Inspection on 22/02/06 for Smugglers Barn

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 16/08/05

Smugglers Barn 06/01/05

Smugglers Barn 20/07/04

Smugglers Barn 13/01/03

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Southfields

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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 Mrs L Riddle Unannounced Inspection 22nd February 2006 12:15 Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Smugglers Barn Address Snow Hill Crawley Down West Sussex RH10 3EF 01342 719162 01883 742759 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) THF Care Estates Limited Mrs Anne Carol Reakes Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 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 provides personal care and support for people with Learning Difficulties, Autism, Aspergers Syndrome, emotional problems and challenging behaviour. The registered provider is Caring Homes Limited who have recently taken over ownership of the home. The responsible Individual is Miss Sylvia Lee and the registered manager in charge of the day to day running of the home is Mrs Anne Carol Reakes. The property is an attractive detached house in a rural setting, part of a barn conversion, 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 the towns of Crawley and East Grinstead. The home provides its’ own transport. A cat lives in the home, and within the grounds there is a stable block, yard and fields which house a variety of farm animals, including chickens, goats and pigs. These and a vegetable garden are cared for by the staff and residents at Smugglers Barn. There is also a second care home in the grounds which houses five residents and is also under the management of Mrs Reakes and known as Little Smugglers. They are two separate homes and are inspected separately by the Commission. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a period of four and a quarter hours by one inspector between the hours of 12:30 and 4:45 pm as part of the yearly inspection process. Prior to this inspection the previous inspection report was read along with other documents and correspondence relating to the home. Some records and documents were examined during this inspection and a partial tour of the premises was undertaken which included two of the resident’s rooms, one of which was in the process of being redecorated. The residents were not at home when the inspector arrived, being either out working in the grounds of the home or at a day centre. Two came home a bit later for lunch and the remaining two arrived home shortly before the inspection concluded. One resident was spoken with at some length and was happy for his room to be visited with him. Two staff including the deputy manager were spoken with and discussion also took place with the registered manager who had not been able to be present for most of the inspection. Four male residents were being accommodated. What the service does well: The service provides a warm and comfortable environment in which residents are enabled and encouraged to achieve their potential and live as fulfilling lives as possible. Their days are full and the activities in which they participate are imaginative and stimulating. Thorough assessments of individual’s needs and detailed care plans upon which these are based, means that staff know exactly what support they must give each resident to help him achieve his short and long term goals. The manager and staff ensure that residents are consulted about and involved in all aspect of life in the home according to their individual abilities. Routines are set around the needs of individual residents as opposed to the convenience of staff. Good staffing levels enable residents to enjoy one to one time both within and outside of the home. The staff team is a generally stable one which provides continuity of care for residents. Staff have opportunities for regular training including National Vocational Qualification training. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 6 The record-keeping systems and procedures employed in the home are well structured and provide all the required information in accessible formats. What has improved since the last inspection? 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 DS0000031912.V277882.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4, 5 Prospective residents are able to visit the home on an introductory basis before a decision is made for them to move there so that they can become familiar with their surroundings and get to know other residents and the staff. EVIDENCE: Following a referral to the home arrangements will be made for the prospective resident to have day visits to familiarise him or her with the home, the staff and other residents and with some of the routines. This would be gradually increased over a period of time depending on the individual and would lead on to overnight visits and longer stays until such time as the person was happy and familiar with everything and the manager and her staff confident that they could meet that person’s needs in the home. Continuous assessment would take place during all of these visits and would form part of the basis upon which the care plan for that person is developed once he or she is admitted. There would still be a further probationary period following admission. 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 each written contract was seen to be in the resident’s files. The deputy manager said that where a resident is able to understand, a staff member sits down with that person and goes through the contract with them. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Residents are well supported in recognising and achieving their personal short and long-term goals. EVIDENCE: The four resident’s files were examined. Care plans were found to be developed to a high standard and cover every aspect of each resident’s life such as medical, dietary, day-care/employment, and financial arrangements. A background history of each person identifies interests and hobbies known strengths and positive behaviours and known negative behaviours in the ‘getting to know the resident’ information. Before each annual review of the care plan takes place a full skills assessment is undertaken which covers for example clothing, personal hygiene, cooking/general kitchen skills, community knowledge, reading, numbers, telling the time, friendships and many more aspects of their lives. The working care plans identify short and long-term goals under each area of need for example in relation to bathing one long term goal identified stated “to be able to wash himself and attend to his own personal hygiene” The short-term goal stated “to be able to wash himself satisfactorily”. There are clear details of the specific support required which include the steps to be taken in order to achieve those goals. As another example in relation to communication, the long-term goal stated “to Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 10 communicate his wishes and needs without becoming anxious or demanding” the short term goal stated “to ask for a cup of tea without being demanding”. As an example of the specific support required in this case the plan stated “when he demands a cup of tea, staff should inform him that they will help him once he asks calmly”. Each part of the plan is signed and dated by the key worker or other support staff and the resident where possible, where this is not possible it states “resident unable to sign”. The plans also contain monthly progress sheets and there are very detailed risk assessments to cover all activities and specific areas of need. An instruction to staff in each file says “If you are in doubt as to whether a risk assessment should be done in a particular area, then write one!”. All risk assessments are reviewed monthly, signed and dated. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 15, 17 Residents are supported to become part of and participate in the local community and to make and maintain relationships within and outside of the home. Their health and wellbeing is promoted through the provision of a nutritious, varied and balanced diet. EVIDENCE: Care plans and activity programmes for each resident show that they use/attend community facilities and services such as local transport, sports clubs, theatres, concerts and football matches etc. They participate in the food shopping for the home and go into town on personal shopping trips. Through their day centres and clubs they can establish relationships and they quite often go to other homes for tea or parties. If they wish they can invite friends back to the home. A resident spoken with said that he can choose to be private in his room when he wishes and said that he likes to spend quiet time drawing or making things. Residents participate in tasks around the home with varying degrees of support depending on their abilities. They help to keep their rooms clean and tidy, deal with their laundry and assist in the kitchen and some like to work in the grounds and help look after the animals. A resident said “I look after the Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 12 cat, I feed him, he’s called Alfie and I chose his name”. He said “when I go to my Mum’s the staff look after him”. He said that usually they would be going to a club that evening but they were not going this week as there was no driver available. He said “so I’ll be doing some art and bits and pieces after my bath”. He had been out in the grounds during the morning caring for the pigs and other animals. Menus and records of food examined showed that residents have a healthy and varied diet. They have a snack lunch midday of their choosing when they are at home and the main meal is cooked in the evening. Every week each resident chooses an evening meal, goes shopping with staff to select the ingredients for it and assists with the preparation, cooking and serving. The resident spoken with said that the food is very good and his favourite when it’s his turn to choose is chicken drumsticks and chips. It was noted in the records that vegetables, salads and fruit are included. Special dietary needs are catered for. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The healthcare needs of residents are assessed and recognised and procedures are in place to address them. EVIDENCE: The deputy manager confirmed that all four residents are registered with the same GP practice because not all practices are willing to support them with the types of medications they need. Additional specialist support is available to residents from the Community Team for People with Learning Disabilities. For example, two of the residents receive speech therapy and one has had the support of a community psychiatric nurse. All are seen for regular checks and medication reviews by a psychiatrist at the Martin Long Centre. Chiropody care is available if residents want or need this and they use a local dentist and optician. Files were seen to contain detailed records of resident’s healthcare needs and how they are addressed. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Residents views are valued and any complaints or concerns acted upon in their best interests. EVIDENCE: The home has a complaints procedure which is in pictorial format to assist resident’s understanding. The deputy manager said that it has been explained to each resident but she thought that only one could realistically understand how to use it. She said that all staff have a good in-depth knowledge of the residents and will usually recognise if one of them is unhappy about something. She said that recently one resident said that his WC flush wasn’t working properly and he wanted to let the home’s owners know. A staff member wrote a letter which he was able to copy and it was sent off to the registered provider. As a result the flush was repaired to his satisfaction and it helped him to understand the process of making a complaint as well as enabling him to help himself which is very good practice. Resident’s meetings are held every four to six weeks when they are encouraged to say what they like and what they do not like and generally be involved in what is happening around them. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 Residents live in a warm, clean, comfortable and well maintained home where they can have their own possessions around them. EVIDENCE: The home is a character property and offers the residents comfortable accommodation which is maintained in good decorative order. The furnishings are comfortable and homely and the standard of cleanliness in all areas seen was good. The extensive grounds add a further dimension to the home and the resident’s quality of life because of the added interests and occupation provided through the various animals and vegetable garden they help to tender and support. The home meets the requirements of the local fire officer and environmental health department. The rooms of two residents were seen during the inspection. The maintenance man had almost finished re-decorating one of these including the en-suite bathroom and he said that he had shown the colour chart to the resident beforehand who had chosen the colours. Both rooms were quite spacious and reflected the personalities and interests of the occupants. They are comfortably furnished with good storage space and it was noted that both rooms contained personal items such as videos, DVDs, books, posters and lots Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 16 of other items which made them very individual. Each resident has his own en-suite facility. The laundry is sited well away from food storage, preparation and serving areas. One resident is able to do his own laundry without staff support but the others require varying degrees of help. Suitable equipment is provided. Infection control procedures are in place and staff have had training in these. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 Residents are cared for by staff who are experienced and competent and in sufficient numbers to meet their assessed needs. EVIDENCE: There have been some difficulties with staff shortages which has resulted in the use of regular agency personnel. However, a new full time member of staff was due to start work the week following this inspection and another will be commencing employment in the very near future. The agency staff who work in the home are always the same people and have been working in the home for some time therefore they know and are known by the residents. Duty rotas showed that good cover is provided at all times and is sufficient to enable staff to provide residents with one to one support when needed and give them quality time. This includes evenings and weekends. Evenings are often very busy as residents lead very full lives and participate in a lot of activities outside of the home. Weekends are noted as ‘own choice’ on resident’s activity sheets and staffing levels are generally lower than during the week days. However, if a resident/residents wants to do something special the deputy manager said extra staff are brought in appropriately. Four staff files were examined at random. They were well set out and contained all necessary documentation to show that robust recruitment procedures are followed. Documentation included evidence of Criminal Records Bureau and POVA (Protection of Vulnerable Adults)checks, two references for each employee, completed application forms, notes of interviews Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 18 job descriptions and copies of each contract of terms and conditions. The files also contained training records. In relation to agency staff the home had a list of the CRB clearance numbers from the agencies. There was also written confirmation of all checks undertaken by the agencies including work permits and immigration approval for overseas workers. The home has a training programme and staff spoken with confirmed that they have opportunities to undertake training in various work-related topics and National Vocational Qualification training at levels 2 and 3. The deputy manager said she has just completed level 2 and will be commencing level 3 in the near future. The registered manager has just completed level 4 and the Registered Managers Award. The registered manager said that a new induction programme is being introduced which will be very comprehensive. It was noted that only three members of staff have had in-depth training in the safe handling of medicines and it is recommended that this be extended to all staff. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Policies and procedures are in place and staff are given appropriate training to ensure so far as possible the health, safety and welfare of residents. EVIDENCE: Records examined and discussion with staff confirmed that they are given regular training and updates in topics relating to health and safety such as fire safety, first aid, infection control and food hygiene. Staff have also received training in dealing with epilepsy and challenging behaviour. There are comprehensive policies and procedures to be followed in the interests of maintaining a safe environment and safe working practices including risk assessments for these. Records showed that fire points are tested weekly and the fire equipment and installations serviced regularly by a contractor. Monthly electrical equipment tests are undertaken and recorded and there is a monthly checklist of the grounds/gardens. Documentary evidence was seen showing that sterilisation of the cold water storage had taken place. Hot water temperatures in areas used by residents are regulated. Arrangements are in place for waste management. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 20 Accidents and incidents were seen to be recorded in detail and there is a reporting procedure to be followed where applicable. Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 N/A 2 N/A 3 N/A 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 N/A ENVIRONMENT Standard No Score 24 4 25 N/A 26 3 27 N/A 28 N/A 29 N/A 30 3 STAFFING Standard No Score 31 N/A 32 N/A 33 3 34 4 35 3 36 N/A CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 N/A N/A N/A N/A LIFESTYLES Standard No Score 11 N/A 12 N/A 13 3 14 N/A 15 3 16 N/A 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score N/A 3 N/A N/A N/A N/A N/A N/A N/A 3 N/A Smugglers Barn DS0000031912.V277882.R01.S.doc Version 5.1 Page 22 NO 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. 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 YA35 Good Practice Recommendations All staff who administer medication should have training in safe handling. 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