Inspection on 10/06/09 for Whitley Farm Cottages

This inspection was carried out on 10th June 2009.

CQC found this care home to be providing an Poor service.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whitley Farm Cottages 18/12/08

Whitley Farm Cottages 17/07/07

Whitley Farm Cottages 27/07/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Whitley Farm Cottages Doncaster Road Whitley Bridge Goole East Riding Of Yorks DN14 0HZ Lead Inspector Carol Haj-Najafi Key Unannounced Inspection 10th June 2009 09:15 Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitley Farm Cottages Address Doncaster Road Whitley Bridge Goole East Riding Of Yorks DN14 0HZ 01977 663476 01977 663476 whitleyfarm@btconnect.com 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) Mary Theresa Care Homes Ltd Manager post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th December 2008 Brief Description of the Service: Whitley Farm Cottages is owned by Mary Teresa Care Homes Limited and is registered to provide personal care and accommodation for up to 8 people with learning disabilities. The home is a large detached building and has 8 single bedrooms over two floors. There is a variety of communal space and five activity rooms. There is a private drive to the house with parking facilities for visitors and staff. Whitley Farm Cottages is situated in Whitley Village 10 minutes drive from Selby, where there are many amenities, local shops and a railway station. The home has a statement of purpose that explains information about the care and services on offer at the home. At the key inspection on 18 December 2008 we were given information that the fees ranged from £2238 to £2879 per week and extra charges are made for chiropody, hairdressing and newspapers. Whitley Farm Cottages DS0000064380.V375796.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 no star – poor quality. This means the people who use this service experience poor quality outcomes. The Care Quality Commission (CQC) inspects care homes to make sure the home is operating for the benefit and well being of the people who live there. More information about the inspection process can be found on our website www.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in December 2008. We completed a Random Inspection in May 2009 and have included information from this inspection in this report. Before this visit we reviewed the information we had about the home to help us decide what we should do during our inspection. Surveys were sent out to health and social care professionals before the inspection. We received feedback from four professionals and their comments have been included in the report. People who live at the home have limited communication and are unable to tell us if they are satisfied with the service they receive or if their needs are being met. On the day of this inspection, three people stayed at the home two people went out. We observed how staff interacted with people who stayed at home. Two inspectors were at the home for one day from 9:15am to 7:15pm. We spoke to eight staff and the responsible individual who is also the owner. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We spent a total of 10 hours at the home. Feedback was given to the responsible individual at the end of the visit. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: People who live at the home could have a better care plan that identifies their individual care needs and how these should be met. This will make sure people’s needs are met. The home could continue to develop systems for making sure decisions made on behalf of people who live at the home are done through a formal assessment process and in consultation with others including relevant professionals. This will make sure people’s rights are protected. Risks to people who live at the home could be more appropriately assessed, and any action to minimise the risk could be identified. This will help make sure people are safe. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 7 People who live at the home could receive more appropriate healthcare and any advice from healthcare professionals could be followed more carefully. This will make sure people’s healthcare needs are met. Two healthcare professionals that work with people with learning disabilities raised concerns about the level of understanding that staff have in relation to autism and felt very few suggestions that they recommended were introduced. A more robust safeguarding process could be introduced. This will make sure people who use the service are safeguarded. Safeguarding meetings have highlighted that information has been passed on to the relevant agencies. We are dealing with this under our enforcement procedures. The home could have a decoration plan which will help make sure people live in a pleasant and reasonably decorated environment. The current car parking arrangements could be reviewed to help make sure people have better access to the home. Recruitment practices could be much more robust. This will help make sure people who live at the home are protected. Staff must receive training that equips them with the knowledge and skills to deliver a safe service that meets the specialist needs of the people who live at the home. This will make sure people are safe and individual needs are met. We are dealing with this under our enforcement procedures. The home could have a registered manager who is qualified, competent and experienced. This will make sure people benefit from a well run home. The Annual Quality Assurance Assessment could contain better information that accurately reflects the home. This will help make sure the quality of the service is properly assessed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are properly assessed before they move into the home and they are assured their needs will be met. EVIDENCE: Since our last key inspection in December 2008 nobody has moved into the home. At the last key inspection we made a judgement that people’s needs are properly assessed before they move into the home and they are assured their needs will be met. We have not received any information since our last inspection to show the outcome would be different. Whitley Farm Cottages DS0000064380.V375796.