admission with a review taking place at three months and six months. The process outlined above aims to determine the prospective resident’s needs, whether the home can meet those needs, whether the prospective resident and those involved in their care network believe the home is suitable, and, of equal importance, whether the person is likely to settle in to the home and get on with current residents. All are consulted before a final decision is made. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment of needs, and action to meet needs set out in support plans aim to ensure that residents needs are met, that their independence is supported, that risk is minimised, and that care is provided in line with the person’s wishes. The current support plan documentation is complex and does not facilitate the participation of the resident in the process. EVIDENCE: A ‘Support Plan’ is in place for each service user. The manager said that the home was moving towards Person Centred Plans (PCPs). The current documentation comprises a number of files for each resident: (1) an ‘Information’ file, (2) a healthcare file, (3) a ‘Healthcare Passport’, (4) a file Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 12 containing information on finance and related matters, (5) an activity file, and, (6) daily diaries. The current structure is complex and there is scope for rationalisation and a more person centred approach. One good feature of the current structure is the scanning in of digital photographs of people, activities or objects of interest to the resident. Staff encourage service users to be involved in planning and reviewing their care. The home’s concept of the model of PCP it wished to develop seemed unclear. How much of the development would come from the home itself, from senior managers, from other services in the organisation, or from examples of good practice externally was not clear at this point. This was ‘work in progress’ at the time of the inspection visit. Service user plans are comprehensive and included evidence of liaison with other agencies as well as detailed consideration of individual support needs and how such support is to be provided. Plans included monthly summary reports by the person’s key worker. However, weaknesses noted included, undated documents, apparently related documents held in different files, some files without photos, and incomplete documents. The manager acknowledged that standards were currently uneven and said that the home was planning to deal with this now that the Christmas and New Year holidays were out of the way (this inspection took place in January 2008). Link Workers hold meetings monthly to discuss service user support needs. Residents are involved in decision making through day to day interactions with staff and each other, meetings with their link workers, meetings on home issues (such as menus), and in personal shopping. Risk assessments are well developed and cover a wide range of activities. These include (among others): conduct in the community, risks when in the kitchen, choking when consuming food, aggression, risks related to epilepsy, and when travelling in the house vehicle. Generic risk assessments include: moving and handling, fire safety, gardening, cooking, cleaning, using the barbeque, and lone working. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead a varied lifestyle according to their interests, abilities and wishes. This ensures that residents experience a range of social, leisure and other activities and are involved with the wider community. Residents have a varied diet. EVIDENCE: Staff encourage and support residents in carrying out daily activities such as cleaning their own bedroom, laying the table and clearing up after meals. Residents are consulted with regard to trips out and menu planning. All three residents go to the Winslow Centre for Art and Crafts for sessions on arts, crafts, aromatherapy and music. On Tuesdays a tutor from college visits the home to run cooking sessions with the residents. It is expected that one resident will start to attend these sessions in college later in 2008. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 14 The home is located in a small close in a village. The village has two pubs but no shops. Residents occasionally go out for walks in the village (the High Street is a short distance from the home). The home has its own vehicle which is regularly used for shopping in Milton Keynes, Buckingham and Aylesbury, and for planned trips home to families, and other outings. Residents have a National Trust card and together with staff visit stately homes and landscaped gardens - such as Stow House and Waddesden Manor – and other places of interest. All residents are in touch with their families and two go home on a regular basis. Social events are occasionally held with a neighbouring home and a home in Newton Longville about eleven miles away. Residents have not had a holiday away from the home in recent years. The manager hopes to arrange a few short breaks during the course of 2008. Residents tend to get up when they feel ready and there is no hard and fast routine to the day – with the exception of Tuesday when the tutor is scheduled to visit. Medicines, where prescribed, are administered at 08:00, 12 noon, 14:00, 18:00 and 22:00 hours. Residents and staff take meals together and the home adopts a high level of flexibility with regard to meal times. The home has strict rules about privacy and staff do not normally enter residents room when they are not in the house. Staff knock before entering residents rooms. Staff and residents were observed to interact well together and it was felt that there was a supportive atmosphere in the house on the day of the inspection. Menus are planned using menu books and cards. These include colourful pictures of meals. The manager said that the home endeavours to provide a healthy diet and it is thought that using fresh vegetables from the garden will reinforce this. Advice on healthy eating is available in the home. The advice of a dietician is sought where necessary. The way in which residents make their choice is recorded in detail. Residents are weighed monthly. The manager said that home uses fresh fruit and vegetables as much as possible. Breakfast on Monday to Saturday usually consists of cereal or porridge, toast, fruit juice and hot drinks. A cooked breakfast is served on Sundays. Lunch is a light two course meal and selections from menus in December 2007 and January 2008 included: Pizza followed by Instant Whip; Chicken Drumsticks with Tomatoes followed by Fresh Fruit; Jacket Potato with Tuna Mayonnaise followed by Fruit Salad; and, Fish Fingers and Baked Beans followed by Instant Whip. The evening meal is a one course meal and selections from the same menus and on the same days included: Vegetable Lasagne; Shepherds Pie accompanied by Carrots and Peas; Minced Beef Pie accompanied by Potatoes, Peas and Carrots; and, ‘Party Food’. A roast is served on Sundays. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for supporting residents and liaising with community health services are good. Arrangements for the control and administration of medicines are good. These ensure that residents healthcare needs are met. EVIDENCE: The detail of residents care needs are recorded in individual care plans. The staff know the residents well and are familiar with their preferences for care and support. This is often expressed non-verbally by the resident and staff were observed to check their understanding of residents responses during the course of the inspection visit. The Community Learning Disability Team (CLDT) based at Manor House Hospital in Aylesbury is in touch with each of the residents in this home. Specialist learning disability or mental health services are accessed through the CLDT. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 16 All residents are mobile and at the time of this inspection none required specialist aids. The home would arrange for the installation of specialist equipment if required. One example of this was a report to the inspection that the home had received an unsatisfactory response from an organisation with regard to additional support to a person with a visual disability. It was pursuing other avenues in respect of this and it seemed clear that the home was endeavouring to provide as much support as it could to this person. All residents are registered with a GP practice in Buckingham. As stated above all are registered with the relevant CLDT. The manager said that an optician visits the home. One resident had seen an eye specialist at Stoke Mandeville Hospital. Problems were reported in obtaining an NHS dentist for residents. At the time of the inspection visit the home was awaiting a response from the CLDT regarding residents’ access to a NHS dentist. Residents health is monitored by staff. All have an annual health check by their GP. All had received a “Flu jab” this winter. Each has a ‘Health Passport’ which should contain relevant information on their health. However, the content of those examined varied – this may be attributable to the review of care planning documentation which is planned for 2008. The home has a policy governing the storage and administration of medicines. Staff are trained by Boots Chemists at the organisation’s head office in Hemel Hempstead. Competence is assessed by the registered manager. Staff attend updates every three years. Medicines are prescribed by the resident’s GP. The home has a contract with Lloyds Pharmacy in Buckingham. Most medicines are supplied in a monitored dosage system on a monthly basis. Protocols are in place for the administration of ‘as required’ (‘PRN’) medicines. Each bedroom has a sturdy lockable metal cabinet for the storage of medicines. Medicines requiring cool storage are kept in a lockable metal container in the fridge. The pharmacy carried out an inspection of the home’s arrangements in March 2007. A copy of the report was seen. The administration of medicines to a resident in his bedroom was observed. The process included a check by two staff, observing that the resident had taken the medicine, and recording the administration on the administration record (‘MAR’ chart). No errors or gaps were noted on the MAR chart. The home’s monitoring arrangements include a check on medicines stock during the course of each shift. The results of the check are recorded on a chart. Reference texts available to staff included a British National Formularly (BNF) and a general guide to medicines – both were considerably out of date. The manager was advised to obtain more up to date references such as the BMA Guide to Medicines (2007), a more recent BNF, the most recent edition of The Royal Pharmaceutical Society of Great Britain guidelines on medicines in Social Care (2007), and relevant CSCI guidance (downloadable from the ‘CSCI Professionals’ website). Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has comprehensive procedures for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to safeguarding vulnerable adults. Together, these aim to protect service users from abuse and to ensure that complaints are thoroughly investigated. The home’s arrangements for monitoring safeguarding actions do not include periodic review. Failure to include an adequate review process could compromise the dignity and well being of residents. EVIDENCE: The home has a complaints policy but there is not a version of the policy appropriate to the needs of residents in such a care setting. Complaints are recorded and those received since the last inspection were examined. This showed that the home has good practices in recording and promptly investigating complaints. Records include a summary of the action and outcome for each complaint. CSCI has not received any complaints about this home since the last inspection. The home has a policy governing staff actions in relation to safeguarding vulnerable adults. It has a copy of the Buckinghamshire joint agency Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 18 safeguarding policy of 2007 and a comprehensive and informative package of information on the subject published by Buckinghamshire County Council. Some staff have attended training events on ‘POVA’ (Protection of Vulnerable Adults) run by Buckinghamshire County Council and some on ‘Abuse’ run by Hightown Praetorian and Churches Housing Association. The manager had also downloaded a copy of the Department of Health guidance ‘No Secrets’. The organisation has responded promptly to any suspicion or allegation of abuse and has liaised well with statutory organisations in any investigation which has followed. The nature, extent and duration of monitoring such situations was discussed with the registered manager during the course of the inspection visit. The importance of agencies keeping in touch with each other at all stages of the process and of drawing matters to a clear conclusion was agreed. In some cases monitoring techniques continued without multi-agency review could compromise the dignity or well being of a person. Physical and verbal aggression can be an occasional feature of such a service. In this home staff have received training in responding to such behaviour through techniques aimed at reducing the force of the aggression and breaking away from physical contact with the aggressor. The management of residents monies is subject to the policies and procedures of the organisation. A bank account has been opened for each resident and each has his own cheque book. The home has arrangements in place for secure storage of money and valuables. Small amounts of cash are held for each resident. All transactions are recorded and receipts obtained. The balance is checked at each handover. The arrangements are checked monthly by the senior care worker or manager and are also periodically checked by service managers. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 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 provides an accessible, pleasant and well-maintained environment which provides those living there with a comfortable and safe place to live. EVIDENCE: The home is a detached bungalow located in a quiet close just off of the high street in the village of Gawcott, Buckinghamshire. Gawcott is just under four miles from Buckingham and about 15 miles from the centre of Milton Keynes. The area is not well served by public transport. Car parking is available on the driveway or in the street. Entry and exit is controlled by staff. The accommodation cpmprises the entrance hall, living room, dining room, kitchen, utility room, four bedrooms, bathroom and WC, shower room and WC, staff office and sleep-in room, and staff shower and WC. All of the accommodation appears accessible by Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 20 wheelchair but no resident at the time of this inspection required a wheelchair to get around. The standard of the accommodation is generally good. The bedrooms seen on this inspection were of a reasonable size and were well furnished. The paint in one bedroom was peeling in some areas, apparently due to damp. The registered manager said that this was due to be repaired in the near future. None of the bedrooms have en-suite facilities. All bedrooms have a hand basin. The kitchen is well equipped and was clean and tidy and generally in order on the day of the inspection visit. It is noted that some food products stored in the fridge had not been labelled when opened. Guidance on good practice in food safety is on display on the interior surface of cupboard doors. A new set of chopping boards had recently been purchased and the manager said that staff had also endeavoured to buy a matching set of colour coded knives but had not been able to find a supplier. The utility room is equipped with a washing machine, tumble dryer, sink and iron. This is considered sufficient for current use. Due to pressure on space in the kitchen the freezer is also located in the utility room. Standards of décor are generally good. The living room is well furnished and has a TV, DVD and stereo music system. There is a colourful light feature on one wall. Examples of residents’ art and craft work and pictures of outings and celebrations are on display around the home. This creates a nice personal feel to the home. The office/sleep-in room is extremely small, has insufficient space for the storage of records and is barely fit for purpose. The garden is of a suitable size for current use. It backs on to open fields on one side. It includes a patio area with seating and space for barbeques and other events. There is an area of lawn, a swing, bird feeders, a shed for storing garden equipment, and a shed for storing documents. One area has been developed over the past year or so for growing vegetables – a commendable development. It includes a fence, greenhouse and compost bin. The manager is keen to encourage the residents to be more involved in the vegetable garden over the coming year. This is not just for the potential physical and psychological benefits of such activity, but also because of the potential benefits to residents’ well-being in the satisfaction of eating food they have grown themselves and the nutritional benefits of home grown food. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, procedures for the recruitment of new staff, and for staff training, development and support are good. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet the needs of service users living in the home. EVIDENCE: The present staff establishment provides for two staff in the morning, two staff in the afternoon and two additional staff between 10:00 and 18:00 hours. At night there are two staff – one waking and one sleep-in. The daytime staffing may include the registered manager. Eight of eleven staff have acquired NV2 or above – three at NVQ 3. There are four female and seven male staff. Staff turnover is currently low and no staff have been recruited since the last inspection. Some staff have cared for the three residents living in the house at the time of this inspection since before they moved from hospital in 2002. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 22 The home is supported in the recruitment of new staff by the organisation’s human resources department based at its head office in Hemel Hempstead. The manager said that one application was at an early stage of consideration at the time of this inspection. In the circumstances therefore it was not possible to examine evidence of compliance with the Regulations. The organisation’s policy however, requires the completion of an application form, provision of two references, a statement of fitness for a position, and an enhanced CRB (Criminal Records Bureau) certificate – all required by the Regulations. Newly appointed staff are required to complete an induction programme. This is comprised of an induction to the home and a more detailed programme which has to be completed within the new employee’s probationary period of six months. This includes introductory level training in e ‘mandatory’ subjects plus training specific to the work of the home. The latter includes ‘Abuse Awareness’, ‘Diversity’, ‘Epilepsy’, ‘Person Centred Planning’, ‘Learning Disability Awareness’, ‘Mental Health Awareness’, ‘Positive Approach’, ‘Preventing and Responding to Violence’, and ‘Mini Bus Training’. The organisation offers an ongoing programme of training and staff development. Some of this is now to be completed by computer based ‘E’ learning. Each member of staff has an ‘Individual Training Record’. This lists the date a training event has been attended, the frequency of updates, and the