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Inspection on 11/06/07 for Old Farmhouse

Also see our care home review for Old Farmhouse for more information

This inspection was carried out on 11th June 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Due to the communication difficulties of the people who live at The Old Farmhouse it is very difficult to accurately represent their views in relation to the quality of care they receive. However observations made indicate that people continue to be supported by a committed and enthusiastic staff team. Staff who spoke with the inspector felt that the home provides an `excellent` standard of care. All staff spoke positively about the manager and the senior management team and felt well supported to carry out their roles effectively. Staff training opportunities continue to be a strength of the organisation. A person centred care planning system is in place in order to provide staff with the relevant information they need for effective care delivery. Staff said the care files were helpful when providing care and support as each person prefers. In particular the holiday information pack, seen on the day of the inspection, was a very useful and comprehensive document.

What has improved since the last inspection?

The inspector visited The Old Farmhouse in November 2006 to carry out a random inspection. At that time it was noted that the majority of outstanding requirements from the previous key inspection had been met. Since that time the building has undergone a major refurbishment. This work has meant that all outstanding requirements made by CSCI, over a number of years, have been addressed. The standard of the accommodation has improved significantly. Refurbishment has taken place to the bathrooms, the laundry is now situated on the first floor and communal rooms have been redecorated. The Old Farmhouse now has a homely feel to it and one service user said that he liked the changes that have been made. It is to the credit of the management and staff team that people who live at the home were able to stay there while building work took place. Robust risk assessments were carried out and staff had to work flexibly and creatively.

What the care home could do better:

As an immediate response to a requirement made at the time of the key inspection the manager of the home carried out risk assessments in relation to the support needs of one person who lives at The Old Farmhouse and in relation to waking night staffing arrangements. The manager identified increased support arrangements and the need for two waking night staff. The findings of these assessments must now be implemented to ensure appropriate support for service users and for staff who were working long hours through the night. Such prompt action demonstrates the manager`s commitment to improving the quality of the service provided at The Old Farmhouse.

