Care Home: Burrough Farm

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What the care home does well Burrough Farm is a very well run home. People have a good quality of life. The manager finds out about people before they move into the home. This is so that the staff know what the person’s needs are and how best to support them.Each person has a plan of care that is agreed with them. It is reviewed regularly with the person. This is so that the team make sure that they aremeeting that person’s needs.People tell us that the staff is “kind”. They get the support they need to learn new skills like doing their washing or cooking.There are good policies and procedures that ensure people are safe and well supported. Policies are rules about how to do things. Procedures tell people how to follow the rules.The staff does a lot of training. This means that they learn how to look after people properly. What has improved since the last inspection? A new conservatory has been built, which people tell us is a comfortable and nice place to spend time in. What the care home could do better: People should be able to understand their care plan. This means that for some people it would be in pictures and for other people in easy words.The manager needs to check if everything is being done to stop people getting infections. The Department of Health has written guidance about this.The manager must always do checks on staff before they are allowed to work. This will make sure that people are protected that live there. Key inspection report Care homes for adults (18-65 years) Name: Address: Burrough Farm Churchill Way Northam Devon EX391SU three star excellent service The quality rating for this care home is: A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Taylor Date: 2 3 1 0 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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. 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 Information about the care home Name of care home: Address: Burrough Farm Churchill Way Northam Devon EX391SU 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Credence Care Ltd Name of registered manager (if applicable) Mr John Keith Huddy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 0 care home 10 learning disability Additional conditions: The maximum number of service users who can be accommodated is 10. The registered person may provide the following category of service only Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category Learning disability (Code LD) Date of last inspection A bit about the care home Burrough Farm is an old house in Northam. 9 people with learning disabilities. Nearly everybody who lives at the home has their own bedroom. Two people share a room. Buses pass near to the home. This means that the people who live at the home can get around easily. Burrough Farm has a mini bus, which is used all the time by people living there. People pay between £336.90 and £991.18 to live at the home. Social services sometimes pay this. Some charges are made for certain activities, hairdressing, magazines and newspapers. People have to pay for these themselves. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home Burrough Farm has 3 stars. That means people live in an excellent home. Since we last inspected there has been a change in the way the home is run. The provider decided to become a Limited Company and is now registered with the Commission. We looked at 2 people’s care plans. We spoke to people alone in private, with their key workers and in groups about their experiences living at the home. We wrote to all the people that live at the home. We asked them for comments about their life and had 5 back. We also asked staff for their comments and had 1 back. The people made are in the report. The owner sent us a lot of information about how they run the home. What the care home does well Burrough Farm is a very well run home. People have a good quality of life. The manager finds out about people before they move into the home. This is so that the staff know what the person’s needs are and how best to support them. Each person has a plan of care that is agreed with them. It is reviewed regularly with the person. This is so that the team make sure that they are meeting that person’s needs. People tell us that the staff is “kind”. They get the support they need to learn new skills like doing their washing or cooking. There are good policies and procedures that ensure people are safe and well supported. Policies are rules about how to do things. Procedures tell people how to follow the rules. The staff does a lot of training. This means that they learn how to look after people properly. What has got better from the last inspection What the care home could do better People should be able to understand their care plan. This means that for some people it would be in pictures and for other people in easy words. The manager needs to check if everything is being done to stop people getting infections. The Department of Health has written guidance about this. The manager must always do checks on staff before they are allowed to work. This will make sure that people are protected that live there. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Susan Taylor CQC South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 03000 616161 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 set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 are given a lot of information enabling them to decide whether Burrough Farm is the right place or not for them. The assessment process ensures staff have detailed information about the needs people have and how they are to be met. Evidence: In surveys 100 percent (5) of people responding tell us that they received sufficient information about the home prior to moving in there. Information sent to us by the provider (The AQAA) tells us that they encourage overnight visits and trial periods for people interested in moving into the home. One person had moved into the home in the last 12 months. We looked at their files and saw that they had visited the home on several occaisions before moving in. Similarly, in a survey a person wrote I came and looked around first and I liked what I saw. We case tracked 2 people and looked at their care files. These demonstrated that comprehensive assessment information had been obtained, which has ensured that the care team are aware of what peoples needs are. Assessments had been regularly reviewed with the individuals concerned. Excellent examples seen demonstrated how this had been done with people in a document entitled About me, which contained information