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff know people who live at the home well but because the home does not have effective care plans in place people’s needs could be overlooked. People’s rights to make decisions is being better promoted, which has given people more choice. EVIDENCE: At the random inspection in May we spoke to seven staff and at this inspection we spoke to eight staff. They told us people are happy living at the home. Staff could tell us about people’s routines, likes and dislikes and family members. At the key inspection in December 2008 we recommended that the care planning process should be developed to make sure people’s care needs and Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 11 aspirations are properly identified, which would make sure people’s needs and wishes are met. At this key inspection we looked at three people’s care records. These had some good information about how people’s needs should be met. One file had a summary of ‘things to know about me’ which said what they like to be called and how often they like a bath. This record was not dated. Each person’s care plan has a set of objectives and staff make a daily record against the objectives that have been relevant that day. People have as many as thirty seven objectives. One person’s objective for drinking stated, ‘Drinking- no problem. Drink the recommended dose’. In the daily objective staff had written ‘juice’ between eight and ten times every day. This is time consuming and does not appear to serve any purpose. Some care records were confusing. One objective for ‘my environment’ stated, ‘Staff must never go into my room with me. Staff can go into my room but ask me first. Staff can go into my room anytime but must knock first. Staff can go into my room if I am not there but only in an emergency.’ One care plan had information that was not relevant to the person. This had not been picked up by staff or management which shows the care records are not being read, and the plans are not person centred. Some parts of the plan referred to the person as a different gender. It was obvious that another person’s objective had been copied and some wording changed. The plan stated that the person ‘will often sit in the conservatory’ but staff confirmed this applied to a different person who lives at the home. Some information was general. For example under the section of ‘who is important to me’ one plan stated ‘my support staff’ and ‘my family and relatives’. It did not say who the family members are. One care plan identified that the person had a specialist healthcare need but the care plan contained no information about how the person’s specialist need should be or is being met. We have covered this in more detail in the personal and healthcare section of this report. One file had a summary of ‘things to know about me’ which had some good information about the person. For example; what they like to be called and how often they like a bath. This record was not dated. Care plan files are very large and contain a lot of information. It is difficult to easily find the information you are looking for. We looked at risk assessments. Each care file had a range of risk assessments but some information that should be included in a risk assessment was missing. Some assessments had a level of risk recorded i.e. medium, high, Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 12 but it was not clear how staff had reached the decision. There was no information about potential dangers or frequency. An assessment identified that one person had requested staff to lock their bedroom door when they are in their room and this was a medium risk. There was no information about how they reached the level of risk. Another assessment for using a bath chair went through each step of using the chair but did not show that an assessment of risk had taken place. One care file had a blank risk assessment form that had sections to record all important information that should be recorded in a risk assessment. The responsible individual said she would look at using this type of form for everyone. At the key inspection in December 2008 we made a requirement that decisions made on behalf of people who live at the home must be done through a formal assessment process and in consultation with others including relevant professionals. This will make sure people’s rights are protected. At the random inspection in May 2008 we spoke to staff about promoting choice and supporting people to make decisions. Staff consistently told us that good improvements have been made, and the home has focused on promoting choice. Staff gave us examples of changes that have been introduced since the last inspection. For example people now access the kitchen and help prepare drinks and snacks. One staff said, “People have got a lot more choices now.” Another staff said, “Everyone is asking service users what they want to do.” After the random inspection we spoke to a Community Nurse who has recently been working with staff to develop care plans and behaviour strategies. They said, when they started visiting the home, the care plans did not have enough detail, and staff needed clearer guidance, needed to know the triggers for behaviours, and needed to take a more positive approach. They said they have visited regularly and staff have done what has been asked. They also said they have been working with staff to make the home more person-centred and think they have made progress. At the random inspection we were satisfied that the home had started to introduce better systems that help promote choice and decision making and recommended that they continue to develop systems to make sure people’s rights are protected. We spoke to staff at this key inspection. Everyone confirmed that they are continuing to develop systems for choice and decision making. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a varied lifestyle and are supported to develop skills. EVIDENCE: Staff said they thought the home does well when supporting people with daily living routines, such as cleaning their own rooms. They said they encourage people to be independent but also make sure they receive the right support. The routines are built into the activity programme and recorded in people’s care plans. Staff also told us people are encouraged to maintain contact with their relatives and they often accompany people to visit their family if support is required. Daily records showed us people have regular contact with their relatives. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 14 Concerns have been raised about the home by some professionals because important information was not always passed on to relatives. The responsible individual has introduced a system to help make sure the home passes on important information. Staff told us the staffing is better organised and a better system has been introduced for allocating staff to work with people who live at the home. Staff said allocating staff is completed in advance so activities can be planned. Staff said people receive enough staff support. People can do a range of inhouse activities, which includes sensory, relaxation, arts and crafts. Staff told us activities are structured and this generally works well. We looked at daily records and these showed that people do different activities on a regular basis which includes going out into the community and people are involved in daily living routines around the home. One person’s daily records told us they had recently been out walking, and when they were at home they had done ‘hoovering, laundry, sensory and arts and crafts’. At the last inspection we recommended that meal arrangements should be reviewed so people who live at the home could enjoy their food when staff and people who live at the home are eating together. Staff said this has been resolved because new menus have given people a better choice and more variety so people are happier with the meals they receive. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal care needs are well met. Robust systems are not in place to make sure people receive the right support with healthcare which could lead to people’s health needs not being met. EVIDENCE: Staff said the home is good at meeting people’s personal and healthcare needs. Daily records told us people have daily support with their personal care. Care plans contain good information to show what support people need with their personal care. Daily records also told us that staff make a record when they notice any changes and complete a body map to show what these changes are. Healthcare plans have been reviewed regularly and appointments are clearly recorded. People’s weight is monitored regularly. One person’s records told us Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 16 they have regular input from healthcare professionals and staff have passed on important information. Another person’s records did not tell us they were receiving enough support from healthcare professionals or their health needs were being met. Their care plan identified they have osteoporosis but the only action to meet this need was recorded as ‘to advocate on their behalf with regards to reviewing medication’. The responsible individual accepted this did not show how the person’s needs should be met. We did not see any evidence that the person was receiving appropriate support for their osteoporosis. We received information from two healthcare professionals who work with people with learning disabilities. They raised concerns about the level of understanding that staff have in relation to autism, which we have covered in the staffing section of this report. They also raised concerns over the quality of a care plan and recording systems for one person and felt very few suggestions that they recommended were introduced. We looked at medication records, checked storage of medication and counted some medicine stock. These were all correct and showed us systems are in place to make sure the right medication has been administered. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguarding practices are not robust and do not safeguard people who live at the home. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) did not give us the number of complaints the home had received in the last twelve months. At the key inspection, the responsible individual told us they have not received any formal complaints since the last inspection. We looked at the complaints record, which had details of concerns raised in the last year, although none of these were formal complaints. The record showed that the concerns had been investigated and action was taken to put things right. At the key inspection in December 2008 we made a requirement that the home must have a robust safeguarding process for referring any allegations of abuse to the relevant agencies, which would make sure people who use the service are safeguarded. Since the key inspection in December a number of safeguarding incidents have occurred at the home. On at least four occasions the home has not followed safeguarding procedures. We know safeguarding incidents took place on Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 18 19/01/09, 10/02/09, 27/02/09 and 05/03/09. We did not receive written notification of these incidents until 27/04/09. The following serious concerns have been raised at safeguarding strategy meetings. • • • • • The home had not made safeguarding referrals or shared information about safeguarding incidents with North Yorkshire County Council, the host Local Authority. Funding authorities did not receive information about safeguarding incidents. The home had failed to share safeguarding information at one person’s annual review so everyone attending the review did not know safeguarding incidents had taken place. CSCI (now CQC) did not receive notifications of safeguarding incidents. Information was provided at the safeguarding meeting by a person working for Mary Teresa Care Limited but this did not correspond with the information provided by three other professionals attending the meeting. At a safeguarding meeting on 6th May it was concluded that there were a number of discrepancies in the information being passed by the home to other agencies. • At the random inspection in May 2009 we looked at care records for two people’s care. From the records we saw that an incident had occurred at the end of April, and one person was hit on the head by another person who lives at the home. We looked at the daily and weekly care records for the person who had been hit but there was no reference to the incident. We also noted that there was no reference to whether or not the incident had been reported to the family of the person or to their care manager. We saw that an entry had been made in the person’s weekly report for week commencing 4 May 2009. This stated the person was ‘not eating as well’ as they usually do and ‘has had some sleeping tablets prescribed’. We spoke with the owner about this and asked why it had not been documented in the person’s care plan and why relevant people had not been informed. The owner said it was an oversight and a mistake. Staff attended safeguarding training with North Yorkshire County Council at the beginning of May. They told us, as a result of the training, they had a better understanding of safeguarding and reporting safeguarding incidents. Staff could describe types of abuse. One staff said, “It’s anything, the way you speak, what you say in front of them, if unsure pass on and let management Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 19 decide if it is abuse. We were given information at training.” Another staff said, “I think they would report it now.” At the random inspection we noted that the home had details of how to report any allegations of abuse. Although staff have attended safeguarding training and a safeguarding procedure is available at the home it is evident that the home has not yet introduced a robust system for referring any allegations of abuse to the relevant agencies so people who use the service are not safeguarded. We did not look at safeguarding practices at this key inspection because the requirement made at the inspection in December 2008 is being dealt with under our enforcement procedures. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a spacious, homely and clean environment. EVIDENCE: The home was clean, tidy and free from any offensive odours. Accommodation is over two floors and each bedroom has either an en-suite shower or bathroom. There is ramped access to the home to assist people with mobility problems to enter and leave the home, although access between floors is by stairs only. People have plenty of communal rooms to use. There is a lounge, dining room, conservatory, sensory room and activities room. The activities room is used for recreational purposes but also has kitchen facilities and a computer. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 21 The home has a garden with furniture and seating so that people can sit outside if they want to. The environment is reasonably well maintained although some areas are ready for decorating. We also found that some area needed decorating at the last key inspection. The maintenance person and the responsible individual said decorating is planned although acknowledged a decorating plan is not in place. The exterior has recently been painted. At the last inspection we found that some people’s personal toiletries were stored in a communal room. We suggested people should have lockable facilities in their room and if it is not appropriate to have lockable facilities this should be identified through a formal risk assessment process. People now have lockable facilities in their room. The home has entrance gates that are fitted with security locks to promote people’s safety and there is a driveway to the house with car parking. This is a busy area and the amount of car parking space that is available is very limited. We made a recommendation at the key inspection in July 2007 to look at parking because it could affect access to the home for people working at the home, relatives and emergency services. The home has appropriate laundry facilities and meets the requirements of the Water Supply (Water Fittings) Regulations 1999. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff morale and team work has improved which has created a nicer atmosphere for people to live and work in. People who live at the home are not supported by a suitably trained staff team which could lead to people’s needs not being met. Recruitment practices are not robust which does not safeguard the people who live at the home. EVIDENCE: At the key inspection in December 2008 we made a judgement that the staff team had not been properly managed which had led to a fragmented and unhappy workforce. We talked to staff at the random inspection in May and at this inspection about team work and staff morale. Everyone we spoke to said they were happier and thought the team was working together. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 23 Staff also thought staffing was generally organised better. They have introduced a system for allocating staff to work with people who live at the home. We looked at these records and these showed clearly where and when all staff should work. Staff thought staffing levels were generally good. At the key inspection in December 2008 we made a requirement that staff must receive induction and training that equips them with the knowledge and skills to deliver a safe service that meets the needs of the people who live at the home. This will make sure people are safe and individual needs are met. This requirement was outstanding from a previous inspection and the timescale of 30/10/08 had not been met. In May 2009, information was shared with us because two healthcare professionals had concerns about the level of knowledge of staff working at the home. They had concerns that staff did not have an appropriate level of knowledge and understanding of Autism even though Whitley Farm Cottages is a specialist autism unit. At the random inspection in May 2009 we looked at the staff training records of five staff and the training matrix that was maintained for all staff. We saw that a lot of the training at the home was provided in house using training materials supplied by an independent company. The training matrix showed us that some staff had not completed the mandatory training that is set out in the Mary Theresa Group training strategy. For example the training matrix showed that one staff had completed infection control training in the last year but the training strategy states staff should receive this training every year. The training matrix states that some staff completed Moving and Handling training in July 2008. Staff told us they have not completed Moving and Handling training. The training matrix states that eight staff completed First Aid training in 2008. We could find no evidence of this in staff files. The owner could only produce evidence that one staff had a first aid certificate (This was an appointed person’s first aid certificate). The person had attended the course before they were employed to work at Whitley Farm Cottages. The Mary Theresa Group training strategy states staff should receive First Aid training yearly. We saw that many of the training certificates had been issued by the Mary Theresa Care Group. For example: A certificate for Supervision dated 18 September 2008 had been issued by the Mary Theresa Group. A certificate for POVA training dated 16 June 2008 had been issued by the Mary Theresa Group. Details of the trainer were not recorded. A certificate for medication training dated 16 June 2008 was issued by the Mary Theresa Group. Details of the trainer were not recorded. We also saw from the training records that staff had completed multiple choice questionnaires for health and safety and fire safety training. These had been Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 24 supplied by the independent training company and bore their logo. Some questionnaires were not dated or signed by staff or whoever had marked them. The question sheets stated the