CARE HOME ADULTS 18-65
The Mount Faircrouch Lane Wadhurst East Sussex TN5 6PT Lead Inspector
Caroline Johnson Unannounced Inspection 18th January 2006 10:00 The Mount DS0000021251.V267128.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 Mount DS0000021251.V267128.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 Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Mount Address Faircrouch Lane Wadhurst East Sussex TN5 6PT 01892 782025 01892 782917 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) The Mount Camphill Community Brigitte van Rooij Care Home 39 Category(ies) of Learning disability (39) registration, with number of places The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of residents to be accommodated is thirty nine On admission residents to be aged sixteen to nineteen years Some of the residents may also have associated mental health problems Date of last inspection Brief Description of the Service: The Mount Camphill Community is an independent specialist college that provides further education and training for residential and day students aged 16 to 25. The Community is a registered educational charity providing up to 39 residential places for young people with moderate learning disabilities. The Camphill Movement, founded in 1940, works to create communities in which vulnerable children and adults can learn and work with respect. Camphill is inspired by Christian ideals as articulated by Rudolph Steiner and is based on the acceptance of spiritual uniqueness of each human being, regardless of religious or racial background. The Mounts training programme extends over 4 years. An educational year is approximately 38 weeks divided into 4 terms, with students returning home or to other placements during the holidays. There are 4 community houses on-site, each with its own character. There are craft workshops for pottery, bakery, weaving, woodwork and catering. In the main house, which is a renovated monastery, are classrooms, a library and a community hall. There is a large vegetable garden and orchard, which provides the venue for a horticultural course and extensive grounds and woods where the estate and rural skills course is taught. There is also a gymnasium on the site. The Mount is staffed by residential co-workers and day staff. The senior co-workers live permanently in The Mount. Most staff take on the role of house co-workers, team leaders and some are also College tutors. The trainee coworkers are volunteers from a wide range of countries and usually work at The Mount for up to one year. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second inspection in the year running from April 1 2005 to March 31 2006. The inspection lasted from 10.00am until 3.30pm. Mrs C Johnson, Lead Inspector was joined by Ms L Latreille, Inspector, for the duration of the inspection. During the inspection there was an opportunity to observe a students meeting and both inspectors shared lunch with students in two of the houses. Time was spent with three of the management team and there was also an opportunity to meet with eight trainee co-workers. A number of records were examined including policies and procedures, risk assessments, aims and targets and medication. This report should be read in conjunction with the report of the previous inspection of the service carried out on 13 July 2005. The majority of the standards not assessed on this occasion will have been assessed at that inspection. What the service does well: What has improved since the last inspection?
The service has revised the format for completing risk assessments. A very detailed fire risk assessment has been carried out and the service are also taking further advice to ensure that as far as possible they can safeguard against the risk of a fire occurring. Peer-supervision has commenced and includes the management team observing each other working and providing constructive advice on their observations. Trainee staff have a mentor who they can go to at regular intervals for advice and support. The registered manager has enrolled on an NVQ level four course and she is due to commence training later in the year. All the recommendations made at the last inspection of the service have been met. The service has introduced a
The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 6 new weekly forum for students to meet in a large group and discuss issues relating to the service and how it is to be run. There is also a new student complaint procedure in place, which is easy to read and clearly details the steps to be taken should a student wish to make a complaint. 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 Mount DS0000021251.V267128.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 Mount DS0000021251.V267128.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 Information from the assessments of students’ needs and abilities that relate to the provision of personal care and daily living tasks should be held in the each of the houses so that trainee co-workers can refer to them at any time. EVIDENCE: Pre admission assessments were not seen on this occasion. It was noted however that following admission to the home there are four different assessments of needs and abilities carried out in the first term. Individual learning plans are then drawn up and in the second term the outcome of the assessment process is discussed with trainee staff. The majority of the documentation relating to the assessment process is stored in the main house but details of the actions to be taken to meet individual needs is recorded in house meeting notes. In the first term the trainees rely more on information that is passed on verbally from the co-workers. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 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): 6,7,8,9 The service has worked hard to identify the individual aims and targets for each student and to consider any risks that could occur in meeting individuals’ needs. The actions to be taken by staff in relation to meeting these needs should be more detailed so that the outcomes can be more easily measured. The introduction of the weekly forums is a very good example of how the service is continually developing and providing increased opportunities to encourage students to have a say in how the service operates. EVIDENCE: Aims and targets are set for each individual student. Some of the aims and targets are detailed clearly and progress made in achieving them is identified. Some aims and targets are less clear. An example of a target set is to `cross the road more independently’. Records did not indicate how progress was to be measured, how frequently opportunities for crossing the road would be provided and who should take responsibility for ensuring that opportunities would be provided. Since the last inspection the service has introduced more opportunities for students to have a say in their Community. House meetings continue as normal but in some of the houses it is now the students that chair the meetings. A new Monday morning forum has been introduced and the first
The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 10 meeting had been held the week of the inspection. The first meeting focussed on how individuals felt about being back for a new term and what they were looking forward to in the new term. It is also hoped that in the future student representatives will join the regular co-worker meetings. A requirement was made at the last inspection of the home that individual risk assessments should be more detailed in describing the level of the perceived risk and the action to be taken by staff to minimise the risk of an accident/incident occurring. Since then the service has revised the format used for carrying out risk assessments. However whilst a wider number of topics and areas are assessed in relation to risks perceived, the level of risk and information about the action to be taken needs to be more detailed. In one risk assessment it stated that the student can have epileptic fits and is given medication. There is no reference to how often they experience seizures, what type of seizures they experience and the action to be taken by staff should they observe a seizure. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 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): 13,14,16 The service is to be commended for the quality of the meeting observed on the day of inspection. The newly revised activity risk assessments were very detailed and gave clear advice to staff of the actions to be taken to minimise risks of accidents/incidents. EVIDENCE: During the inspection there was an opportunity to observe one of the coworkers running a meeting with a group of students. Emphasis was placed on ensuring that everyone spoke at the meeting, that students listened to each other and that everyone was clear about the tasks they were taking responsibility for at the end of the meeting. Risk assessments are carried out in relation to all activities run by the home. Those seen were very detailed and included the level of perceived risks and the actions to be taken to minimise risks of accident and incidents occurring. Through the summer months the service provides fruit and vegetables to the local health shop. One of the students spoken with stated that she helps in the delivery of the fruit and vegetables on a regular basis. The meals provided on
The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 12 the day of inspection were appetising and well presented. There was a good opportunity for everyone to socialise and the meal was not rushed. As part of fund raising, the main hall is hired out on occasions to the wider community and has been used to host classical concerts. There is also a weekly yoga class run that is open to members of the wider community. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 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): 20 Staff should receive formal training on the medication in use in the home. Whenever a student is unwell a written risk assessment should be carried out to determine the level of supervision to be provided. EVIDENCE: Staff advised that they have not received training on medication. The storage of medication was examined in one of the houses. A small number of students self-administer their medication and storage facilities are provided for them in their individual bedrooms. The format for recording homeopathic medication has been redesigned to allow for each medicine to be signed individually. Should a student be unwell they would stay in their house or bed. However, as co-workers and trainees are involved in session work, supervision at these times for anyone staying in their house is minimal. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 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): 22,23 There is a very good new complaint procedure in place for students. It is easy to read and details the steps that can be taken by a student should they wish to make a complaint. The address and telephone number of the Commission needs to be included. EVIDENCE: The service has a detailed complaint procedure in place. Since the last inspection the service has also introduced a new complaint procedure for students. Although the address and telephone number of the Commission is included in the more detailed version of the complaint procedure it has not been included in the new student version. The crisis intervention guidelines have been revised and updated as required at the last inspection of the home. The restraint procedure has also been updated. None of the students have been assessed as likely to require restraint so it has not been necessary for staff to be provided with training on this subject at this time. Staff receive training on the subject of adult and child protection on an annual basis. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 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): 24,30 The service is continually monitoring the quality of the environment and looking for ways of improving the facilities provided for students. EVIDENCE: Since the last inspection a detailed fire risk assessment has been carried out. Arrangements had also been made for a Fire Safety Officer to visit the service to examine the risk assessment to check that everything was in order. The service is working on the creation of an internet café and library. They have computers and are building up a more detailed library of books. Some of the students have e-mail accounts already. Since the last inspection one of the flat roofs has been replaced. The organisation has applied for planning permission, to provide a car park and outdoor sports area. All areas of the home seen during the inspection were clean and there were no unpleasant odours. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 16 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): 32,33,35,36 In relation to peer-supervision the addition of some ground rules and clarification as to what is expected in terms of observations would add to the system that has been developed. EVIDENCE: Trainee co-workers are expected to complete an OCN accredited course, which is equivalent to NVQ level two. Since the last inspection one member of the permanent staff team has also started studying for this course. The registered manager advised that when this member of staff has completed the course another member of staff would then start the course. The home has introduced a six-step programme for the provision of peer supervision on an annual basis. A procedure has been drawn up but has yet to be discussed and agreed. A mentor system is in place for trainee co-workers. Each trainee has a mentor that they meet with on a regular basis and there are also weekly house co-worker meetings. Trainees spoken with stated that they value the mentorship facility and the support provided to them. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 17 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): 37,38,39,41 Trainees are encouraged to provide feedback on their induction. However, they should also be encouraged to provide feedback on the information that they think is essential in the very early stages of their induction so that this can be used for reference by the service. (As recommended in standard nine, more detailed individual risk assessments might assist in this process.) In relation to quality assurance the service is continually looking at ways to evolve and develop and they are to be commended on the quality of the work undertaken to meet this standard. EVIDENCE: The registered manager advised that she has two more units left to do to complete NVQ level three. She is due to commence the RMA (Registered Manager’s Award) in the near future. Some of the trainees spoken with raised issues regarding the induction to the home. Information is provided on a gradual basis and in the first few weeks incidents can occur where they might be unsure of what to do to support
The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 18 students. They did however understand the policy of the organisation not to overburden trainees with too much information initially and they were happy with the regular opportunities provided for formal and informal training on the needs of the students and wider issues relating to supporting people with learning disabilities. The service completed a self-assessment report and quality improvements plan in December 2005. Part of this process involved sending satisfaction questionnaires to parents, students and trainees. Through this process they examine all aspects of the service they provide and then detail an action plan stating the action they propose to take to address the shortfalls they have assessed in their service. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 19 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 2 X X X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 4 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Mount Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 3 2 4 X 3 X X DS0000021251.V267128.R01.S.doc Version 5.0 Page 20 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 YA6 Regulation 15(1) Requirement Aims and targets set for each student must be more specific in detailing the action to be taken by staff to assist students to reach their goals. (This was a requirement of the previous inspection and it has been partly achieved.) Individual risk assessments must be more detailed in describing the level of the perceived risk and the action to be taken by staff to minimise the risk of an accident/incident occurring. (This was a requirement of the previous inspection and it has been partly achieved). Staff must receive formal training on medication. Timescale for action 30/06/06 2. YA9 13(4) 30/04/06 3. YA20 13(2) 15/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
The Mount Refer to Good Practice Recommendations
DS0000021251.V267128.R01.S.doc Version 5.0 Page 21 1. 2. 3. 4. 5. Standard YA2 YA20 YA22 YA36 YA38 Information from the assessments of students’ needs that relate to the provision of personal care and daily living tasks should be held in the each of the houses. When a student is unwell the service should carry out a written risk assessment to determine the level of supervision to be provided. The student complaint procedure should include the address and telephone number of the Commission. In relation to peer-supervision the service should include in their procedure the addition of some ground rules and clarify what is expected in terms of observations. Trainees should be encouraged to provide feedback on the information that they think is essential in the very early stages of their induction so that this can be used for reference by the service in planning future inductions. The Mount DS0000021251.V267128.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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