Inspection on 08/08/07 for Old Court Barn

This inspection was carried out on 8th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Old Court Barn 10/09/09

Old Court Barn 04/05/06

Old Court Barn 31/10/05

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 Key Unannounced Inspection 8th August 2007 14:00 Old Court Barn DS0000024727.V341841.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 Court Barn DS0000024727.V341841.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 Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Court Barn Address Lumber Lane Lugwardine Hereford Herefordshire HR1 4AQ 01432 851260 01432 853158 oldcourtbarn@hotmail.co.uk 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.V341841.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents with physical disorder or mental disorder in addition to their learning disability may be accommodated. 4th May 2006 Date of last inspection Brief Description of the Service: Old Court Barn is owned and operated as the sole concern of The Barns. The Home offers a personal care service to seven younger adults with severe learning disabilities, some of whom have Autism. The Home is situated on a quiet country lane in the village of Lugwardine three miles from the City of Hereford. The Home is set in pleasant grounds and the accommodation is divided into two adjoining areas that contain five and two single bedrooms and communal facilities. The provider has written information about the service that can be sent out to interested parties. The inspection reports are available in the Home for visitors’ to see. The current fee range is between £707 and £1704 per week dependent on each individual’s assessed needs. Additional charges are made for personal items such as clothes and toiletries, personal services such as chiropody and haircuts. Residents pay a contribution towards the cost of holidays and their mobility allowance goes towards the cost of providing the two vehicles. Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on a weekday between 2pm and 5.30pm. The senior was on duty and she helped. The inspector looked around the house and spoke with two of the staff. The residents were seen going about their daily routine. One resident showed the inspector his bedroom. Some records were looked at such as care plans, medication and money. The manager sent information about the Home to the inspector. What the service does well: The home only offers a place to someone if they can meet their needs. Each resident has a care plan that says how they like and need to be supported. Good records are kept to help protect the residents and support the care planning. The residents are supported to stay healthy and access community health services. There are enough staff to support the residents with their preferred routines. The residents attend activities and college courses that they benefit from. The residents are supported to stay in touch with their families. The house is homely, comfortable and safe. Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 6 Careful checks are made before people are offered a job at the Home. The staff team is small and quite stable so they get to know the residents well. The staff are trained and supported to do a good job. The home is well run and the residents and their families’ views are listened to. What has improved since the last inspection? What they could do better: Follow up plans to give the two residents who share a bedroom their own bedrooms. Enable the residents to use their bedrooms more to relax in. Further develop pictorial communication aids and always use them to inform the residents. Old Court Barn DS0000024727.V341841.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 Court Barn DS0000024727.V341841.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 Court Barn DS0000024727.V341841.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): 1, 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives would be provided with up to date information about the service to help them make an informed choice. The needs of any potential new residents would be carefully assessed and a trial period arranged to ensure they could be met before permanent admission took place. EVIDENCE: The manager continues to regularly review the Statement of Purpose and Service Users Guide to keep them accurate. A version of the Guide has been developed into a format where the information is more accessible to people with a learning disability. There have not been any new admissions into the Home since 2004. This was before the current manager took up her post. If a vacancy was to occur there is an admissions policy. The manager showed evidence in the Annual Quality Assurance Assessment, (AQAA), which was submitted to the Commission before the inspection, that she was aware of good practice assessment methods such as transition tea visits and overnight stays. She confirmed an assessment would be obtained from the placing authority and then she would complete her own assessment. Any admission would initially be on a trial basis. To support this procedure she plans to develop an assessment tool ready for when the next vacancy occurs. Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 10 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, 8. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents can be confident that their support needs are reflected in their care plans. The residents are being encouraged to make decisions for themselves where possible. Reasonable risks are being taken to enable the residents to learn independence skills and enjoy new experiences. EVIDENCE: All residents have a care plan folder that includes guidance about their needs, likes, activities, behaviour patterns, family history and health etc. The two care plans sampled showed that the care information and associated risk assessments continue to be kept under regular review. These reflected the care practice that was observed during the inspection. Each resident has a keyworker and they meet the manager and senior monthly to review each resident’s situation and keep the plans up to date. Monthly summaries are written to collate the main issues or changes and this information is then used to inform the formal reviews that are held at least six monthly. The staff have attended training in Person Centred Planning and the manager has started to introduce this style of planning. The personal care guidance is the first area that has been produced with pictures and in an easy read format. Some of the Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 11 residents may be able to keep their own folders if they are involved and enabled to understand the content. Staff complete daily records noting information about several relevant areas e.g. activities, frame of mind, food intake, health, personal care etc. If a significant event occurs more detailed information is recorded on either incident or accident forms. These are signed off by the person in charge of the shift and passed to the manager. Where appropriate these have also been copied to the Commission. The records were of a good standard and the information was relevant and useable for monitoring purposes. Relatives and involved professionals are invited to reviews and the residents are encouraged to stay in the meeting or be involved in a part of it. Minutes are written up and the manager now sends these out to confirm agreed action points. The questionnaires showed the relatives feel positive about the care planning process. One resident’s parents said they really appreciate the consideration shown to their son and how his needs are met individually. Staff are at times required to manage difficult situations when a resident becomes anxious and agitated leading to aggression to themselves or others. Clear step-by-step guidance is in place informing staff how to respond in these circumstances. The community team psychologist has been involved in developing this and it is linked with the training staff have had. The level of physical interventions that are sometimes necessary with two residents are monitored. Staff aim to intervene quickly and redirect the resident to defuse the situation. During the inspection staff were seen to implement these strategies effectively. The manager reported in the AQAA that each resident is encouraged to reach their potential and increase their independence. They are enabled to make choices mainly around meals, clothing, and whether they want to attend an activity. The majority of the residents have limited or no speech, but all staff are observant and alert to their needs and facilitate their participation in all aspects of the life of the home. The residents were seen to be encouraged to make choices for themselves during the inspection and the care plans showed goals for development and information about how they make choices. She plans to further develop work on communication s and person care plan information being presented in a format suitable for the residents to understand. Currently all residents have family members involved in their lives so there is no apparent need for advocacy. The manager has made contact with the advocacy service and would access this service if needed. Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 12 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): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are being supported to develop independence skills and take part in appropriate activities in-house and in the community. The residents are being assisted to maintain close contact with their families. The residents’ rights are respected and they are experiencing a good quality of life. They are being offered nutritional home cooked meals served flexibly in a pleasant atmosphere. EVIDENCE: The work to increase the focus on the residents’ personal development is continuing. Each has several aims identified as Pathways to Independence. These have been agreed by key staff and the residents’ representatives to be areas where each resident has potential to increase his skills. These tasks have been broken down through task analysis and staff complete a form to log the level of participation and progress each time they support a resident to complete one of these tasks. Some of the areas focused on include dressing, doing personal laundry, and bathing. The manager gave the following Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 13 examples in the AQAA of the residents demonstrating their skills; several of the residents attend Hereford College and participate in cookery sessions and they also cook at home; one now chooses the recipe he wants to make for his lunch, he then walks to the shop and purchases the necessary ingredients, on his return he cooks the meal and eats it; another resident enjoys woodwork and he oftens helps with DIY at home involving the use of saws, hammers, screwdrivers; another recently fell off his horse during a session at the RDA, but he got back on another horse and has continued to ride; another now makes his own coffee. She reported that they are all encouraged daily to help around the home e.g. making beds, tidying bedrooms, dusting, cleaning windows, taking the bins out, cooking, shopping etc. Some of the residents hold their own money tins and use their money to buy magazines, CDs and DVDs etc. Each resident has an activity plan some of which is fixed e.g. set sessions at college, and others that are flexible such as community outings. There are two unmarked vehicles that several of the staff can drive and the provider and manager also use their cars if needed. One resident enjoys using the local bus service when going into town. The manager reported in the AQAA that the residents use the local shop, post office, pub and community playing field. They also visit the local barbers in town and they go shopping for groceries, toiletries and clothes. Some residents have attended the local chapel and seem to enjoy the services and participate by singing and clapping. Some appear to enjoy going to the local car boot sales. During college