Inspection on 05/07/07 for Tithe Barn

This inspection was carried out on 5th July 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tithe Barn 31/07/08

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 09/07/2008.

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 Inspection started 5th July 2007 12:00 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.V345145.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.V345145.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 Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 2nd & 9th November 2007 Brief Description of the Service: Tithe Barn was first registered as a care home in 1999. The provider is a subsidiary company of a much larger organisation, Craegmoor Healthcare, which took over its management in March 2004. The manager is Andrea Creed who was appointed in November 2006. Mrs Creed has recently submitted an application to the Commission for registration as joint manager of Tithe Barn and another care home Stable Cottage. These homes have the same provider and are next door to each other, although they operate as separate services. This home provides accommodation with personal care for thirteen adults (men and women) aged from eighteen to sixty-five. Service users must require care due to learning disabilities and have a medium to high dependency on staff for their care needs. They may have physical disabilities that are associated with their learning disability and use behaviours that can challenge a care service. Tithe Barn is set in seven acres of ground and has a rural location in the small village of Sellack, which is about four miles from the market town of Ross-onWye. Although there are few local facilities, the home has three vehicles so staff can support service users to go out and take part in community activities. The property consists of several converted barns and one two-storey barn is divided into five separate flats for service users. One flat accommodates one person; two flats are for two people and the other two flats are for four people. The bedrooms are single and have wash hand basins, although none have ensuite facilities. There is not a passenger or stair lift and so three flats upstairs would not be suitable for anyone with poor mobility. Each flat has a kitchen, sitting/dining room and bathrooms. The home’s office and staff facilities are in a separate building that also houses a swimming pool. Another building was been converted to an activities area, with a sensory room for service users. There is written information about the home for interested parties, available from the home and the Craegmoor Healthcare website. The current fee for the service ranges from £735 up to £1823.82 per week depending on the assessed needs of individual service users. Additional charges are made for personal clothing and toiletries, electrical items, day trips that are not covered by the home’s activities budget, holiday costs, specialist activities e.g. horse riding and aromatherapy, college fees. Service users are also expected to contribute towards staff expenses when they are taken out for the day. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of Tithe Barn. This means the inspector checked all the Standards that can be most important to people who live in care homes. The first visit to the home was made without telling staff and service users beforehand. Most of this afternoon was spent in four flats with service users to observe their activities and interactions with each other and staff. The second visit was arranged at the first visit to talk to the manager about how the home is run and changes made since the last inspection. An annual self-assessment form was completed before this visit (as now required). This asks managers to say what they think their care home does well and could do better and about their plans to improve the service. A Commission pharmacist inspector also visited as part of this key inspection to carry out a specialist inspection of the arrangements for handling medicines, which took over three and a half hours. It is difficult to discuss the home with service users because of their disabilities and limited communication. Survey forms were sent to their families and to health and social care professionals who are involved with them, asking for their views of the service. About half of them responded and their feedback is referred to in this report. Several staff were also spoken with about their job, training, the support they receive and about service users’ care and lifestyles. Various records about service users, staff and that show how the home is kept safe were checked and the premises looked at. All other information received by the Commission about the home since the last inspection is also considered. What the service does well: There is good information about Tithe Barn to give possible service users and their families. The manager meets and assesses anyone who might like to live at the home and they can visit and try it out to check it could meet their needs Service users each have a care plan showing their needs, likes and dislikes and any possible risks. Plans help staff to know their needs and how to meet them and how to keep them safe and manage some challenging behaviours better. Staff enable service users to go out to mix in the community and for activities. The home’s large grounds, activities room and swimming pool also provide facilities for service users to exercise and to take part in activities they enjoy. Staff make sure that service users’ personal and health care needs are being met. The home also manages their medicines safely on their behalf. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 6 Tithe Barn offers service users a secure and comfortable home. The separate flats make it more homely and the large grounds are nice to walk and relax in. Training is arranged for staff to help them keep the home and service users safe and know about their special needs and how to support them. New staff complete a special training programme and necessary checks are also taken up to help to make sure they are suitable to care for people. 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.V345145.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.V345145.