Inspection on 18/12/08 for Whitley Farm Cottages

This inspection was carried out on 18th December 2008.

CSCI 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 10/06/09

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 19/06/2009.

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 18th December 2008 09:00 Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whitley Farm Cottages DS0000064380.V373533.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. Whitley Farm Cottages DS0000064380.V373533.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.V373533.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th July 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. The current scale of charges at the time of the site visit on 18 December 2008 range from £2238 to £2879 per week and extra charges are made for chiropody, hairdressing and newspapers. Whitley Farm Cottages DS0000064380.V373533.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 0 star. This means the people who use this service experience poor quality outcomes. The Commission for Social Care Inspection (CSCI) 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.csci.org.uk The last key inspection was carried out in July 2007. A key inspection was due before July 2009. We received information about the home in November and December and decided to bring forward the key inspection. We completed a Random Inspection in July 2008. Information from this inspection has been included in this 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, five people who live at the home went out for the day; one person stayed at home. We observed how staff interacted with the person who stayed at home One inspector was at the home for one day from 9:00am to 5:30pm. During the visit we looked around the home. We talked to eleven staff, the manager and the area manager, and looked at care plans, risk assessments, daily records and staff records. Feedback was given to the manager and the area manager at the end of the visit. After the inspection we met with the managing director and discussed the findings of our inspection. The managing director told us that many of the problems at the home were because the home had not been properly managed over a period of time. She also told us what they are doing to put things right. 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. Whitley Farm Cottages DS0000064380.V373533.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: Care plans should be more person centred and cover all areas of the individual’s life. They should be a better working tool. This will help make sure people’s care needs and aspirations are properly identified and met. Daily records should be easier to follow. This will help monitor people’s quality of care and welfare. Decisions made on behalf of people who live at the home should be done in consultation with others and through a formal process. This will promote choice and make sure people’s rights are protected. Meal arrangements for people who live at the home and staff should be reviewed to make sure people can enjoy mealtimes together. People who live at the home should be given the option of having fresh milk. To make sure they are given a varied and nutritious diet. Payments made using people’s money must be fair, equitable, and for their benefit. This will make sure people’s finances are protected. Financial records must be kept at the home so these can be checked when we carry out our inspections. The home’s safeguarding process for referring any allegations of abuse must be more robust and staff should be encouraged to contact relevant agencies if Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 7 they are concerned. This will make sure people who use the service are safeguarded. Car parking arrangements should be reviewed so people have better access to the home. Bedroom furniture and window blinds should be replaced or repaired when they are no longer fit for purpose. This will make sure people live in a comfortable environment. Staff must receive a more structured induction and better training. This will equip staff with the knowledge and skills to deliver a safe service that meets the needs of the people who live at the home. Staff should receive better support and supervision, and be encouraged to work more effectively as a team. This will help make sure people live and work in a more positive and pleasant atmosphere. Staff working patterns should be formalised so staff know their rota pattern. This will help reduce anxiety amongst the team and improve staff morale. The home should have better, more consistent management arrangements so everyone benefits from a well run home. External fire doors must be accessible 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. 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. Whitley Farm Cottages DS0000064380.V373533.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.V373533.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. People’s needs are properly assessed before they move into the home and they are assured their needs will be met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Since the last inspection two people have started using the service. It was several months ago but staff said the admissions were well planned. We looked at one person’s records. There was very good information to show that the admission was carefully planned and staff at the home and other professionals worked well with the person to make sure the home could meet their needs. The acting manager was not working at the home when the last two people started using the service but she said all of the organisation’s admission policies and procedure are on disc and they would follow these for any future admissions. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use the service experience adequate quality outcomes in this area. 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. Control measures are sometimes introduced through an informal process and without proper consultation. This can restrict people’s rights unnecessarily. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: We talked to eleven staff. They had good knowledge about the people who live at the home. In the main, staff said people are happy living at the home and their quality of life is good. They thought the commitment of the staff team is what makes the home successful. Care files contained a lot of information about people but because there was so much it was difficult to find what was current and what was old information. A Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 11 lot of the information was not dated. The content of some care plans was quite general and did not identify how individual needs should be met. For example, one person had a care plan for hair care that stated ‘ask if like hair cut, make appropriate arrangements, staff to offer full support at hairdressers’. The care plan did not provide any details about what the person likes or support with daily hair care or hair washing. Each care plan has a set of objectives. Staff write a daily report for each objective. This is time consuming because staff are recording information in up to thirty sections. It is also very difficult to get an overall picture of what the person has been doing. Recording general daily information in one section would provide a clearer picture which would make it easier to monitor whether people’s health and welfare needs are being met. Staff said care plans and risk assessments are read by all staff when they start working at the home but opportunities to read through the information after this is limited. Behavioural strategies have been drawn up with the support of other professionals. These are very good and provide staff with very clear guidance of how behaviours should be managed. The acting manager told us they have identified that the care plans are not effective documents because they contain too much information. They have started to introduce new personal profiles and routines which are more personalised. These contain some very good information about each person although some should be more specific. For example one plan stated ‘use short sentences so I do not become overloaded’. This is clear guidance that staff can follow. Another plan stated that staff should ‘redirect back to bed using firm but calm manner’. The guidance should be clearer because the term ‘firm’ can be interpreted very differently. One person’s daily records told us that staff regularly told a person they would contact their parent if they did not do as they were asked. Once this was said the person appeared to comply which shows it has a powerful effect. Staff said this has been agreed with the parent but it was not recorded in the person’s care plan. The home provides a specialist service to people with autism and to meet people’s needs successfully it is sometimes necessary to introduce a structured routine. It is very important that these and any control measures are agreed through a formal process with relatives and other professionals and clearly recorded. The area manager carried out an investigation into a complaint that care plans were not being followed. Following the investigation an action plan was Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 12 produced which identified that care plans will be regularly reviewed and staff will receive person centred training. At the end of the inspection we discussed care planning with the manager and area manager. Everyone agreed that the home should review the care planning process but it would take some time to do this because staff needed person centred and care planning training and care plans must be introduced in consultation with others. Since August 2008 everyone who lives at the home has had an annual review with social services. The manager said these have all been very positive. We looked at one report which confirmed that people at the review agreed the person who lives at the home had made good progress and appeared to be settled at the home. A care manager told us that at a person’s review they agreed the home was meeting their needs and they had made good progress. Staff told us choice is promoted and gave examples when people make decisions. For example choosing what clothes to wear and where to spend time in the home on an evening and weekend. We talked to staff about rules at the home. Some staff had a perception that some rules applied. For example the TV cannot be switched on before 4pm, people who live at the home cannot go in the kitchen or the office, and have to go to bed before 10pm. The acting manager agreed to look at the examples we were given, assess them formally and decide if they are appropriate. Before we did this inspection we received a complaint about the home and concerns were raised by social services. The areas of concern were care planning, care practices, safeguarding and staffing, and are detailed in the protection, staffing and management sections of this report. Whitley Farm Cottages DS0000064380.V373533.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): 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. People have a varied lifestyle when they are at home. We have made this judgement using a range of evidence, including a visit to the service. 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 not recorded in care plans so people might receive different levels of support because staff do not have guidance to not follow. Staff also told us people are encouraged to maintain contact with their relatives. Care plans contain details of the support people need to maintain relationships with family members. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 14 Staff said people always receive enough support when they are at home and everyone has an activity programme. People can do a range of in-house activities, which includes sensory, relaxation, arts and crafts. Some staff told us more structure had recently been introduced for daytime activities. They thought some elements were positive because people had more to do during the day. However some concerns were raised because they felt the structure was so rigid that people who live at the home cannot spend time together. One staff member said people who live at the home are not being allowed to live together because they can’t socialise. Staff said people go out on a regular basis but some staff didn’t think people always receive the right amount of additional support that has been agreed with the funding authorities. Staff thought this had improved but still thought there were shortfalls in hours. One staff said sometimes additional staffing hours are saved up so people can go out for a longer periods of time but people who live at the home get bored when they are ‘saving up the hours’. The area manager is introducing a recording system to make sure all additional staffing hours are properly identified then everyone can be very clear that people are receiving the right support. Before we carried out this inspection, concerns were raised by social services because people were not getting a choice of meal. The manager said they had started reviewing food options before the concerns were raised and a new menu which offers choice was introduced the week before the inspection. We looked at the new menus which offer choice, and are varied and nutritious. Staff told us the new menus were better. We asked staff about the quality of food. In the main, staff said the meals were good, and fresh fruit and vegetables were used on a regular basis. On the day of the inspection a food delivery arrived. This contained a good selection of fresh produce including fruit and vegetables but only long life milk. The manager and area manager agreed that people should be drinking fresh milk. They said they are reviewing the household shopping because they currently do shopping on-line but would like people who live at the home to be more involved. Care staff are responsible for preparing and cooking meals. Staff said this sometimes has an impact on care because they have one less staff working with people who live at the home during this period. The area manager has sent a response to a safeguarding investigation which said they are considering whether to recruit a cook. Staff eat meals with people who live at the home but they bring their own food. Staff said this sometimes causes problems because people who live at Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 15 the home want to eat food that staff are eating. One person said sometimes staff will buy a takeaway or bring food and cook a Sunday lunch to share. This arrangement is not acceptable because it impacts on the people who live at the home. Staff said when they used to eat the same as the people who live at the home it was not a problem but this was stopped by the organisation. People who live at the home regularly go out for meals and drinks. Staff always support people in the community but raised concerns because they pay for their own meals and drinks. Some staff said they do not always have spare money to pay and will either organise a different activity or sit in a café/restaurant without a meal or a drink. This policy should be reviewed to make sure activity programmes can be followed. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 16 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 People who use the service experience good quality outcomes in this area. People’s health and personal care needs are well met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Staff said the home is good at meeting people’s personal and healthcare needs. People have daily support with their personal care. The manager has started expanding information in care plans to make sure personal care needs are properly identified. Daily records showed us that staff are vigilant and look for changes in wellbeing. For example; staff had noticed that one person had a graze on their body. They recorded the time and detail in the daily record and completed a bodymap. Staff had followed this up later and confirmed the graze was healing. We looked at information that showed us people’s health is properly monitored. Staff regularly review healthcare plans to make sure people are Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 17 receiving the right healthcare checks. All healthcare appointments are clearly recorded. Peoples’ weight is monitored monthly. We looked at medication systems. Medication is well organised and systems are in place to make sure the right medication has been administered. Clear guidance is available that identifies when people should receive ‘as and when required’ (PRN) medication. Some staff have completed medication training through external training organisations. Others have completed medication awareness training. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 18 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 People who use the service experience poor quality outcomes in this area. Safeguarding practices are not robust and do not safeguard people who live at the home. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: We did a Random Inspection in July 2008 because we received some information that raised concerns about staffing, management and safeguarding. We also identified that there had been a lot of safeguarding incidents since October 2007, some of which had not been reported or dealt with appropriately by the management team at the time. At the Random Inspection we found that there had been problems but the management team had taken action to start putting things right. We asked staff about care practices and staff attitudes in general. Staff said they thought care practices were good and people had a positive attitude towards the people who live at the home. At the Random Inspection some staff talked about supporting people with autism and how it can be difficult because it is important to have structure and boundaries in place but it is also important to respect people’s rights. One person said ‘it is a very fine line’. Staff said the team would benefit from some training in this area. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 19 Since the Random Inspection in July two safeguarding referrals have been made. One related to financial irregularities and the registered provider agreed to reimburse monies to one person who lives at the home. A financial audit is being carried out on other people’s finances. Another referral was made because concerns were raised about staff practices. The home were aware of the allegations before the local authority and CSCI were informed but chose not to share the information. This is unacceptable because it does not comply with safeguarding procedures or protect people who are living at the home. At this inspection several staff raised concerns about a staff meeting that had been held three day before the inspection. At the meeting the staff team were told some staff had contacted CSCI on a number of occasions and made specific allegations about other staff members. Senior management said staff had recently telephoned CSCI and reported specific allegations against specific members of staff. They were also told they are a ‘laughing stock’ because they had made so many calls. One staff said they told us we are seen as a nuisance. Others said we were told not to contact CSCI. Another staff said we were told not to go ‘outside’. Staff were misled at the staff meeting because the information they were given was incorrect. CSCI has received one anonymous call, since the random inspection in July, and general information was shared. For example the person said there were financial irregularities and people who live at the home were not getting the right level of staff support. Staff were not told that a safeguarding investigation by the local authority and Mary Theresa Care management team highlighted specific safeguarding allegations. At the inspection we passed on our concerns to the manager and area manager, who is the responsible individual, that staff had been misled. They accepted that staff had been given incorrect information and had been told they are a laughing stock. This is poor practice and does not promote good safeguarding principles and therefore puts people at risk. The home has two vehicles. One arrived a few days before the inspection; the acting manager said the home is funding the new vehicle. One person who lives at the home leases the other vehicle although everyone who lives at the home has used it on a regular basis. We were told two people make a payment, towards the cost of the vehicle, to the person who leases the vehicle. This arrangement is unacceptable because the cost has not been shared equally between the people who use the vehicle. We asked to look at financial records for transport but were told these were not available at the home. The home must review vehicle running costs because the current arrangements are not satisfactory. People’s financial records must be available at the home. Whitley Farm Cottages DS0000064380.V373533.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience good quality outcomes in this area. People live in a spacious, homely and clean environment. We have made this judgement using a range of evidence, including a visit to the service. 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.V373533.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. Aids and adaptations are in place to promote people’s independence and mobility. Decoration was generally satisfactory although some areas needed some attention. The staircase had flaking paint. The acting manager said they are decorating several areas of the home. Window blinds were damaged in one bedroom. The acting manager said the home replaces these when needed because the person often breaks them but it was unclear when they were last replaced. A chest of drawers was also broken. The person’s care plan did not contain any information about damaging items or the home taking responsibility for replacing them. People have their own personal toiletries. Two people have toiletries in their room. Others are stored in a communal room and staff have to cross the courtyard to access these. Staff confirmed they are locked away for safety reasons. People should have lockable facilities in their room. If it is not appropriate to have lockable facilities this should be identified through a formal risk assessment process. 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 last 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 a separate laundry area. Since the last key inspection an industrial washing machine and tumble dryer have been purchased, which has made washing and drying clothes much more efficient. Control Of Substances Hazardous to Health (COSHH) materials are also stored in this room. An external fire door could not be used because the key was missing. We have written more about this under the management section of this report. Whitley Farm Cottages DS0000064380.V373533.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use the service experience poor quality outcomes in this area. 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. The staff team has not been properly managed which has led to a fragmented and unhappy workforce. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: We spent much of this inspection talking to staff. It was clear that generally staff are unhappy and don’t feel supported. Several said they are looking for other work because the same problems keep reoccurring. People told us the team are not working well together and morale is very low. We did a Random Inspection in July 2008 because we received some information that raised concerns about staffing at the home. At the Random Inspection people told us the home had gone through an unsettling period and this had caused some difficulties amongst the staff team. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 23 Everyone said things had improved but acknowledged there was still work to do to make sure people are supported by an effective and happy staff team. Staff said the team had been divided and this had caused problems but now people were all starting to ‘work together’ and ‘pull in the same direction’. At this inspection we identified that similar problems are still going on. People said the staff team are divided. One person said, “There are different camps.” Another person said, “You feel isolated. We need to work as a team.” Several staff said there is ‘no trust’ amongst colleagues and this had intensified following the staff meeting when the team were told staff members are regularly telephoning CSCI. At the Random Inspection in July, the area manager, at the time, said they had identified that staff were not adequately trained and was organising some specialist autism and complex needs training with a psychologist. This training was not provided. We made a requirement that people must receive training that equips them with the knowledge and skills to meet the specialised needs of the people who live at the home. At this inspection we looked at staff training records. The acting manager said she had to do a new training programme because some staff records were not in place when she started working at the home in August 2008. The acting manager has identified shortfalls in mandatory training and has recorded this on a training matrix. Some staff have not completed health and safety, Protection of Vulnerable Adults, Infection Control, and medication training. Dates for staff to complete the mandatory training have not yet been arranged. Staff complete physical intervention training (SKIPR). Some have only done part of the course and did not know when they would complete the remaining modules. The acting manager said they are addressing training shortfalls as a matter of urgency. We looked at induction training. New staff members sign a checklist of what they cover during their induction but there is no workbook or guidance for the induction. The acting manager said she has identified the induction does not cover all key areas and is hoping to review this with the registered provider. We talked to staff about training. Some staff said they would benefit from some specialist training and suggested training around autism and learning disability and mental health. The acting manager also suggested osteoporosis. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 24 The acting manager has provided basic autism awareness training with staff but acknowledged that she has not done in depth training that would equip her with the knowledge to train others. The acting manager said five staff have NVQ level 2 in care and one is working towards the award. Five staff have started NVQ level 3. The home provides a specialist service to people with autism. It is very important that staff receive adequate training so they have the knowledge to understand and meet people’s needs. At the Random Inspection staff had not received formal supervision, and a new supervision system was being introduced. We again found the same at this inspection. From July staff have not received formal supervision but the acting manager has just started introducing supervision. This shows the staff are not receiving consistent support or being supported to develop. At the Random Inspection in July some staff said they were worried because the rota patterns were being changed. The area manager, at the time, said they had been looking at the rotas since February because they needed to be built more around the needs of the people who live at the home. These changes were not introduced. At this inspection staff said they were anxious because again they had been told the rota pattern was changing but were not happy about how the management team were introducing this. Some staff said they were anxious because they did not know if their hours were being reduced; others said they did not know how many days they would be working per week; others said they were unclear about break entitlements. It is understandable that staff are feeling anxious when the management team have talked about changes for ten months but have not introduced them. We looked at the recruitment process for three people that had started working at the agency since the last inspection. Staff files had application forms, proof of identification, references and CRB (criminal records bureau) checks. Three staff confirmed they could not start work until all the pre employment checks were carried out. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 25 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 People who use the service experience poor quality outcomes in this area. The home has not been properly managed for a prolonged period of time which has led to deep rooted problems amongst the staff team. The current management team are working hard to put things right but still have a lot of work to do. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home has not had a registered manager in post since February 2008. The deputy manager is currently ‘acting’ manager with support from senior management. The area manager said they are in the process of recruiting a permanent manager and would make sure the successful candidate submitted a registered manager’s application once they are in post. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 26 In February 2008, the organisation said they had identified that the home was not being properly managed and were taking action to address this. Staff told us the current problems were caused because the home has had different managers and it has been inconsistently managed. Staff said they thought the acting manager and area manager are working hard to put things right. After the inspection we met with the managing director and discussed the findings of our inspection. The managing director told us that many of the problems at the home were because the home had not been properly managed over a period of time. She also told us what they are doing to put things right. Generally staff were unhappy about the recent staff meeting and felt senior management had not handled things well and it had made things worse. People generally thought the meeting was destructive because they had been spoken to inappropriately. One person said they had to sign a sheet to say they had read certain policies but they had not received the policies. One person said it was a good meeting because the team needs sorting out. The Random Inspection in July 2008 and this key inspection found similar problems. There were tensions amongst the staff team and staff were not adequately trained. We were assured that everything was being sorted in July. It is evident this did not happen because they are still having similar difficulties. On-going tensions must have an impact on the quality of service that people who live at the home receive. The area manager who has been in post for a few weeks has been spending a lot of time at the home. He has carried out quality assurance audits and identified areas where the home should improve. Some people’s risk assessments identified that staff must carry a ‘walkie-talkie’ with them so they can call for support from other colleagues if required. This is to make sure everyone is safe. Staff could not follow the risk assessment guidance because on the day of the inspection there were only two handsets and these were broken. The key for an external fire door was missing from the ‘emergency break glass’ box. The door could not be unlocked because there was no key at the home. The manager said one staff member has a key but they had gone out for the day. The area manager agreed to make sure the problem was sorted out on the day of the inspection. We spoke to the area manager after the inspection and he confirmed the key was now kept next to the door, and they were looking at changing the type of lock to prevent the same problem occurring again. Management told us relevant policies and procedures are in place and equipment has been serviced or tested as recommended by the manufacturer Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 27 or regulatory body. Staff and management told us regular health and safety checks are carried out around the home. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 28 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 2 33 2 34 3 35 2 36 1 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 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 2 3 X X 2 X Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 12 Requirement 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. Financial payments made by people who live at the home must be fair, equitable, and for their benefit. Financial records must be kept at the home and made available for inspection. This will make sure peoples’ finances are protected. The registered person must make sure the home has a robust safeguarding process for referring any allegations of abuse to the relevant agencies. This will make sure people who use the service are safeguarded Staff must receive induction and training that equips them with DS0000064380.V373533.R01.S.doc Timescale for action 28/02/09 2 YA23 13 31/01/09 3 YA23 13 31/01/09 4 YA32 13 18 31/03/09 Whitley Farm Cottages Version 5.2 Page 30 YA35 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 is outstanding from the last inspection. Timescale of 30/10/08 was not met. 5 YA42 13 People must be able to exit fire external fire doors at all times. 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. 31/01/09 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 YA6 YA16 2 3 YA6 YA13 YA33 4 YA17 Good Practice Recommendations The care planning process should continue to be developed to make sure people’s care needs and aspirations are properly identified. This will make sure people’s needs and wishes are met. Records about people who live at the home should be recorded in such a way that enables people’s welfare and care needs to be properly monitored. The home should introduce a better system to demonstrate that people who live at the home are receiving the right amount of additional staff support. This will make sure people’s assessed needs are met. Meal arrangements should be reviewed so people who live at the home can enjoy their food when staff and people DS0000064380.V373533.R01.S.doc Version 5.2 Page 31 Whitley Farm Cottages 5 6 7 YA17 YA24 YA24 8 YA24 9 10 11 12 13 YA33 YA33 YA36 YA37 YA38 who live at the home are eating together. People who live at the home should be given the option of having fresh milk. This will make sure they are given a varied and nutritious diet. The current car parking arrangements should be reviewed to enable people to have better access to the home. Toiletries should be stored in personal accommodation, which could be placed in lockable facilities, unless it has been identified as unsafe through a risk assessment process. This will help promote dignity and independence. Bedroom furniture and window blinds should be replaced/repaired when they are no longer in working order. This will make sure people live in a comfortable environment. The staff team should be encouraged to work more effectively together to make sure people live in a positive and pleasant atmosphere. Staff working patterns should be formalised so staff know their rota pattern. This will help reduce anxiety amongst the team Staff should receive regular supervision. This will make sure their standard of work is reviewed. The home should have a registered manager that is qualified, competent and experienced. This will make sure people benefit from a well run home. The management approach of the home should provide people who live and work at the home with leadership and a clear sense of direction. This will help make sure peoples’ needs are met. Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Yorkshire & Humberside PO Box 1254 Newcastle upon Tyne NE99 5AR 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 Whitley Farm Cottages DS0000064380.V373533.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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