holidays various day trips are organised, either in small groups, pairs or on their own. These have included places such as West Midlands Safari Park, local castles, Brecon Dinosaur Park, The Royal Forest of Dean and Butterfly World at Symonds Yat. Some also enjoy bowling and train rides. A group holiday is provided once a year in a country cottage known to the residents. It is felt that the familiarity lowers the residents’ anxiety levels and enables them to enjoy the break. The records seen confirmed that the residents were being offered regular meaningful and enjoyable activities. In-house the TV lounge is used in the evenings and the dining room doubles up for art and craft sessions. The garden is popular and well equipped and the kitchen is now being used more frequently. All the residents have personal hobby belongings in their bedrooms and some have certain items they like to bath with. As mentioned under the environmental section consideration should be given to how bedrooms can be fitted out to provide greater opportunities for the residents to enjoy this private space. It is positive that a fish tank has been tried in the lounge, but the fish died. A different variety is now going to be tried after some advice was sought. Work is continuing to develop total communication methods with the aid of the community team’s Speech Therapist. She also assessed the residents’ Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 14 potential for further language development last year and some are talking more. Staff were very excited about these changes and were seen to encourage one resident to use language to make choices about drinks. The computer programme for symbol and pictorial systems purchased last year is being used for the pictorial activity rotas and for the personal care guidance. The visual display board for activities was blank on the day of the inspection, as the senior had felt unable to confirm activities because one resident was unsettled and possibly unwell. Outings and in house activities were being arranged at short notice as the situation was monitored. Consideration should be given to using the board to communicate what is going to happen such as baths, meals, time in the garden etc. and then in these circumstances at least residents have some security from the structure. When something else is planned at short notice this could be added to the board with the residents when they have agreed to join in. Positive work continues to support links between the residents and their families. Most visit and stay with their families one weekend a month. Relatives have given very positive feedback about the Life Books that are given to them by the residents each Christmas. An example of one was seen. They contain information and photographs collated throughout the year of activities and achievements. Communication journals between families and the Home have also proved successful so these continue to be used. The meal records on the daily records showed a good variety of healthy meals are being offered to the residents. Their preferences are well known and the menu takes account of these. The fridge was well stocked and fruit was on display. The lunchtime meal was a snack and was relaxed and the staff enabled the residents to make choices and chatted nicely to them. It is positive that one resident has now rejoined the dining room to eat with the group but his preference to sit on a separate table is respected. Another is currently eating at a table in the hall to support him to focus on his meal and not on the other residents as this has led to incidents. There is a focus on healthy living and one family reported that the manager has listened to their concerns about their son’s weight. Old Court Barn DS0000024727.V341841.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. 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents’ personal and health care needs are being met in a flexible and personalised manner. Medication is being safely managed and administered by suitably trained staff. EVIDENCE: The ratio of staff provided during the waking hours allows the residents to be supported with their personal and health care needs in a personalised manner and have baths or showers at least daily and more often if needed. Charts continue to be kept to monitor the personal care that is provided. Routines are reasonably flexible although it is acknowledged that a structured routine is important for some of the residents. The care plans contain clear guidance about how the residents prefer to be supported. These are person centred and have recently been developed into a pictorial and easy to read format to help the residents understand them. The manager provided information in the AQAA submitted to the Commission that all staff have in depth training during their shadow shifts and probationary period with regards to personal care and support required to ensure the residents’ privacy, dignity, choice and independence are safeguarded. These areas are also covered during the Common Induction Standards, LDAF and NVQ training. She also reported that Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 16 one resident seems to prefer a male carer to support him and this is provided as much as possible, and that residents are usually supported by their keyworker to go shopping and buy clothes that are appropriate to their age and personality. Discussions were held about how one resident was supported to accept new clothes, which he finds very difficult, so he could attend a family wedding in formal atire. The residents looked well presented and their relatives gave feedback that they are confident that the Home provides good personal and health care. Records showed that potential health issues were being picked up, monitored and discussed in staff meetings where necessary. The residents’ health needs have been assessed and appropriate checks are being accessed as preventative measures e.g. annual Well Man’s checks, dental and chiropody treatments. Weights are being monitored