This inspection was carried out on 11th May 2010.
CQC found this care home to be providing an Adequate service.
The inspector found no outstanding requirements from the previous inspection report,
but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for adults (18-65 years)
Name: Address: Primrose Hill Farm Primrose Hill Farm Meadowsweet Road Kings Norton Birmingham West Midlands B38 9QW one star adequate service 11/12/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Donna Ahern Date: 1 1 0 5 2 0 1 0 Information about the care home
Name of care home: Address: Primrose Hill Farm Primrose Hill Farm Meadowsweet Road Kings Norton Birmingham West Midlands B38 9QW 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Catherine Dowe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care Through The Millennium care home 39 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 39 The maximum numbers of service users who can be accommodated is:39 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Learning Disability LD Date of last inspection Brief description of the care home Primrose Hill Farm is located in South Birmingham a few miles from Cotteridge Village. The home has been registered to provide a learning disability service for up to 39 younger adults. It is divided into seven separate houses. Six of the houses
Care Homes for Adults (18-65 years) Page 2 of 11 1 1 1 2 2 0 0 9 Brief description of the care home accommodate six people and one house is for three people. Central to the community there is a 14th century farm house and barn. The barn is currently undergoing interior renovation and when completed will be a community centre with planned activities. The farmhouse has been converted into offices and a training room is available.The community is fully enclosed by fencing with a gated entrance accessible via an intercom system. All houses have almost identical facilities including fitted kitchen, utility room, lounge and dining room with an additional seating area. All bedrooms are ensuite and are located on both ground and first floor level. To the rear of each house there is a small enclosed garden. There are extensive shared gardens. The houses are wheelchair friendly on ground floor level however there is no lift. It is the homes intention not to provide a service to people who are dependent on a wheelchair to mobilise. The fee level is not specified in the service user guide. This information can be sought from the manager. Individual fee details were contained in peoples care plans. Care Homes for Adults (18-65 years) Page 3 of 11 What we found:
The focus of inspections undertaken by the care quality commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This random visit to the home was undertaken by one inspector over one day. The home did not know that we would be visiting that day. Primrose Hill Farm consists of seven separate houses. There were ten people living in five of the houses. We looked around parts of all houses that were occupied. We spoke to six people who live there and three staff. We looked at care plans , risk assessments, staff training, recruitment records, complaints records and medication practice. The registered manager resigned in January. At the time of this visit the operations manager was acting manager. We were advised shortly after this visit that she would be leaving. The owners have put temporary management arrangements in place. A manager from another registered home within the company commenced as acting manager the week after this visit and we were informed that the managers position is to be recruited to. The six previously raised requirements were met and improvements had been made in some areas. However the overall picture remains of concern and indicates that this home is not being well run for the benefit of the people living there. We looked at three peoples care plans. Care plans tell us how people should be supported to meet their needs and acheive their goals. We saw that some progress had been made on improving two of the care plans so staff have the information they need to support people. One persons care plan we looked at was incomplete. Parts of their care plan and some of the risk assessments were not available for us to look at and could not be found by staff. We were told that different managers and staff had been involved with reviewing the care plan and information had been misplaced. We made an immediate requirement for the information to be located and available for staff to read and follow. The home met this immediate requirement and sent us copies of the documentation. The person has complex needs and also has behaviour that is described as difficult to manage. There were no proper behaviour management strategies in place. These would inform staff about supporting the person, reducing risks and keeping the person safe. We read entries in their care plan where physical intervention had been used to manage their behaviour. We saw entires with concerning use of inappropriate language by staff. We read recordings where people were refused drinks for being naughty. The recordings indicated that staff were not confident or consistent in how they were supporting the person and lacked knowledge and understanding of people with complex needs including autism. We were told that physical restraint is not used at the home but this contradicts what is recorded in the persons care plan. These incidents are reportable to us but we had not received any notifications about these. We were so concerned about what we saw and read that we made a safeguarding referral to Birmingham Social Services department the morning after our visit. A lot of the staff team are new to care work and require significant support and training so they are able to meet peoples needs. We looked at staff training records and saw that
