Inspection on 12/01/06 for PIA - Barnfield

This inspection was carried out on 12th January 2006.

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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

PIA - Barnfield 18/06/07

PIA - Barnfield 04/07/06

PIA - Barnfield 14/07/05

PIA - Barnfield 26/01/05

PIA - Barnfield 22/06/04

PIA - Barnfield 12/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Pia - Barnfield Church Lane Gaydon Warwickshire CV35 0EY Lead Inspector Sheila Briddick Unannounced Inspection 12th January 2006 09:30 Pia - Barnfield DS0000004279.V277482.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 Pia - Barnfield DS0000004279.V277482.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. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Pia - Barnfield Address Church Lane Gaydon Warwickshire CV35 0EY 01926 640521 02476 640146 dbadger@people-in-action.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) People in Action Mrs Denise Badger Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Denise Badger must successfully complete the NVQ Registered Managers Award or a qualification equivalent to a diploma in management studies (NVQ 4) and a qualification equivalent to NVQ 4 in care by 1st July 2007. Denise Badger must inform the Commission for Social Care Inspection when she has achieved these qualifications. 14th July 2005 2. Date of last inspection Brief Description of the Service: The home is a large domestic bungalow in a small village setting, providing accommodation and care for 5 young adults who have severe learning disabilities and/or physical disabilities. South Warwickshire Primary Care Trust owns the property. People in Action manage the home. Two of the five bedrooms have en-suite facilities. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 12th January 2006 between the hours of 9:30 a.m. and 4 p.m. During this time the inspector had the opportunity to meet with the people living in the home and observe the interactions between service users, staff and their environment, tour the home and examine documents relating to the service users and the management of the home. The views of staff members were sought during the inspection process however service users were not able to give verbal feedback. What the service does well: What has improved since the last inspection? What they could do better: The people living in this home should have more opportunity to develop their independent living skills especially in meal preparation, making choices and other household activities. Medication management is steadily improving however attention is required in recording all carried over medication on MAR charts and ensuring that all written protocols for the administration of medicine to be given as required are signed and dated. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 6 The registered manager must develop a process for ensuring the ongoing competency of staff when administering medicine is regularly reviewed. The registered manager must also ensure that a copy of the Electric Wiring Certificate for the home is held on file and provide the Commission for Social Care Inspection with an action plan for the refurbishment of the kitchen area. Good practice recommendations were made regarding administration of medicine and quality assurance systems. 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. Pia - Barnfield DS0000004279.V277482.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 Pia - Barnfield DS0000004279.V277482.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 These standards were not assessed on this occasion. EVIDENCE: Pia - Barnfield DS0000004279.V277482.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): 7 and 9. Staff have a very good understanding of service user’s needs and this is evident from the positive relationships observed between the staff and service users. Service users however are not always given opportunity to make decisions regarding everyday choices. Risk management in the care plan review system now ensures that risks to service users reviewed as needs change and strategies updated. EVIDENCE: Examination of care plans during the visit showed that risks assessments are being reviewed on a regular basis and a record made of the outcome on the care plan. Risks to new service users coming to live in the home are being assessed during their trial period of living in the home and strategies put into place to prevent harm to them, this includes mobility and access around the home and personal care support. Staff spoken with demonstrated an understanding of the individual risks to service users and the ongoing assessment and observation that was necessary to ensure that new people living in the home could do so safely. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 10 Care plans clearly document the preferred needs and choices of service users and staff spoken with demonstrated a good understanding of these. There is evidence that object referencing is being used to support the decision-making process. Observation of care practice in the home at times however did not reflect the good care practice that has gone into developing communication methods and this was noted during meal times. Staff did not ask individual service users whether they wanted more toast at breakfast time, discussing this between themselves, rather than ask the service user and choices of food available were not visible to service users as the food was prepared away from them. Pia - Barnfield DS0000004279.V277482.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): 11, 13 and 17. The people living in this home continue to be supported to be part of the local community in which they live. Opportunity for service users to develop independence in daily living skills is not routinely promoted and this does not support their personal development. The meals in this home are good offering variety and catering for special dietary needs. EVIDENCE: The people living in the home were having breakfast at the onset of this visit and although appropriate support was being given to people to assist them with eating their meal, service users were not being supported to develop their independent living skills in food preparation. The breakfast food was prepared away from service users and brought to them, this was cereal and toast. Discussion took place with the staff on duty about promoting independent living skills by supporting service users to put cereal and milk in their own bowl, pour their own drinks and spread butter on their toast. Promoting independence rather than creating dependence was discussed with the registered manager who was aware of the need for continuing development in this area. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 12 Diary records were examined and life storybooks read. These show that service users are participating in a variety of activities in the community, which are structured to meet individual needs. There is a weekly activity programme on display and the staff were following this at the time of this visit. Activities enjoyed include swimming, theatre trips, going to wrestling matches, eating meals out and visiting local parks and other interesting venues locally. Steady progress is being made in opportunity for service users to participate in village activities with service users enjoying the local fete last year and participating by having a stall to sell goods. One service user enjoys a walk on a daily basis around the village. Menu records show that meals are well-balanced and nutritious, food prepared is always fresh and home cooking is promoted. Care plans show that dietician support and advice is accessed when necessary. Staff were seen to give appropriate and sensitive assistance to people who needed support when eating their food. Specialist equipment is provided and staff competency is monitored routinely and procedures to be carried out when people have to be fed artificially (P. E. G. feeding systems). Pia - Barnfield DS0000004279.V277482.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 20 The people living in this home are receiving personal support in the way they prefer and require. There has been significant improvement in the way medicine administration is managed in his home with further development to continue regarding staff competency and guidelines for staff to follow. EVIDENCE: During this inspection visit staff were seen to be sensitive and flexible when meeting the personal care support needs of the people living in the home. People were being moved safely both manually and with the use of hoists. The changing needs of people living in the home regarding their personal support are monitored closely and appropriate action is taken to meet changing needs. Staff are working closely with physiotherapists and occupational therapists to meet needs and records show that visits to the home by therapists is on a regular basis and responsive to urgent requests for support. Physiotherapists are also supporting staff in ensuring that skills and knowledge necessary for supporting people safely with light exercise programs are developed and maintained. Staff supporting service users were working with equipment that had recently been provided, and demonstrated a confidence when using the equipment and the service user appeared comfortable with the new equipment. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 14 Staff spoken with demonstrated an understanding of the importance of observation of service users preferences and concerns during this time to maintain the service users health and well-being. There has been an increase in staff cover of 10 hours a week so that the changing needs of people living in the home can be met. Times for getting up and going to bed are flexible to meet needs and the registered manager complimented the staff team on the sensitive manner staff are supporting and meeting personal care needs. There is a gender care policy in place and people living in this time have support from a mixed gender staff team. Requirements were made at the last inspection regarding administration of medicine in the home and only the components of standard 20 relating to these were assessed. Individual written protocols are now in place for all medication to be administered as when required; one of these however had not been dated and signed by the clinician. Homely remedies prescribed by the home’s GP have written protocols that have been developed by the registered manager following discussion with the GP. A good practice recommendation was discussed regarding the recording of the date this discussion took place so this can be reviewed on an annual basis or as needs change. All staff administering medicine are completing Distance Learning accredited training in the safe administration of medicine. The registered manager intends to monitor staff’s ongoing competency on a regular basis. Medication Administration Record (MAR) charts are colour-coded to correspond to the dosage card, this practice can result in the wrong medicine being administered to a service user as staff may not refer to the written prescription when administering, depending only on the colour-coded system. The preferred way of taking their medicine is recorded on the service user’s care plan and staff were seen to respect choices when giving medicine. The preferred choice of two service users is to take their medicine with food. Staff were observed to let the service users know and see the medicine with the food before it was given however good practice recommendations were made regarding having a discussion with the pharmacist about other options that may be available and the effects fruit may have on an individuals medicine. Pia - Barnfield DS0000004279.V277482.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): 23 There are policies and procedures in place to ensure that the people living in the home are protected from harm by the people supporting them. EVIDENCE: People in Action have established and effective policies in place to protect people from harm and maintain their well-being. All staff coming to work in the home access training in the Protection of Vulnerable Adults and training in Positive Approaches to Behaviours that Challenge and Positive Communication. There is significant evidence on care plans that the home is working closely with specialist services and consultants, including psychiatrists and psychology services when agreeing care plan programmes to meet specific needs. Effective and well-established policies and practices are in place regarding service users money and financial affairs and advocacy services are available when necessary to act as Appointees for service users. All incidents that affect the well-being of service users are routinely reported to the Commission for Social Care Inspection. Pia - Barnfield DS0000004279.V277482.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, 28 and 30 The environment is appropriate to the service users particular lifestyle and is comfortable warm and welcoming. The design and layout of the kitchen area does not promote the development of independent living skills. EVIDENCE: New worktops are now in place in the kitchen area and this supports effective cleaning procedures however the design and layout of the kitchen does not allow free access to service users for the development of independent living skills. The kitchen is a large area with one half partitioned off by kitchen units and the other half used as a dining area. There is one low working surface for a wheelchair user however many cupboards are at a height not accessible to all people living in the home or those using a wheelchair. Service users spend most of their time in the kitchen little of which is spent in the food preparation area. When spending their time in the kitchen service users are sitting at the large kitchen table or on the floor if they wish. Although the area is clean and in good order the area could be further improved through the provision of carpeting or soft furnishings. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 17 Some investment since the last inspection has taken place and bedroom carpets have been replaced and redecorating has taken place in bedrooms. Funding has been agreed for the refurbishment of the patio access to the garden so that this can be safer for service users to use. Pia - Barnfield DS0000004279.V277482.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): 34 and 35 The recruitment policy and procedure in this home is ensuring that service users are protected from harm by the people supporting them. Staff working in the home are being supported through an effective training and development programme to have the skills and knowledge necessary for the specific needs of the people living there. EVIDENCE: The registered manager ensures that copies of all documentation required during the recruitment process are maintained in the care home and this includes a copy of all Criminal Records Bureau clearance checks of staff working in the home. These were examined and found to be acceptable Staff have written guidelines to follow when supporting service users with light physiotherapy exercises and the PEG feeding system. Systems have been developed for ensuring that staff supporting these activities does so only after their competencies have been assessed by a nominated person with the appropriate skills and knowledge. The support of physiotherapy services has been sought as part of this process and in the ongoing monitoring of skills and knowledge of the nominated person. There continues to be an active NVQ programme and staff are completing the Learning Disability Award Framework, (LDAF) as part of induction. A staff member with some supervisory responsibilities is working towards achieving an NVQ at Level 3 and also accessing training in supervision. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 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 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, 39 and 42 The manager is supported well by the staff team and providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The home is developing effective systems for reviewing its performance and ensuring that the people living and working in the home are protected from harm. EVIDENCE: The registered manager continues to work towards achieving the Registered Managers Award and is enrolled on an NVQ Level 4 programme to start in March 2006. The registered manager has opportunity to take further training necessary for their role and responsibility as manager of the home and this has included risk management. A Quality Assurance folder is being developed by the manager and this was found to be in good order and up-to-date. The manager has identified a Business Plan for the year 2006 and this is based on the needs and aims and objectives of service users. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 20 A process for seeking the views of service users is being considered and it is intended that the viewers of family members will also be sought this year on the service provision. Alongside the quality assurance folder the registered manager is maintaining health and safety records. These also were up-to-date and in good order. Records evidence that safe working practice is promoted through provision of training for staff in moving and handling, fire safety, first aid, food hygiene and infection control. There are policies and procedures in place for the safe storage and disposal of hazardous waste, ensuring central heating systems and electrical systems, including electrical equipment, are well maintained and serviced on a regular basis. The current Electric Wiring Certificate for the home was not available on this occasion. Water temperatures are monitored weekly to ensure that temperatures are maintained close to 43°C. Fire safety management includes ensuring weekly testing of alarms, testing and routine maintenance of fire fighting equipment and regular fire drills are taking place. People in Action have produced a revised Health and Safety Policy and Procedure Manual. The manual is very comprehensive and provides information on appropriate monitoring systems to be used as part of risk management in the home. Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 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 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 X 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 2 X 3 X LIFESTYLES Standard No Score 11 2 12 X 13 3 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 2 x 3 X 3 X X 3 X Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 22 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 YA7 Regulation 12 Requirement Service users must be given opportunity to make everyday choices and this must include choices at mealtimes. Service users must be given opportunity to maintain and develop independent living skills and this must include, based on risk assessment, being actively involved food and mealtime preparation . Staff competency audits must be undertaken to demonstrate their ongoing competence in the administration and recording of medicines An action plan, including timescales for completion, must be forwarded to the Commission for the refurbishment of the kitchen area as part of making the facility appropriate to the needs of the people living in the home. The registered manager must ensure that a copy of a current Electric Wiring Certificate for the home is maintained on home records. Timescale for action 30/01/06 2. YA11 12 30/01/06 3. YA20 13 15/03/06 4. YA28 23 15/04/06 5. YA42 23 28/02/06 Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 23 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 YA20 Good Practice Recommendations It is recommended that the registered manager seek the advice of the pharmacist regarding the action, if any, fruit juices may have on medicine when they are taken together. It is recommended that the use of colour coding Medication Administration Records, (MAR) is discontinued. It is recommended that the registered manager record the date of when discussion took place with the GP regarding protocols for the administration of homely remedies so that this can be reviewed with him on an annual basis. It is recommended that is part of the quality assurance system the registered manager seeks the views of other professionals involved in the care provision. 2. 3. YA20 YA20 4. YA32 Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. Extracts may not be used or reproduced without the express permission of CSCI Pia - Barnfield DS0000004279.V277482.R01.S.doc Version 5.1 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!