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): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. There is suitable information available to help prospective service users (with their relatives and/or representatives) decide if they might like to live at Tithe Barn and if the home could meet their needs. Good assessment procedures help to make sure that the home would be able to meet their needs. EVIDENCE: Appropriate information documents are provided for the home, which include a statement of purpose and a service users’ guide. The guide is in a suitable format with pictures and simpler language so people with learning disabilities can understand it better. Copies of the guide, and residency agreements made with funding authorities, were seen in service users’ care records. There are two new service users since the last inspection. Their care records were looked at and their admission discussed with the manager and staff. It is confirmed the manager visited them at their previous residence to meet them and assess their needs. Information about Tithe Barn was given to them and their relatives. They had then visited the home several times over a month for meals and to meet everyone before trial stays were arranged. The home has a welcoming procedure in place. Review meetings were held at the end of their trials before a decision was made about the suitability of the placement, which involved service users, their families, the home and other relevant people. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 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. 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 this visit to the service. Each service user has a detailed care plan showing their care needs, likes and dislikes and how staff should manage their behaviours and meet their needs. Relevant risk assessments have been carried out to minimise any safety risks. Plans need to be reviewed with service users and relevant people to include their personal goals and focus more on supporting them to develop their life and social skills. Whilst service users make some choices in their lives and daily routines plans should also show when decisions are made on their behalf. EVIDENCE: A sample of service users’ care records was looked at and their care needs and daily lives discussed with support staff. Each person has a needs assessment, a care plan, risk assessments and behaviour management plans as necessary. Staff make daily reports about service users’ activities, their mood, health and behaviours. They also keep personal care checklists, records of health care input, physical checks, food intake charts and family contact sheets. These all provide helpful information about service users’ current and ongoing lives. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 10 Although plans reflect service users’ needs and action staff should take to meet them, the manager recognises their needs should be reassessed. Plans should focus on service users’ personal goals and developing their individual skills to improve their lifestyle. Plans currently include some likes & dislikes, preferred daily routines and what is important in their lives. However it is difficult because of service users’ disabilities to ascertain what they want and their goals and so reliance is placed on staff knowing them well, family input and care reviews. Advocates could be involved but the home has tried but not been successful so far in obtaining any input from local advocacy services. Keyworkers allocated to each service user from the care staff team should play a lead role in this process, but this has been affected by staffing issues. The staff turnover has meant some staff have left and agency staff are being deployed. Consequently whilst keyworkers are expected to review and update plans and risk assessments monthly some have not been reviewed since April. The provider is introducing a more “person centred” care planning system and the manager, deputy and some staff have attended training. The manager and team leaders intend to work with keyworkers to introduce and set up plans using the new care plan format. Reviews will have to be held and how service users’ choices and goals are ascertained, and decisions made for them, should be reflected in their plans. Regular future reviews should then specify if their goals have been met and show if and how they have benefited them and developed their skills (or not) with revised goals and action plans as necessary. Communication is important in care planning and because of most service users’ limited verbal communication it is difficult to obtain their views. The provider has set up a user involvement project called “Your Voice” with service users as members and regular meetings held to involve them in decisions made about their care services. A meeting has been held at Tithe Barn but service users are unable to actively participate. Plans to develop the use of communication boards, cards and photographs to enable service users to make choices (e.g. food and activities) should therefore continue. It is good that some basic Makaton signs have been printed off for staff to help them communicate better with a new service user. Care records also show that general risk assessments have been carried out to promote service users’ safety such as when using the pool, the kitchen, out on community activities, bathing and choking. A Behaviour Therapist has helped to set up comprehensive behaviour management plans and staff are expected to monitor and record challenging behaviours and use particular techniques to help minimise and manage them. These too need to be reviewed regularly. One stated aim of the home is to promote an inclusive environment where everyone is valued, contributes and has an opportunity to fulfil their potential. Issues of equality and diversity are also covered in induction and staff are to have training on The Mental Capacity Act. These principles must be reinforced through staff supervision and meetings to ensure staff practices reflect them. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Progress is being made to facilitate service users’ activities and opportunities to go out and mix within the wider community. Contact with their families is maintained and efforts made to provide varied and wholesome meals they like. EVIDENCE: One of the staff is now designated as activities co-ordinator and has assessed service users’ social and developmental needs. Activity plans are being drawn up and new opportunities sought to meet their identified needs and interests. Plans include a list of activities each person enjoys and they will also have a fitness plan and a weekly timetable. For one new service user this includes promoting their independence e.g. preparing meals and the home is seeking a life skills course at college. Daily reports show all their activities, outings and daily living tasks undertaken. The co-ordinator is also devising an activities file for each service user to include a weekly report of activities taken part in (and if not why not) and to record if they had enjoyed and/or benefited from them. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 12 Another aim is for service users to each have a life book with pictures and photographs etc. of their outings, activities and holidays to show and/or give to their families. It is also planned to use pictures and objects of reference to enable some people to choose what they want to do each day. Service users’ community based activities include horse riding, using snoozelen sensory facilities, skittles, bowling, garden centres and shopping. The home has also been trying to increase their community integration such as going out to pubs, for meals and to a local club for people with learning disabilities and most people now go out somewhere every day. Today three of the men went shopping to Gloucester and had lunch out; two went to the snoozelen; one service user was at a day service and others out shopping in Ross. The home has large grounds with lovely gardens, a wooded area and a trim trail. There is also a separate activities room (with a sensory area and new pool table) and a swimming pool. The co-ordinator has recently purchased art and crafts equipment etc. and two service users were observed doing a mosaic craft session with two staff and seemed to be enjoying this and were being encouraged to join in and choose colours etc. Regarding service users’ families most say that they are kept informed and consulted by the home about their relatives care. They are also invited to take part in care reviews. One care manager confirms the home has been active in connecting service users with their families and they are trying to re-establish contact with one person’s family, organising transport and an escort. There is a record kept detailing family visits and contacts and keyworkers are expected to keep in touch and send cards on special occasions etc. on behalf of service users. The home also organises occasional coffee mornings, parties and a barbecue was recently for Tithe Barn and Stable Cottage. In respect of food provision there are three weekly set menus, with a variety of mostly healthy main meals, which include traditional, pasta and rice dishes. Breakfasts and snack meals are flexible and service users in one flat were asked to choose their sandwiches and also had crisps and a cake. One of them chose and made their own sandwiches. Menus are currently under review and pictures of meals and food will be used so service users can be more involved in choosing what they want to eat. There is an up to date list of their food likes & dislikes for staff reference. The housekeeper buys the home’s food and provisions and ensures flats are supplied as per the menus. Staff say they aim to promote healthy eating, with fresh fruit and vegetables and ensure service users are offered fruit regularly. No service users require a specialist diet, although efforts are being made to monitor two people’s intake to help them lose some weight. Food intake records are kept and guidance is specified in care plans when assistance and/or supervision at mealtimes is needed. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Staff support service users with their personal and health care needs. It would confirm that their health needs are being monitored; preventative steps taken and that their good health is promoted if they each have a Health Action Plan. People who use this service are protected by the home’s policy and procedures for dealing with medication. EVIDENCE: Service users’ plans include assistance they need with their personal care and daily records are kept showing support they have received. Service users were observed to be well presented and appropriately dressed and most relatives confirmed they were satisfied overall with the care provided. The manager says they have established with families that intimate care is provided by care staff of the same gender and/or in accordance with each service user’s wishes. There is information in relation to service users’ medical condition, their health history and current health needs. The home arranges routine health care checks, such as from the dentist and blood pressure taken by a district nurse. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 14 Some service users receive specialist health care support from a psychiatrist. Records sheets are kept of this input and of physical health care checks such as weight and seizures. There is written guidance on epilepsy and a seizure protocol and body charts are used when service users have marks or injuries. Records of visits to GPs and routine and specialist health care appointments are kept. One GP says the home communicates well, there is always a senior to confer with and that their advice is taken up. They can see service users privately and staff appear to understand their needs. They have no complaints and are satisfied with the overall care commenting that “Residents have very complex needs with complicated medication. Generally staff manage this well” It is considered good practice by the Department of Health for people with learning disabilities to have an individual Health Action Plan (HAP). HAPS can help to ensure that their health is closely monitored; any problems identified and their good health is being promoted. This includes that all their special health care needs are recognised and understood and they are supported to stay healthy through preventative as well as routine and specialist health care input. HAPS had not yet been implemented, although they are part of the new person centred plan format and keyworkers have started to set them up. The pharmacist inspector looked at some stocks and storage arrangements for medicines in the five flats. Some