more consistently and the manager reported in the AQAA that all residents now have a Health Action Plan. Accidents are being recorded and body charts used to show any marks that are found. These are monitored each month to look for any patterns. There is a good level of liaison with and direct involvement from specialists from the community team such as the continence nurse and psychologist. Three health professionals gave very positive feedback about the standard of care provided and the skills and commitment of the manager. The medication management system and records were audited. A policy is in place and staff are given appropriate guidance and training before being permitted to administer medication. Four administration errors have occurred since the last inspection. The manager has reported these to the Commission and thoroughally reviewed the proccedures and staff training each time to see what lessons can be learnt. The systems are now well developed and robust. The records were clear and showed the prescribed doses had been given. Those relating to one resident’s recent medication changes were clear and trackable. Staff have been alerted to possible side affects. The controlled drugs were being safely managed and a reconciliation showed the records were accurate. The manager reported in the AQAA that each resident’s medication is being kept under regularly review with their GP or psychiatrist. The supplying pharmacist carries out regular medication checks and any recommendations are promptly actioned. Old Court Barn DS0000024727.V341841.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, 23. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents and their representatives’ views are listened to and acted upon whenever possible. The residents continue to be actively protected from abuse, neglect and self-harm. EVIDENCE: No complaints have been received by the Commission since the last inspection. It is very difficult for all residents to express their views and raise concerns in a formal way. The residents’ wishes are being respected when possible e.g. if they show they do not want to join in an activity. Each resident has a keyworker and their family who advocate on their behalf. A complaints procedure is in place and the manager reported that since the last inspection this had been reissued to all residents’ representatives. The families that returned questionnaires confirmed they were aware of the procedure and confirmed that the manager dealt promptly with any concerns. One said the management should be congratualted for listening to concerns and acting upon them. Three complaints had been received and logged on a central record. These were about relatively minor issues e.g. a group being slightly late for a horse riding lesson. In each case the manager had written to the complainant to confirm that action she was taking to prevent a further occurance. It is positive that if the manager or provider could not resolve a complaint they have made a commitment to engaging an external person to investigate and negotiate a resolution. The manager showed evidence in the AQAA, which was submitted to the Commission before the inspection, that she helps prevent complaints arising by having communication dairies that go back with each resident when they visit their family. Review meetings are held six monthly Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 18 and questionnaires are circulated to try to obtain the views of families and any ideas for improvement. The manager reported in the AQAA that robust recruitment and induction and training arrangements help protect the residents. With this aim she carries out three monthly audits of the residents’ finances. The staff spoken with reported that they were encouraged to report any concerns promptly. Staff training is provided in Adult Protection and clear guidance is in place about how to respond positively to residents’ complex behaviours. An Abuse and Whistle Blowing policy are in place and are covered in the induction and during supervision sessions. In July 06 a worker raised concerns about the standard of personal care and support one resident had received. The manager reported this under the local Adult Protection procedure. A strategy meeting agreed that the manager should investigate and report her findings. The member of staff was suspended during this time. The matter was closed when all agreed it was a training issue and not a case of neglect. As a result of this incident the manager did take action to improve the training, recording and handover arrangements. Old Court Barn DS0000024727.V341841.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, 25, 26, 27, 28, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are living in a comfortable, clean and safe home that is being well maintained. The communal living and bathing facilities meet their needs and they benefit from using the attractive garden. The residents have been supported to personalise their bedrooms, however there may be scope to further improve outcomes in this area. EVIDENCE: The house is detached and set in secluded gardens that overlook a small lake and farmland. It is part of a small village that is 3 miles from Hereford city. There are two vehicles provided but the village is also on the bus route. Little Barn provides accommodation for two residents in single ground floor bedrooms. This area has a bathroom, lounge and kitchenette. Big Barn provides accommodation for five residents on the first floor in three single and one shared bedroom. This area has two bathrooms with self-contained showers, three toilets, a lounge, a dining room, the laundry, office and main kitchen. No lift is provided and the Home is not registered for residents with mobility difficulties. Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 20 The new manager had begun a programme to improve many areas of the Home at the last inspection. Improvement work has continued and the results are positive with the house looking homely and comfortable. Specific improvements include the lounge in Big Barn which has been painted, recarpeted, had new sofas, curtains and wall decorations. One of the upstairs showers has been replaced and retiled and a bathroom has been tiled and decorated. In Little Barn an internal wall has been removed and this has allowed a much bigger kitchen to be fitted. This has increased the amount of imput these two residents can have in their meal preparation and normal household kitchen tasks. There are further plans to replace other flooring and then a rolling programme of ongoing decoration and maintenance will continue. The sample of bedrooms seen were comfortable and had been personalised. The bedrooms meet the minimum size standards. The shared room has a partition part way across the room to provide some privacy. The provider is considering plans to extend and provide another bedroom so all the residents can have single bedrooms. This would be a very positive step. One resident has a spy hole fitted into his door, which was used by staff to observe him when he was displaying challenging and possibly self-injurious behaviour in the past. This resident has developed and changed significantly and the senior worker spoken with had not seen this used. If it is not essential on the basis of a risk assessment it should be removed to help safeguard his privacy. The residents’ bedrooms do not have sinks or door locks. Historically these were not considered appropriate because of their abilities and behaviours. As some residents have developed well in the last two years the manager should review this and consider if any of them would benefit from these facilities and the greater independence and privacy they would provide. Discussions were held with the senior about how more residents may be able to safely have personal entertainment equipment in their bedrooms and comfortable chairs so they could be enabled to use their rooms more during the day if they wished. The manager reported in the AQAA that the home meets all the requirements of the Fire Regulations, Health and Safety, Environmental Health and Disability Discrimination Act. She consulted with families and they have reported that they feel the house is well kept and the bedrooms meet their children’s needs. She confirmed that the residents are encouraged to be involved in decorating and personalising their bedrooms e.g. one had chosen some pictures from the internet and one had made a wooden chair at college for his bedroom. The house was found to be clean and cleaning schedules are in place. Protective clothing and infection control training are provided for staff. The laundry is quite small but functional and appropriately equipped. Old Court Barn DS0000024727.V341841.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, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are being supported by a competent and effective staff team who are suitably trained, qualified and supervised. The residents are being safeguarded by the Home’s recruitment procedures. EVIDENCE: Appropriate staffing levels are being maintained with one worker based in Little Barn and at least three in Big Barn. At night one worker is awake and one sleeps in and is on call. The manager and the provider also support weekday shifts e.g. to provide extra support to enable the residents to attend day activities. Any gaps in the rota are usually covered by existing staff or by agency staff who now know the residents. The rota pattern is still based around most staff working full days but they do go home at 8am if they have then been on the sleep-in duty. The staff were observed to interact positively with the residents. They were communicating well with each other and making sensible decisions about the days plan based on one resident’s frame of mind. Several examples were seen when staff enabled and encouraged the residents to make choices about drinks and food. They seemed motivated and organised, enabled one resident to use the kitchen to make drinks and another to work on his numeracy skills. Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 22 The recruitment record for the newest worker was sampled. This showed robust procedures had been followed and clear records maintained that included application forms, written references, job descriptions and interview details. The manager confirmed in the AQAA that the Home’s recruitment procedure is fully implemented and that staff usually do not start until a full CRB disclosure has been returned. If the Home is very short staffed then a PoVA First check is obtained and the worker is closely supervised and not allowed to carry out personal care tasks until the full check is received. The manager reported the folloeing in the AQAA. She is responsible for the staffs training and development programme and the training required is carried out. Each employee has their own training and development plan folder and these are reviewed during the yearly appraisal. The training includes the Common Induction Standards (CIS), Learning Disability Award Framework (LDAF), Fire, Health and Safety, Food Hygiene, First Aid, Moving and Handling, Autism Awareness, Positive Approaches to Challenging Behaviour, Managing Actual and Potential Aggression, Protection of Vulnerable Adults, and Person Centred Planning. There is also detailed in house training carried out by the senior in charge and the manager uses the Croner staff training resource which covers all of the CIS. Staff then proceed to the NVQs. The Home does not financially support staff to carry out their NVQ 3 but does support them to carry out their training. All staff have training by the community Speech and Language Therapist that includes Makaton and Total Communication. Certain staff have had Signalong training. There is always someone on shift who is able to communicate effectively with the residents. The records for the newest worker confirmed that he was working through the CIS and LDAF. A worker spoken with said she had attended lots of courses that had been very useful. The manager reported that of the