Inspection on 19/07/05 for Penrose Farm

This inspection was carried out on 19th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Penrose Farm 04/10/06

Penrose Farm 17/01/06

Penrose Farm 04/11/04

Penrose Farm 18/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Penrose Farm Bodmin Road Goonhavern Truro Cornwall TR4 9QF Lead Inspector Richard Coates Announced 19 July 2005 10:00 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. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Penrose Farm Address Bodmion Road Goonhavern Truro Cornwall TR4 9QF 01872 573938 01326 371099 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) Spectrum Mr John Keys Care Home 6 Category(ies) of Learning Disability (6) registration, with number of places Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No conditions have been set. Date of last inspection 4 November 2004 Brief Description of the Service: The registered provider for Penrose Farm is Spectrum. Spectrum is an organisation which provides services to people with autistic spectrum conditions. Spectrum is registered to provide accommodation and care at this home for up to six service users who have a learning disability. The home is in Goonhavern, a small village near to Newquay, Truro and Perranporth. Penrose Farm consists of two buildings. The main building has four single bedrooms, a kitchen diner, conservatory, an activities/sitting room, and a small sitting area. Two of the bedrooms are on the first floor. The barn conversion has two bedrooms on the first floor and a lounge diner, bathroom and toilet, and kitchen on the ground floor. Access to the main house is over some shallow steps which could be ramped if required. There are two steps in an internal corridor leading to two residents bedrooms. One of these bedrooms is accessed by two steps down. The new barn conversion has ramped access. Residents can access the spacious garden from the main house through level access once through the main door, or through the conservatory which involves a step down. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned announced inspection and took place on Tuesday 19 July 2005 over about 7 hours. The inspector is grateful to the manager, staff and residents for their assistance. The registered manager had submitted an informative pre-inspection questionnaire before the inspection. The aim was to review the compliance with the requirements set in the last inspection report for 4 November 2004 and to focus on key standards in the areas of the choice of home, individual needs and choices, personal and healthcare support, complaints and protection, staffing and the management of the home. The environmental and lifestyle standards will be included in the unannounced inspection later in the year. The inspector spent time with the registered manager, staff and residents, examined records and documents, and toured the premises. What the service does well: What has improved since the last inspection? Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 6 The statement of purpose has been dated so that the latest version can be identified. The terms and conditions for residents sets out how their benefits are used to contribute towards fees and to provide a personal allowance. The care planning for individual residents has been improved. Care plans direct and inform staff in detail about the interventions required to meet the care needs of residents and promote their safety and wellbeing. The previous system of medication administration records had been improved. However, the provider has decided to introduce the monitored dosage system- a pre-programmed system of medication dispensed by the pharmacist. The registered manager has taken action to further the understanding of staff and residents of adult protection issues. Procedures and practices for recent recruitment and selection have met required standards. The registered manager and deputy have introduced regular formal supervision for staff. 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. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 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 Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 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) 1, 2, 4 and 5 Residents and prospective residents receive appropriate information material in order to make an informed choice about the home. EVIDENCE: The statement of purpose and the service users guide are complete and dated. Current residents do not need these documents in an alternative format. There was a dated record of a recently admitted resident receiving a copy of the service users guide. Case tracking the records for this recently admitted resident showed that appropriate assessments had been carried out before admission to the home. The records demonstrated that the views and preferences of the resident and his representatives were taken account of. The resident visited the home and was visited by Spectrum staff at his previous residence. The resident discussed with the inspector his visits and how he had made a choice. A statement of terms and conditions was on file which specified the room to be occupied on a floor plan. Residents admitted more recently receive a statement in their terms and conditions as to the use of their benefits in paying towards the fees. The registered manager reported that the benefits arrangements for the most recently admitted resident had not been finalised, and he would receive this information when this matter was settled. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 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 Care plans reflect the residents’ needs and personal goals and the risk assessments support residents to take risks so that they can pursue an independent lifestyle. EVIDENCE: The records for a recently admitted resident were case tracked. The care planning documentation comprised the risk assessment and safe working practice document, a care plan summary, and other elements of the care plan specific to the individual resident, for example weekly activity plans. The care plan set clear objectives, gave staff directions and information on the care to be delivered, and provided a risk assessment. A first monthly profile had been completed and there were daily logs. However, the staff responsible are not signing the daily logs. The resident discussed his care plan with the inspector. It was evident that some aspects of the original care plan and risk assessment as initially set out have been modified since admission. The manager is aware of these issues and a date for a formal review has been set. The individual care plans sets out effective communication strategies for staff with residents to support them to make decisions. Spectrum has a policy and Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 10 procedure on the assessment and management of risk. Risk assessments provide direction on how residents’ choices and preferences can be met safely – an example would be how one resident is supported to enjoy trampolining. Other risk assessments provide specific individual directions to staff for managing, for example, a missing resident. During the day, staff were providing residents with information, assistance and communication support to make decisions. Residents said that staff were helpful in supporting them in making decisions, for example about activities and shopping. The preinspection questionnaire notified those residents for whom a Spectrum representative acts as appointee for benefits purposes. The pre-inspection questionnaire also stated that two residents have outside advocates. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 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) These standards will be included in the unannounced inspection later in the year. EVIDENCE: Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 12 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, 20 The arrangements for providing personal support to residents and for meeting their healthcare needs are satisfactory. The policies and procedures for dealing with medicines do not fully protect residents. EVIDENCE: The residents at Penrose Farm, in the main, manage their own personal care. Where required, staff provide prompting and not direct assistance. Residents disclosed that they were able to follow their preferred routines. Times for getting up can be linked to activities, for example attending college. There are individual agreements for residents linked to their risk assessments and care plan. A recently admitted resident discussed how he was ‘quite happy with it’. He was happy with the accommodation; the staff were nice, good at their jobs and helped him out. A resident went to the hairdresser on the day of the inspection and chose a new hairstyle. Case tracking the records of a resident showed that his healthcare needs were reviewed and addressed. There were detailed directions and information for staff in the care plan, daily logs and evidence of regular contacts with GP, consultant and clinical specialist. There was evidence of appointments for dental and optical services. The registered manager stated that the arrangements for medication are to be changed to the monitored dosage system at the end of the week. The current Spectrum policy and procedure on the handling of medicines does not cover all Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 13 the areas identified in the standard. The manager has an additional procedure note for staff, but this also lacks some areas. Medication is stored in a lockable filing cabinet. This is not a suitable or adequate storage facility given that one specific controlled drug is being stored. The provider should install a controlled drug cabinet of the required standard. Staff receive training in basic competence in handling medicines at induction, but this is not a certificated course in the safe handling of medicines provided by a suitably qualified provider. However, staff receive training and thorough guidance in the administration of ‘ emergency’ medicines for the treatment of seizures. The manager and deputy have introduced the checking and signing of the transcribed medicine administration record and updated the staff signature list as required in the last inspection report. The former measure will be superseded by the introduction of the monitored dosage system. The manager and deputy record a weekly audit of medication stocks and have satisfactory procedures in place for the ordering, receipt and checking of medicines and auditing stocks. A check of a controlled drug showed that the stocks agreed with the records. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 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 The systems for listening to the views of residents are satisfactory. The arrangements for adult protection do not fully protect residents. EVIDENCE: The complaints procedure complies with the standard and regulations. One complaint has been received and responded to in the last year. It is recommended that the provider maintains a record to hold all complaints and compliments received. There are regular residents’ meetings to discuss the running of the home. One resident stated that she had no concerns about any issues at present, but she had confidence in the manager and staff. Residents appeared relaxed when with staff and interactions were appropriate and facilitative. The Spectrum adult protection policy and procedure is being reviewed. It needs to state clearly that all concerns and allegations about the abuse of a vulnerable adult must be referred to the social services department. Spectrum staff should not begin adult protection investigations but follow local multiagency procedures. Staff have signed to confirm that they have read the current policy and procedure. The registered manager has a copy of the local multi –agency adult protection procedures and holds copies of the procedures for other authorities who sponsor residents. Staff receive training in adult protection during induction, but have not received consistent refresher training. However, the registered manager reported that he and the deputy will be attending a course in the protection of vulnerable adults which they will cascade to other staff, and staff will soon be attending the local multi-agency training in adult protection. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 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) These standards will be included in the unannounced inspection later in the year. EVIDENCE: Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 16 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, 34, 35 and 36 The staff team is effective in supporting residents, but the arrangements for training and personal development of staff need reviewing and developing to ensure that the individual and joint needs of residents are met. Recruitment practice protects the well being of residents. EVIDENCE: The home has recently expanded from providing accommodation to four residents to six. This has resulted in the influx of a number of new staff. The registered manager stated that, before this, the home was meeting the standard for at least 50 of staff to be qualified. He expects that current training will re-establish the 50 level of qualification very soon. Six out of sixteen staff have an NVQ level 2 in care; two staff have completed their NVQ level 2 but have not received certificates; one more staff is due to finish very soon. Further staff will be registered for NVQ level 2 in due course. The staff roster showed a staffing level of six or seven staff to six residents. At night there is a waking member of staff with one sleeping in on call. The roster identifies which staff will be working principally with each resident. This level of staffing allows for the day to day running of the home, activities and one to one work with residents, and the management and administration of the home. Staff turnover has been low in the last year. There are no staff aged eighteen or below. There are regular recorded staff meetings. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 17 The recruitment records for three recently appointed staff, accessed through the computer link to head office, demonstrated that the standard application form, with criminal record and health declarations, had been submitted, identification confirmed, and two references, a Criminal Records Bureau Disclosure and copies of relevant certificates obtained. There are standard job descriptions and person specifications. The registered manager had been involved in the recruitment and selection process. Staff receive a statement of terms and conditions. All staff at Penrose have a training and development profile which detail individual training records. There is an initial four-day induction at Spectrum head office. The induction is then continued in the care home. A recently appointed member of staff reported that the induction was very informative and pitched at the right level, including training on policies and procedures, and good training on health and safety and record keeping. She had found the manager and deputy very supportive during her induction at the home. In relation to other required training, the current training systems do not evidence consistent refresher training for staff in health and safety, food hygiene, handling of medicines and adult protection. Spectrum has recently provided the commission with its new training plan and detailed information on systems for assessing and meeting the training needs of staff in the future. The implementation of this training plan should ensure the provision of adequate refresher training for staff in the identified required areas. The manager and deputy have started to provide staff with regular recorded supervision. This needs to be at least six times a year. We discussed the different forms that supervision can take. The provision of regular supervision to staff will be reviewed at future inspections. Staff reported that they felt well supported and received effective informal supervision. They had confidence in the registered manager. Spectrum does not currently have a system for annual staff appraisals. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 18 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, 41 and 42 There are a small number of regulatory issues which require addressing, but the home is, essentially, well run. The record keeping generally safeguards the rights and best interests of the residents. The health and safety, and wellbeing of residents are promoted. EVIDENCE: The registered manager reports that he has three units to complete for his registered managers award. He plans to complete this well before 31 December 2005. He exceeds the experience requirement. There are a number of systems for quality monitoring. These include monthly recorded visits by a Spectrum manager, as required by regulation 26, a questionnaire for residents and their families and other stakeholders, threemonthly residents’ meetings and the monthly report that the registered manager is required by internal procedures to submit to head office. The manager and deputy reported that the format for recording each resident’s Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 19 views for their regular review is being revised, and the team reviewing policies and procedures includes service users. Work is in progress to make available a summary of the outcomes of the quality monitoring processes. The staff records sampled complied with Schedule 2 to the regulations. The residents’ records sampled complied with Schedule 3 to the regulations. The roster, visitors record, accident record and records of fire drills were also in place. However, the new accident record compatible with the Data Protection Act is not yet in use. Monthly visits by a supervising manager required by regulation 26 appear to be taking place; records of these visits are not being consistently submitted to the commission. The pre-inspection questionnaire detailed required maintenance and safety records. A check on the original documents for a sample of these showed them to be satisfactory. Spectrum provides corporate policies and procedures on health and safety and draws up detailed risk assessments for residents. The fire risk assessment has been drawn up and was approved by the fire service at registration. The records show regular required tests of the alarm system and emergency lighting. Fire procedures are posted at points in the building. There are records of monthly drills for staff and residents. No obvious health and safety risks were detected during the inspection, other than two chairs in the office which do not comply with the Display Screen Equipment regulations and are generally unsuited to their purpose. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 20 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 3 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 2 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 x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x 3 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Penrose Farm Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x 2 3 x D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20 Regulation 13 Requirement Timescale for action 31.10.05 2. 36 18 3. 39 24 4. 35 18 A single medication policy and procedure must include the ordering, receipt, storage, administration and disposal of medicines. (This requirement has been amended from the last report as some elements of the previous requirement have been met.) The registered person must 31.12.05 arrange for regular staff supervision to take place at least six times a year. (Renotified requirement, previous timescale has not been met.) The registered person must 31.10.05 make available to current and prospective residents, and their representatives the outcomes of quality assurance processes. (This requirement has been amended from the last report as some elements of the previous requirement have been met.) Staff must receive training 31.12.05 appropriate to the work that they are to perform. This must include refresher training in food hygiene, health and safety, first aid and the safe handling of medicines. D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Penrose Farm Page 22 5. 41 26 6. 23 13 The registered person must arrange a monthly visit in accordance with regulation 26 and supply a copy of the report to the home and the commission. The adult protection procedure must direct staff clearly to follow local multi-agency procedures and report all incidents and concerns to the social services department. 31.10.05 31.10.05 7. 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. 3. 4. Refer to Standard 7 20 23 42 Good Practice Recommendations Staff should sign the daily logs for each resident. A specific suitable storage facility should be used for controlled drugs. The registered person should review the training provided for staff on adult protection. The registered person should review the safety and suitability of the two chairs in the office. Penrose Farm D52-D04 S41536 Penrose Farm V232398 190705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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