medicine record charts, other medication records and the home’s medicine policy and procedures were also checked. There were discussions about medicines with the manager and three care staff. No service users are assessed as being able to look after their own medication so staff take on this role. Care plans indicate each person’s preferences for taking their medicines. A pharmacy from Hereford provides most medicines monthly in a monitored dose system with printed medicine charts on which staff record medicines administered. There are records of medicines received, administered and disposed of to make sure there is no mishandling. All medicines needed were in stock and there was no evidence during the last month of any medication being out of stock. Detailed records are kept about doctor’s visits and changes in medication. Medicines are stored safely at the right temperature and were all within their expiry date. Sample checks of the records and medication in stock indicated the records were all in order. There was just one exception where a tablet for one person remained in the blister pack although the chart was signed as though the dose was given. The manager noted the details to investigate further with the staff involved. For each tablet or capsule not packed in the blister packs there is a checklist for stock balances after administration. This is signed as well as the chart after administration so it is easy to see what should be in stock. Including a carried forward balance from the previous month on each sheet would make checks easier. This also applies to the charts used to record doses of medication administered only on an ‘as required’ basis. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 15 There are detailed protocols in the medication files telling all staff how to use medicines prescribed to use ‘as required’. A protocol for a second laxative is needed for one person and the name of the medicine should be included in another protocol rather than just referring to ‘inhaler’. There was no protocol for another medicine included on the medicine chart as ‘one or two at night as required’ but these tablets are not used now. It would be best to return them to the pharmacy and tell them to remove this item from the printed chart. There were two instances where medicines are prescribed ‘as required’ with protocols in place but the medicines are no longer printed on the medicine chart. Liaison with the pharmacy can make sure these items remain on the chart so a record on this chart can be made if doses are ever administered. Protocols for three service users about the use of an emergency medication by an invasive technique need revising to indicate that staff do not use them now (a paramedic is called). The directions for the use of a cream and an ointment for one person need reviewing to clarify how they are used, as the record chart was not always signed to indicate treatments had been applied. There is some information about use but more detail would help. Two members of staff are involved when medicines are administered and separate records are kept of the witness check. Inspection of these records for the last month showed these were all completed except for just two occasions when there was only the witness signature. The tablets were not in the packs so the assumption is the medicines were administered correctly as prescribed. The manager noted the details to investigate further with the staff involved. Staff who handle medicines are properly trained and most staff have recently undergone a reassessment of their competence in handling medicines safely. Up to date information about medicines administered is kept. A written policy & procedures for dealing with medicines are in place and are readily available. This means staff should be quite clear how the company expects them to deal with medication issues. The temperature for fridge storage needs correcting in one procedure and was pointed out to the manager. Suitable procedures are also in place for using homely remedy medicines so that staff can respond appropriately to minor ailments service users may occasionally suffer from. Tithe Barn DS0000069473.V345145.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 adequate. This judgement has been made using available evidence including these visits to the service. There are frameworks in place to deal with complaints and protect the service users. However there are still vulnerabilities in the service, which need to be stabilised to promote more consistent care and minimise risks to service users. EVIDENCE: The home provides a written complaints procedure that is available in a userfriendly format. There are also comment/suggestions cards for service users and the “Your Voice” user involvement project, which aim to enable service users to express their views. Whilst it is unlikely that current residents could be actively involved or report any concerns directly however, their relatives confirm that they are aware of the home’s complaints procedures. They also say they have (or would) raise concerns on their behalf, which have usually been dealt with appropriately. The home is also trying to obtain external advocates for service users but this has not been very successful due to a lack of advocates in local advocacy services. There have not been any complaints made to the Commission about the service since the last inspection. There are policies & procedures in place to promote service users’ safety and protect them. They include whistle blowing and for managing behaviours to minimise aggression, self-harm and their effects on other people. The home also has a copy of the multi-agency procedures for the Protection of Vulnerable Adults (POVA). Staff receive relevant instruction during their induction and the local POVA co-ordinator has also taken a training session for staff at the home. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 17 Several more referrals have been made and dealt with under the multi-agency adult protection procedures since the last inspection. Most relate to allegations of abusive practice by care staff and have resulted in their suspension and subsequent investigations. The Police were involved in some incidents and the matters then passed back to the provider for their investigation. This has resulted in one staff member being dismissed and disciplinary action taken against others. Two staff are currently suspended whilst the concerns raised are still being investigated. Whilst it is positive that poor practice is being reported and that referrals have been made by the manager through the adult protection procedures it is of concern that they are still occurring. This reflects on the culture of the home and the monitoring and management of staff and their practice. The ongoing high staff turnover also continues to increase the vulnerability of the service because of the possible effects on the quality of staff and team morale. These factors all have the potential to affect the quality of care. Tithe Barn DS0000069473.V345145.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 the service. Tithe Barn offers service users a secure, safe and clean home that suitably meets their needs. Progress has been made to improve the quality of the décor, furniture and fittings, which has made the environment more homely. EVIDENCE: Tithe Barn is in a lovely rural location and is set in seven acres of grounds that include woodland, a sensory trim trail, well-maintained gardens and patio areas. The accommodation is private and secure and whilst there are few local facilities within walking distance the home has three vehicles to facilitate community access. The accommodation is divided into five separate flats so providing smaller and more homely living units. Each flat has a core staff team who should therefore get to know service users and their needs better. All the flats were looked around and found to be clean, tidy, fresh and airy. A housekeeper and maintenance person carry out day-to-day cleaning, laundry and minor repairs and there are daily and weekly schedules for care staff to Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 19 check that service users’ bedrooms and the kitchens are kept clean and tidy. Policies and procedures are provided on infection control and this topic is included in staff induction and training. The home provides disposable gloves and aprons for staff. It is good to see that improvements have now been made to the premises as were outlined in a programme for this work, as part of the home’s “Pathway” improvement plan. Most flats have now been completed, which include new kitchen units, flooring, carpet, redecoration in flat 2 and new patio doors in flat 3 so providing better access to the garden. Flat 5 has a new suite and pictures and mirrors etc had been purchased and were about to be put up. Most flats have had new kitchen units and some redecoration. The overall impression is much more bright and homely. In addition one new service has his own chair and television etc and has a key to lock his bedroom. Although another new service user is unable to express their views their parents were involved and chose a colour they felt he would like for the décor in his bedroom. Tithe Barn DS0000069473.V345145.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 the service. Appropriate staff are deployed to cover the home. However service users’ care is being affected by unstable staffing and lack of staff supervision and support, which also has an impact on the training and so competence of the staff team. The home’s recruitment procedures are thorough and should help to protect service users from unsuitable staff working at the home. EVIDENCE: The manager and staff rotas confirm that there are always at least eight staff deployed during the day and four at night. Whilst this is an adequate level to cover the home staff vacancies means that managers are having to make a constant effort to find cover and some contracted staff are often working overtime. Agency staff are also having to be used again, especially at night. The recruitment drive is ongoing, as there is still a high staff turnover, which is compounded by the staff suspensions. A lack of permanent staff clearly can affect the consistency of care service users receive as well as have an impact on the experience, training, commitment, morale and so competence and effectiveness of the staff team. The manager confirms they will continue to recruit staff and that staff turnover is being monitored three monthly. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 21 There have also been issues reported in previous inspections relating to staff turnover and culture of the home. Also the possibly adverse affects of long working shifts, lack of staff incentives (e.g. pay) and divisive separate shifts. Concerns have also been raised by current and ex staff about the lack of staff support and culture of blame and allegations. Relatives also comment on the high staff turnover, saying there are too many short-term staff who don’t get to know service users’ needs. Unfortunately staff morale still seems low, due in part to staff turnover and the suspensions and disciplinaries. Staff also say the home’s layout and organisational structure isolates them from managers and that they feel they are unsupported and undervalued. It is positive that the manager and deputy recognise these difficulties and are making plans to address them. This will include increasing their direct input and availability to staff and changing some working arrangements so staff work shorter shifts and not always in separate shifts. Improvements will also depend on there being more permanent staff and so a stable staff team. Also on regular team meetings and staff receiving formal individual supervision. Regarding recruitment applicants are now required by the provider to submit a full employment history (with any gaps explored and a satisfactory explanation obtained). References must also be from a creditable source including their most recent employer. Staff records seen at the home confirmed this and that two suitable written references and a CRB (Police) check were being taken up and copies of relevant documents and their photograph obtained. Craegmoor’s Human Resource department also verify all applications before and whilst new staff are being selected. Currently three new staff were being inducted to the home and undertaking the provider’s comprehensive induction programme, which is linked to Skills for Care core standards. There is a rolling training programme to ensure that all staff complete the core health & safety and other topics such as abuse and safe handling of medicines. Various