Inspection on 13/03/08 for Smugglers Barn

This inspection was carried out on 13th March 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Smugglers Barn 21/11/06

Smugglers Barn 22/02/06

Smugglers Barn 16/08/05

Smugglers Barn 06/01/05

Smugglers Barn 20/07/04

Smugglers Barn 13/01/03

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

CARE HOME ADULTS 18-65 Smugglers Barn Snow Hill Crawley Down West Sussex RH10 3EF Lead Inspector Niki Palmer Unannounced Inspection 13 March 2008 10:00 th Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 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 Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 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. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Smugglers Barn Address Snow Hill Crawley Down West Sussex RH10 3EF 01342 719162 01342 719162 smugglersbarn@consensussupport.com www.caringhomes.org Consensus Support Services – part of Caring Homes Group Limited Vacant Care Home 4 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) Category(ies) of Learning disability (4) registration, with number of places Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2006 Brief Description of the Service: Smugglers Barn is a registered to accommodate up to four people with learning disabilities aged between 18 and 65 years of age. It was first registered with the CSCI in October 2002. The home’s literature states that it aims to provide a high standard of care to people with additional care needs such as Autism, Aspergers Syndrome, emotional problems and challenging behaviour. The Registered Provider is Consensus Support Services who are a division of Caring Homes Group Limited. The Responsible Individual is Miss Sylvia Lee. Mrs Caroline Robins has recently been appointed as the Manager in charge of the day-to-day running of the home, although is not as yet registered with the CSCI. The property is an attractive detached house in a rural setting, set in enclosed grounds on a site of approximately four acres. It is close to the village of Crawley Down and within easy travelling distance of Crawley and East Grinstead. All rooms are for single occupancy and are located over two floors. A cat lives in the home, and within the grounds there is a stable block, yard and fields that house a variety of farm animals, including hens, goats and pigs. The animals and a vegetable garden are cared for on a daily basis by the staff and residents at Smugglers Barn. Car parking is available at the home. There is also a second care home in the grounds that houses five residents known as Little Smugglers Barn. They are two separate homes and are inspected separately by the CSCI. The home provides personal care and support to residents who are funded by Social Services. The home’s fees as of 13th March 2008 ranged from £1727.88 to £1969.33 per person per week. Written and pictorial information regarding the services and facilities provided at the home are available on request from the home. Further information can be found on the organisation’s website. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Smugglers Barn will be referred to as ‘residents’. This unannounced inspection took place on Thursday 13th March 2008 and lasted just over 6 hours. This enabled to Inspector to observe the daily routines within the home and meet and talk with three residents and four members of staff. Four male residents were living at the home on the day of the inspection, aged between 25 and 53 years of age. The first part of the inspection was facilitated by the acting Deputy Manager, whilst the latter part of the day was spent with the appointed Manager. Three bedrooms, all communal areas and the grounds were seen. Two care records were looked at for the purpose of monitoring care. Other records and documents seen include: the home’s Statement of Purpose and Service Users’ Guide, medication procedures, complaints procedure and the systems in place to safeguard people from harm, staff recruitment checks and the provision of training, the home’s quality assurance systems and some health and safety records. An Annual Quality Assurance Assessment (AQAA) was completed by the appointed Manager and returned to the CSCI prior to the inspection. This gave the service the opportunity to say what the service does well, identify any barriers to improvements that have been faced over the past 12 months and how the service plans to make improvements within the next 12 months. A number of their comments have been reflected throughout this report. What the service does well: Smugglers Barn is a well managed service that is run in the best interest of residents. The recently appointed Manager is skilled and efficient in providing clear direction to the staff team in order to meet the needs of residents. The organisation have been innovative in making sure that the Service Users’ Guide is presented in an easy to read and understand format, which incorporates the use of colour pictures, symbols and photographs. This helps to make sure that information about the home is meaningful and interesting to residents. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 6 The staff take on board any comments or concerns that residents may have and make sure that prompt action is taken to rectify the matter as quickly as possible. This has resulted in worn carpets being replaced in the downstairs hallway and on the stairs. Residents lead busy and active lifestyles and are supported to make excellent use of local community facilities and take part in a number of different meaningful activities. Residents are supported and encouraged to maintain important friendships and relationships with others. The home is good at monitoring and reviewing what they are doing and to identify areas of strength and areas that need improvement. This helps to make sure that residents receive a high standard of care and support from the home. Most care staff have worked at the home for a reasonable length of time and have therefore got to know each resident well. Staff interactions were observed to be very good throughout the inspection. All residents were spoken with in kind and respectful manner and their responses clearly listened to. It was evident that positive relationships have been formed between them. What has improved since the last inspection? What they could do better: No requirements have been made as a result of this inspection, as the Manager rectified two matters that were raised on the day of inspection in respect of door wedges being used and unguarded radiators. Two recommendations have been made: The staff team should consider different ways in which they can empower and support residents to manage their own medicines and handle their own finances based on individual risk assessments. This would help to empower residents and help them to work towards achieving their personal goals, wishes and aspirations. Clearer guidelines need to be in place for all medicines that are prescribed on an as and when required basis (PRN). This will help to support staff in determining when such medicines should be given. All handwritten entries on medication administration records should be countersigned by a second person. This will help to ensure that the correct medication, time and dose are recorded. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 8 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 Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can visit the home and get full, clear, accurate and up to date information about whether the home can meet their needs and expectations. The home has good systems in place to make sure that no person moves into the home whose needs cannot be met. EVIDENCE: The home has a detailed Statement of Purpose and Service Users’ Guide in place, both of which have been recently updated. The Statement of Purpose provides the reader with an introduction to the organisation, details of the appointed Manager, the number, relevant qualifications and experience of staff working in the care home and overall service provision. The Service Users’ Guide is presented in an easy to read and understand format. It includes information in respect of the accommodation, the arrangements for residents to engage in social and leisure activities, the systems in place for dealing with concerns or complaints and the arrangements for making sure that residents’ needs are identified, met and regularly reviewed. In addition it makes clear what the processes are for moving into and out of the home and the role of the CSCI. Both documents are on display in the sun lounge area of the home. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 10 Each of the residents have lived at Smugglers Barn between 3 and 5 years (two since the home first opened). Staff commented: “The compatibility of residents is good, although they all have very different and individual needs”. They explained that on occasions, conflict can arise between some of the residents, however it must be noted that the home works well using strategic guidance to make sure that a harmonious environment is maintained. Albeit that there have been no new admissions to the home for some time, the Manager was able to describe in detail the arrangements in place for assessing all prospective residents in order to ensure that the home could meet their needs and that they would be compatible with others. She explained that all initial referral queries would be dealt with by staff at head office and that new prospective residents would be given the opportunity to visit the home prior to moving in; this could involve staying at the home for a day, overnight or several shorter visits. Details of the home’s pre-admission assessment procedures are outlined within the home’s Statement of Purpose and Service Users’ Guide. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported well by the home’s comprehensive care planning procedures. The ethos of the home promotes the rights of residents to make choices in all aspects of their lives to the best of their abilities. EVIDENCE: The Manager explained that the home has been working hard to update all personal care records in line with person centred planning in consultation with residents. Each person has two care files in place; the first provides care staff with a personal pen portrait and overview of the person and their likes/dislikes and care needs, whilst the second file is more comprehensive and covers areas such as risk assessments, behaviour management guidelines, healthcare needs and daily records. Both records seen were noted to be reasonably well detailed with evidence of regular review, although some long-term goals had been set that were not necessarily important to that person (e.g. learning to Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 12 use a handkerchief to wipe his nose). Whilst clearer, more achievable goals such as learning to manage their own finances and to manage their medication more independently had also been identified, it must be noted that there was little evidence to show that staff are thinking of creative ways in which to support these processes. Person centred reviews take place on a six monthly basis. This gives the individual and their carers the opportunity to focus on the achievements of the last six months and to plan goals for the next six months. Residents confirmed that they are involved in the planning of these meetings and are asked whom they would like to invite (or not). Most reviews take place at the home, but can be arranged elsewhere based on individuals’ personal choice and preference. Residents talked openly with the Inspector about how the staff team support them to make individual choices and decisions. They said that are given the choice of activities that they wish to take part in (or not), what food they would like to buy and eat and where they would like to go on holiday and who with. They explained that that they are kept informed about any changes within the home that may affect them through regular house meetings. Whilst all residents have individual risk assessments in place for most activities of daily living, the home should consider ways in which residents can be empowered and supported to take more responsible risks in order to promote their independence e.g. being more involved in managing their own medication and in handling and looking after their own monies. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in a wide range of activities to lead fulfilling lives, meet their needs and ensure their personal development. Residents play an active and fulfilling role in their community and maintain positive relationships with family and friends. EVIDENCE: It was evident throughout the inspection that residents lead a varied and busy lifestyle. The organisation owns a nearby working farm (Tandridge Hill Farm), which residents are supported to work on some weekdays. In addition to this some residents choose to attend local colleges and study subjects such as IT, arts and crafts and cooking and help to look after the animals kept at Smugglers Barn. Residents can choose to stay at home should they wish. Residents explained that one day a week is allocated as a ‘daily living skills day’. This offers each person the opportunity to receive 1-1 support from their Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 14 key worker to undertake some domestic chores such as cleaning their bedroom and attending to laundry duties followed by shopping for personal items, lunch out and/or just taking it easy at home (watching TV, videos/DVD’s, playing on the Playstation etc.). Weekly planners for each person were seen on display in the home’s dining area and in care records. Although the home does have access to it’s own vehicle, residents said that they encouraged as much as possible to use public transport. Staff explained that one person has been supported by care staff over a period of time to develop independence skills that enable him to use public transport on his own. Residents said that evenings and weekends are relaxed and generally very flexible. Some residents choose to stay with relatives, whilst others have the choice of taking part in a number of different leisure activities such as going to the local pub, having friends/relatives over to visit, going to church, swimming and visiting nearby shopping centres such as Crawley, East Grinstead and Brighton, carriage riding and going to local events such as the Gateway Club. Residents talked about a forthcoming Easter egg hunt that has been organised for them. Residents said that staff support them to go on holiday each year. Historically they have all gone to Center Parcs resorts together, but just recently at a residents’ meeting, one person said that he would like to go somewhere different and stay in a caravan. Staff said that they are in the process of trying to organise this. No holidays have as yet been abroad. Staff interactions were observed to be very good throughout the inspection. All residents were spoken with in kind and respectful manner and their responses clearly listened to. It was evident that positive relationships have been formed between them. The home has a cat, which residents are encouraged and supported to look after. Residents said that staff support them to plan the menu for the week. They explained that they go shopping with staff to the local supermarket to purchase the food and are encouraged to take part in meal preparation. In addition, they explained that they each take it in turns to prepare a meal for their housemates and staff throughout the week. All residents are encouraged to eat together with staff in the relaxed and pleasantly decorated dining area and help clear away afterwards. All residents spoke highly of the variety and provision of food. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive support from staff in the way they prefer and want and are supported to access a range of healthcare services to meet their individual needs. Residents are mostly safeguarded by the home’s policies and procedures for the safe administration of medicines. EVIDENCE: All residents are reasonably independent and therefore require minimal assistance with personal care, although one person did say that staff are always on hand to help if needed. All residents are registered with their own choice of GP and dentist and are supported to all healthcare appointments as necessary. Clear records of all healthcare appointments are kept. Input from the local Community Learning Disability Team (CLDT) is requested as necessary. Recent requests for referrals have included support from a Clinical Psychologist and Consultant Psychiatrist. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 16 One of the residents has epilepsy, which is generally well controlled with medication. He told the Inspector that he was recently invited to attend a training session for staff, which was facilitated by an external trainer, which he found very interesting and empowering. Staff said that as a result of this training, they are keen to learn more on the subject and request a referral to an Epilepsy Specialist Nurse in order to have an up to date review. Guidelines for staff to follow in the event of a seizure occurring were in place. Emergency medication has been prescribed by the GP in the event of a prolonged seizure occurring, although staff have not received any training in it’s use. The Manager confirmed that this will be addressed as a matter of priority. The home’s medication records and storage systems were seen. The home uses pre-packed blister packs issued by the local pharmacy, which are easy to use and monitor. Staff confirmed that they received medication training during their induction period to the home and that refresher training has been booked for later this month. The Manager said that she is currently developing an assessment tool that can be used to reassess staff on a regular basis. At present, no residents are able to self-administer their medicines, although discussions with staff highlighted that one person possibly could. How this could be supported was discussed at length with the Manager on the day of the inspection. Whilst medication administration records (MARS) were mostly sufficient and there was evidence to show that all medicines are dispensed, administered and signed for by two members of staff, two minor shortfalls were identified: - Some residents are prescribed medication on an ‘as and when required’ basis (PRN). Whilst guidelines were in place for some of these, the Manager must make sure that clear guidelines are in place for all. - On some occasions e.g. when residents are prescribed short-term prescriptions such as antibiotics or topical creams or medicines are discontinued, care staff handwrite these changes on the MARS. In order to reduce the risk of human error, it is recommended that all handwritten entries be countersigned. This will help to ensure that the correct medication, time and dose are recorded. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others can be assured that the home will listen to and act upon any concerns or complaints they may have. The home has good systems in place to protect people from harm, neglect and abuse. EVIDENCE: The home has a detailed complaints procedure in place, which is included within the home’s Statement of Purpose/Service Users’ Guide (in a simplified pictorial format) and is on display in the sun lounge. It gives clear guidance with regards to how a complaint can be made and how the complainant can expect it to be dealt with. No complaints have been received by the CSCI since the last inspection. All of the residents and staff spoken with said that any concerns (no matter how minor) are usually raised at that time by one of the residents, or at one of the regular residents’ meetings. The home keeps a record of all complaints received. It was pleasing to note that a resident was encouraged and supported by staff to write a letter of complaint in respect of the carpet in one of the communal areas. The home has a detailed Safeguarding Vulnerable Adults and whistle-blowing policy and procedure in place in accordance with local multi-agency guidelines. Staff said that recent training has been provided by the organisation and that they would feel confident in reporting any concerns of suspected abuse and Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 18 poor practices within the home. No alerts have been raised since the last inspection. Three residents have their own bank accounts, which they are supported to access by staff. The Deputy Manager explained that the home is currently in the process of supporting the fourth person to set up their own account, although some difficulties have been encountered, which the home are currently trying to resolve. All residents’ personal money tins are stored in the staff office. Through discussions with staff and residents, it would appear that this decision has been based on historical reasons as opposed to individual needs, choices and wishes. As already mentioned, some residents have expressed a wish to learn to look after and manage their own monies. How the staff team could support this process was discussed in length on the day of inspection. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Smugglers Barn offers a friendly and relaxed environment that is kept in good decorative order. It presents as a clean, well maintained and homely place to live. EVIDENCE: Smugglers Barn is a large detached older style house (some areas are over 300 years old). Accommodation is provided over two floors. It is surrounded by its own gardens and in addition has a large area designated to car parking. Communal space is plentiful, consisting of lounge, kitchen/diner, office and conservatory that is also used as an activity room. The property is sitting on four acres of grounds and farm buildings. All rooms are for single occupancy with two having en-suite facilities. Three of the residents kindly showed the Inspector their rooms. It was evident that residents have been involved in choosing their own furniture, accessories and décor. All residents have their own TV, video and stereo equipment in their Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 20 rooms. There are a number of photographs displayed throughout the home of each of the residents, all of which have been nicely framed and presented. In addition, residents’ artwork is proudly displayed throughout. Since the last inspection some areas of the home have been redecorated and new laminate flooring has replaced the worn carpet in the downstairs hallway and on the stairs. Residents said that they are responsible for keeping their own bedrooms clean and tidy although care staff tend to make sure that the communal areas are well maintained. Residents and staff said that the organisation employs a ‘handy person’ to make sure that any faults, repairs or maintenance issues are dealt with fairly quickly. Whilst all areas of the home were noted to be clean and hygienic on the day of inspection, some concerns were raised in respect of door wedges being used to wedge open fire doors in some areas of the home and unguarded radiators. These matters are further discussed under the Conduct and Management section of this report. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a knowledgeable and well trained staff team who know each of the residents well. The staff team are supported by the Manager to provide consistent and flexible care through regular supervision and staff meetings. EVIDENCE: Rotas confirmed that the home employs a total of nine care staff in addition to the appointed Manager. Only two of the care staff have achieved NVQ Level 2 in care, although some are currently working towards this qualification. The Manager is aware of the need to make sure that at least 50 of staff are trained to this level. Due to the sometimes challenging nature of the work environment, all staff are employed as Senior Support Workers. The staff team is relatively stable and many have worked at the home for a number of years. It was evident throughout the inspection that staff have developed positive relationships with each of the residents. Feedback from residents was also very positive. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 22 Agency and ‘bank’ staff (temporary workers) are used on occasions to cover annual leave and staff sickness, but the Manager explained that they tend to only use people who have worked at the home before and are known to the residents in order to maintain a degree of consistency and familiarity. There are usually three members of staff on shift. Shift patterns are split into early shifts and late shifts. Staff said that their working hours need to be flexible in order support residents in their chosen daily activities. There is always one waking night and one sleep-in staff on duty at night. All staff spoken with were very positive about working for the organisation and said that a good level of training is offered. Individual training needs are identified through regular staff supervision sessions. Recent training includes: Safeguarding Vulnerable Adults, First Aid, food hygiene, fire training and epilepsy. Staff commented that the appointed Manager has recently been ‘tapping into’ additional free training in the local area. Some staff are recruited through employment agencies (or begin by working at the home whilst working for the agency). Most job adverts are placed in local newspapers and job centres. All initial information is sent out directly from the home. Two staff recruitment files were seen, which confirmed that all the necessary checks are undertaken including satisfactory police checks and written references prior to any person starting work at the home. The Manager said that she has begun to involve residents in the recruitment and selection of staff. The Manager explained that the organisation is in the process of reviewing their induction programme. This will be e-learning in line with Skills for Care Common Induction Standards. The home’s progress with this will be followed up at the next inspection. Staff confirmed that they receive regular supervision from the Manager. Records of these were seen on the day of inspection, although the contents were not read. Staff said that regular staff meetings are held, which they find to be useful and informative. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A skilled and experienced Manager provides clear direction and support to enable the staff to provide a high standard of care to residents. Both residents and staff benefit from a well managed and organised home. EVIDENCE: The previous Registered Manager of the home, who was in day-to-day charge since the home first opened, left the service in July 2007. Since this time Caroline Robins has been ‘acting up’ from her Deputy Manager’s role and has recently been successful in her application to become the appointed Manager. She has over six years experience of working with people with learning disabilities and has achieved NVQ Level 2 in Care and is due to complete Level 3 in the very near future. She explained that she is also due to start working towards a City and Guilds Diploma in Learning Disabilities and then complete her Registered Manager’s Awards (RMA). She was knowledgeable Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 24 about the needs of the residents and feedback from staff and residents about her management style was very positive. One person said: “I have to sing her praises… she’s been great” She is in the process of submitting an application to the CSCI to become registered as the Manager, although is due to go on maternity leave in June 2008. It is anticipated that her recently appointed Deputy Manager will take responsibility for the management of the service in her absence. The home has a good quality assurance system in place to monitor what they are doing and to identify areas of strength and areas that need improvement. The home’s AQAA stated that they do this through regular 1-1 meetings with residents, residents’ house meetings and feedback questionnaires from relatives and other health and social care professionals (although feedback from others has not been sought since 2006). In addition, the Responsible Individual visits the home on a regular basis to meet and talk with residents and staff and do ‘spot checks’ on the premises, care records, incident/accident reports, complaints and the provision of daily activities. The home’s AQAA was returned to the CSCI before the date it was due. This is because the Manager had been working on it and updating it at regular intervals. It gave an accurate, open and honest account of how the service is performing. Feedback from residents indicated that they do feel the home is run in their best interests. Whilst the home was mostly found to comply with health and safety regulations, two shortfalls were noted which were raised on the day of inspection: - No radiators within the home were covered or protected to safeguard residents and staff from burning themselves. Although staff said that they were regulated, on closer examination some regulators had been broken, which is why two of the radiators in the lounge area were found to be very hot. There were no risk assessments in place for these. The Manager promptly contacted the maintenance department and requested that radiator covers be provided throughout the home. The Manager confirmed in writing that this work had been completed within two weeks of the inspection. - The home’ own health and safety guidance states that no doors should ever be propped open, however it was of concern to note that door wedges were being used to prop open the staff office door and one person’s bedroom (both fire doors on the top floor). It also emerged through discussions with staff that the resident’s bedroom door was also being wedged open at night. The Inspector required that that the Manager with the Fire Safety Officer in respect Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 25 of this, although the Manager promptly contacted the maintenance department and requested that alternative fire safety devices be explored as a matter of priority. The Manager confirmed in writing that the appropriate fire safety devices had been fitted within two weeks of the inspection. It must be noted that the records for the monthly health and safety checks that are carried out by care staff stated that no door wedges were in use throughout the home and that all health and safety checks were good. This indicates that staff were not checking all areas thoroughly before signing to state that all areas were safe. This was brought to the attention of the Manager on the day of inspection. In light of the fact that the appropriate action was taken by the home in respect of health and safety matters, these have not been reflected as requirements of this report. Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 26 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 4 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Not applicable 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. Standard Regulation Requirement Timescale for action 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 YA9 YA20 YA23 Good Practice Recommendations That the home considers different ways in which staff can empower residents and support them to learn independence skills such as: - Being more involved in managing their own medication - Being more involved in handling and looking after their own monies. That clear guidelines are in place for all medicines that are prescribed on an as and when required basis (PRN). That all handwritten entries be countersigned on the medication administration records. This will help to ensure that the correct medication, time and dose are recorded. 2. YA20 Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Smugglers Barn DS0000031912.V359448.R01.S.doc Version 5.2 Page 29 - 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. 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