This inspection was carried out on 10th October 2005.
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 there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.
CARE HOME ADULTS 18-65
Pound Farm Gorsley Ross-on-Wye Herefordshire HR9 7SL Lead Inspector
Jean Littler Announced Inspection. 10 October 2005 12.30 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. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Pound Farm Address Gorsley Ross-on-Wye Herefordshire HR9 7SL 019989 720546 01989 720188 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) Salters Hill Charity Ltd Mrs GH Sackett CRH 14 Category(ies) of LD Learning Disability 14 registration, with number of places Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: In addition to the registration information on the previous page the Condition below has been placed on the Homes registration. 1. Residents may also have a mental disorder or a physical disability, or a sensory impairment associated with their learning disability. Date of last inspection 8th March 2005 Brief Description of the Service: Salters Hill Charity, a charity set up to provide residential care for adults with learning disabilities opened Pound Farm in 1988. Salters Hill Charity Ltd has another care home in Herefordshire and runs another service in Gloucestershire under the Supporting People arrangements. Pound Farm provides a service to 14 adults whose primary care needs arise from learning disabilities. Some people using the service also need care and support due to physical or sensory impairment or intermittent mental health needs. The emphasis at Pound Farm is on the people who live there playing an active role in the day-to-day life of the Home, ongoing learning and skill development and on enjoying a full and active life. The accommodation is provided in a farmhouse style house and adjoining barn. The buildings are linked by a covered walkway. The extensive grounds are used to grow vegetables and keep farm animals. Involvement in the care of the garden and the animals is an important element in the Home’s statement of purpose which indicates that prospective service users need to have an interest in this type of lifestyle. A small day care service is also offered to people who live at another of the groups homes and in the local community. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out on a week day afternoon between 12.30pm and 3pm. The main purpose of the inspection was to see the progress of the major restructuring of the premises that is taking place. Three service users were spoken with briefly. All seemed relaxed and two confirmed that they were enjoying the changes taking place in the Home. One was very positive about her new and larger bedroom. The manager assisted with the inspection process and explained during a tour of the buildings the overall plans and how the changes were being managed with the least disruption to service users. Information already known about the service, and communications between the service and the Commission since the last inspection were also considered as part of the inspection process. What the service does well: What has improved since the last inspection?
Major internal building work is taking place to increase the size of some service users’ bedrooms, provide more en-suite facilities and to provide more communal living areas so service users can live in groups of no more than four. The changes will allow the way the Home is organised to be much more person centred, for example service users will be supported by a smaller team of staff, hold their own medication in their bedrooms, and prepare some of their meals in small domestic kitchenettes. The planned changes have been under consideration for a long period and the way service users are being supported through these major changes is commendable. The way medication is managed has been improved through policy development and record keeping systems. The way service users’ support needs are recorded and monitored has been improved so the information is kept up to date and can accurately inform staff.
Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 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. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 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 Pound Farm E52 E02 S24729 Pound Farm V246287 101005 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) - EVIDENCE: The number of places the Home is registered for has been reduced to fourteen from sixteen as for some time the two double rooms have only been used as singles. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 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) 8. Excellent arrangements have been made to consult and involve service users in the changes to their home and lifestyle. EVIDENCE: Care plans and support records were not inspected, however the manager reported that changes to service users’ support needs are now being noted in the care plans as soon as they are recognised and staff action to meet them is agreed. It is positive that links are in place with the Herefordshire Person Centred Planning co-ordinator and the aim is to develop support plans with service users that are in a format they understand and can be fully involved in putting together. An independent advocate has been funded to work with the service users throughout the planning process. This support is still being provided as the changes are carried out. This external input has greatly benefited the service users and enabled them to understand what was being proposed and make genuine choices about their future home environment and who they share flats with. The pictorial displays were still up where service users had been able to place a picture of themselves, on Velcro, to show who they wanted to share with. Now the final groups have been agreed key staff are arranging regular group discussions where decisions are being made about furnishings and
Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 10 carpets etc. These have led to shopping trips to purchase personal and communal items. One service user had chosen to have her new large bedroom with en-suite painted pink. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 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) - EVIDENCE: These standards were not assessed, however the majority of service users were out at regular activities that form part of a timetable agreed with them. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 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) 19. Service users health needs are being appropriately addressed. EVIDENCE: The medication system was not inspected, however the manager reported that the medication management policy and procedures have been changed in line with the guidance given at the pharmacy inspection. Staff have not yet accessed the required additional training as all training providers are currently going through the process of being awarded formal accreditation. The manager rightly wants to ensure the training arranged is accredited so a new date has been agreed for this required action to be completed by. The manager continues to make efforts to arrange with the GP surgery for annual health checks to be offered to service users. Known health issues and current concerns are being addressed through links with relevant professionals. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 13 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) - EVIDENCE: No complaints have been received by the Commission about the service and no vulnerable adult concerns have been raised. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 14 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, 26, 27, 28. The layout of the Home is being significantly changed to make it much more suited to its purpose. Service users are being fully involved in this process and the changes will improve their quality of life. EVIDENCE: Building work is taking place to provide service users with larger bedrooms, more en-suite bathrooms, smaller more homely communal areas and kitchenettes. The work is being carried out in stages and service users are moving into the new rooms of their choice as they are being completed creating space for the next stage of work to go ahead. Some service users have had to move into rooms on a temporary basis to allow the cycle of work to take place safely. This has been managed well and service users have been fully involved in the planning of the process and the décor of the areas they will live in. The communal areas and bedrooms completed to date have been attractively furnished and decorated. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 15 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) 33. Suitable staffing levels are being maintained and more staff are being recruited in preparation for small group living. EVIDENCE: Efforts are continuing to recruit into the two part time vacancies that exist. Unfortunately two staff recruited did not take up the posts offered to them. Sufficient staffing levels continue to be maintained but the manager is aware that once the home is divided into small units more staff will be needed. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 16 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) 42. Health and safety arrangements are being well managed during the building process. EVIDENCE: The manager is liaising closely with the contactors and has regularly formally reviewed a risk assessment to ensure service users and staff are safeguarded during the building process. These risk assessments have been forwarded to the Commission and the Fire, Building Control and Environmental Health Authorities have also been consulted appropriately. There was no automatic door closure on the door of the new kitchenette in the main house. The manager agreed to consult the Fire Officer again to ensure suitable fire prevention measures are in place before the area is used. Other established health and safety checks are continuing as normal e.g. the servicing of fire equipment. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 17 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 x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x x 4 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 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 x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Pound Farm Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 18 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 YA20 Regulation 13 Requirement Staff handling medicines must receive accredited training. Timescale for action 30-4-06 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 YA42 Good Practice Recommendations Consult the fire officer before using the new kitchenette in the main house. Pound Farm E52 E02 S24729 Pound Farm V246287 101005 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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