completed sheets should be sent back to the independent training company for marking and certification. There was no evidence to show this part of the process had been followed. We spoke with the owner about the independent training and she told us that they could verify the training and test papers. We pointed out that the questionnaires stated that they should be returned for marking and validation. We spoke to a senior staff member who has facilitated a lot of the in house training. She told us that she was unaware that the test papers should be returned for verification. Staff told us they had recently completed the learning disability qualification (LDQ), which is a recognised qualification. An external trainer had facilitated the course. When we spoke with the owner, who is also the responsible individual, we asked why the certificate was issued by Mary Theresa Group. The owner said staff had gained the formal LDQ but the assessor/trainer was waiting to be registered with the awarding body. Staff had certificates in their files, which were headed, ‘Learning Disability Qualification’ and a certificate of completion. These had been issued by the Mary Theresa Group. One person had a certificate but the workbook was blank. Another person’s workbook had all sections completed and there were pencil comments asking further questions. e.g. what is a risk assessment? One staff confirmed that they had recently completed their LDQ. They said that they had to complete a big course booklet and included in the training was a ‘one hour or so’ talk on autism. We spoke to staff about the LDQ training. One staff said she had completed an induction with a new trainer ‘a couple of months ago’. During this induction she had done a ‘few’ hours on autism training. Another staff said she told them that she had been told the LDQ had to be completed within a week. She said, ‘I would have taken more in if I had more time’. She said she came in one evening after her shift to complete the LDQ. She said she met with the trainer and went over the answers she had given. The trainer told her she must give more detail. She understood the work booklets were sent off for marking. After the inspection we received a letter from the trainer, which told us the workbook was designed around the ‘Skills for Care Common Induction Standards’. Staff told us they have completed Breakaway technique type training (SKIPr) and training records showed us the majority of staff have completed SKIPr training in the last year. We asked to look at the certificates for the two people Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 25 facilitating the training- one is an employee, one is a previous employee. The owner said they have not yet got certificates to teach but the home had received a letter to confirm they can facilitate the training. We did not see the letter during our inspection. We spoke to a Community nurse after the random inspection and they told us they had highlighted that some staff are not confident and need additional training, Although staff have received induction training it is evident that staff have not received training that equips them with the knowledge and skills to deliver a safe service that meets the needs of the people who live at the home. We did not look at staff training at this key inspection because the requirement made at the inspection in December 2008 is being dealt with under our enforcement procedures. We looked at the recruitment process for six new staff who have started working at the home since the last inspection and found that pre employment checks were incomplete. One staff file had all the correct information to show that proper pre employment checks were carried out. One staff file had most of the information but a criminal records certificate was not available. The responsible individual said she had seen a copy of the criminal records certificate. Two staff files had an application form, and a criminal records certificate but only one reference and no proof of identification. The responsible individual said she had seen the proof of identification for these two people but could not find the copies that should be held on file. One staff file had the correct documentation but the application form had no employment history. The responsible individual said this was because the person had been self employed. However one reference was from a previous employer. One staff file had an application form with full employment history and two references but did not have evidence that a criminal records certificate had been obtained. The responsible individual said they had sent for this but were still waiting for it to be returned. The file did not have satisfactory proof of identification. We spoke to three staff who have recently started working at the home. They all confirmed they had an interview where they discussed their experience and answered questions that are relevant to their work. They also said they had Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 26 talked to people on the interview panel about the home. They told us they were enjoying the job and thought the home provided a good service. Staff said they have started receiving more regular supervision. Managers from two sister homes have been providing management support to the home and providing formal supervision to the staff team. Staff said they have felt more supported since the responsible individual who is also the owner has started having a more active role at the home. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of a consistent management team and effective management systems has led to the home failing to provide a safe and consistent service to people who live at the home. EVIDENCE: The home does not have a manager in post and has not had a registered manager since February 2008. The responsible individual, who is also the owner, is taking management responsibility for the home. Two managers from other Mary Theresa Group homes are also providing management cover. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 28 In February 2008, the organisation said they had identified that the home was not being properly managed and said they were taking action to address this. At the last key inspection in December 2008 we made a judgement that the home had not been properly managed for a prolonged period of time but the management team were working hard to put things right even though there was still a lot of work to do. The management team we referred to no longer have management responsibility for the home. A manager was appointed in February 2009 but left in April 2009. After the key inspection we wrote to the responsible individual in January and again in May because we were concerned that the home did not have a registered manager. We received a response letter from the responsible individual’s solicitor that told us a manager had been registered and left her post in September 2008, and another manager had applied and been interviewed for registration with the Commission for Social Care Inspection but left her post in April 2009. This information we were given is incorrect. We have checked our records and have not received or started to process either of the applications the solicitor referred to. Concerns were raised at the inspection in December 2008 about the management of the home, and level of tensions amongst the staff team. Everyone we spoke to said this had improved and the responsible individual was working hard to put things right. One staff said, “We are getting clearer direction.” On 22 April 2009 we asked the home to complete our Annual Quality Assurance Assessment (AQAA) and return it by 20 May. We had not received this by the due date and sent out a reminder letter on 2 June stating the AQAA must be returned by 8 June. We received the AQAA on 8 June. The AQAA was completed but the information was of poor quality and showed us that the home has not identified what they do well, what they could do better and how they could improve. For example in the ‘conduct and management of the home’ section, under the ‘what we could do better’, they stated ‘we could enable one or more staff to undertake assessor training to enable the care home to undertake more in-house training’. They made no reference to the management of the home, quality assurance or health and safety. Parts of the dataset were also incomplete. They did not provide dates when equipment was tested or serviced, or when policies and procedures were updated. They did not give us the number of complaints they had received. We spoke to the responsible individual about the quality of the AQAA. She explained that the AQAA had been filled in last minute and acknowledged that it did not contain sufficient information. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 29 The home does have effective quality assurance systems in place. The home should be assessing quality and identifying areas for improvement but these have continued to be identified through safeguarding investigations and inspections. At the key inspection in December 2008 we made a requirement that people must be able to exit external fire doors at all times and equipment for staff to call for assistance must be available when it has been identified through the risk assessment process. This will make sure the health and safety of people are protected. At the random inspection in May 2009 staff confirmed the communication system was working well and they could get assistance when required. Two staff tested the ‘walkie-talkie’ system when we were present and this worked well. A new system had been fitted to make sure people can exit external fire doors at all times. We found sufficient evidence to show this requirement has been met. We looked at some health and safety records. These were all up to date and showed us that fire tests are being carried out regularly, water temps are checked regularly. An environmental health report from August 2007 stated there are no significant problems. As stated in the staffing section, we identified that staff had not completed some important health and safety training so staff will not know about health and safety practices or have up to date knowledge, which puts people at risk. Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 30 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 1 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 1 33 3 34 1 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 1 X 1 X X 2 X Version 5.2 Page 31 Whitley Farm Cottages DS0000064380.V375796.R01.S.doc 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 person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement People who live at the home must have a care plan that identifies their individual care needs and how these will be met. This will make sure people’s needs are met. Risks to people who live at the home must be appropriately assessed, and any action to minimise the risk should be identified. This will help make sure people are safe. People who live at the home must receive appropriate healthcare and advice from healthcare professionals must be followed. This will make sure people’s healthcare needs are met. The registered person must make sure the home has a robust safeguarding process. This will make sure people who use the service are safeguarded. This is being dealt with under our enforcement procedures. 5 YA34 19 The registered person must DS0000064380.V375796.R01.S.doc Timescale for action 30/09/09 2 YA9 13 30/09/09 3. YA19 13 31/08/09 4. YA23 13 03/08/09 31/08/09 Version 5.2 Page 32 Whitley Farm Cottages 6 YA35 18 make sure recruitment practices are robust. This will help make sure people who live at the home are protected. Staff must receive training that 03/08/09 equips them with the knowledge and skills to deliver a safe service that meets the specialist needs of the people who live at the home. This will make sure people are safe and individual needs are met. This is being dealt with under our enforcement procedures. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations The home should continue to develop systems for making sure decisions made on behalf of people who live at the home are done through a formal assessment process and in consultation with others including relevant professionals. This will make sure people’s rights are protected. The home should have a decoration plan which will help make sure people live in a pleasant and reasonably decorated environment. The current car parking arrangements should be reviewed to enable people to have better access to the home. The Annual Quality Assurance Assessment should contain information that accurately reflects the home. This will help make sure the quality of the service is properly assessed. The home should have a registered manager that is qualified, competent and experienced. This will make sure people benefit from a well run home. 2. YA24 3 4 YA24 YA39 5 YA37 Whitley Farm Cottages DS0000064380.V375796.R01.S.doc Version 5.2 Page 33 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Tyne and Wear NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshireandhumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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