training sessions are also arranged relating to service users’ care and special needs, such as autism awareness, person centred planning (PCP) and interventions for the management of challenging behaviours. The home has recently delegated a team leader as their training co-ordinator and a training plan has been put in place. The manager said that training is continually being arranged and staff spoken with had undertaken most topics and some were doing an NVQ qualification in social care. Whilst this is good unfortunately the team’s training is affected by staff turnover so although many had started NVQ (six are working on it now) only three care staff have actually achieved it. Care staff had still not been receiving formal individual supervision on a regular basis or have an individual development assessment & profile as the Standards specify they should. A supervision system is now being implemented and all staff have now had one session. This increase in support and supervision must continue and hopefully will encourage the staff team to work together, feel better supported and be more positive, for the benefit of service users. Tithe Barn DS0000069473.V345145.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, 38, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to the service. The home’s management arrangements have yet to be finalised and plans to improve management input and support should also be implemented to create a more positive and open atmosphere, which would be better for service users. There are systems in place to check how the home is run and for the continual development of the service, for the benefit of service users. Whilst the home’s policies & procedures help maintain safety and promote good working practices in the home the provider should ensure safety issues are dealt with quickly. EVIDENCE: There has not been a registered manager in respect of the home since June 2004. One manager was appointed and found to be unsuitable, and two other people had taken the role temporarily. The manager now in post (Mrs Andrea Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 23 Creed) has been registered in respect of another care home, and is suitably experienced and qualified. The provider proposes that this position will also include the management of Stable Cottage, which is adjacent to Tithe Barn and owned by the same provider. Mrs Creed’s application for registration has been recently submitted to the Commission. The manager and deputy manager share management responsibilities and the day-to-day running of Tithe Barn and Stable Cottage. Some management tasks are also delegated to the six team leaders, such as COSHH risk assessments, medication, health & safety and fire checks and one is the home’s training co-ordinator. As already referred to in this report there have been some ongoing issues in the home, which have had a negative affect on staffing and so on the service and support service users receive. It is good therefore that the manager is working closely with their line manager to address them, which will hopefully result in a more positive and supportive management and staff approach. In addition the provider had carried out a full unannounced audit of the service in January this year and a detailed Quality Improvement Plan was put in place. The resulting report includes many recommendations for improvements, which reflect the shortfalls identified in this report. Whilst some have already been dealt with it is essential that the provider continues to support the home to focus on action needed and to meet the timescales specified. Part of this formal quality assurance (QA) & monitoring system is the “Your Voice” project and questionnaires sent to service users’ families to obtain their views, which are analysed by the QA manager to inform how the service needs to develop. Regarding health & safety in the home staff training is arranged in all the mandatory topics. It is also confirmed that the home undertakes required fire safety checks at the specified intervals. Relevant risk assessments have been carried out and the home has appropriate COSHH risk assessments in place. Other regular checks and servicing are also arranged regularly such as electrical, gas installations and the central heating system. There were no safety hazards identified in the environment during these visits, although comments were made that sometimes it can take longer than is safe for more major repairs to be agreed and actioned. Tithe Barn DS0000069473.V345145.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 3 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 2 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 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 2 3 X X 2 X Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 1 YA33 Regulation 18 Requirement Staff turnover must continue to be monitored and kept under ongoing review. The recruitment drive and training programme must also continue (including NVQ) until there is a more stable and complete staff team with staff who are suitably trained and qualified. Timescale for action 31/12/07 2 YA35 18 Previous timescales of 30/09/06 & 09/12/06 were set. A formal individual supervision and 30/09/07 support system for care staff must be fully implemented and each staff member should have a training and development assessment & profile. Previous timescales of 31/03/06, 15/07/06, 30/09/06 & 31/12/06 were set. However due to ongoing staff issues limited progress has been made. Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 26 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 Service users’ care needs and goals should be reassessed and their plans and risk assessments drawn up using the more person centred format. Care reviews should involve service users’ relatives and relevant other people as much as possible and reflect when, who how and why choices and decisions are being made on their behalf. Health Action Plans should be set up for service users to help to confirm that their health needs are monitored; preventative steps taken and that their good health is being promoted. 2 YA19 Tithe Barn DS0000069473.V345145.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park Droitwich Road Worcester WR3 7NW 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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