current team of twelve staff, seven have achieved their level 2 NVQ, one has achieved level 3 NVQ. Three are working towards their level 3 and two are working towards their level 2. The two new employees are currently working towards their CIS and LDAF. Once they near the end of their LDAF she will apply for their NVQ 2. The number of staff with a qualification in Care is now above the minimum standard of 50 for the first time. This is a positive achievement and confirms there is a positive commitment to staff development. Staff are being provided with bi-monthly supervision and annual appraisals. Care practices are reviewed in these meetings and regularly at handovers and at the monthly staff meetings. Staff are de-briefed following any incidents and these are used to help staff develop their skills and strategies. The staff spoken with felt well supported and they were positive about the residents and the way the Home is run. The feedback from relatives and professionals about the staff was positive about their attitude and commitment. Some professionals felt the majority of the team were appropriately skilled but that there was room for further development. Old Court Barn DS0000024727.V341841.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, 38, 39, 40, 41, 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents continue to benefit from a well run service that is focused on their wellbeing where the support is based on a professional ethos but delivered in a personal and homely way. The residents are being safeguarded by well developed management, personnel and record keeping systems. The views of the residents and their representatives are sought and listened to. The residents’ health, safety and welfare are being actively promoted. EVIDENCE: The provider is actively involved in some aspects of the Home’s management e.g. medication and the residents’ finances. The manager continues to demonstrate her commitment to the role through her ongoing drive to improve the service and her open approach. She is appropriately qualified and attends relevant training to keep herself informed about professional developments. She is supported by a senior worker who is well established in the role. The Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 24 staff team are well managed and the outcomes for residents are actively monitored. Feedback from staff, relatives and professionals was all positive about the manger’s competence and attitude. The recording systems have been developed so they are fit for purpose and very well organised. The staff have been trained to complete the records they are responsible for accurately and to cross reference the information where relevant. Following the last inspection the manager reported that the residents’ financial record keeping system had been changed so it was clearer and more transparent. The provider keeps the records, but the manager now carries out 3 monthly audits to double check the accuracy and so she is appropriately informed of each resident’s financial situation. These records were not checked on this occasion. There are a full set of policies and procedures in place that continue to be updated. Staff sign to show they have read these and the findings of the inspection confirm they are put into practice. The provider and manager have further developed the quality assurance (QA) system since the last inspection. The process involves periodic audits of the service against different areas of the National Minimum Standards e.g. health and safety, medication management, residents’ daily activities. The findings of each audit have been submitted to the Commission. Staff, external professionals, residents and their relatives continue to be consulted as part of this process. The residents’ relatives and social workers are invited to the care reviews and these forums are also used to obtain feedback and ideas for improvements. A report of the findings from a full cycle of the QA process is yet to be shared with stakeholders to show the findings and any improvements. Systems are in place to manage Health and Safety matters e.g. regular monitoring checks on the water system and fire equipment. Records sampled at this and previous inspections show these systems are implemented fully. The manager provided information in the AQAA confirming that all equipment had been serviced regularly e.g. the fire equipment and electrical items. Environmental and care related risk assessments are in place and staff sign to evidence they have read and understood these. Staff attend relevant safety training and take part in fire drills. A risk assessment had been completed in relation to safeguarding a pregnant worker. The manager has a good record of taking a proactive approach to managing safety but also balancing risks against the need for the residents to experience a normal way of life. Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 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 4 23 3 ENVIRONMENT Standard No Score 24 3 25 2 26 2 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 4 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 4 4 3 4 3 3 x Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 26 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 YA11 Good Practice Recommendations Always provide the residents who benefit from a visual structure to each day with this information even if outings are not being planned in advance. Remove the spy hole fitted to one resident’s bedroom door unless a current risk assessment shows this is essential to his or others safety. Consider how residents may be enabled to use their bedrooms to further promote their independence and privacy. 2. YA26 YA25 Old Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Local Office The Coach House, John Comyn Drive Perdiswell Park Droitwich Road WORCESTER WR3 7NW 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 Court Barn DS0000024727.V341841.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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