Care Home: Fenners Farmhouse

Similar services:

• Coopers Mill Ltd
• Bramley Avenue (73)
• Paradise Lodge
• Grangewood
• Upaya Ananda
• Newton Court (1-2)
• Kings Lane (32)
• Pemdale

What the care home does well People have very busy lives with lots of activities. Staff work hard to make sure they support people with their interests and learning new skills. They also make sure that people have opportunities to use the local community and to maintain links with their friends and families. People have excellent opportunities to live a fulfilling lifestyle. The home is well maintained and furnished and people can keep their rooms as they would like. They are involved in household activities. There are meetings every week where each person is asked about what they would like to do, what they think of things, and what they would like to eat during the following week. They have opportunities to make suggestions about things and to share their news and achievements. People have the support they need to maintain their health. What has improved since the last inspection? There was nothing that we said the management team had to do by law when we last visited. The management team look at the quality of the service and this is audited regularly to see what they could do to improve things for themselves. This includes the way the home is run and maintained. What the care home could do better: There are two things that need to happen by law. The management team need to make sure that all incidents that affect people`s welfare are properly and fully recorded. This is also so they can be sure any action to help protect people or support them emotionally can be put in place promptly The management team must make sure that action they have taken to meet one person`s needs is successful in making sure that other people living at the home have their rights protected and they are not harassed or bullied. There are some other things that they could think about doing to make things even better. Angela Carver or Gill Bradfield can tell you about these. CARE HOME ADULTS 18-65 Fenners Farmhouse Fersfield Diss Norfolk IP22 2AW Lead Inspector Mrs Judith Last Announced Inspection 21st August 2008 02:00 Fenners Farmhouse DS0000027455.V370507.R02.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 Fenners Farmhouse DS0000027455.V370507.R02.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. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fenners Farmhouse Address Fersfield Diss Norfolk IP22 2AW 01379 687269 01379 687234 fenners@clara.co.uk 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) Fenners Limited Mrs Gillian Frances Bradfield Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Fenners Farmhouse provides residential care and support for up to 9 adults with learning disabilities, in a sixteenth century farmhouse with an extension, set in half an acre of grounds, it is in a rural setting about three miles from the town of Diss. The home has been registered to provide this service since 3 October 1989. Transport is available in order to access local facilities. Accommodation is on two floors, offering 9 single rooms. A purpose built art studio/day care facility is situated in the grounds with easy access from the main home. Day care is provided on and off site. Charges for the service are from £516 to £1028 per week according to need. There are additional charges for transport, holidays over 7 days, TV rental and concessionary licences and personal spending. The management team make the inspection report available where visitors enter the home. Fenners Farmhouse DS0000027455.V370507.R02.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 stars. This means the people who use this service experience good quality outcomes. Before we visited we looked at all the information we had available about the service, including information sent to us by the manager, staff and residents when we reviewed the service earlier this year. We told the management team we were coming a few days before we visited. This was so they could prepare people living at the home who find the presence of strangers difficult to cope with. We spent about six hours in the home. When we were there we used a method of inspection we call “case tracking”. This is used to see what records say about people’s needs and to find out from observation and discussion what happens in the daily lives of those people and the outcomes they experience. We also looked at and listened to what was going on while we were in the home. We spoke to the manager, director, two members of staff and three of the people living at the home. We used all this information and the rules we have, to see how well people were being supported in their daily lives. What the service does well: People have very busy lives with lots of activities. Staff work hard to make sure they support people with their interests and learning new skills. They also make sure that people have opportunities to use the local community and to maintain links with their friends and families. People have excellent opportunities to live a fulfilling lifestyle. The home is well maintained and furnished and people can keep their rooms as they would like. They are involved in household activities. There are meetings every week where each person is asked about what they would like to do, what they think of things, and what they would like to eat during the following week. They have opportunities to make suggestions about things and to share their news and achievements. People have the support they need to maintain their health. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fenners Farmhouse DS0000027455.V370507.R02.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 Fenners Farmhouse DS0000027455.V370507.R02.