date on which the basic and update training events were attended. The record also includes ‘In-House’ training, ‘Outside Training’ and ‘Certificated Courses’. Completion of the form for every member of staff should support an analysis of training needs by the manager by identifying gaps in training. There was not time to examine in detail where the home was in relation to this process. The impression gained was of work in progress. It seemed that some staff had yet to attend update training on safeguarding vulnerable adults by statutory organisations (due, it would appear, to the availability of places on such courses and not to any fault of the home). Staff acknowledged the training opportunities offered by the organisation. Systems for individual staff supervision are in place. This takes place on a four or six weekly basis. It is confidential and notes are taken. A list of sessions was on file and on the notice board in the office. Staff confirmed that supervision takes place and is generally a positive experience. All staff have an appraisal annually. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 and 43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home ensures that residents live in a safe, supportive and comfortable environment. EVIDENCE: The registered manager has been employed by Hightown Praetorian and Churches Housing Association for over 10 years and has managed the home for two years. The registered manager was pursuing the Registered Managers Award at the time of this inspection. Difficulties with the NVQ provider responsible for the process has extended the time for completing the RMA. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 24 The registered manager said that a key quality assurance activity is the annual audit which is carried out by a manager from another home in the organisation. The process involves examination of documents, observation of practice and interviewing staff and residents. At present the process does not involve seeking the views of other stakeholders. This work leads to a report and recommendations for action. The manager said that the residents sense of well-being, of approval or disapproval of an aspect of the service, is communicated verbally and nonverbally and is understood by staff who know them. The views of families are communicated on an ad hoc basis but staff are in regular contact with key members. Relative feedback to this inspection indicated a high level of satisfaction (i.e. ‘Always’) with communications between the home and family and with the level of support given to residents. A slightly lower level of satisfaction (i.e. ‘Usually’) was indicated in relation to staff skills, diversity, responding to concerns, and supporting people ‘…to live the life they choose?’. Residents expressed a good level of satisfaction with living in the home. In the AQAA the manager said that she was auditing and reviewing ‘..all systems to ensure the home and staff are promoting best practice’. A key area for action arising from this work is the present system for care plans (see narrative under standard 6 above). Another example cited by the manager is the implementation of processes outlined in ‘Safer Food, Better Business’ which is published by the Food Standards Agency. This aims to ensure that high standards of practice are maintained in all aspects of catering in the home. However, it was noted that standards of labelling food stored in the fridge are variable and greater consistency in staff practice is required. The report of an inspection by an Environmental Health Officer (EHO) carried out in 2007 could not be located at the time of the inspection visit. This seemed in part due to pressure on space on paper records in the home. Senior managers conduct monthly Regulation 26 visits to the home. The records of such visits were not examined during this inspection. The organisation has a Health and Safety Committee and a Health and Safety policy governing staff practice. The home has a representative on the committee. Staff training is provided but a mixed impression was gained on whether all staff were up to date on health and safety training. The organisation had recently introduced ‘E’ learning (computer based training) but this had not yet been fully implemented within the home. Contracts for the maintenance of equipment are placed by the maintenance department of Hightown Praetorian and Churches Association. The home had been visited by the fire authority on the day before this inspection visit. A report was awaited but the manager was not aware of any Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 25 adverse findings. Fire training is organised six monthly and fire drills are held quarterly. Fire points and exits are checked weekly by staff. Numerous risk assessments are on file. These cover a range of activities including trips out of the home, domestic activities, the risk of choking while eating (in some cases), risk of epilepsy and aggression. The home is required to follow the policies and procedures of Hightown Praetorian Housing Association and is supported in delivering its services by departments based at the organisation’s head office in Hemel Hempstead. The home had a development plan set out in table form on the office wall. However, it was felt that this lacked detail and in particular could have included more specific objectives and measurable indicators of progress. Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 26 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 2 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 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 27 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. Refer to Standard YA24 Good Practice Recommendations It is recommended that the organisation review the staff office / sleep-in room, with a view to an improvement of these facilities and the provision of secure storage for residents records. It is recommended that the registered manager review the format of support plans with a view towards developing a format which facilitates the involvement of residents. It is recommended that the registered manager obtain up to date reference texts on medicines for staff use. It is recommended that the implementation of policies and procedures for safeguarding vulnerable adults include a review of monitoring processes. 2 3 4 YA6 YA20 YA23 Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Old Barn Close (4) DS0000023095.V356066.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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