Care Homes for Adults (18-65 years) Page 4 of 11 training on medication, fire, challenging behaviour, infection control, diabetes, manual handling had all taken place since our last visit. We found it difficult to get an overview of staff training as there is no staff training matrix or staff training plan showing planned training and updates. We were told that training on autism awareness is planned for June. However this is a one day general awareness day and does not explore the specifics of autism and how to support people. Staff require specific training in autism so they have an understanding of the people they support and the skills and knowledge to meet their needs and keep them safe. We were informed that all staff do a basic first aid course. We could not establish which staff had completed more advance first aid training and who was responsible for overseeing first aid arrangements in the home. We looked at staff rotas and saw that staffing levels vary. There are two to three staff on duty in three houses and two houses have one staff working. Rotas had been improved so we could see who was working in each of the houses. Waking night staff were in place in the houses where peoples needs required this. We were told that no agency staff are being used and staff work mainly in one house so people receive more consistent care. We saw that staff still have no built in time in their shift for a handover of information to take place. This is still reliant on staff turning up early for work which may mean that important information is not passed on. We looked at the recruitment records of a staff member who had recently been employed. All the required information was available including the persons criminal record bureau check (CRB). This should ensure that the homes procedures are robust and only staff who are suitable are employed. We received a complaint about the home and this was passed onto the manager to investigate using the homes procedures. We asked to look at the outcome of the complaint during this visit. The complaint was to do with staff conduct and there were issues to do with the well being of the people living there. We were told that part of the complaint had been passed onto the owners to investigate and records were not available of the outcome and the manager was not able to tell us what it was. We do not feel confident that the home has procedures in place for conducting their own investigations in a timely manner, recording the outcome of complaints and taking action to prevent any further occurrence. We looked at fire records in three houses. These were better organised and a system is in place for staff to do regular fire checks and tests. However we found in one of the houses the record of tests had not been recorded since March. We saw individual fire risk assessments in peoples files who we case tracked and these tell staff how they must support the person to keep safe in the event of the fire alarm being activated. We were informed the work to repair the fire doors so they shut properly had been completed as identified as required at our last visit. Some improvements have been made to medication practice. Staff have received training and we were informed that only staff who are competent give out medication. We observed medication being given to people. The staff member checking and dispensing the medication signed the medication administration record (MAR) but did not give the medication to the person. This was done by the second staff member who was observing. This procedure does not follow medication guidance and does not ensure that people
Care Homes for Adults (18-65 years) Page 5 of 11 receive their medication safely. We looked around the houses that were occupied and these are generally well maintained. We were concerned about the condition of one persons bedroom. The walls were damaged and the carpet was heavily soiled. We were assured that work was about to take place to refurbish the room and ensure it was clean safe and comfortable for the person. We received confirmation that the work was completed within two days of our visit. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 7 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 20 13 Arrangements for the 30/06/2010 administration of medication must be improved. So people receive their medication safely and as prescribed. 2 22 22 There must be a robust complaints procedure in place. so people can be confident that their concerns will be listened to and aced upon. 30/06/2010 3 23 13 The home must review its physical intervention policy and procedures and ensure staff follow the policy. So peoples rights and interest are protected in accordance with department of health guidance. 30/06/2010 4 23 37 Incidents impacting on the 30/06/2010 well being of people must be reported to CQC. This is a legal requirement so Care Homes for Adults (18-65 years) Page 8 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action that incidents can be monitored. 5 23 12 Management plans must be in place for people who present difficult to manage behaviour. So risks are reduced and people are supported to feel safe and behaviours reduced. 6 35 18 Staff must have training to meet the indiviual needs of people. So they have the knowledge and skills to support people and meet their individual needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 30/06/2010 31/07/2010 1 2 3 6 9 33 Care plans should be further developed so that a detailed plan is in place that includes people preferences. Risk assessments should be developed so that risks to peoples safety are well managed. Consideration should be given to recognising the importance of staff handover between shifts and building this into the shift pattern. Ensuring that important information is passed on. A staff training matrix for Primrose Hill should be developed so that an overview of what has been achieved, what is outstanding and what needs up dating can be made. A risk assessment should be completed to assess the level of first aid training that is required across the site so that peoples health, safety and welfare is promoted.
Page 9 of 11 4 35 5 42 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 6 42 Fire records should be consistently maintained across all occupied houses so people are protected from the risk of fire. Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 11 of 11 - 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!