about each person; their goals, desires and social networks in a format that was individual to them and in a format that was appropriate for the person. Assessments were comprehensive and person centred. This included the persons needs in terms of disability and medical background. Additional information gathered included a persons preferences about bedtime routines and meals, significant relationships and social interests. Where appropriate the individuals advocate had also been involved in the process. The home had obtained a copy of the care plan produced for care management purposes for people. Evidence: The manager had implemented a system for cascading important information to other professionals that support people living at the home. This had ensured that continuity of care was paramount for individuals who needed specialist support. For one person this had included the input of a psychologist to help the team manage a challenging behaviour that was impacting on other people living in the home. We read a risk assessment, which clearly set out the concerns and guidance as to how the behaviour should be managed based on the advice received from the psychologist. We looked at daily and incident records, which demonstrated that there had not been an occurance for some considerable time. Additionally, we observed staff following the plan of care by giving direct feedback to the person that respected them as an individual and at the same time made them aware that their behaviour was not acceptable. The outcome for this person was that they rarely presented this behaviour and staff reported that the individual was much more settled. Therefore, this indicated a significant improvement for the individual. The manager verified that they had done Mental Capacity Act and Deprivation of Liberty Safeguards training. As a result of the knowledge gained, she told us that she would be doing comprehensive mental capacity assessments for all of the people living in the home. Whilst there was some information about this across the range of care plans we looked at, this did was not explicit about whether the individual had the capacity to make decisions about all aspects of their life. Similarly, the manager demonstrated that they understood that if the person did not have capacity the assessment and plan would need to clearly outline who would be responsible for making best interest decisions of the individuals behalf. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 are enabled to make choices about their lives, which are respected and acted upon. Evidence: 5 people returned surveys about their experiences living at Burrough Farm. In these people tell us that they can always make decisions about what they do each day, with comments like normally I can do what I want to. Information sent to us by the provider (AQAA) tells us that they are trying to promote greater independence for people. We read minutes of meetings, which demonstrated that these regularly take place with people in the home. We case tracked 2 people, which included reading the care files for these individuals and talking to them. Both had detailed care plans that had been discussed with the person. Regular reviews had taken place and corresponded with changes in peoples needs. For example, one person with a physical disability requires the person to be catheterised intermittently. The care plan was clear to follow and instructions were detailed. The main aim was to keep the person free from infection, whilst being catheterised, and also considered issues around dignity and discomfort that the individual might experience. Staff verified that some of the staff had been trained by the District Nurses to do this invasive procedure for the person. We saw authorisation forms in staff files, which confirmed that the individual was competent to do this and had been signed by the District Nurse. Daily records demonstrated that it was being followed by staff and had helped the person maintain good health free from infection. Evidence: Another persons file highlighted that the person had communication difficulties, which sometimes had a negative affect on other people. A behavioural plan had been developed to help the individual communicate with other people in a positive way. A risk assessment was in place, which corresponded with the plan and recorded measures that were being taken to minimise the risks to others and the person themselves. We observed the care plan being put into effect with the individual in a positive way that respected their dignity. We met a group of people who told us that their care plans are discussed with them individually, and that they are asked what they would like to achieve to maximise their independence. We asked them whether they had a copy of their plan of care, which people said they did not. Some of the people had life plans that had been done with them by professionals involved in the persons care. These were in alternative formats. However, none of the care plans we looked at for the people we case tracked were in an alternative format. Information sent to us (Annual Quality Assurance Assessment) tells us that the provider is aware of this and they intend to improve this by using formats such as easy read and pictorial formats and had sought guidance from the the community speech therapist about this. We asked people what involvement they had with the recruitment of new staff. They told us that they are asked for comments and meet potential new employees during the interview process. This demonstrates that peoples views are taken into consideration and reflects good practice. We looked at 2 peoples financial records. One of the people said I have my own account and I go out with staff to take money out when I need to. We saw statements and saving account books that verified this. Balances were checked and found to be in order. Two signatures were seen on balance sheets denoting withdrawals. Receipts were kept for items bought on behalf of people and corresponded with entries seen in the records. Therefore, there are systems in place which protect peoples interests and enable them to manage their own finances where possible. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a good quality of life, which ensures they have freedom to mix, make friends and learn new skills. Evidence: In surveys, 100 percent (5) people living in the home tell us that they can do what they want to do during the day, evening and at the weekend. We looked at 2 peoples files, which showed that they are involved in different activities in the community. For some people this has involved voluntary work. Others have been involved in the community doing park and beach cleaning and participating in a variety of creative activities with Branching Out organisation. The home has its own minibus, which we saw people using during the day. We were shown photographs from the holiday in 2009, which people said they enjoyed. Similarly, people showed us lots of photographs from a barbecue party that they had held and to which approximately 60 guests were invited to. The garden had been totally landscaped and had been a lovely place to sit out in during the summer, people said. One of the people we case tracked told us that they had a boyfriend, whom they liked to visit and this was important to them. Information about the persons relationship was recorded in their care plan, which supported the persons right to have a sexual relationship with that person. Staff were respectful about this when we spoke to them, whilst at the same time understood the need to be discreet in ensuring that the individual did not become vulnerable. We observed people being encouraged to learn new life skills. For example, one person Evidence: took responsibility for laying the table at tea time and another individual helped to gather up plates after the meal. Information that the provider sent us (AQAA) tells us that they have tried to ensure that people have more one to one time with their key workers for shopping trips, hairdressing appointments or going to the library. One of the people we case tracked told us they usually told staff when they wanted to get money out of the bank and were accompanied to do this. The record of meals provided demonstrated that meals are varied. We joined people for a sandwich lunch and observed individuals preferences being catered for as various fillings were chosen. Additionally, we saw that people were at ease helping themselves to yoghurt, drinks and fruit from the fridge and cupboards. A four weekly menu plan was in place. Minutes of recent meetings highlighted that meals are regularly discussed and menus are altered as a result of comments made. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated with dignity and respect. The home works in partnership with other professionals to meet the healthcare needs of the people that live there. Evidence: In a survey, 5 people responding tell us that staff always listen and act on their wishes. All of the people that were at home. From information sent to us by the manager, the gender balance of people living at the home is relatively well matched to that in the staff team. People were dressed in their own individual style, some wore jewellery and make up. We heard comments like Im going to have my hair cut on Saturday and we were told that the person uses a local hairdressing salon. We case tracked 2 people and looked at how their healthcare needs were being met. Records demonstrated that the home works closely in partnership with professionals. For example, staff had recently had a training session with a psychologist about how to deal with behaviour being exhibited by an individual, we were case tracking, that had a negative affect on other people. We observed staff putting this learning into practice during the inspection, using distraction techniques and reframing behaviour in a more positive way. Therefore, guidance is sought from professionals ensuring that people are cared for in an appropriate manner. One person said I went to see the doctor when we asked people about their health. Similarly, daily records demonstrated that the person had also seen the dentist and optician since moving into the home a few months before. Additionally, the manager told us that 2 people had recently seen a consultant at the hospital for monitoring and tests. A person with a physical disability required intermittent catheterisation due to a medical condition. The team were working closely with the District Nursing team and had ensured Evidence: that the individual was free from infection and that their dignity had been maintained, whilst being catheterised. Therefore, peoples healthcare needs are well met. Medicines were kept in an appropriate secure cabinet securely affixed to the wall in the office. Medication Administration Record charts are in use and no gaps in the records were seen. We observed that medicines had been administered as prescribed and saw individuals coming to get these after tea, before going out to a disco. Each person had individual attention and any queries they had about their tablets were answered in a respectful way that valued the persons need to know more. We saw a personal medication profile for an individual we were case tracking. This had been completed when the person moved into the home and had comprehensive medical and allergy information for staff to refer to. Staff giving out the medicines was able to give us a detailed picture of the individuals medical history, which corresponded with what we had read in the persons file. Training records demonstrated that key staff involved in administering medication had received appropriate training. Additionally, the manager said that all new staff was supervised and their competency assessed before being able to administer medication on their own. We saw records demonstrating this on some staff files that we looked at. Information sent to us (AQAA) by the manager highlighted that medication systems are regularly audited. A recent audit had picked up a dispensing discrepancy when medicines had been delivered, which was quickly rectified without any adverse effect to the people living in the home. Therefore, medicines are managed safely for people living at Burrough Farm. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Burrough House are protected and able to voice their concerns, if they have any, safe in the knowledge that these will be taken seriously and dealt with promptly. Evidence: 100 percent of people responding (5) in a survey verified that they knew how to complain and who to speak to if they were unhappy. The procedure was displayed on the wall next to the kitchen and was presented in total communication format. Since the last inspection, the Commission has received no concerns or safeguarding issues. We spoke to people about how concerns are dealt with in the home. They made comments like I would tell XXX and she would sort it out or I can talk to XXX or any of the staff, they are kind. Therefore, people have access to information that tells them how they should raise concerns and people are confident that these will be dealt with. Surveys returned by 5 people tell us that they are always treated well and staff listen and act on their wishes. The home had a written policy and procedure for dealing with suspected allegations of abuse. We spent sometime observing interactions between staff and people living there. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. Training records demonstrated that all of the staff had attended a course covering the protection of vulnerable adults. Additionally, some staff were at a Mental Capacity Act and Deprivation of Liberty Course whilst the inspection was underway. 2 staff on duty had a clear understanding of the concepts of whistle blowing and knew what procedures they should follow if they ever witnessed or suspected any form of abuse. The provider told us that they had to recently deal with bullying behaviour between people living in the home. We were shown minutes of a meeting with people, in which the matter had been discussed. This had been done in a sensitive way so that no individual was singled out, but made everyone aware of the negative impact such behaviour might have on a person on the receiving end of it. We case tracked one person whose behaviour at times had a negative impact on other people. The care records for one person demonstrated that a behaviour plan had been agreed between the home in Evidence: collaboration with healthcare professionals and the individual themselves. Positive reinforcement was being used, and the behaviour had reduced significantly as a result of this approach. We discussed Deprivation of Liberty Safeguards with the manager and provider, when they returned to the home after attending training on the subject. They both verified that people at Burrough Farm lived an unrestricted lifestyle and that there were no issues for people at the current time that would warrant referral to Devon County Council for a Best Interest assessment to be undertaken. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of accommodation has significantly improved for people, is clean and well maintained and provides a homely environment. Evidence: In a survey all of the people responding (5) tell us that the home is always clean and fresh. Information sent to us by the provider tells us that residents have been involved in the choice of decor and furnishings. Two people that we case tracked proudly showed us their rooms, both of which reflected individual interests and tastes. One person told us that they had chosen their room before moving in and had been told to make it your own place with whatever you want. The persons room was bright and airy, with new modern furniture. A large spacious conservatory had been built of the lounge, which greatly increased communal space for people. We sat with a group of 4 people in the lounge before the evening meal and they made comments like the conservatory is lovely and look at our new furniture, isnt it lovely. The home has undergone a total refurbishment and now provides a very homely and comfortable place for people to live. Information sent to the Commission (AQAA) tells us that equipment like the central heating, fire and electrical systems are regularly serviced by contractors. Other people showed us their bedrooms, which reflected their individual tastes. One person who liked horse riding had lots of photographs, pictures and ornaments reflecting this interest. We looked around the home and saw that the home was clean and very well maintained. People we spoke to told us that they are reminded to wash their hands after using the toilet, before meals or when helping in the kitchen. Staff told us that gloves and aprons are always available and that they are encouraged to use them when delivering personal care. Training certificates demonstrated that all of the staff had recently done infection control training. Information sent to the Commission by the provider (AQAA) tells us that Evidence: the Department of Health Essential Steps is not used to audit infection control management in the home although the provider and manager said they were aware of this tool. However, we did observe that staff followed safe procedures with regard to separating bed linen and clothing to maintain good infection control. At the same time this did not detract from some people being supported to learn these skills by doing their own washing. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices at Burrough Farm are not robust and therefore fail to protect people. The training and development of staff, and ensures that competent and knowledgeable staff care for people Evidence: 5 people living in the home tell us in a survey that they are always treated well by the staff. We observed that people had the right level of attention and support from staff. The atmosphere in the home was calm. Duty rosters demonstrated that people receive care and support consistently by the same staff and there is a low turnover and low rate of sickness in the team. We looked at files for 3 staff recruited since the last inspection. Two written references had been obtained. Additionally, checks had been carried out with the Independent Safeguarding Authority (ISA) and Criminal Records Bureau (CRB)and were satisfactory. However, induction records for these 3 staff demonstrated that all of individuals had started working at the home before some of this information had been obtained. For example, the induction record for an individual was dated 24/7/08 yet references were dated 3/10/08 and 30/9/08. The ISA for this individual was dated 4/8/08 and CRB dated 31/12/08. The provider told us that there had been a dispute with the umbrella agency and despite applying for the ISA and CRB on 21/7/08 the ISA did not arrive until mid August 2008. We concluded the appointment of the individual had been unsafe at the point of employment, however the provider had subsequantly obtained information and was able to demonstrate the suitability of the person to work with vulnerable people. We discussed the regulatory requirements with the provider and manager who told us that they would put systems to ensure that the recruitment process is robust and protects people. We spoke to 2 staff during the inspection. Both staff verified that they had had a Evidence: thorough induction. They told us that the provider constantly encourages them to develop professionally through training. Whilst we were inspecting the home a group of staff, the responsible individual and manager were at a training session about the Mental Capacity Act and Deprivation of Liberty Safeguards. Information sent to us (AQAA) tells us that the home follows the Skills for Care framework. One of the staff showed us their training portfolio, which contained a number of certificates for training done in 2009. For example, the District Nursing team had provided training for senior staff on how to catheterise a person that required this to be done intermittently due to an ongoing medical condition. We saw a record that had been signed by the District Nurse, which verified that the individual was able to do this procedure competently. Information sent to us by the provider demonstrates 10 out of 14 (71 percent) of carers have either completed NVQ level 2. 