CARE HOME ADULTS 18-65
Old Farmhouse Sundorne Grove Shrewsbury Shropshire SY1 4TP Lead Inspector
Janet Oxley Unannounced Inspection 28th February 2006 10:15 Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 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.V278729.R01.S.doc Version 5.1 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.V278729.R01.S.doc Version 5.1 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 Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th September 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 Homes 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 DS0000020666.V278729.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and commenced at 10.15am. It included observing activity within the home, inspecting the premises, looking at a number of records and talking to 5 staff. The Manager, Deputy Manager and staff on duty were welcoming and helpful throughout the inspection and feedback was given to the Head of Services for Vision Homes. It was found that the National Minimum Standards assessed, which the staff at the home were responsible for, had been met and that the overall quality of care provided was satisfactory. 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 continues to try to improve the programme of daily living skills for the individual residents however given the current problems in the home staff have found it difficult to achieve all the identified aims and objectives. The home has not complied with the requirements made at the time of the last inspection with the exception of planning independent advocacy arrangements for individuals when occupancy levels at the home are reduced. 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 in attempts to achieve best practice and maintain a high quality service.
Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 6 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 DS0000020666.V278729.R01.S.doc Version 5.1 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.V278729.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 DS0000020666.V278729.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 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 respect service users rights and there is a constant monitoring and review process to assess if 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 however it was reported that a number have been curtailed when the staff compliment has been reduced due to sickness and holidays. It was considered that with an increase of staff individuals could be supported to promote and increase their independence. It was evident through observations, examining records and discussions with
Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 10 staff that they respect the service users rights and that despite the service 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, continues to update these assessments regularly and they are included in staff induction, training and on going development. Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 and 16. The lifestyle of the service users living at this home, given the restrictions that the accommodation presents and the challenging behaviours of one individual, is generally 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. 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. It has to be noted here that the challenging behaviour of one service user has
Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 12 escalated to such level that 4 other service users and all staff have been attacked by the individual and have received injuries such as a black eye and deep scratches. Inevitably this must have a very negative and unsettling impact on the lifestyle experienced at the home by all. Specialist intervention has been received and many strategies used by the staff group however the manager and staff have now reported to the placing authority that they do not consider that they are meeting service user needs and they cannot guarantee the safety of the service users. The reduction in the numbers of service users at this home has been discussed for a number of years and it is apparent that all visiting professionals fully acknowledge that this is long overdue and that the needs of the service users are not being met despite the best efforts of the staff. Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19 The health and personal needs of service users are generally well met by staff, with evidence of regular review and of good multi disciplinary working taking place on a regular basis. It was considered that the physical and emotional needs of the service users were not being fully met due to the physical attacks delivered from one individual. EVIDENCE: Records seen 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 the last 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 last 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 DS0000020666.V278729.R01.S.doc Version 5.1 Page 14 It has to be noted here also that it is considered that the manner in which the staff undertake their duties in efforts to meet these standards is commendable however as mentioned in other standards it was considered that the situation, whereby physical injuries are being received by four service users from another, is wholly unacceptable. Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 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: One complaint has been received by the home since the last inspection from a neighbour and has been professionally dealt with. One complaint was made by a staff member, on behalf of a service user, who was physically attacked whilst in the bath by another service user. This resulted in POVA meetings being held and currently the situation is ongoing. Staff at the home have fully complied with the recommendations that were made as a result of the meetings however the problems continue with 4 service users being assaulted on a regular basis. 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. Given the proposed plans to reduce the occupancy at the home, local independent advocacy arrangements will 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 DS0000020666.V278729.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 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 at the time of the last inspection 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. These matters have not been attended to. 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 in and bedrooms were seen to be personalised and used individually. Communal areas are warm and
Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 17 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 between the kitchen and the dining room. Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 34. Service users are supported by a well trained and committed staff group who are doing all they can to meet 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. No staff have been recruited since the last inspection. 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, the challenging behaviours from one service user in particular and the complex identified needs of all service users it was considered that increased staffing must be provided at times and that staffing levels must be maintained at all times to ensure that all necessary activities are carried out effectively and efficiently to meet the individual and collective needs of the service users at the home. At the time of this inspection care staff have to shop, cook, clean, undertake all laundry chores and garden, inevitably
Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 19 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 DS0000020666.V278729.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 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 current manager is resigning in March 2006. A replacment has been recruited, will commence duties at the end of March 2006 and it was reported that an application will be made to register the new manager without unreasonable delay. The deputy manager 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. Quality assurance systems are in place and there was evidence available to indicate that the manager, her deputy and staff ensure, so far they are able,
Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 21 the health, safety and welfare of service users and staff. All necessary training has been undertaken, there is a first aider on duty at all times and accident records were seen to be professionally recorded. Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 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 X 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 2 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 x 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 x 13 3 14 3 15 x 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 x x 3 x x x x 3 x Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES 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 YA24 Regulation 23(2b) Requirement That the overgrown trees in the back garden be pruned. This requirement was made at the time of the last inspection – the timescale for action being 31/10/05. That the kitchen be refurbished and satisfactory cooking facilities be provided. This requirement was made at the time of the last inspection – the timescale for action being 31/12/05. That the bathroom on the first floor and the shower room on the ground floor be refurbished. This requirement was made at the time of the last inspection – the timescale for action being 31/12/05. That increased staffing be provided to support the service users assessed needs at all times. This requirement was made at the time of the last inspection – the timescale for action being 20/09/05. That an application to register the newly appointed manager be forwarded to CSCI. Timescale for action 31/03/06 2 YA24 16(2g) 31/05/06 3 YA27 23(2b) 31/05/06 4 YA33 18(1a) 31/03/06 5 YA37 8 31/05/06 Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 24 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 YA32 Good Practice Recommendations That 50 of care staff be trained to level 2NVQ. Old Farmhouse DS0000020666.V278729.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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