Inspection on 20/09/07 for The Farmhouse

This inspection was carried out on 20th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Farmhouse 17/11/06

The Farmhouse 07/12/05

The Farmhouse 14/07/05

The Farmhouse 20/10/04

The Farmhouse 12/05/04

The Farmhouse 10/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 The Farmhouse Hundred Elms Farm Off Elms Lane Sudbury Middlesex HA0 2NP Lead Inspector Julie Schofield Key Unannounced Inspection 20th September 2007 09:15 The Farmhouse DS0000017504.V347943.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 The Farmhouse DS0000017504.V347943.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. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Farmhouse Address Hundred Elms Farm Off Elms Lane Sudbury Middlesex HA0 2NP 020 8904 8282 020 8903 9860 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) Residential Care Services Ltd DR FRANK ERIBO Mr Tohoully Hughes Gilbert Seri Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2006 Brief Description of the Service: The Farmhouse is a care home providing personal care to 6 adults with learning disabilities. At the time of the inspection there were no vacancies. The house is a Grade II listed building and is in a quiet residential part of Wembley but close the Harrow Road and Watford Road. There are bus routes along both of these roads and the nearest underground station is Sudbury Town. The property is detached and has a garden at the front and at the rear/side of the property. It is situated at the end of a short passageway (wide enough for access by car) and there is parking for approximately 4 vehicles outside the front gates of the home. There is also parking on the main road. The house consists of two floors, ground and first floor. The ground floor consists of an open plan lounge and dining area, a kitchen, bathroom (with toilet) and three service users bedrooms (two with ensuite toilet and one with ensuite toilet and shower). On the first floor there are three service users bedrooms (all with ensuite toilet and shower), the office, the laundry room and a quiet room (with ensuite toilet) that is used at night by a member of staff sleeping in. Details of fees may be obtained, on request, from the company’s head office, the telephone number of which is available from the care home. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three visits to the home and a visit to the company’s office in Forty Lane. On the 20th September 2 visits took place. The first visit started at 9.15 and ended at 9.55am. The second visit started at 3.40 and finished at 5.30pm. The Inspector returned to the home on the 26th September at 5 pm and finished at 5.50 pm. The visit to the company’s office to view staff records took place on the 9th October. While in the home, records and policies & procedures were examined, a site visit took place, the preparation of a meal was observed, care practices were observed, case files were examined and care pathways case tracked. Discussions with the manager, members of staff and residents took place. Compliance with the statutory requirements identified during the previous key inspection in November 2006 was checked. What the service does well: One of the residents said that they had lived in another care home prior to living in the Farmhouse. He said that the Farmhouse was the best and that he liked this house. Two residents that were able to give verbal feedback regarding the quality of the service received were positive in respect of the support given by staff, their accommodation, the meals provided and the annual holiday. Residents treat the Farmhouse as their home and move around the home as they please. They enjoy spending time in their room relaxing after returning to the home in the afternoon. They each have a comprehensive day care programme, which may include attending day centres and undertaking college courses. They may also attend clubs, which are held in the evenings or at the weekend. At the weekend they are able to take it easy or take part in activities. The company’s training programme for staff provides a package of training that includes NVQ training, training in areas specific to the client group and training in safe working practices. The training needs of individual members of staff are identified and recorded in personal development plans. Members of staff work together as a team and are knowledgeable about the needs and the likes and dislikes of individual residents. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: During this inspection 8 statutory requirements have been identified and 2 of these are outstanding from the previous inspection in November 2007. The home has not had the opportunity to demonstrate that the documents used to record the content of visits made to the home by a prospective resident include the views of the prospective resident and those of the existing residents and that these documents are available in the home, for reference. It has also not been able to demonstrate that the records of the visits are comprehensive and are signed and dated. The home needs to contact the funding authority when a review meeting is overdue to request that one is convened. The home needs to consider how the safety of the resident (that has been wearing a label when attending day centre) can be protected without compromising their dignity. If specialist support is sought for a resident the home must show that there are good reasons, (that are recorded), for not putting any recommendations made into practice. The heavy curtains in the lounge/dining area need to be of a sufficient length that they reach the windowsill. The flooring in the bathroom needs to be straightened out and the walls painted. The stain on the ceiling of the lounge must be made good and redecorated and the chipped tiles in the ensuite toilet replaced. Please contact the provider for advice of actions taken in response to this The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 7 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. The Farmhouse DS0000017504.V347943.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 The Farmhouse DS0000017504.V347943.