Inspection on 07/12/05 for The Farmhouse

This inspection was carried out on 7th December 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Farmhouse 20/09/07

The Farmhouse 17/11/06

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 Unannounced Inspection 7th December 2005 4:00 The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 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.V269496.R01.S.doc Version 5.0 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.V269496.R01.S.doc Version 5.0 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 Dr Lynda Osarieme Eribo Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th July 2005 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 was 1 vacancy. 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 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. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place in December 2005 and was carried out over 2 visits. The first visit was unannounced and started at 4 pm and finished at 5.35 pm. Two support workers were on duty and the manager returned to the home during the inspection. All of the residents returned to the home from their day centres during the inspection. A second visit was made to the home, by appointment, approximately a week later. A senior member of staff from the company was on duty in addition to support workers. The residents returned to the home during the inspection. The second visit started at 4 pm and finished at 6 pm. The Inspector would like to thank the manager, staff and residents for their comments during the inspections. During the inspection a partial site inspection took place and selected records were inspected. What the service does well: What has improved since the last inspection? Staff have received training in adult protection procedures. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 6 The laundry room door has been repaired and the woodwork near the front door has been repainted. The wooden building in the garden at the front of the house, which resembled a children’s playhouse, has been removed. 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. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 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 The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 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): 2, 4 Carrying out an assessment of the resident, prior to their admission, ensures that the needs of the resident are identified and that the home is able to determine whether these can be met. Residents and their relatives are involved in the process of choosing a care home that can meet the resident’s needs and their decision is made after a programme of introductory visits to the home. EVIDENCE: One resident has been admitted to the home within the previous 12 month period. The resident had transferred from another of the company’s care homes. The case file was examined and an assessment of need for moving to a larger unit was on file. (The previous care home had accommodated 2 residents). The manager of the home had undertaken the assessment of need and it was discussed with the social worker from the placing authority. A review meeting had been held. The resident (and their relatives) were in agreement to the move. As part of the transfer the file contained a transition plan and there was a record of a visit made to the Farmhouse by the new resident, who was accompanied by a relative, and the social worker. The key worker from the previous unit also came to support the resident. There was a programme of introductory visits to the home so that the new resident could view the accommodation, meet staff and meet the current residents. The new The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 9 admission was also discussed with the current residents at a residents’ meeting. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 10 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, 7, 9, 10 Comprehensive care plan assessments identify the needs of the residents and specify the support to be provided so that the resident receives a good quality service that meets their needs. Reviewing care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed. Residents exercise their right to make decisions about their lives. Staff support residents to take responsible risks so that residents can enjoy an independent lifestyle. Maintaining confidentiality when handling and storing information ensures that the resident’s right to privacy is respected. EVIDENCE: Two case files were examined and it was noted that there was a recent care plan assessment and evidence of regular reviews. The care plan included the personal care, health care and social care needs of the resident. The routines of residents were also recorded. The reviews consisted of those convened by the home and those convened by the placing authority. The manager said that family members are encouraged to support the resident at case reviews, with the permission of the resident. On one of the files there was a proposed care management plan formulated by the Crisis Intervention Team. The home operates a key worker system and there were minutes of meetings between The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 11 the resident and their key worker on file. Two residents were aware of who their key worker was and were satisfied with their support. The manager said that in order for residents to make informed choices information is given to the resident during 1 to 1 sessions with the resident’s key worker. An example of this was when repairs were carried out in a resident’s room and the resident moved into the vacant room. Residents are encouraged to choose their own personal items, when out shopping with their key worker. They are encouraged to decide what to wear each day. At mealtimes they are invited to choose alternatives to the main meal if they do not like or want the main dish. (This was observed). They have a choice of whether they want to take part in an activity or whether they want to socialise. (This was observed). Collective decisions are made in respect of menus or holidays. All residents receive support in managing