Inspection on 31/07/08 for Tithe Barn

This inspection was carried out on 31st July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tithe Barn 05/07/07

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOME ADULTS 18-65 Tithe Barn Tithe Barn Upper Moraston Sellack Ross-On-Wye Herefordshire HR9 6RE Lead Inspector Christina Lavelle Key Unannounced Inspection 31 July and 1 August 2008 12.30-5 and 2ST st Tithe Barn DS0000069473.V367784.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 Tithe Barn DS0000069473.V367784.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. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tithe Barn Address 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) Tithe Barn Upper Moraston Sellack Ross-On-Wye Herefordshire HR9 6RE 01989 730 491 01989 730 391 Parkcare Homes (No2) Ltd Ms Andrea Creed Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only:Care Home only (PC) to service users of the following gender:Either whose primary care needs on admission to the home are within the following categories:Learning Disability (LD) 13 2. The maximum number of service users to be accommodated is 13. Date of last inspection 5th & 11th July 2007 Brief Description of the Service: Tithe Barn was first set up as a care home in 1999. The provider is a subsidiary company of a much larger organisation, Craegmoor Healthcare which took over management in March 2004. The manager is Andrea Creed who was appointed in August 2006. Ms Creed is also the registered manager of another care home (Stable Cottage), which is next door to Tithe Barn and has the same provider, although the two homes operate as separate services. Tithe Barn provides accommodation with personal care for up to 13 adults. People living there must require care due to learning disabilities and may also have physical disabilities associated with their learning disability and use behaviours that can challenge a care service. They have medium to high dependency on staff for their care. Tithe Barn is a rural location in the village of Sellack, about four miles from the market town of Ross-on-Wye. There are few local facilities, but the home has three vehicles for staff to use to support people to go out in the community. The home is set in seven acres of grounds with a woodland trail and patios. The property consists of several converted barns. One two-storey building is divided into four separate flats, one flat for two, one for three and two for four people. Bedrooms are single and have wash hand basins, although none have en-suite facilities. There is no lift and so the three upstairs flats would not be suitable for anyone with limited mobility. Each flat has a sitting/dining room, kitchen and bathrooms for everyone to use and the office is now located in the same building as the flats. Another building has a swimming pool, laundry and meeting rooms and there is also an activities building with a sensory room. Information about the service is provided in a statement of purpose and service users guide, which are available from the home and Craegmoor’s website. The weekly fee for the service depends on the assessed needs of each resident, as agreed with their funding authority. Additional costs include personal clothing and toiletries, electrical items, day trips not covered by the home’s activities budget, holidays, specialist activities such as aromatherapy and horse riding, college course fees and a contribution towards staff expenses on day outings. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people using the service experience adequate quality outcomes. This is a key inspection of the service provided by Tithe Barn. This means that all the Standards that can be most important to adults living in care homes are assessed. We, the Commission, made two visits to the home, the first one without telling staff or people living there beforehand. During the first visit time was spent in three flats in residents’ company. It is not possible to ask most people directly about their support and lifestyles because of their learning disabilities and communication difficulties. Three care staff were also spoken with about their job, recruitment, training and support. In the second visit the manager discussed how the service is being run and any changes made since the last inspection. Some relevant documents and records were looked at. Surveys were left at the home for ten staff, one resident who can complete it with support, four relatives of residents and one person’s social worker asking their views of the service. Only five surveys were returned and their feedback is used to inform this report. The manager had completed an annual quality assurance assessment (AQAA) before these visits, as now required. This asks managers to say what they think their service does well, could do better, what has improved in the last year and about their plans to improve the service. All other information received by the Commission about the home since the last inspection is also considered. This includes events that had affected people living at the home, one complaint raised about the service and one referral made under the multi-agency procedures for safeguarding vulnerable adults. What the service does well: The manager meets and fully assesses the needs of anyone who wishes to use the service. They can visit and try out the home to ensure it can support them. Everyone living at the home has a plan showing their care needs. Plans help staff know their needs and how to manage them, and their behaviours better. Residents are enabled to go out in the community. The home’s swimming pool, safe grounds, activities and sensory rooms provide good facilities for activities. Staff ensure that residents’ personal care needs are met and they have regular health checks. The home also manages their medicines safely for them. Tithe Barn offers people living there a secure and comfortable home. The four separate flats make it more homely and the grounds are large and pleasant. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 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 Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. People who may wish to use the service can be sure the home would be able to support them. This is because a full assessment is made of their needs, involving both them and their representatives. EVIDENCE: The home’s annual quality assurance assessment (AQAA) states that, prior to admissions, a full and thorough assessment is carried out for all prospective residents to ensure that the home would be suitable. The assessment process followed in respect of a new resident was discussed with the manager and their care records checked. It was confirmed that the manager had made several visits to this person’s former care home to meet them and discuss their needs with the home’s staff and was given a copy of their care plan from this home. This individual visited Tithe Barn a few times over a month with their previous home care staff, who first stayed at the home with them to talk to staff and then left them there for a while. A few overnight stays and a weekend stay were arranged prior to their admission for a trial period. The potential resident’s family had also visited Tithe Barn and other care homes to look around etc. with support from their relative’s social worker. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 9 The manager completed an initial needs assessment and an “on admission” checklist for the possible resident. This appropriately included some of their likes and dislikes, as discussed with their family and former care home staff, although there is very limited information about their life history. The home has drawn up an every day plan of personal care and put detailed management plans in place since their admission in respect of their behaviours that include supervision needed from staff, but had not yet set up an activities programme. A review of the placement was held after six weeks with the home’s staff, the person’s family and social worker, as they are unable to contribute directly due to their disabilities. Another review is to be arranged soon when they will have been staying at the home for six months to decide if they will live there and to finalise their contract with their funding authority. It was discussed with the manager that the home must ensure that suitable arrangements are in place and agreed with their funding authority for any specialist health care support they need that might not be available locally. Their plan and contract should then be agreed and signed by the person’s representative on their behalf. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Each person living at the home has a detailed care plan showing their needs, some likes and dislikes and how staff can meet their needs and appropriately manage their behaviours. Risk assessments are carried out to minimise safety risks. Their diverse needs and goals could be known better and opportunities to make choices in their lives enhanced with greater involvement of significant other people and by using different methods to facilitate their communication. EVIDENCE: Progress has been made to introduce a more “person centred” (PC) format for care planning. Plans include pictures and are easier to read, which should help people be more involved in planning their own support and lifestyle. A social worker says the home used person centred planning well to help them get to know the support one resident needs. Plans are based on an individual needs assessment, and their likes and dislikes in respect of food and activities, which helps staff know residents’ needs and provide more consistent support. Plans contain limited information about their history, background and skills however to help staff understand their needs better and identify any personal goals. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 11 Care planning and review should also focus more on progress to achieve goals, develop skills, what has worked (or not) for people and identify action points. There are also limited details about their preferred methods of communication. One person’s plan just says they make noises, point and can show what they want. Whilst the manager says that communication aides such as pictures and boards had been tried with some residents at the home they do not seem to have considered using aids such as photographs and objects of reference to enable this person to take part in care planning and making daily life choices. Efforts should continue to use communication aids to promote independence. The AQAA says plans refer to equality and diversity, identifying needs in six strands of diversity. This is not evident as support issues in relation to gender, age and disability in particular are not mentioned or assessed. The AQAA also says plans focus on individual preferences and goals/aspirations to encourage them to make their own decisions and choices to lead a purposeful, fulfilling life, enabling them to be as independent as possible; also the home ensures residents and those significant to them are supported to develop a care plan. Whilst it is recognised that, due to their disabilities and limited communication, it is difficult for residents to express their preferences and choices, involvement of other people is not evident. The manager says that resident’s families are reluctant to attend reviews, or be involved in agreeing and reviewing their relatives’ plans, but efforts to involve them should continue and be recorded. Keyworkers are allocated to residents from the staff team and they have a role in care planning and reviewing plans monthly. This should help to personalise care but the home needs to ensure that staff have opportunities to work on a 1 to 1 basis with these residents, as staff report time available can be affected by which flat they are allocated to work in and the current staff shortages. Keyworkers could also help to obtain information about residents’ background and set up life books showing their past and current lives, skills and abilities. Regarding residents’ capacity to make informed decisions and give information letters had been sent to their funding authority asking them to be involved in a capacity assessment. The manager said they had not received any responses, which should be followed up or discussed in placement reviews. Ms Creed is aware that best interest groups should be set up when consent is needed for serious issues or freedom restricted as required under the Mental Capacity Act. Plans include risk assessments on general safety areas, such as travelling in vehicles and road safety. Comprehensive individual risk assessments are also carried out for challenging or aggressive behaviour that may put people at risk. Management plans have been set up with the input of a Consultant Behaviour Therapist to try to prevent certain behaviours developing into risks. They include strategies to manage behaviours such as distraction, possible triggers, levels, with behavioural checklists and records completed of all incidents for analysis. The therapist had recently put in place a detailed management plan for one resident with increased staff supervision and the situation is improved. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to the service. Residents engage in activities but if more individualised they would meet their personal needs and interests better. Staff support people to keep in touch with their family and make daily life choices. Healthy meals are offered but some people’s health could be better ensured with closer monitoring of their diet. EVIDENCE: Residents’ plans include their interests and things that they like to do. Some people have individual additional plans saying they could be more independent, need to access their interests and hobbies and to have more social interaction. The AQAA says “Tithe Barn is committed to supporting people using the service to develop and/or maintain skills such as independent living, social, emotional and communication skills. Goals will be identified with the individual and support given to enable them to be achieved”. Whilst there are limitations to most residents’ ability to develop independent life skills and/or interact with others because of their disabilities and behaviour their plans do not specify any identified goals or skills or reflect how they are enabled to do things they like. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 13 Some people do not have an activities programme and if their activities need to be arranged flexibly because of their moods and behaviours, records do not show if they have been offered an activity or outing and/or refused and how they benefit from activities (or not). One person’s activities record just shows for weeks they had been in the garden, out with family, listened to music and played with beads. The home’s activities co-ordinator had started to assess all residents’ developmental and social needs and to set up individual activity plans, but has left recently so this still needs fully implementing. One social worker comments the home should “Keep increasing service users’ choice for lifestyles and day time activities”. Some residents need 1 to 1 or two staff to support them out in the community. Staff report this is being affected by staff shortages and they also do not have much individual keyworker time available. The manager says they aim to give residents opportunities to go out each day. They are also trying to arrange outings and activities with people from different flats according to their interests. This is good, as activities need to be more meaningful to individuals. Regular activities within the community include two people on a life skills course at college and another attends a day service on some weekdays. Residents are supported to go horse riding, shopping, to use sensory facilities and local cafes and pubs etc. with the home’s three vehicles providing transport. In-house facilities for activities include a swimming pool, activity and sensory rooms and large grounds with a woodland trail. Staff confirm they know residents’ preferred routines and preferences and aim to accommodate them and encourage them to make choices about their daily lives. A relative comments “Improvements have been made in residents’ lives by giving them freedom to go about the grounds and facilities as they please”. Although it is difficult for most people to be involved in household tasks those able to are encouraged to help prepare meals and with shopping etc. and to be involved in doing their laundry and keeping their bedrooms clean and tidy. Some residents have regular contact with their family and the home facilitates visits to them. The manager says their relatives are invited to care reviews and socials, although most choose not to attend and they are not able to find external advocates for people without family input. Records are kept of family visits and contacts and keyworkers are expected to keep in touch with them. Regarding food provision three weekly menus are drawn up showing a variety of mostly wholesome meals, including salads and fresh vegetables. Staff say meals offered are usually healthy and they encourage residents to eat such as cereals, yoghurts and fresh fruit. Individual food intake charts are completed, weight records kept and advice had been sought from a Dietician in respect of one person. Care records show however that two residents have weight issues and one person’s plan does not specify how the Dietician’s recommendations are being followed and the other that their weight loss has been identified and followed up. Care records should also show for both people that their weight changes are being monitored and/or addressed to promote their good health. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to this service. Residents receive good personal care. Whilst procedures are in place for staff to follow to manage their behaviours their well-being would be better ensured if all aspects of their health and lifestyle are monitored and appropriate action taken. Residents’ medication is managed safely by the home on their behalf. EVIDENCE: Residents all require a lot of support from staff with their personal care. Each person has an everyday plan of the support they need and staff complete daily hygiene charts showing which aspects and who has given them support. One relative comments “Residents always appear clean, well and sensibly dressed”. The AQAA states residents are actively encouraged to maintain independence but whilst some plans say their independence should be encouraged in all areas they do not include any specific goals and how these may be achieved. Plans seen have limited background information about residents’ health; just stating they have severe learning disabilities and associated conditions. There are few details about one person’s autism and another person’s epilepsy, including procedures or instructions for staff to manage their conditions. The “person centred” plans that are being set up at Tithe Barn have a section on Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 15 Health and Keeping Safe, which include space to record diagnoses, specific medical conditions, medication and how people should be encouraged to have an active lifestyle for the benefit of their health. However they need to be fully completed to specify all individuals’ health related issues and support required. Records are kept of input sought and/or treatment received from health care specialists. Some involve appointments made by the home for routine checks ups such as Dentists, Opticians and Chiropodists. Others are for preventative or specialist care for example from a Dietician and Psychiatrist. As previously referred to in this report the home is responsible for ensuring arrangements are in place and agreed so individuals can access specialist support they need. Plans cover some specific health related areas and assessments had been made of some residents’ mobility and support needed with eating and drinking. When necessary, records are kept about such as continence management and body charts are completed when marks on people’s skin or injuries are found. Mental health and behaviours are also assessed and the manager confirms that staff are expected to monitor moods and behaviours and to report any changes in each resident’s daily reports. Detailed management plans are in place for some people, which have been drawn up by a Consultant Behaviour Therapist who provides regular input to the home. Plans specify such as engagement and intervention procedures and behaviour checklists are kept for analysis by the Behaviour Therapist with records of incidents of challenging behaviours. The AQAA states that “Staff recognise and respond appropriately to changes in behaviours, moods and general well being”. Whilst behaviours are monitored more attention could be paid to promoting healthier more active lifestyles. For example one person’s records show they are overweight but they continue to put on weight. Advice was appropriately sought from a Dietician about their diet, which also recommended more exercise, but records have not been kept about action being taken and progress. Staff know what is needed to support this person but a proactive plan should be drawn up. Another resident has lost weight since their admission but this did not appear to have been identified. Regarding medication none of the residents are able to manage their own and so staff take on this role. Consent forms are available but had not been signed by their representatives. There are suitable policy, procedures and individual protocols in place relating to safe management and use of people’s medicines. Suitably secure storage is provided and required medication records are kept. Those checked were being maintained appropriately and regular audits are also undertaken. Staff handling medicines are properly trained and medicines are only administered and witnessed by designated trained staff. A Community Pharmacist peridically checks the medication sytem with good reports received. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. If people have concerns about the service there are ways for them and/or their representatives to complain. The home safeguards people living there from abuse, neglect and self-harm and takes action to follow up any allegations. EVIDENCE: The home provides a complaints procedure that is available in a more suitable format for people with learning disabilities. The AQAA confirms that copies are given to residents’ relatives and significant other people. A record is kept when complaints are received by the home detailing investigations and outcomes. No complaints had been made to the home since the previous inspection. An anonymous complaint was sent to the Commission around the time of this key inspection expressing concerns about high staff turnover and the extra hours staff are doing just to minimally cover the home. It is alleged this lack of staff puts residents at risk and affects the time staff have to support them with their activities. This matter has been referred back to the provider and is being dealt with. Our findings about staffing are referred to another section of this report. Policies and procedures are also provided in relation to abuse, safeguarding vulnerable adults and whistle blowing. Since the last inspection whistle blowing procedures were used and a former staff member was subsequently referred to the Protection of Vulnerable Adults (POVA) register. The manager is aware that some issues and/or incidents need to be referred under the multi-agency safeguarding procedures and had made one appropriate referral in respect of the issue just discussed and has also considered doing so in another situation. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 17 Staff receive training in respect of abuse and protection and staff spoken with know about whistle blowing. They have also had training about how to respond to verbal and physical aggression and challenging behaviours. This training includes use of techniques such as de-escalation and diversion, as the manager confirms that physical restraint is not used in the home. One social worker is aware that there has been some protection issues at the home and comments “Staff need to be trained and review professional responsibility for protecting service users as well as promoting their interests and respecting their rights”. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People who live at Tithe Barn have a safe and well-maintained home that is comfortable, clean, pleasant and hygienic. EVIDENCE: Tithe Barn has a lovely rural location and is set in seven acres of grounds, which include a woodland trail and well kept gardens. The accommodation is secluded and whilst the only local facilities within walking distance are a village shop and pub the home has two cars and a minibus to facilitate community access. The home is a safe and pleasant environment and is divided into four separate flats that provide small and more homely living units for residents. We looked at all the flats and overall these were in a good state of repair and decor although one shower facility needs to be upgraded and staff report that it does not really provide enough space for residents to be supported easily. There are plans to put windows in one bedroom’s patio doors and to continue redecoration. Patio doors have been put in one flat since the last inspection. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 19 The flats were observed to be clean, tidy and fresh and a housekeeper and maintenance person are employed to carry out regular cleaning of communal areas, laundry tasks, minor repairs, gardening and decorating. They also have responsibility for shopping for provisions for the home and carrying out regular safety checks such as water temperatures and fire. There are daily and weekly schedules for staff to follow to make sure that bedrooms and kitchens are kept clean and tidy. Policies and procedures are in place relating to infection control and most staff have received relevant training. The home provides disposable gloves and aprons and there are appropriate arrangements for soiled waste. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 20 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 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to this service. Residents do not always receive appropriate support because the staff team is unstable. They could also have their special needs met better if all staff had received relevant training and have the right supervision from their managers. Robust recruitment protects residents from unsuitable staff providing their care EVIDENCE: The AQAA states “Staffing is more settled with an established team of staff”. Albeit that ten staff (over a third of the team) had left the home during the last year and some staff only been working there for a relatively short while. There are also four care and two team leader posts vacant currently and two other staff on long-term leave. Staffing rotas and management reports show that consequently there has been difficulty covering the home and some staff have been working many extra hours for at least two months. Extra shifts have also resulted in staff working long days and sometimes a week without a day off. The manager and deputy manager have also been covering care shifts, rather than using their allocated time for managing Tithe Barn and Stable Cottage. Agency staff had not been deployed, as it is felt unfamiliar staff can be difficult for residents with complex needs and autism as well as effect care consistency. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 21 High staff turnover and staffing shortages at Tithe Barn have been subject to requirements from the Commission for at least two years. This is clearly not a satisfactory situation as such instability has a potentially adverse impact on staff effectiveness and morale. It has also effected staff time available for such as providing individual support to residents and facilitating their activities and community opportunities. It is acknowledged that efforts to recruit staff are ongoing and the home is now awaiting satisfactory checks for two people and has arranged interviews for two other posts. The provider is also keeping staffing under review and is arranging extra management and care support from other homes and will deploy agency staff if necessary to reduce pressures on the staff team. New working patterns had also been introduced since the last inspection, which means that staff work shorter daytime shifts and are not always allocated to work in the same flat. The manager feels this has been positive for team working and individual support received by residents. When staffing is more stable the positive benefits of this should be more evident. Regarding recruitment the AQAA confirms that “All new staff are subject to robust checks and all the required documentation is always obtained prior to the employee starting work”. Records of two new care staff were checked and appropriately include their photograph, application forms with full employment history and a health declaration. Enhanced Criminal Record Bureau (CRB) checks and two written references (one from their last employer) had also been obtained. One reference was not positive and the manager confirmed that this had been discussed with the applicant and with Craegmoor’s Human Resource officer and it was still decided to offer the person the post but their appointment was only confirmed following a satisfactory probationary period. The AQAA says “All staff receive appropriate required induction, training and supervision, which is provided by appropriate trainers from the organisation and external trainers”. Whilst suitable policies, procedures and formats are also provided and the importance of the right training and support recognised staffing issues have clearly also had an adverse affect on staff training, the induction of new staff and care staff having the benefit of regular individual supervision. All staff have received training in mandatory health and safety topics and adult protection but some new staff had not completed an induction programme, as required. Time to work on shadow shifts has also been limited and was said by a staff member to “throw new staff in at the deep end” and put more pressure on existing staff. Staff spoken with had also not completed training relevant to the specialist needs of people using the service such as autism or received formal supervision for some time. Only about a third of the staff team have now achieved a National Vocational Qualification (NVQ) in social care and no staff are working towards it. This impacts on the knowledge and skills of staff, how their work performance and developmental needs are monitored and addressed and therefore the competence of the staff team. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to this service. People could have more confidence in the way the service is run and managed if the home’s management had more time for their task. The ways the home ensures it is getting things right should show more clearly how it is planned to continue to develop the service and review practices, as residents want and/or for their for benefit. The environment is safe for the people living there and staff because good health and safety practices are carried out. EVIDENCE: The manager (Andrea Creed) has been registered in respect of Tithe Barn and Stable Cottage since the last inspection and has 12 years experience in the care of people with learning disabilities. Ms Creed has achieved NVQ level 4 in care and level 5 in management and also has other qualifications in Health and Safety, Communication Skills and Learning and Support. The deputy manager has also completed NVQ level 4 and the Registered Manager’s Award. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 23 The manager clearly understands the importance of person centred planning and thinking (and has made progress to implement this approach). However this still needs further development to ensure the service focuses on residents’ individual needs and goals, also ensuring that equality and diversity issues are taken into account. Clearly the effect of staff instability on their training and effectiveness has also had an impact on such as individualising support and activities. The home has also had a lack of management cover this year as the deputy manager was absent for several months, the manager and deputy have been covering direct care shifts and there are two vacancies currently for team leaders. Staff say and the providers’ management reports show that this has effected support given to staff, in particular individual staff supervision, which can impact of monitoring work performance and identifying training needs etc. There is a formal quality assurance and monitoring system operated by the provider. This includes a Clinical Governance framework to facilitate a process of continual improvement. Their programme includes measures of structures and outcomes that should ensure residents receive a high quality service. Part of this process is regular audits carried out by the home’s manager covering specific aspects of the service and a full external audit undertaken periodically. A representative of the provider (area manager) also visits the home monthly as required to check aspects of the service and to talk to residents, staff and other people, resulting in written reports on the conduct of the home. Tithe Barn is reportedly working towards the quality improvement points made from the last full audit. Whilst this is so their annual quality assurance assessment (AQAA) includes limited details of any improvements made in the last 12 months or planned improvements and the ways they plan to achieve them. It therefore does not provide sufficient information and/or show how the home is continually improving based on quality assurance processes and the views of residents and/or their relatives and stakeholders. Regarding the promotion of the health, safety and welfare of residents and staff in the home it was previously confirmed there is an appropriate policy and all necessary procedures are provided to promote good working practices. The manager is trained in health and safety for care homes and all staff receive mandatory training. The AQAA also confirms the following:• Portable electrical appliances (PAT) tests are being carried out. • Fire safety checks on the system and equipment are carried out and/or arranged at the specified intervals. • Regular servicing and/or maintenance of the heating system and gas installations are arranged. • There are suitable arrangements in place for disposal of soiled waste • COSHH risk assessments are in place. There were no safety hazards identified in the environment during our visits. Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 24 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 X 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 2 X X 3 X Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO – although some previous requirements are carried forward as recommendations STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The home should assess and record the preferred communication style of each person using the service and consider using communication aides. All staff should also receive relevant instruction. This is so that staff can enable residents to communicate and make more choices and decisions to promote their independence. Progress to implement a more person centred approach to care planning should continue. Plans should also include reference to equality and diversity, residents’ goals, skills and abilities. This would mean more focus on individuals and how they can develop skills and achieve identified goals Efforts should continue to support residents to take part in more individualised and meaningful activities, which would also meet their personal needs and interests. The home should ensure that there is detailed information available to staff about residents’ health and that all aspects DS0000069473.V367784.R01.S.doc Version 5.2 Page 26 2 YA6 3 YA12 4 YA19 Tithe Barn relevant to their health are more closely monitored and followed up so that their wellbeing is promoted. 5 YA33 Staff turnover should continue to be monitored and kept under ongoing review with a proactive strategy to support and retain the staff team. This would promote consistency of care and so better support for residents. The provider should ensure that all new staff complete an appropriate induction and training relevant to the specialist needs of people using the service. The programme of NVQ training should also continue. This is so that staff have the right skills and knowledge to enable them to understand and so support and meet the needs of residents better. The provider should ensure that that the service continues to develop for the benefit of residents to meet their individual needs and that the manager has sufficient time and support to address the improvements necessary. 6 YA35 7 YA37 Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Tithe Barn DS0000069473.V367784.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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