Inspection on 16/08/05 for Smugglers Barn

This inspection was carried out on 16th August 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 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 13/03/08

Smugglers Barn 21/11/06

Smugglers Barn 22/02/06

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 RE10 3EF Lead Inspector Elaine Southall Unannounced 16 August 2005 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. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Smugglers Barn Address Snow Hill, Crawley Down, West Sussex, RH10 3EF 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) 01342 719162 THF Care Estates Limited Mrs Anne Carol Reakes Care Home 4 Category(ies) of PC Care Home only - 4 registration, with number of places Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 06 January 2005 Brief Description of the Service: Smugglers Barn is a Care Home registered to accommodate up to four people of both sexes between the ages of 18 to 65 years, in the category of Learning Disability. The home is privately owned by THF Care Estates Limited, and cares for people with Learning Difficulties, Autism, Aspergers Syndrome, emotional problems and challenging behaviour. The property is an attractive detached house, part of a barn conversion, set in enclosed grounds on a site of approximately four acres. A dog and a cat live in the home, and within the grounds there are a stable block, yard and fields which house a variety of farm animals, including chickens, goats and pigs that are cared for by the staff and residents at Smugglers Barn, together with a vegetable garden. The home is situated close to the village of Crawley Down, in a rural setting, but with easy access to the nearby towns of Crawley and East Grinstead. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 2.00pm. It took place over the next four hours. There are four long-term residents living at Smugglers Barn, all male. The Inspector spent time observing their activities: three were at home during the afternoon, the fourth returned from Tandridge Hill Farm, a THF daycare facility, later in the afternoon. She spent time with the staff members on shift, and interviewed two of them separately. A short tour of the premises took place and records were also examined. What the service does well: What has improved since the last inspection? The home gained the Investors in People Award in June 2005. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 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. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 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 Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 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) 2 & 3. Assessments of need are carried out to a commendably high standard. Written contracts are satisfactory. EVIDENCE: Case files contain full and detailed assessments of need, together with any relevant previous history/specialist reports. An Admission Profile is completed and the information gathered is used to develop an individual care programme. A written care plan agreement is signed by the resident, their Care Manager and the manager of the home. All assessments are very detailed and addressed individual needs with sensitivity and insight into the resident’s past life experiences. Care needs to be taken that all reports are signed and dated by the author. Before final agreement of a new placement a ‘Proposal of Care’ letter is sent to the placing authority which clearly states the specific detail of the individual care which will be provided at Smugglers Barn. A copy of their written contract is in the resident’s file. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 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) 6, 7, 8 & 9. Residents at Smugglers Barn are well supported in recognising and achieving their personal goals. They can make decisions about their own lives, and are actively involved in all aspects of life in the home. All activities are risk assessed. EVIDENCE: Care planning is carried out to a consistently high standard. Each resident has a set of specific guidelines for staff to use to meet individual needs. Residents sign their own care plan agreement. Care plans detail arrangements for all aspects of the resident’s life - including medical, financial, dietary, daycare/employment , hobbies and interests and known strengths and positive/negative behaviours. A skills assessment is completed, which looks at all areas of daily living, personal care and sexual knowledge/behaviour. The Working Care Plan is developed from these assessments, and specifies that: ”Service Users should be consulted as much as possible throughout their care plan and agreement reached with them on what skills to work on”. The Individual Area of Need Sheet specifies short and long term goals for each skill and details the support that will be given to help the resident achieve their target. Each sheet is signed by the resident and their keyworker. A weekly monitor sheet records the specific support that is given, and is used to review Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 10 the care plan each month. Formal reviews take place in the home every six months. The annual review notes completed by one resident’s social worker in May 2005 state “It’s only when one looks back can it be fully understood how […..] and the service have empowered and improved his life. …All involved have a common goal”. Every resident’s care plan includes a ‘Daily Living Skills Day’ when they stay at home and are supported in cleaning their room and doing their own laundry. On that day they choose the evening meal, and make a trip to the shops for the ingredients and any personal items that they need. Residents also work in the grounds of the home, gardening and caring for the animals. They are paid a wage for their work. A risk assessment is carried out for all activities and specific areas of individual need. Individual risk assessments are reviewed each month. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 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) 11, 12, 14 & 16 There are a wide range of activities provided for residents that promote their personal development and quality of life. Their rights and responsibilities within the home are appropriately addressed. EVIDENCE: Each resident has a weekly activity plan. All have a varied timetable and their days are full. Three attend a local college, where courses include music and rhythm, arts and crafts, woodwork, computers, and cooking. THF Care Estates has a farm at Tandridge where residents can develop work skills. Their achievements are assessed each year in a report completed for their annual review. Areas assessed include effort, motivation, task completion and attitude. On weekday evenings the residents attend local clubs where they can take part in such activities as sports, exercise, glass painting and treasure hunts. One evening in the home is a games night, and on Fridays everyone joins in the house shopping trip. Outings take place to the coast, picnics, bowling and the pub. Recently, trips have been made to a steam rally and an air show – one resident’s daycare notes record that he;…”enjoyed walking around, looking at Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 12 the aircraft and collected lots of leaflets.” A holiday at Center Parcs Longleat has been booked for September. Individual residents enjoy time in the sensory room, reading sessions, playing soccer box, cider nights and a six-weekly pampering day. The residents’ individual rights and responsibilities are a key factor of the care provided in the home. Each resident’s care plan and guidelines contain detail about their preferred name and choices about every aspect of their daily routine. An incident had taken place on the morning of the inspection that had been triggered by a difference in understanding about privacy and personal space between two of the residents. The incident report and discussion with staff showed that residents had been helped to think through their actions and their responsibility for the outcome. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 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 standard(s) 18, 19 & 20 Routines in the home are flexible, in order that guidance and support meets individual residents’ needs. Arrangements for healthcare are satisfactory. EVIDENCE: Resident’s choices in every aspect of their personal care and daily routines are detailed in their care plans. Daycare notes record the varying times that each resident gets up and goes to bed each day. They manage their own care needs with the support and encouragement of staff. Additional support is available when necessary from healthcare professionals. One resident receives regular visits from a Community Psychiatric Nurse based with the local Community Team for People with Learning Disabilities. Letters on file from a consultant Psychiatrist show how medication was recommended for this resident, who initially refused. He has recently said that he has decided that he will begin taking medication, and records show that his first dose was administered on the day of the inspection. All records of medicine administration are satisfactory, with two staff signatures, one on the administration sheet, and one on a witness sheet. Staff told the Inspector that two of the residents are self-administering their own medication in the evenings, under staff supervision. They showed the Inspector a tick chart for one resident which provides visual motivation for him Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 14 as one column is ticked each day that staff dispense the medication, and another when he does it himself. He enjoys the fact that he gets more ticks than the staff, and the chart shows the growth in the level of his responsibility. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 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 standard(s) 23 The welfare of residents is promoted, and they are protected from abuse. EVIDENCE: Staff guidelines for working with each resident give a clear picture of individual behaviour patterns. The Inspector was told that this means that; “Everyone’s aware of certain things to look for, before things escalate.” Very detailed behaviour charts are kept, that record any challenging behaviour, events that took place just before, and what happened as a result of the behaviour. Concern of Behaviour sheets record more serious events in detail. A member of the staff team told the Inspector that she feels that Smugglers Barn is:”…a challenging unit – but very rarely has challenging behaviour – we are doing so well”. Staff are trained in the protection of vulnerable adults and non-violent crisis intervention. Records of serious events are satisfactory and show that they are managed well by staff. Staff who spoke with the Inspector were clear about the home’s whistle blowing procedure. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 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 standard(s) 24, 28 & 30. Smugglers Barn provides well-maintained and attractive accommodation. EVIDENCE: Smugglers Barn provides a particularly high standard of accommodation. It is a character property, which has a comfortable and homely atmosphere. All areas of the home are well furnished and decorated. Standards of cleanliness are good. The gardens and grounds are features which add to the quality of life enjoyed by the residents. A cat and a dog live in the house, and the grounds are home to a group of farm animals, including rabbits, ducks, geese, pigs, goats and two newly arrived calves. With staff support, the residents take part each day in caring for the animals and enjoy making full use of their spacious and attractive surroundings. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 17 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 & 35 Staff at the home are well-trained and understand the needs of the residents. EVIDENCE: Staff files were not available for inspection. Staff on shift told the Inspector that they receive core training in Health and Safety, food hygiene, first-aid, fire safety, vulnerable adults and non-violent crisis intervention. In addition, they have attended specialist courses in Makaton, epilepsy, medication administration, autism, and managing challenging behaviour. Staff told the Inspector that there is always one member of staff on shift who is trained in the use of rectal valium. Staff told the Inspector that they receive a three-month probation, annual appraisals, and regular monthly supervision. They spoke of the strength of the team. Staffing levels are satisfactory. The Inspector observed that staff were always focussed on the needs of the residents, listening carefully to them. They acted at all times in a calm and containing manner, giving ongoing support and encouragement while enabling the residents to have personal space. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40 & 41. The home is managed well and run efficiently providing a safe and stable environment for the people living there. EVIDENCE: Staff spoke very highly of the management approach in the home, and the support they receive. They have benefited from the open door policy used by the manager, Mrs Reakes, and say that they feel that they belong to a “fantastic team”. The atmosphere is that of a “home from home” for staff and residents, and the relaxed environment reflects positively on the well-being of the residents. Monitoring visits are made each month on behalf of THF Care Estates, when residents at home are spoken with by the visitor. It should be noted that the last report received by the Commission was dated 26th May 2005. All of the written procedures seen by the Inspector were focussed upon the rights and best interests of the residents. The records kept in the home are of a high Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 19 quality and the systems used are operating well, with all key information easily accessible, and all files up-to-date and in good order. Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 4 x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 4 4 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 4 x 4 x 4 x Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Smugglers Barn Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 4 x x H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 21 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 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 Good Practice Recommendations Smugglers Barn H60-H11 S31912 Smugglers Barn V243850 160805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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