their finances. Any restrictions or limits on the facilities or the way of life of the resident is documented, after discussions and agreements with all interested parties. Bars were fitted on the window of one of the residents’ bedrooms. Prior to his admission to the home the resident had been a persistent absconder and had injured himself in leaving premises. Copies of risk assessments were on file and these were tailored to meet the individual needs of the resident. Risk assessments included risk management strategies. Risk assessments included road safety awareness, aggression, electrical hazards, holding a key to the bedroom door, eating too quickly, hot water awareness etc. Risk assessments were reviewed on a regular basis. Each resident has their own individual diary and this is taken with them to the day centre so that the staff on duty in the day centre are aware of any events that have taken place in the home that may affect the behaviour of the resident in the centre etc. While they are at the day centre the staff on duty in turn record any events that may affect subsequent behaviour in the home. It was noted that the member of staff in the home who welcomed the resident on their return asked to see the diary and it was the responsibility of the resident to pass the bag containing the diary to the member of staff. Other information i.e. case files etc are kept in the office and the door is locked when the office is not in use. Case files are kept in a locked filing cabinet. Staff are aware of when information needs to be shared with the manager. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 12 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): 15, 16 The support of staff enables residents to maintain contact with their families so that residents can enjoy fulfilling relationships. Standards 12, 13 and 17 were inspected during the previous inspection in July 2005. EVIDENCE: The manager and staff were knowledgeable about which residents received visits from their relatives and of the regularity of these. Residents confirmed that they received visitors and it was noted that their relatives had signed the visitors’ book when they came to the home. A resident said that staff made their relatives welcome when the relatives visited the home. Residents may choose whether they wish to see a visitor and it was noted that some residents might choose not to see certain family members. Visits can take place in the lounge or in the privacy of the resident’s room. The manager said that relatives were invited to social events in the home and to events organised by the company i.e. the end of year party, which was taking place a few days after the first inspection visit. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 13 There was information on the case files in respect of daily routines. It was noted during the site visit that staff knock on the bedroom door and wait for permission to enter, where this can be given, before entering. It was noted that service residents are comfortable with being addressed by their first name. During the inspection residents went to their room when they wished and that their privacy was respected. The contract specifies restrictions in respect of smoking and alcohol. Residents are encouraged to keep their rooms tidy and to help with their washing. It was noted that residents liked to help in the kitchen and they were encouraged to clear away their dishes after use etc. When repairs were necessary in a resident’s room the key worker discussed the options available, including moving into the vacant room opposite. The resident chose to move rooms and his wish to stay in that room (indicated during the inspection) rather than to return to the previous room, has been respected. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 14 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): Standards 18, 19 and 20 were inspected during a previous inspection in July 2005. EVIDENCE: The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 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 the following standard(s): 22, 23 The rights of residents are protected by a clear and simple complaints procedure. An adult protection policy and protection of vulnerable adults training for staff contribute towards the safety of residents. EVIDENCE: There is a copy of the complaints procedure on display in the home. It includes timescales for each stage of the process and details of how to contact other agencies. There is a reference to the CSCI, including the telephone number of the local office, and reference to the local councillor etc. The manager said that no complaints had been recorded since the last inspection. A resident said that they could talk to a manager, or member of staff if they had a concern. A statutory requirement was identified during the previous inspection in July 2005 that all staff receive training in adult protection procedures. The manager said that this has been done. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 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 the following standard(s): 24, 30 A comfortable and “homely” environment provides residents with an enjoyable place in which to live and a maintenance programme for the property keeps it in a good state of repair. Residents live in a home where standards of hygiene and cleanliness are good. EVIDENCE: A statutory requirement was identified in the previous inspection in July 2005 that the woodwork near the front door is repainted and that the laundry room door is repaired. These had been done. During the inspection the handyperson was on duty carrying out routine maintenance of the home. It was recommended previously that the wooden building, resembling a children’s playhouse, be removed from the garden at the front of the house. This has been done. A partial site inspection took place and it was noted that all areas seen were clean and tidy and were comfortably furnished and decorated. Levels of heating and lighting were suitable for the time of year. The house is well maintained and although off the main road and not visible to most people, does not detract from surrounding properties. Residents said that they were satisfied with their rooms, which were comfortable, and a resident said that the home was “good”. During the inspection the flooring in the ground floor bathroom had been replaced and work was still being done to The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 17 make good the part of the wall immediately above the floor where adhesive was visible. The parts of the home that were seen were clean and tidy and free from offensive odours. Laundry facilities are situated on the first floor, away from the bedrooms. The laundry room contains hand-washing facilities. Staff have received training in infection control. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 18 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): 32, 35 The quality of the support given to residents is enhanced when staff have the knowledge and understanding of the needs of the client group and the home continues to support staff undertaking NVQ training. The training programme for members of staff ensures that staff are able to meet the objectives contained in the Statement of Purpose and to meet the individual and changing needs of residents. Standard 34 was inspected during a previous inspection in July 2005. EVIDENCE: A statutory requirement was identified during the previous inspection in July 2005 that 50 of carers achieved an NVQ level 2 qualification by the 31st December 2005. Although the timescale will not be met good progress is being made as the majority of staff are enrolled for either level 2 or 3 training and deputy managers and managers have the opportunity to study level 4. The home is one of a number of care homes within the company and the company has a training budget with a manager who has responsibility for overseeing the training needs of the staff and developing a programme of training to meet these. The company provides induction and foundation training for new staff, using the TOPSS training package. The company also provides NVQ training, training in areas specific to the client group e.g. epilepsy and autism and training in safe working practices e.g. infection control The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 19 and food hygiene. Training in supporting residents who have challenging behaviour was recommended by the Crisis Intervention Team and this had been competed in November 2005. Records are kept of the training undertaken by each member of staff and their training needs are identified and recorded in personal development plans. The training needs analysis is developed from looking at these plans. An external company carried out an analysis for each home and drew up a training plan. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 20 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): 37, 39 The manager is experienced and competent and is able to encourage and develop good working practices in the home, which provides residents with a safe environment where their rights are respected. Quality assurance systems are in place to gather feedback on the quality of the service provided. The feedback needs to be incorporated into an annual development plan so that the home can demonstrate that the service changes and adapts to meet the needs of the residents and that it meets the aims and objectives set out in the Statement of Purpose. Standard 42 was inspected during a previous inspection in July 2005. EVIDENCE: A discussion took place with the manager in respect of NVQ level 4 training in management and care. The manager said that when she had contacted a college with a view to enrol she had been advised that due to her qualifications and experience a higher level of training would be more appropriate. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 21 Quality assurance systems present in the home were reviewed. Residents have the opportunity to give feedback during residents’ meetings, review meetings, one to one sessions with their key worker and directly to managers and proprietors. Members of staff have the opportunity to give comments during staff meetings, supervision sessions and directly to managers and proprietors. Relatives can record comments in the visitors’ book, at review meetings or directly to staff, managers or proprietors. Questionnaires had been sent to relatives but the manager said that as these had not been retuned the practice had ceased. The manager said that the end of year party or other social events is used by relatives to make comments in an informal setting. A relative had suggested occasional Saturday visits to restaurants and these now take place. Social workers can contact the home at any time to make comments or they can use the review meeting. The manager said that the suggestion box has been empty. The Farmhouse DS0000017504.V269496.R01.S.doc Version 5.0 Page 22 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 3 X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Farmhouse Score X X X X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X X DS0000017504.V269496.R01.S.doc Version 5.0 Page 23 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. 1 2 3 Standard YA24 YA32 YA37 Regulation 23.2 18.1 9.2 Requirement That work on the flooring of the ground floor bathroom is completed. That 50 of staff achieve an NVQ level 2 or 3 qualification. That the manager forwards a letter from the college, confirming their advice that the manager is already NVQ level 4 competent. That the feedback obtained from quality assurance systems is used to plan and develop services and to formulate an annual development plan, a copy of which is forwarded to the CSCI. Timescale for action 01/02/06 01/09/06 01/04/06 4 YA39 24.2 01/04/06 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 YA7 Good Practice Recommendations That the need for bars at the window of a resident’s bedroom is discussed at each placement review meeting DS0000017504.V269496.R01.S.doc Version 5.0 Page 24 The Farmhouse 2 YA35 and the decision recorded in the minutes. That a copy of the training plan for the Farmhouse, drawn up by the external company that carried out a training needs analysis, is forwarded to the CSCI. 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