CARE HOME ADULTS 18-65 Old Farmhouse Sundorne Grove Shrewsbury Shropshire SY1 4TP Lead Inspector Sue Woods Key Unannounced Inspection 11th June 2007 09:15 Old Farmhouse DS0000020666.V336185.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 Farmhouse DS0000020666.V336185.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 Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Farmhouse Address Sundorne Grove Shrewsbury Shropshire SY1 4TP 01743 440318 01743 440319 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) Vision Homes Association Mrs Sally Diane Rumsey Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The Old Farmhouse is a Care Home, registered with the Commission for Social Care Inspection to provide accommodation and personal care for up to six Adults with Learning Disabilities and associated complex behavioural needs. The Old Farmhouse is operated by Vision Homes Association. The organisation provides a block contract for the provision of this service to Shropshire County Council. Ms Sally Rumsey is the registered manager. The home is of a traditional detached cottage style and located in the Sundorne area of Shrewsbury town. It stands in its own spacious grounds, within a private housing estate. The building has recently undergone a major refurbishment. The Home seeks to provide a positive homely environment for service users affording the appropriate levels of support required to meet their needs. Consultation with service users takes the form of regular observations and detailed care and support plans that identify and review likes and dislikes. Advocacy services are promoted. Current fees are charged on a block contract basis and amount to £96,607 per quarter Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of The Old Farmhouse took place on 11th June 2007 from 09.15 am until 03.00 pm. The inspection reviewed all 22 key standards and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the fieldwork activity the inspector met with service users, staff and the manager of the home. The inspector reviewed one care file in detail and other documentation referred to within the report. Prior to the inspection visit the manager completed and returned an Annual Quality Assurance Assessment. Information contained within this document was very comprehensive and is referred to throughout this report. What the service does well: Due to the communication difficulties of the people who live at The Old Farmhouse it is very difficult to accurately represent their views in relation to the quality of care they receive. However observations made indicate that people continue to be supported by a committed and enthusiastic staff team. Staff who spoke with the inspector felt that the home provides an ‘excellent’ standard of care. All staff spoke positively about the manager and the senior management team and felt well supported to carry out their roles effectively. Staff training opportunities continue to be a strength of the organisation. A person centred care planning system is in place in order to provide staff with the relevant information they need for effective care delivery. Staff said the care files were helpful when providing care and support as each person prefers. In particular the holiday information pack, seen on the day of the inspection, was a very useful and comprehensive document. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place that would enable the successful admission of new service users to the home however no admissions have taken place over the last six years. EVIDENCE: As there have been no admissions to the home for a number of years the judgement made at previous inspections has been carried forward. It was noted also that the Annual Quality Assurance Assessment (AQAA) received by CSCI on 18/05/07 reflects that all appropriate information is available to support an admission. The manager identified that following the refurbishment of the home there are now only 5 bedrooms and therefore the registration of the home will be amended to reflect this. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Clear care-planning systems enable staff to effectively meet the assessed needs of the people who live at The Old Farmhouse. People who live at the home are appropriately supported with decision-making processes and enabled to take responsible risks. EVIDENCE: People who live at The Old Farmhouse have person centred care plans that contain detailed information in relation to their care and support needs. As part of the inspection the inspector reviewed the care file of one man who lives at the home. It was found to contain all essential information including a ‘pen picture’. Following some recent incidents the manager said she is in the process of rewriting behavioural support guidelines to ensure they reflect the current Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 10 issues. It was recommended that the manager seek input from the appropriate health care professionals, as she has not completed the relevant training. The AQAA reflects the findings at the time of the inspection and suggests that people who live at the home are offered choices and are consulted and supported to make decisions. At the time of the inspection interactions between service users and staff reflected this. For the future the manager plans to review processes and paperwork to make them more empowering and user friendly. The manager stated that reviews have taken place for all of the people who live at the home although minutes have not been received. The manager suggested that a further review is required for one service user as his needs have changed since the time of his last review. Risk assessments were seen on files reviewed and a ‘Holiday pack’ has been produced for the person going on holiday on the day of the inspection. It was seen to be a very comprehensive document containing essential personal information, a checklist for a safe environment and risk assessments to support the holiday. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12, 13, 15, 16 and 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service users lead full and active lives with opportunities to participate in new and exciting activities of their choice. Service users benefit from a balanced and varied diet. EVIDENCE: At the time of the inspection people living at The Old Farmhouse were seen to be taking part in a number of activities both in house and within the local community. One person was preparing to go on holiday with the support of three staff. All planning had been done and the individual was supported to relax before the journey. One man was observed enjoying music therapy with an outside worker in the conservatory. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 12 The inspector spoke to one man who lives at the home. He said that it was ‘Alright living here’. Everyone who lives at The Old Farmhouse had plans for the day of the inspection. All were individually based. People came and went from the home with very little disruption reflecting the effective planning and preparation that takes place at the start of each day. The inspector was able to observe the menus. They reflect that for breakfast and lunch people choose what they eat. The evening meal is planned. Foods recorded reflected a nutritional diet and a choice of meal. A separate menu was seen for a man who has special dietary needs. On the day of the inspection one man told the inspector that he would like sausage and chips for lunch and that is what he had. Again the AQAA reflected numerous opportunities for people living at the home with ample supporting evidence. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The personal and health needs of the people who live at The Old Farmhouse are well met enabling them to have a good quality of life. People are safeguarded by the home’s system of handling, storing and administering medication although improved written communication in some circumstances may offer better protection. EVIDENCE: The AQAA reflects that the home is proactive at meeting personal and health care needs. Health Action Plans are in place and these were seen at the time of the inspection. Staff detailed how they offer effective support to people who live at the home and observations demonstrated how staff offer support sensitively and discreetly. The deteriorating health of one person living at The Old Farmhouse was discussed with the manager who said that she has made appropriate referrals to health care professionals for input and re assessment. His support needs especially at night time have increased and a risk assessment sent to CSCI Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 14 following the inspection identified that two staff are now required to support him at night. Medication arrangements were reviewed and found to satisfactory although a potential area of vulnerability for the home was identified when information is given from a GP to the home via a third party. The manager will review the arrangement and seek some form of written handover of information. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at The Old Farmhouse are protected by staff having an awareness of complaints and adult protection procedures. EVIDENCE: The home has received no complaints in relation to the service within the last twelve months. Staff who spoke with the inspector both at the time of this inspection and during previous inspection visits were aware of the complaints and whistle blowing procedures. The AQAA states that staff are supported to speak out for the people who live at the home and again in discussions on the day of the inspection staff were knowledgeable about the needs and rights of the people they support. The home has a robust recording and monitoring procedure for managing the spending money of the people who live at the home. Staff continue to receive refresher training in Adult protection issues. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 27, 28 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Refurbishment works at the home have provided people with a clean, safe and homely place to live. EVIDENCE: At the time of the inspection the majority of the refurbishment work to The Old Farmhouse had been completed to a good standard. It was evident that work has had a massive impact on the house in that it looks more homely. The office is now downstairs making paperwork and the manager more accessible. Communal rooms have been re decorated and art work produced by people who live at the home is now prominently displayed. In the garden the lawns are being maintained and people who live at the home are growing marrows and beans. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 17 Bathrooms and toilets have been refurbished and there is a new laundry room upstairs. Staff are pleased with the additional shower facilities that they have. The home has plans to redecorate bedrooms on a rolling programme and work started on the day of the inspection to redecorate the room of the person going on holiday in colours that she has already chosen. It is recognised that the refurbishment of The Old Farmhouse was a massive undertaking with people who live there remaining in their home throughout. The manager and staff are to be commended for the way they ensured the safety of service users while managing the changes. Evidence suggests that people still went out to pre planned activities and enjoyed day trips to enable work to proceed as quickly as possible. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 18 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): Standards 32,34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at The Old Farmhouse are supported by a committed, trained and enthusiastic staff team enabling their care and support needs to be effectively met. EVIDENCE: The AQAA states that staffing levels currently meet assessed needs although a possible issue with support for one person at night was identified. This was found to be the case at the time of the inspection visit when staff also shared their concerns around night time support. Since the time of the inspection the manager has actioned a requirement made on the day to identify the number of night staff required. The manager must now implement the outcome of her risk assessment and the inspector is confident that she will do so. Staff who spoke with the inspector said that training and support opportunities are good. One staff member said that she liked working at the home so much she returned after a short spell of working elsewhere within the organisation. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 19 Day time staffing levels are flexible to enable effective support to people living at the home. During a recent stay in hospital by one person who lives at the home two staff were deployed to support him at all times. Given that the home does not use agency staff this flexibility is a credit to the staff team who demonstrated their commitment to supporting the people who live at the home. One staff member has just taken on the role of Visual Impairment Liaison Support Worker. His role is to use his skills and experience to review the physical environment of the home and make suggestions for improvement. Staff said that they have regular formal and informal supervision and supervision notes were seen ready to file. The recruitment file for one staff member was seen to contain all required information. The home’s training coordinator confirmed that all mandatory training had been completed and training in relation to adult protection was planned for the near future. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 20 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): Standards 37,39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who live at The Old Farmhouse benefit from being supported by an effective management team. The health, safety and welfare of the people living at the home and support staff is promoted and protected. EVIDENCE: The manager of The Old Farmhouse is knowledgeable about the needs of the people who live at the home and proactive in advocating individual’s rights. She is well respected by the staff team and offers effective leadership. She has demonstrated over recent months that she can lead a team through major change while ensuring people who live at the home are safely supported. She Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 21 is aware of the strengths of the home and throughout the AQAA she was also able to identify areas of improvement. The manager stated that she has ‘fantastic support from staff’. As part of the inspection accident and incident forms were reviewed and discussed with the manager. It was found that appropriate actions had been taken following these incidents. Staff were seen to follow health and safety guidelines. In particular the inspector observed a support worker using appropriate protective equipment in relation to handling laundry. Fire safety checks were seen to have been appropriately carried out and recording sheets in relation to health and safety matters are faxed to head office for weekly monitoring. The manager stated that there has been no recent fire officer visit but fire risk assessments have been done. The manager stated that she would update this document to support the use of a lock on the kitchen door. Senior home managers carry out routine unannounced visits. The manager is currently without a computer and this is impacting upon her ability to update records and produce appropriate documentation. Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 22 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 23 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 YA6 Good Practice Recommendations It is recommended that the manager seeks input and support from appropriate health care professionals to develop and implement behavioural support plans to ensure that the plans reflect current best practice and training that has been provided to the majority of the staff team Old Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Farmhouse DS0000020666.V336185.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!