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): 2, 4 People who use this service experience good outcomes in this area. An assessment of the needs of the resident, prior to admission to the home, enables the home to determine whether a service tailored to the individual needs of the resident can be provided. A trial visit to the home gives the prospective resident an opportunity to sample life in the home and to decide whether the service provided is suitable. Comprehensive records of these visits would demonstrate that the wishes and feelings of other residents have been listened to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new residents have been admitted to the home since the last key inspection in November 2006. However, the home has an admission policy in place. This includes obtaining all the required information about the prospective resident, from the funding authority. In addition, a manager of the company carries out a needs assessment of the prospective resident. The home has previously demonstrated that the policy is put into practice when a referral is accepted. During the last inspection 2 statutory requirements were identified in relation to the programme of pre-admission visits made to the home by the The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 10 prospective resident. The first requirement was that documents used to record the content of visits made by a prospective resident, as part of a transition plan, are kept in the home, on the resident’s case file. The second was that the record of each visit made as part of the transition plan includes comprehensive details of the reactions of the other residents, staff observations, what the prospective resident did/what they said/how they reacted/significant changes in behaviour etc and that the record is signed and dated. The manager confirmed that for future admissions these details would be recorded and that the records would be kept in the home and not at head office. As the home has not had the opportunity to demonstrate that it has incorporated the requirements into its working practices the timescales for compliance have been extended. The Farmhouse DS0000017504.V347943.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, 9 People who use this service experience good outcomes in this area. Reviewing the care plan and the placement on a regular basis ensures that changes in the needs of residents are identified and can be addressed but the home needs to contact the funding authority if the external review meeting is overdue. The residents’ right to exercise choice in their daily lives is promoted and respected. Staff support residents to take responsible risks so that residents can enjoy an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the previous key inspection in November 2006 a statutory requirement was identified that daily recordings must be made after events happen and not before. After this incident occurred during the previous inspection the The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 12 manager has spoken to staff and recordings are now made at the end of the shift so the requirement is now met. Three residents’ case files were examined. It was noted that each contained the content of a care plan in the care plan review document, which included illustrations. The home monitors the goals set in the care plans, on a weekly basis, and keeps a record of this. On two files the last review by the funding authority had taken place at least 18 months previously and no appointment had been made for a review meeting in 2007. On another file, although a review meeting by the funding authority had taken place in May 2007, the minutes were absent. The home reviews the placement on a regular basis. It also maintains a system of care plan reviews and these were up to date although it was noted that on 2 case files the content of the review was identical to the previous review that had taken place 6 months earlier. The manager said that no changes had taken place so no amendments were necessary. There was evidence that relatives were invited to attend review meetings, to support the resident. Files contained personal profiles or daily routines, which included information regarding the resident’s likes and dislikes. In order to offer choice and for residents to make decisions about their day-today lives the manager said that it was important for good communication to take place. He has recently attended a Makaton training course and is cascading the information to the members of staff, although he would like each of the members of staff to attend the course. Residents said that they have the opportunity to exercise choice in the menu, what activities they take part in, what to wear, when to go to bed and when to get up in the morning, when to take a shower, whether they want to have a lie in at the weekend, how and when to use their room and whether they want to socialise with others. One of the residents attends a “speaking up for yourself” course at college. Residents’ finances were examined. Records, including receipts for items purchased, were kept. These were up to date and complete and included a balance after each transaction. Residents had savings accounts; although 1 resident’s financial affaires were managed by the resident’s family. When examining the 3 case files it was noted that each contained a number of risk assessments, which were tailored to the individual needs of the resident. Risk assessments covered a wide range of activities or situations including road safety, aggressive behaviour, angry behaviour, the provision of a bedroom door key and using the kitchen. The assessment identified the hazard and the risk that was involved, included strategies for minimising the risk and listed the actions to be taken by staff. Risk assessments were subject to a 6 monthly review. The home’s manual of policies and procedures includes a missing person’s procedure. The Farmhouse DS0000017504.V347943.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, 17 People who use this service experience good outcomes in this area. Taking part in activities, developing new skills and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. By maintaining contact with their family and friends the resident’s need for company and fellowship is met. Residents are encouraged to become more independent by making decisions and by having their wishes respected. Wearing a label with details of the name of the resident and who to contact if the resident is on their own in the community compromises the dignity of the resident. Menus respect the religious, cultural and dietary needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A resident said that they attended a day centre in Wembley and that they enjoyed going there as they had made friends with other people attending. All of the residents have a day care programme that covers Mondays to Fridays. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 14 On the day of the inspection all of the residents chose to attend their day centre. Residents have access to college courses organised by BACES through their day centres (adult independent living skills and “Speaking up for Yourself”). Residents use facilities in the community including the shops, the local sports centre, cinemas and local restaurants for meals that meet the religious/cultural/dietary needs of residents. A resident confirmed that he went shopping recently and bought some personal items. The home has the use of a mini van to transport residents or residents can use public transport or taxis. Residents’ names have been entered on the electoral roll and there was evidence that polling cards had been available to residents at the last election. A resident talked about living in the home and said that they had been swimming last week. They said that they liked to watch television in their room (and gave examples of the programmes that they enjoyed watching) or listen to music. They had enjoyed going on holiday to Minehead and the manager said that 5 of the 6 residents had joined in the holiday. The sixth resident goes abroad on holiday with their family. Financial records confirmed that residents also went to clubs. The residents confirmed that they went out shopping on a regular basis and that they went to church, if they wished. Whilst in the home residents like to relax watching the television, listening to music, reading the paper or drawing etc. A resident confirmed that their relatives visited them and agreed that staff made their relatives feel welcome on visits to the home. Visits can take place in the privacy of the resident’s room or in the lounge. The home has a policy of welcoming visitors to the home at any time prior to 10.30pm. Some residents’ relatives visit the home and then take the resident out with them. Relatives are invited to attend social events organised by the company. Residents were involved in the daily routines in the home and one of the residents said that he likes to help in the kitchen and chop vegetables. Residents said that they helped to do their washing and that they kept their rooms clean and tidy. It was noted during the site inspection that staff knocked on the bedroom door and either waited to be invited in, or waited a short time before entering if the resident was not able to invite them into the room. Residents were able to spend time in their bedroom without unnecessary interruption. When one of the residents returned from day centre it was noted that that he had a label pinned to the front of his clothing that read “My name is….. if I am found…….” The resident has absconded from the day centre in the past. During the previous key inspection in November 2006 a statutory requirement was identified that main meals must include servings of vegetables (green where possible) or salad. On the 26th September the preparation of the evening meal was observed and vegetables were being prepared. The menus The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 15 were examined and vegetables/salad were included in main meals. This requirement is now met. Talking with the member of staff that was preparing a meal he stated that changes had been made to the meal that was to be prepared as one of the residents said that they wanted something different. The member of staff confirmed that he had undertaken food hygiene training. The home has 2 menus in order to meet the religious and cultural needs of residents. The main menu includes African-Caribbean food. The alternative menu is for 2 Asian residents that are vegetarian. A resident has been recently diagnosed as diabetic and the home is waiting for a diet sheet to be provided by the dietician. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 16 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, 20 People who use this service experience good outcomes in this area. Residents receive assistance with or prompting with personal care in a manner, which respects their dignity and privacy. Recommendations by specialist health care workers need to be implemented so that the care of the resident is enhanced. Residents’ health care needs are met through access to health care services in the community. Residents’ general health and well-being is promoted by staff that assist the resident to take prescribed medication in accordance with the instructions of the resident’s GP. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was noted on a previous inspection that the assessment for the care plan document included information regarding assistance with personal care tasks. If residents require direct assistance this can be provided by a carer of the same gender, as there is a male carer on each shift. Where assistance is provided in the form of “prompting” this is done in a way that respects the dignity of the resident and advice about clothing and its suitability in terms of The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 17 the weather is given in a friendly manner. The personal profiles or daily routines documents are informative and would help a new member of staff provide care in the way that the resident prefers. The staff team includes African and African-Caribbean members of staff and four of the six residents are African-Caribbean. Although Asian residents are accommodated in the home none of the members of staff are Asian. All residents are able to speak or to understand English and all staff are able to speak English. When necessary specialist support was sought on behalf of the resident e.g. a speech and language therapist assessment or the continence advisor. One file contained guidelines from the PCT regarding autism and recommended the use of a “communication passport”. This has not been implemented. Case files contained evidence of access to health care services in the community. Residents had regular appointments with the psychiatrist, GP and optician. There was evidence that members of staff supported residents to attend out patient appointments at the hospital. The storage of medication was inspected. It was safe and secure. It was noted that medication had been appropriately administered prior to the inspection, corresponding with the day of the week and the time of day that the inspection took place. Records of the administration of medication were inspected. They were up to date and complete. The training plan records that each person working in the home has completed medication training and a member of staff on duty confirmed that they had attended training. It was noted that staff had undertaken their training in 2005 or 2006. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 18 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, 23 People who use this service experience good outcomes in this area. Residents are aware of their right to complain if the care that they receive is not satisfactory. An adult protection policy and protection of vulnerable adults training for staff contribute towards the safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints procedure was available in the home. The simple procedure includes timescales for each stage of the procedure and referred complainants to the directors of the company, if the home’s manager could not resolve matters. Information regarding access to other agencies e.g. the CSCI was included, with the address and telephone number of the local office. The manager said that no complaints have been recorded since the last inspection. A resident said that if they had a problem they could talk to the manager or to a member of staff and were able to give the names of the staff on duty in the home. There is a protection of vulnerable adults policy in place in the home. The manager has previously said that the home also has copies of each funding authority’s interagency guidelines in the event of abuse. A copy of the summary of the multi agency procedure was present on residents’ case files. He said that no allegations or incidents of abuse have been recorded since the last inspection. Staff on duty confirmed that they had received training in The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 19 protection of vulnerable adults procedures and that they had undertaken training in supporting residents with challenging behaviour. The manager and a member of staff on duty were able to describe what they were obliged to do in the event of a disclosure being made. They demonstrated an awareness of the whistle blowing procedure. A resident said that if they had a problem they could talk to the manager or to a member of staff. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 20 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, 30 People who use this service experience good outcomes in this area. Residents enjoy a comfortable and “homely” environment with pleasant communal and private facilities in which to relax. Some minor redecoration/repairs are needed. Residents live in a home where standards of cleanliness are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the previous key inspection in November 2006 two statutory requirements were identified. The first requirement was that the heavy curtains in the lounge/dining area are of a sufficient length that they reach the windowsill. The second requirement was that the flooring in the bathroom is straightened out and that the walls are painted. It was noted during the site visit that both requirements remained outstanding. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 21 Communal areas are decorated and furnished in a “homely” manner and the general upkeep of the building is good. It was noted that there was a stain on the ceiling in the lounge and that there were some chipped tiles in an ensuite toilet on the ground floor. There was a damp smell in one of the first floor bedrooms. Two of the residents said that they were satisfied with the house in general and with their room and liked to spend time there watching their television. A resident said that it was very comfortable and that they slept well. One of the residents said that although they did not want to attend a place of worship at the moment they could pray in their room and that members of staff respected their privacy when this took place. Each resident has their own single bedroom. Each bedroom has an ensuite toilet and some also have an ensuite shower. It was noted during the site inspection that all areas inspected were clean and tidy and free from offensive odours. All staff have undertaken training in infection control procedures and the home has an infection control policy. No soiled clothing is carried through any area where food is prepared, stored or consumed as the laundry facilities are situated in a room on the first floor. The washing machine has a sluicing cycle as one of the residents has continence problems. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 22 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, 33, 34, 35 People who use this service experience good outcomes in this area. NVQ training enhances the general skills and knowledge of carers and contributes towards the quality of service that the residents receive. The rota demonstrated that there were sufficient staff on duty to support the residents and to meet their needs. Recruitment practices, which include checks and references, protect the welfare and safety of residents. Residents are supported by staff that have access to a comprehensive range of training courses, enabling them to meet the residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A discussion took place with the manager in respect of NVQ training for staff. Two of the 4 members of staff on the rota have completed their NVQ level 2 training and the other 2 members of staff are currently studying towards their NVQ level qualifications. A member of staff on duty confirmed that they had successfully completed their NVQ level 2 training. Therefore the home has met the minimum target of at least 50 of support workers achieving an NVQ level 2 or 3 qualification. A discussion took place with a member of staff on duty The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 23 regarding communicating with residents that cannot verbally express their wishes and feelings. He said that body movements, signs and expressions contribute towards communication and that good communication depends on trust. He added, “Building trust takes time”. It was noted during visits to the home that 3 people were on duty each shift, including the manager. He said that during the week 3 staff are on duty during the day, at the times when the residents are at home. At the weekend there could be 2, 3 or 4 members of staff on duty depending on what activities are taking place. Three residents that wish to attend a church (all different places of worship) are escorted on a 1:1 basis by a member of staff either on a Saturday or a Sunday. Sometimes residents take part in outings with residents from other care homes owned by the company. At night 1 member of staff undertakes waking night duties and 1 member of staff is asleep, but on call. If the home uses agency staff they are always paired with a permanent member of staff. The staff team reflects the gender composition of residents and includes staff that reflect the cultural background of some of the residents. Two staff files were examined, including 1 that belonged to an agency member of staff. Each file contained proof of identity (passport details with a photograph), evidence of a satisfactory enhanced CRB disclosure, 2 satisfactory references and evidence of right to stay and work in the UK (where required). A copy of the training plan for the Farmhouse, covering the period 2007 to 2008, was supplied by head office. The plan listed the names of the five members of staff working in the Farmhouse (both on a permanent and on an agency basis) and there was an up to date record of training courses attended. The plan included both statutory training and additional courses, which enabled staff to fulfil the aims of the home and to meet the needs of the residents. Staff files contained copies of training attendance certificates and it was noted that staff had attended courses in respect of safe working practices e.g. fire safety, infection control, food hygiene, medication etc. They had also attended courses to enable them to support residents e.g. autism, challenging behaviour, epilepsy and protection of vulnerable adults. At present none of the staff working in the home are working through an induction training package. A copy of the Personal Development Plan was available. This is used in the appraisal process and includes an identification of training needs. It has recently been expanded to provide the company with information regarding the effectiveness of training courses. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 24 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, 42 People who use this service experience good outcomes in this area. By establishing good working practices and monitoring the quality of care in the home the registered manager promotes an enjoyable environment for residents. Service satisfaction questionnaires, meetings and individual discussions with residents help to monitor the quality of the service provided to residents and contribute towards the development of the service. The training that staff receive in safe working practice topics enables them to safeguard the health, safety and welfare of the residents. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 25 The manager holds an RMA qualification. He has approximately 5 years experience of working as a manager of a care home for adults with learning disabilities. He undertakes periodic training to update his skills and knowledge and since the last inspection he has undertaken fire safety training and makaton training. He is currently studying towards a postgraduate certificate in social care management. The manager said that Regulation 26 visits took place on a monthly basis and copies of the reports were available. They were up to date. The company is in the process of carrying out an evaluation of the service provided by each of its care homes. Although the information is being analysed for some of the care homes the deadline for the return of completed quality assurance forms for The Farmhouse has not yet expired. A discussion took place with the member of staff at head office regarding how the information received was to be used and an example was given of how the information could change future practice. Feedback is also given by residents on a day-to-day basis in the home, either verbally or by non-verbal forms of communication etc. Review meetings, meetings with key workers and discussions with the manager are all opportunities for residents (and/or the resident’s relatives) to give comments regarding the quality of the service received. Certificates were available in the home for the servicing and checking of the portable electrical appliances, the fire extinguishers, the fire alarms and emergency lighting, the electrical installation, the Landlords Gas Safety Record and the bacterial analysis of the hot water system. A fire risk assessment was available. Staff undertake training in safe working practice topics and the training is refreshed and updated at regular intervals. The Farmhouse DS0000017504.V347943.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 X 2 3 3 X 4 2 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 3 X X 3 X The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA4 Regulation 12(1) Requirement The registered person must ensure that documents used to record the content of visits made to the home by a prospective resident are kept in the home to demonstrate that the views of the prospective resident and those of the existing residents are listened to and acted upon. The registered person must ensure that the record of each visit made as part of the transition plan is comprehensive (and is signed and dated) to demonstrate that the decision to admit the new resident has been taken after a thorough review of the resident’s wishes and feelings. The registered person must ensure that they contact the funding authority when a review meeting is overdue to request that a review meeting is convened so that the resident is assured that their needs continue to be met. Timescale for action 01/02/08 2 YA4 12(3) 01/02/08 3 YA6 15(2) 01/12/07 The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 28 4 YA16 12(4) The registered person must ensure that the safety of the resident is protected when the resident is in the community without compromising the resident’s dignity. 01/12/07 5 YA18 12(1) The registered person must 01/12/07 ensure that if specialist support is sought for a resident that there are good reasons, (that are recorded), why any recommendations made are not put into practice to assure the resident that the quality of their care is not being diminished. The registered person must ensure that the heavy curtains in the lounge/dining area are of a sufficient length that they reach the windowsill to assure residents of smart and attractive surroundings. (Previous timescale of the 1st January 2007 not met). The registered person must ensure that the flooring in the bathroom is straightened out and that the walls are painted to assure residents of a facility that is pleasant to use. (Previous timescale of the 1st January 2007 not met). 01/12/07 6 YA24 16(2) 7 YA24 16(2) 01/12/07 8 YA24 23(2) The registered person must 01/12/07 ensure that the stain on the ceiling of the lounge is made good and redecorated and the chipped tiles in the ensuite toilet are replaced to assure residents of smart surroundings and facilities that are pleasant to use. The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 29 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 YA6 Good Practice Recommendations That if the minutes of the review meeting convened by the funding authority have not been received within a month of the meeting being held, the home writes to request a copy of the minutes. That residents have the choice of staff from the same ethnic, religious or cultural background working with them. That the cause of the damp smell in one of the first floor bedrooms is investigated and remedial action taken, as necessary. 2 3 YA18 YA24 The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 The Farmhouse DS0000017504.V347943.R01.S.doc Version 5.2 Page 31 - 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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