3 other carers (21 percent ) are the process of doing it. Therefore, the percentage of carers with this award exceeds the National Minimum Standard which is to be commended. Both the responsible individual and the manager hold the Registered Managers award and NVQ level 4 in management and are NVQ assessors. Therefore, people are cared for by appropriately trained and experienced staff. Appraisal records for 2009 were seen in the staff files we looked at. Staff told us that the manager and provider were always approachable. We saw formal supervision records on the 3 files we looked at. Therefore, the quality of care and support provided to people is monitored through supervision procedures. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Burrough Farm is a well run home, in which where people are consulted about all aspects of their life there. Evidence: Since the last inspection, the provider registered as a Limited Company. However, the same people are involved in running the company that had previously been registered. The Registered Manager has the Registered Managers Award and NVQ Level 4 in Care Management. He told us that he continues to use the internet extensively, in particular the Commissions professional website, to keep up to date thus ensuring that the care delivered is best practice. Throughout the inspection we found him and the responsible individual to have a clear understanding of their roles in meet the stated aims and objectives of the home. Similarly, they provided the Commission with a lot of information in a document entitled AQAA (Annual Quality Assurance Assessment). In it they outlined what the home could do better to improve the quality of life of people living there and how it would be done, in addition to explaining what had improved. They highlighted that they need to provide people with information in a format that is suitable for them. This was also borne out in our findings. Care plans, assessments and activity programmes should be in a format that is suitable for the individual. Our main concern at the inspection has been that the recruitment procedure was not consistently followed and therefore people have not protected at the point that staff were employed. We are confident that this will be addressed and audited in the future to ensure that this does not happen again. We observed that there are clear lines of accountability within the home. The provider also has extensive experience in running two homes - Burrough Farm and Credence House. The responsible individual was able to produce reports that she had completed every month which demonstrates that quality assurance is being measured. Evidence: People told us that the registered provider is also very much hands on and we observed them asking for feedback throughout the day. For example, we observed people being asked whether they had enjoyed the evening meal and what they wanted to do for the evening. We toured the premises and saw that the certificate of registration was displayed in a prominent position where people living in the home and visitors could see it. In surveys the responses people gave tell us that they are content living in the home. Similarly, staff made positive comments a survey such as I thoroughly enjoy working at Burrough Farm, its the best job Ive ever had. A quality assurance report had been written, which collated all the views from people living in the home, their relatives and other stakeholders. Resulting from this, the provider had compiled an action plan that is based on excellence and not just national minimum standards. Therefore, systems are in place which seek feedback from people about the quality of their life at Burrough Farm and their views are valued and acted upon. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed in the kitchen stating who was responsible for implementing and reviewing these. The fire log was examined and demonstrated that fire drills, had taken place regularly. We saw certificates demonstrating that staff had had fire training in 2009. Similarly, certificates from a contractor verified that the fire alarm had also been regularly serviced. People living in the home, and staff told us that the alarm was regularly checked once a week. In information sent to the Commission, the manager verified that risk assessments are carried out. As we toured the building we observed cleaning materials were stored securely and used with by staff wearing gloves. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Recommendations made by the Environmental Health Officer in his report had been implemented - pipes in the kitchen had been boxed in and records being kept of the temperatures of cooked food. Records of accidents were kept and showed that appropriate action had been taken. First aid equipment was clearly labelled. Both of the staff on duty verified that they held a current first aid qualification and knew what to do if someone had an epileptic seizure for example. Risk assessments for the environment had been reviewed since the last inspection. Maintenance certificates were seen for the heating, electrical and fire alarm systems. Therefore, peoples health and safety is maintained. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 34 19 The registered person must ensure that recruitment procedures are robust. 31/12/2009 This will help to ensure that people are cared for by appropriate staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 Peoples capacity to make decisions should be assessed and explicit guidance provided for staff detailing how/who is responsible for making decisions for people that are assessed as lacking capacity. This will ensure that decisions are always made in the best interests of individuals concerned. People living in the home, should be able to access their care plan in a format that is accessible to them, for example by using pictures or simple language. The quality of infection control measures should be auditted using Department of Health Guidance. This will ensure that 2 6 3 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations the risk of infection is minimised for people living in the home. 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