Care Home: Farm House

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What the care home does well Residents say they enjoy living at Farm House, and are very happy here. There is an open and friendly atmosphere and visitors are made welcome. Staff are caring and interact with residents well. Residents are supported and encouraged to lead valued and fulfilling lives, with an emphasis on learning and maintaining independent living skills. Staff are good at helping new residents to settle in. The Manager is qualified, experienced, and records inspected evidenced the home is well run. What has improved since the last inspection? All residents have individual written agreements between the home and themselves. Staff training is linked to the Learning Disability Award Framework. The home has had some redecoration and refurbishment, and some new items have been purchased. CARE HOME ADULTS 18-65 Farm House Highlands Farm Woodchurch Ashford Kent TN26 3RJ Lead Inspector Sarah Montgomery Unannounced Inspection 30th April 2008 09:00 Farm House DS0000061263.V361219.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 Farm House DS0000061263.V361219.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. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Farm House Address Highlands Farm Woodchurch Ashford Kent TN26 3RJ 01233 861514 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) Canterbury Oast Trust Care Home 5 Category(ies) of Learning disability (0) registration, with number of places Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Learning disability - LD The maximum number of service users who can be accommodated is: 5 20th June 2006 Date of last inspection Brief Description of the Service: Farm House is registered to provide accommodation, care and support for up to 5 adults with a learning disability. Canterbury Oast Trust (COT) owns the home and the registered manager Emma Cox has day-to-day control. Farm House is an old farmhouse with accommodation on two floors. All bedrooms are singles. The service users have the use of two bathrooms, kitchen, lounge and dining room. The house has a private garden, which is laid to lawn, flower and herb borders, a patio area with seating and a greenhouse; one service user has a shed. The home is situated at Highlands Farm, which is a well-known tourist attraction in a rural area on the outskirts of the village of Woodchurch. A short drive will take you to the towns of Ashford or Tenterden, and approximately 3 miles away is Hamstreet train station. Within the village of Woodchurch there is the local GPs surgery, post office, church and two pubs. The home has transport, which can be used for service users if they wish and a local bus service passes the farm. The current fees are £957.95 per week. Farm House DS0000061263.V361219.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 2 Star. This means the people who use this service experience good quality outcomes. This key unannounced inspection was conducted by Sarah Montgomery, Regulatory Inspector, who was in Farm House on 30th April 2008 from 8:55 am until 2:30 pm. During that time the Inspector spoke with some residents, two members of staff, and an area manager. What the service does well: What has improved since the last inspection? What they could do better: Residents would benefit if policies and procedures were updated. Some health care plans would benefit from having clear information regarding specific support needs. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 6 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. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 3, 4 and 5. Quality in this outcome area is good. Prospective residents can be confident their individual needs and aspirations are assessed, and that they will be offered opportunities to visit and test-drive the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector looked at a recently admitted service user’s pre-assessment documentation, spoke to the service user, and discussed with staff and management the home’s process of gathering information. In addition, the statement of purpose and service user guide was read in order to cross reference, and to enable a judgement regarding suitability of placement. The home has demonstrated a thorough approach to pre-assessment, gathering information from a range of sources, and from conducting their own assessment. The process of assessment is fully documented, and details the needs of the service user. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 9 A service user spoke positively about the assessment, and particularly valued the ‘test-drive’. By being so detailed, the home has ensured as much as possible that they will be aware of all support needs, and that the assessment will serve as a meaningful document to care planning and risk assessment during the initial period of the service user’s stay. Service users spoke with the inspector about their support needs. They demonstrated awareness of their needs and of the support given by staff at the home. Conversations with staff evidenced that they had a detailed knowledge of service users assessed needs, and observation of staff evidenced a consistent approach to meeting and supporting individual service users assessed needs. Contracts were inspected. All contracts are individual both to the home and service user, and fully explain the terms and conditions. Farm House DS0000061263.V361219.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): Standards 6, 7, 8, 9 and 10. Quality in this outcome area is good. Residents can be confident they will be supported to make decisions about their lives, and be involved in planning the care and support they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To assess the above standards, the inspector read through care plans and risk assessments, looked at a sample of notes from residents meeting and individual daily recordings, and spoke with service users and staff. The staff team at Farm House have developed individual care plans based on the service user’s assessed needs. Care plans have a clear link to the information gathered during assessment. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 11 Service users confirmed their involvement with their care plans, and gave examples of consultation with staff and support from staff regarding decisionmaking. Risk assessments are equally thorough. All risk assessments are accompanied by behavioural guidelines and agreed boundaries. Risk assessments and care plans are written in accessible language, and this provides clarity for service users. Daily notes confirmed that staff and service users are working towards goals set in care plans, and also evidenced that service users are consulted appropriately about the care and support they receive. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 15, 16 and 17. Quality in this outcome area is good. Residents are supported to make positive choices about their lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans, risk assessments and daily notes all evidence that service users are guided and supported in making decisions about their lives. Service users are encouraged to recognise their strengths as well as needs, and are supported to link their strengths and needs to education, work and leisure activities. Service users spoke enthusiastically about activities they were doing, and about researching with staff activities (including work and education) they Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 13 might do. It was clear from talking with service users that their rights and responsibilities are recognised, and that staff spend time supporting and guiding them towards positive lifestyle decisions and choices. Records demonstrated and staff and service users confirmed, that links to family and friends remain strong. Farm House supports individuals with remaining in contact with their friends and families, taking into account the wishes of the service user and of any history that may carry restrictions with contact. Service users are encouraged to take responsibility for leading a healthy lifestyle. To this aim, they are involved in planning and preparing meals, and are supported to do this by staff. Service users have access to several cookery books and additional literature that outlines options for healthy cooking. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, 20 and 21. Quality in this outcome area is good. Residents can be confident they will receive support with their health and personal care, in accordance with their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Health care plans were inspected. Recording of individual’s health needs was thorough, and evidenced a clear approach to ensuring that residents have access to healthcare professionals, including regular check ups. Documents inspected evidenced that where residents have been assessed and/or diagnosed as having mental health needs, the team have ensured the resident has access to appropriate professionals, and that the staff team receives support in terms of skills (training) and in developing strategies and guidelines to assist the resident. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 15 Care plans state the preferred support needs and wishes of residents. Two residents spoken with confirmed that staff at the home support them with their personal and health care needs in accordance with their wishes. It was noted that a bathing care plan was ambiguous, and required specific detail regarding the level of support needed. Medication storage and administration was inspected and found to be of a good standard. Medication is stored in a locked cupboard within a locked room. The home does not use a monitored dosage system, as there is only a small amount of medication in the home. All staff have received training in medication administration, and have regular updates. Medication records were viewed and found to be maintained appropriately. All residents have been consulted about their wishes regarding death and dying. This has been recorded. It is recommended that these documents are revisited annually with residents to ensure the recorded wishes remain the same, and to give residents an opportunity to make changes. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. Residents are able to express their concerns, and are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is displayed in a communal area as well as individual copies in resident’s bedrooms. Two residents were asked about making a complaint. Although neither spoke of a ‘complaints procedure’, it was clear that they were aware of both their right to complain, and who to complain to. Both residents stated they were happy at the home, and if anything was getting them down they would talk to staff and it would be sorted out. Neither felt that it had ever been necessary to make a formal complaint. A staff member was asked about their understanding of their role in safeguarding vulnerable adults. It was evident that the staff member had received appropriate training, and in answering questions gave examples of safeguarding concerns. Training records evidenced that all staff receive training in this area. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 17 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): Standards 24, 25, 26, 27 and 30. Quality in this outcome area is good. Residents live in a comfortable and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Farm House presents as comfortable and homely. A tour of the building led by residents evidenced they are proud of their home, feel relaxed in the environment, and have a real sense of ownership. All the communal areas and two bedrooms were inspected. Residents have been encouraged and supported to furnish and decorate their bedrooms in their own tastes and styles. To encourage and support residents to gain skills in independent living, a cleaning rota has been devised. All residents play a pivotal role in ensuring Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 18 their home is clean and hygienic, and during a tour of the home it was evident that these tasks are performed to a very high standard. The home has two bathrooms. The upstairs bathroom is currently being refurbished, and residents did not have access. Work had stopped on the bathroom and staff did not know when the work would recommence, or when the bathroom would be finished. The inspector advised that this needed to be completed as a matter of urgency so to ensure there was sufficient bathrooms to meet the needs of the residents. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 19 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): Standards 32, 33, 34, and 35. Quality in this outcome area is good. Residents’ benefit from receiving support from staff who are skilled and well trained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Interactions between staff and residents were observed throughout the inspection. It was evident that the staff communicate with residents effectively, and with respect. One comment received from a resident stated ‘if I say I want to do something, staff will organise it’. The rota viewed indicated that sufficient staff are on duty to ensure all needs of service users are met. Conversations with staff evidenced that they are knowledgeable about their roles and of individual support needs of service users. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 20 Service users spoke highly of the staff team, indicating that they felt supported and understood by all staff, and were particularly satisfied with the individual support received from staff regarding specific support needs. Records seen indicate the home has robust recruitment procedures. Staff do not work in the home without a satisfactory Protection of Vulnerable Adults (POVA) check and do not work unsupervised until a satisfactory Criminal Records Bureau check (CRB) has been received. All staff receive a thorough induction into the home. This is a formal process and is competency based. Training records were inspected. It is clear that the organisation invests in staff, and all staff receive foundation training in mandatory subjects, as well as additional training in areas specific to the home, for example training in epilepsy awareness and autism and aspergers. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 21 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): Standards 37, 38, 39, 40 and 42. Quality in this outcome area is good. Residents’ benefit from living in a well run home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was not present during the inspection. Records viewed evidenced she has extensive experience in the care sector, and has obtained the Registers Manager Award and NVQ level 4. Inspection of Key records demonstrated that this home is well run; assessments, care plans and risk assessments all evidenced that service users Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 22 receive a planned and individual service based on their needs and wishes, and that the staff and management of the home are trained and skilled. Regular residents meetings, as well as individual meetings held with residents all evidence that residents have opportunities to contribute their views that assist the continuing development of the home. Inspection of the policies and procedure file identified some shortfalls in the organisation’s responsibility to review and update these documents. Some policies had not been reviewed since November 1998, and many policies had not been reviewed since 2002. discussion with the area manager identified that the home and organisation are aware of these shortfalls in reviewing policies, and a review of all policies is being undertaken by June 2008. Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 2 X 2 3 Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 24 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Farm House DS0000061263.V361219.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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