CARE HOME ADULTS 18-65
Old Farmhouse Sundorne Grove Shrewsbury Shropshire SY1 4TP Lead Inspector
Janet Oxley Announced 20 September 2005 10:00
th 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 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 Stationary 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 E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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 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 Care Home 6 Category(ies) of Learning Disability (6) registration, with number of places Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 28th February 2005 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 Liz Evans, the current manager, is responsible for the Home’s day-to-day management. 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 Home seeks to provide a positive homely environment for service users affording the appropriate levels of support required to meet their needs. Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection reviewed key standards only as the home is currently considered to be performing satisfactorily and thus warrants the application of a reduced methodology. The inspection was announced and commenced at 9.45am. It included observing activity within the home, inspecting the premises, looking at records and case tracking and talking to 5 staff. The Manager, Deputy Manager and staff on duty were welcoming and helpful throughout the inspection and a meeting with the Head of Services for Vision Homes took place to discuss future developments. It was found that the National Minimum Standards assessed, which the service was responsible for, had been met and that the overall quality of care provided was good. The five residents seen appeared content and well cared for. Visitors, relatives and visiting professionals have expressed satisfaction with the service and care the residents are receiving and have been complimentary regarding the current management and care practices at the home. What the service does well: What has improved since the last inspection?
The home has improved the programme of daily living skills, the daily and weekly planned activity programme and the management of the service users monies. It was reported that staff morale and the team approach to meeting individual needs have greatly improved Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 6 It was evident that staff continue to work hard to improve the environment for the service users, decorate where they can and personalise the service users bedrooms. It has to be noted that at this home, management and staff are constantly reviewing all aspects of the service to achieve best practice and maintain a high quality service. 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. Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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 standard(s) x 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: Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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 standard(s) 6, 7 and 9. The current service users would not be able to accurately voice decisions about their lives however each service user has a very detailed Personal Development Plan, which includes all aspects of daily living and care they require. Staff evidently respect service users rights and there is a constant monitoring and review process to ensure their identified needs are being met and individualised care given. EVIDENCE: A full and professional Personal Development Plan is available for each service user. These plans are well set out and include all health issues, communication, community activity, daily living, personal care, relationships with others, leisure and recreational activities, community issues, adult education and orientation and mobility. The service users continue to access a wide range of activities and with an increase of staff could be supported to promote and increase their independence. It was evident through observations, examining records and discussions with staff that they respect the service users rights and that despite the service
Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 10 users disabilities, staff continue to work sensitively and professionally in assessing their needs and wishes. Risk assessments have been developed for each service user and include support requirements for each individual, some of which are illustrated. The Deputy Manager, responsible for health and safety issues, updates these assessments regularly and they are included in staff induction, training and on going development. Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15 and 17. The lifestyle of the service users living at this home, given the restrictions that the accommodation presents, is good and through a framework of activities, independence, personal and social skills they are encouraged to develop. Family ties are maintained and regular visits home and meetings with relatives are encouraged and supported. EVIDENCE: There are no group activities at the home due to the complex needs and behaviours of the residents. Activities are always, at the minimum of, one to one supported in the community. Community participation and social inclusion is based on individual interests and activities. The majority of activities tend to be external to the home due to the restrictions of communal space and the individuals complex needs. All menus at The Old Farmhouse are individualised to meet service users preferences. Drinks and snacks were observed being taken as and when required. As mentioned in following standards the kitchen is now in need of refurbishment without delay.
Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 12 Such are the service users disabilities that they would not be able to enter a world of work however it was evident that service users are given opportunities to learn and develop and that this would improve if staffing levels were increased and maintained. Specialist intervention is used whenever necessary and on a regular basis with service users enabled to access all support services. Three vehicles are available to the service users, one having his own. Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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 standard(s) 18, 19 and 20. The health and personal needs of service users are well met with evidence of regular review and of good multi disciplinary working taking place on a regular basis. EVIDENCE: Service user’s records and discussions with staff indicated that the staff monitor health needs, make appropriate referrals and appointments to health care professionals. The support of Doctors and Consultants is ongoing and there is a good relationship between the home and visiting professionals, who speak positively regarding the management and care practices at the home. Behavioural changes of service users are also carefully monitored and plans and risk assessments for all activities are in place. At the time of this inspection aspects of the recording, securing and administration of medication appeared to be satisfactory. When service users are admitted to hospital 24 hour support is provided by staff from the home. Following one service users recent stay in hospital a letter was sent to the manager, from the hospital, praising the staff who supported the individual for their commitment, approach, up to date and accurate information given and their excellent attitude.
Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 22 and 23. It was considered that all stated outcomes are, at the moment, fully met. Staff are sensitive and have developed methods to identify what service users like, dislike or object to in a commendable manner and robust procedures and practices are in place to ensure that individuals are protected from abuse. EVIDENCE: Two complaints have been received by the home since the last inspection, one from a neighbour and one from a relative. Both have been professionally dealt with. Given that the current service users would have difficulty understanding the concept of a complaint it was evident that staff are sensitive and have developed methods to identify what service users like, dislike or object to and explore new avenues in efforts to overcome the difficulties. It was considered that, given the proposed plans to reduce the occupancy at the home, local independent advocacy arrangements must be made to ensure that concerns or complaints regarding the process of reduction are made professionally on behalf of each individual. Robust procedures are in place to protect service users from abuse and are included in all aspects of staff training. Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 24, 25, 27, 28 and 30. It has been identified by the Placing Authority (Shropshire County Council) and Vision Homes that The Old Farmhouse requires extensive refurbishment and that the six service users are not getting a satisfactory quality of life, given the restrictions that the building imposes, and that environmentally it is not sustainable on a daily basis. EVIDENCE: The home remains in ‘limbo’ with regard to the pending refurbishment of the building by Bourneville Trust, the property owners. The programme was planned to include a refurbishment of the kitchen, the upper and lower floor bathrooms and the creation of a new entrance and utility / laundry room. These plans are currently on hold as the development of the service and the possible reduction in residents at the home are being discussed. However it was considered that certain areas, specifically the kitchen, bathroom on the first floor, shower room on the ground floor and the cutting back of trees around the house must be dealt with without delay by Bourneville Village Trust.
Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 16 It was evident that the manager and staff work hard on a daily basis to try to maintain a homely place for individuals to live and bedrooms were seen to be personalised and used individually. Communal areas are warm and welcoming however are not spacious enough for the number of people living and working at the home. At the time of this inspection the standard of hygiene and cleanliness was satisfactory. The laundry however is small and cramped and is sited inbetween the kitchen and the dining room. Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 and 36. Service users are supported by a well trained and committed staff group who are meeting the needs of each individual in a sensitive and professional manner. Staffing levels do need to be increased and maintained. EVIDENCE: Recruitment at the home is thorough and all elements required by Schedule 2 of the Care Home Regulations are maintained on file. The file of a recently recruited staff member was seen to be satisfactory and this staff member was complimentary regarding the recruitment process undertaken and the induction training that she was receiving. Vision Homes Association continue to support staff to undertake their NVQ 2 award, a good variety of other training has been undertaken and staff on duty indicated that they were very sensitive to the service users complex needs and disabilities and that their attitudes and practice were monitored and supervised by the management. Staff meetings, individual supervision and staff appraisals take place on a regular basis. All staff spoken to were complimentary regarding the support and supervision they receive. Given the layout of the building and the complex identified needs of the service users it was considered however that increased staffing must be provided and
Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 18 maintained. At the time of this inspection care staff have to shop, cook, clean, undertake all laundry chores and garden, inevitably impeding their critical care role and discussions confirmed that they lacked the time to successfully provide all the personal support to maximise service users privacy, dignity, independence and opportunities to develop and learn Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42. There are clear lines of accountability within the homes management structure and the management approach creates an open and positive atmosphere from which the service users benefit. The home regularly reviews all aspects of its performance through a programme of self review and consultations and meets the requirements of the Fire Officer and Health and Safety Officer, promoting the health, safety and welfare of the service users. EVIDENCE: The manager is a Registered Nurse and is currently undertaking the Registered Managers Award. She has many years experience. A deputy manager has now been appointed and she is currently undertaking NVQ4. The manner in which management and staff responded to this inspection indicated that a sound management approach is in place and that staff are committed to achieving best practice and to developing equal opportunities.
Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 20 Quality assurance systems are in place and there was evidence available to indicate that the manager, her deputy and staff ensure, so far as is reasonably practical, the health, safety and welfare of service users and staff. Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 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
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x 2 x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 2 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Old Farmhouse Score 4 4 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 3 x E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 22 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. 1. Standard 22.5 Regulation 22 Requirement That given the plans to reduce occupancy levels at the home, local independent advocacy arrangements must be arranged for each individual. That the overgrown trees in the back garden be pruned. That the kitchen be refurbished and satisfactory cooking facilities be provided. That the bathroom on the first floor and the shower room on the ground floor be refurbished. That increased staffing be provided to support the service users assessed needs at all times. Timescale for action Without undue delay. 31/10/05 31/12/05 31/12/05 Without undue delay. 2. 3. 4. 5. 24 24 27 33 23(2)(b) 16(2)(g) 23(2)(b) 18(1)(a) 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. 2. Refer to Standard 32 37 Good Practice Recommendations That 50 of care staff be trained to level 2NVQ. That the manager achieve level 4 NVQ in management. Old Farmhouse E56 S20666 Old Farmhouse V189030 AI 200905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn Shrewsbury SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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