Inspection on 31/10/05 for Old Court Barn

This inspection was carried out on 31st October 2005.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Old Court Barn 10/09/09

Old Court Barn 08/08/07

Old Court Barn 04/05/06

Old Court Barn 31/05/05

Old Court Barn 13/01/05

Old Court Barn 28/05/04

Old Court Barn 22/01/04

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 Old Court Barn Lumber Lane Lugwardine Hereford Herefordshire HR1 4AQ Lead Inspector Jean Littler Unannounced Inspection 02:00 31 October 2005 st Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Old Court Barn Address Lumber Lane Lugwardine Hereford Herefordshire HR1 4AQ 01432 851260 01432 853158 oldcourtbarn@hotmail.com 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) Mr Steven Richard Dodds (trading as `The Barns`) Mrs Victoria Ann Dodds Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents with physical disorder or mental disorder in addition to their learning disability may be accommodated. 31st May 2005 Date of last inspection Brief Description of the Service: Old Court Barn is owned and operated as the sole concern of The Barns Partnership. The Home offers a personal care service to seven younger adults with severe learning disabilities/autism. Service users may also have additional physical disorders or mental disorders associated with their learning disability. The Home is situated on a quiet country lane in the village of Lugwardine three miles from the City of Hereford. An unmarked minibus and car are provided for community access and outings. The Home is set in pleasant grounds and the house is divided into two adjoining areas. Little Barn provides accomodation for two residents in single groundfloor bedrooms. This area has a bathroom, lounge and kitchenette. Big Barn provides accomodation for five residents on the first floor in three single and one double bedrooms. This areas has two bathrooms with self contained showers, three toilets, lounge, dining room, laundry area, office and main kitchen. No lift is provided and the Home is not registered for residents with mobility difficulties. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on a weekday afternoon between 2 and 3.30pm. The main focus of the inspection was to review if the management arrangements have continued to improve in line with an action plan agreed following an investigation in May 2005 and a broader investigation in 2004 under the Herefordshire Vulnerable Adult protection procedures. The majority of residents were at Home and were either engaging in activities with staff or resting in their bedrooms. One support worker was interviewed and assisted with the inspection process prior to the provider arriving. Information already known about the service and communications between the service and the Commission since the last inspection were also considered as part of the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The revised information about the Home should be finalised and issued to the residents, their representatives and the Commission. Efforts to liaise with other services for people with Autism should be continued to help develop the staffs’ understanding of current best practice. Initial work to develop independence goals and communication systems for residents should be continued. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 6 Some shortfalls in the medication management system were identified at a pharmacy inspection in July. The Manager has confirmed that all good practice action points have been implemented. 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. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not fully assessed, however the manager is revising the Statement of Purpose and Service User’s Guide to reflect the changes in the ownership and management arrangements of the service. The Terms and Conditions of Residency document is also under review. The previous requirements regarding these have been brought forward and will be assessed when the revised versions are submitted to the Commission. No new residents have been admitted since the last inspection and there are currently no vacancies. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6. The residents are benefiting from more effective care planning and monitoring systems and greater input from external professionals. EVIDENCE: The support worker spoken with reported that the Home is running smoothly and all the residents are well. He said that the staff did have some concerns about one resident who has recently been withdrawing from activities and not socialising as much as before. His care plan showed that staff are recording these occasions and that the resident’s overall well-being is being monitored. Incident reports have been completed when the resident has become agitated and the ‘engagement and intervention strategy’ had been updated in October 05. Monthly summaries are being completed by the resident’s keyworker. These gave an overview of his activities, health, the current issues, and his progress towards learning to manage his own money. The current concerns have been discussed at the recent review which his family attended. Network days led by the psychologist have now been held for the majority of the residents. It is very positive that the new strategies and medication regimes have meant that one resident no longer needs to periodically go to his room to vent his feelings and damage his room. Staff are anticipating things Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 10 that trigger his anxiety and acting quickly to provide reassurance and distraction. Efforts are continuing to develop communication systems and tools for the residents. The new pictorial rota has unfortunately been moved into the kitchen out of the residents’ reach as it was being damaged. Consideration should be given to the use of lockable perspex display boards so communication information can be displayed but not tampered with. Efforts to further develop communication systems through liaison with other services for people with Autism should continue. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 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, 14, 15. The residents are being provided with appropriate leisure and educational opportunities. Staff positively support residents to take part in integrated activities even though these can present challenges. More opportunities should be provided for residents to develop their potential for independence. Contact with families is being actively encouraged. EVIDENCE: Each resident has an activity plan that has been based on what they like to do and what they can manage without becoming anxious or over excited. The plans are now more personalised and a greater variety of activities are offered. One seen included cooking, pottery, walks, college courses, household tasks and shopping. The majority of residents were taking part in an art session run by the college during the inspection. One resident has been supported to take on responsibility for keeping his money tin and is now saving for special items. This experience has helped the team see the benefits that can be gained by residents if they are offered new opportunities. This developmental aspect should now be considered for all residents and achievable goals that they may Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 12 have the motivation to achieve should be added to their care plans and tested out. One resident continues to attend sessions at a centre even though he can become distressed and has hurt the staff from the Home who support him. The team recognise that the music, woodwork and art therapy sessions are beneficial and work closely with the centre staff to keep the facility open to him. The risk assessment regarding these sessions has been reviewed in October 05. A recent incident has highlighted that newer staff were not aware of a room at the centre that could be used by the resident when he needed to be quiet and calm down. This information should be added to the risk assessment. One resident’s monthly summary records showed he was being supported to phone his family when he requests to, usually about three times a week. He usually visits his family monthly and they attended his recent review meeting. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 13 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): 19, 20. Appropriate arrangements were in place to meet residents’ health needs. Some shortfalls in the medication management arrangement were noted at a pharmacy inspection in July 2005 EVIDENCE: The care plan sampled showed that the resident had recently been to the dentist, the optician and the chiropodist. The resident’s weight was being monitored and any marks noticed on his body were being recorded. A procedure was in place to guide staff about when to administer any ‘as needed’ medication if he became agitated. The resident had been becoming more withdrawn recently but had not been seen by his consultant psychiatrist for nearly a year. It may be prudent to inform the consultant, at this early stage, of the changes in the resident’s behaviour. The possible benefits of psychology input should also be considered with the consultant. It was positive that staff were clearly trying to support the resident emotionally and help him express his feelings. Another resident had had his medication reviewed and was commencing on a long-term programme to change tablets. The manager should consider if the risk assessment and strategies need to be amended to reflect this as the Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 14 resident’s needs may change and staff will need to be monitoring certain areas closely. Arrangements for the management of medication were fully assessed at a pharmacy inspection that took place on June 24th 2005. This was arranged following two medication administration errors that were reported promptly to the Commission. A copy of the report from this inspection is available from the Commission on request. The inspector found several examples of good practice and careful recording. Some shortfalls were noted and five requirements and two recommendations were made. The manager promptly provided an action plan showing how these have been complied with. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 15 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. Suitable arrangements are in place to manage complaints. Adult protection arrangements have been made much more robust. EVIDENCE: No complaints have been received by the Home or the Commission since the last inspection. Suitable procedures are in place should a complaint be received. Adult protection arrangements have been improved. Policies and procedures have been reviewed. Staff have been provided with additional training to help equip them to professionally respond to any of the residents’ behaviour that may challenge them. Currently one worker is not trained to manage difficult situations and the member of staff on duty reported that she leaves the room when a resident becomes agitated or distressed. The incident when staff did not respond appropriately earlier in the year raised the team’s awareness of how essential it is to have agreed strategies for difficult situations. These are now in place following consultation with appropriate professionals, and are being kept under review. Staff are provided with greater support and supervision and when incidents occur they are reflected on and adjustments are made to the arrangements if needed. The manager is operating the Home in a transparent manner and reporting any serious incidents that occur to the Commission. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 16 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 it was noted that communal rooms were clean, tidy and homely. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36. Appropriate staffing levels are being maintained and good progress is being made to get the Home fully staffed by competent workers. Staff are being provided with a good level of management support and guidance. EVIDENCE: At the time of the inspection four staff were on duty supporting the residents who were at Home. The provider returned after collecting one resident after he had spent the weekend with his family. The manager and assistant manager were attending a fire awareness training course. One worker was free to speak and he explained he was on his last working day. He was positive about the Home and hoped to stay in touch with the resident he had been working closely with for the last three years. There has been a significant turnover of staff since the change in management arrangements and there are still some vacancies at the Home. Appropriate staffing levels have been maintained by staff being flexible and covering gaps, although for one short period waking night staff could not be provided so two staff slept over instead. Some waking night hours are currently being covered by agency staff. It is positive that a new worker with relevant experience has been recruited and is due to start shortly. Two other staff have just been selected and when they start the Home will be fully staffed. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 18 There have been some staff management issues since the last inspection but these have been appropriately managed internally through the disciplinary and probationary processes. Staff are being provided with regular supervision and care practices are reviewed regularly at handovers and staff meetings. Training arrangements continue to be improved in line with the agreements made as part of the Vulnerable Adult procedure action plan. The worker spoken with reported that staff were now more confident after receiving Physical Intervention refresher training. Three staff were interacting well with residents whilst they took part in an art session with two college tutors. The residents were obviously enjoying the session and were being praised for their contribution to the bonfire night art. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41. A more robust management framework is in place and the management style is professional and transparent. Work to develop quality assurance systems is continuing to ensure standards continue to be improved. EVIDENCE: A new manager, Mrs Dodds, has been appointed since the last inspection and has been registered with the Commission. Mrs Dodds has suitable experience and has been very open in her style of management in regards to working with outside professionals, liaising with the Commission and discussing issues with the staff team. Recently one of the senior support workers has been appointed to the role of assistant manager to strengthen the management arrangements and to provide cover when the manager and provider are away. She is being provided with additional training and is supporting the manager to ensure effective management and recording systems are maintained. The staff have been helped to accept this change by being given a clear job description of the role. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 20 The provider and manager have decided upon a process to monitor the quality of the service. Periodic audits will be carried out to assess the outcomes for the residents, their relatives, and the staff, along with an annual review of policies and procedures. The manager is aware that these checking systems need to result in periodic reports that are shared with stakeholders and the Commission to show that continual improvements in the service are being made. The new manager is already forwarding some of the staff meeting minutes to the Commission to show the progress being made and she has openly reported all serious incidents that have affected the wellbeing of the residents. Policies and procedures have been reviewed and record keeping systems greatly improved e.g. care planning and monitoring. Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x X X X x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X x LIFESTYLES Standard No Score 11 2 12 3 13 x 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X X 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Old Court Barn Score x 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 X X DS0000024727.V263306.R01.S.doc Version 5.0 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 and 5 Requirement Timescale for action 31/01/06 2 YA5 5 The Statement of Purpose and Service User’s Guide must be revised to include the changes to the service. (Brought forward as work is taking place, previous timeframe 31/7/05). The Terms and Conditions of 31/01/06 Residence need to be expanded to cover the areas detailed under Standard 5. (Brought forward, not fully actioned, previous timeframes 31/3/05 and 31/7/05). 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 Good Practice Recommendations Standard YA3YA6YA7YA8 Develop links with professional organisations specialising in Autism to ensure care planning is in line with recognised current best practice. (Brought forward, work is continuing). YA6YA7YA8 In line with current best practice for people with Autism DS0000024727.V263306.R01.S.doc Version 5.0 Page 23 2 Old Court Barn 3 4 YA20 YA20 develop communication systems to facilitate understanding, choice making, participation and independence. (Brought forward, work is continuing). Storage for controlled drugs to comply with The Misuse of Drugs (Safe Custody) Regulations 1973. (Brought forward, not assessed). Additional information about residents’ consent to medication to be recorded in care plans. (Brought forward, not assessed). Old Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 24 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 © 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 Court Barn DS0000024727.V263306.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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