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): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are admitted to the home have their needs assessed and could be sure the service would be able to meet them. EVIDENCE: No one has been admitted to the home since the last time the inspector visited. When the last person came, a proper process had been followed, and the person’s needs had been looked at so the home could be sure that they would meet them. The inspector therefore considers that, if the process were once again to be followed should a vacancy arise, the standard would be met. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in decisions about their daily lives although there could be improved evidence of how they and their representatives are always involved in reviewing their care and support. EVIDENCE: Everyone has an individual plan that sets out their strengths and needs and what staff need to do to support the person. These are reviewed regularly with handwritten dates and comments added when things change. The provider’s quality standards audit shows that people know their plans are kept in the office. No one holds their own care plans at present. Basic information is in large print and there are photos or display boards available to people to help remind them about their routines and activities. Care plans themselves do not yet make use of photos or other formats to increase people’s abilities to understand and access them. However, people sign some information to show this is explained to them. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 10 Routine reviews are carried out by the management team and do not consistently show that people or their keyworkers are involved. We spoke to two staff about care plans and whether they felt they contained up to date information that would help them to meet people’s needs. One staff member told us that they felt that care plans were well set out and “clear to read”. Another said that care plans outlined everyone’s needs, likes, dislikes and personal aspirations, “everything to do with their life”. They said that care plans worked as a guide for them in meeting people’s needs and commented that they reflected “each individual person”. One staff member told us that part of their induction had been to go through “thumbnail information” about the support needs of each person. They considered this had been “very useful”. There is guidance about supporting people whose behaviour might be aggressive. However, where this happens and is recorded in notes for the person exhibiting the behaviour, it is not always recorded in the records for the person on the “receiving end”. This supports what one staff member wrote to us earlier in the year that incidents are not always recorded, as they should be. People have the opportunity to express their views and to make decisions about their daily lives in both routine consultations with staff (seen and heard) and in weekly residents’ meetings. These are written down. There are risk assessments to do with activities and behaviour that might place people at risk of exploitation, injury or accident. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff work hard to make sure people can take part in appropriate activities inside and outside the home, making use of the local community facilities. People are able to maintain family links, their rights are respected. They enjoy their meals though mealtimes have not always been as relaxed and enjoyable as seen previously. EVIDENCE: People told us about the things they do. Two people go horse riding. One said “I go horse riding every week” and “I got a gold medal in dressage”. This was in a Special Olympics competition. Both are rightly proud of the rosettes and medals they have won. There are photographs of people’s achievements and participation. Efforts are made to find classes that people will enjoy and where they can further interests or learn new skills. There is information in simple words and pictures from Norfolk County Council about courses on offer to help people choose them. One told us “I’m starting sewing in Thetford in September.” Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 12 One person goes to wood carving classes and has sculptures in the home. They also have pictures of themselves at work and with other classmates. They said, “I get ideas from things. I like to make it look right”. Two people work in Thornham walled garden. One person said, “I go to Thornham on Tuesdays”. We saw that one person has passed the tests they need for an “entry level certificate for working life (land based)”. The certificate has been framed and displayed in the home’s dining room in recognition of their achievement. The person said, “I don’t go there now [Easton College]. I go to Thornham instead.” They described to us a busy programme and said, “I had to give up pottery because you can’t do everything.” Some people go bird watching and to water sports (fishing and canoeing), based on discussion and records. On the day we visited a group of people had gone on a trip to Aldeburgh to see an exhibition and for a picnic. One person had just had the picnic and been to the beach. There are weekly meetings for residents to air their views. These provide opportunities for people to share any news that is important to them and to make suggestions for activities. People are then consulted about whether they wish to take part. Records show the last one had been used to plan activities for the bank holiday including a trip to the cinema for those who wish to go. The home has its own day service and tutors to help people learn and practice skills. There is a focus on artwork and Fenners Artists hold an annual exhibition in Diss where their work is for sale. People have two holidays a year. The first holiday had been to the Nancy Oldfield Trust for holiday accommodation and some water sports (canoeing and cruising). The manager told us that one person did not like this and did not want to get on the boats. This person had an individual trip out on land. We asked people about their most recent holiday. One person told us that they had enjoyed the “nice sea air” and had stayed in a “nice chalet in Hemsby”. Records show that all of the people living at the home went together. They also show some discussion in a residents’ meeting afterwards that three people would like to go somewhere different for their next holiday, although others would like to go back to the same place again. The manager says they will need to take account of people’s wishes in planning future holidays so that they do not all need to go together if they are no longer happy with the arrangement. Records show people have regular contact with their family and are supported to visit them and their friends. Staff drive them if people or their relatives need help with transport. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 13 Risk assessments on file relate to personal relationships, how these are supported and take into account the needs of both parties where appropriate. There is a variety of communal spaces that people use as well as their rooms. When we arrived, one person was playing music in their room. During the early evening, one group of people watched a television programme in the main lounge, while a smaller group sat in the sun lounge watching something different. This means people can choose whether to be in company (and who with), or whether they wish to be on their own. There is a large garden with lawns and shrubs to one side of the home, and a smaller “safe garden” that is fenced, to the opposite side. During the evening one person was supported and encouraged with exercises in this area. This means people can access the grounds of the home in safety. We saw records for one person that show they are offered the opportunity to go to Mass should they wish to do so, and when this is accepted or declined. This shows people are supported with their religious beliefs should they wish to practice. People take responsibility for cleaning their own rooms and helping with laundry, subject to their abilities. Difficulties with one person’s obsessional behaviour are reflected in the care plan which shows how their household routine is structured to help support them to achieve what they need to within a reasonable time. People suggest meals they would like at the weekly residents’ meeting. Menus are kept and we heard people being asked whether they wanted fishfingers or fishcakes for their tea. We asked what would happen if someone didn’t like fish and were told that an alternative would be provided. One person said they would like both for their tea. There is guidance about healthy eating on the kitchen wall. There are photographs to help people to select healthy options. Staff helping with breakfast have guidance about people’s preferences and what sort of choices they need to be offering. Mealtimes are flexible according to people’s routines and activities. Arrangements are made where someone finds it difficult to eat with others and might throw things. Records show this has occasionally impacted upon the ability of others to enjoy a congenial environment and relaxed mealtime. Fenners Farmhouse DS0000027455.V370507.R02.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): 18, 19 and 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: We saw and heard that people were spoken to with respect by the staff on duty, and that staff knocked on doors before entering. Records show that people get up and go to bed at times of their choosing but might need prompting depending on their planned activities. Care plans set out people’s preferred routines and the support they need from staff. One person is currently experiencing disturbed sleep patterns and staff “sleeping in” are often having disturbed nights. This situation is being monitored and the manager says that staff who experience considerable disturbance are able to go early from their following shift. The original assessment of needs and routines says that the person generally goes to bed between 9 and 9.30. The nighttime routine as dated June 2008 Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 15 shows how they are to be encouraged and relaxed before bed, and that this is generally 10pm when the part time carer leaves the premises. Other updates show the person is reluctant to go to bed before midnight and is waking at 3.30am. The manager agreed that, given the number of changes, it would be appropriate to re-write the assessment of strengths and needs so current issues are more clearly presented. Staff we spoke to were aware of the recent changes in routine and current difficulties and were able to tell us what is happening to support the person through these. Records show the involvement of a psychologist in supporting the person. She has also delivered training in the management of challenging behaviour to help staff understand and respond to situations appropriately. Records show where other health professionals have been consulted and the outcomes of appointments. Health action plan folders are being introduced specifically to record health care issues and information about professionals who are involved. One person’s mobility has changed over time and a stair lift has been provided to help promote their safety and welfare. Care plans show clearly how staff are to support people with obsessional behaviour or autism and how to help minimise any adverse impact of these on people’s daily lives. We looked at medication administration record (MAR) charts. The amount of medicines received from the chemist is recorded on these and records of administration seen were complete. Medication not in blister packs is dated on packaging for the day the first dose is taken. This means that the medicines can be audited to make sure that those signed for have been given as prescribed. One person administers their own medication and there is a supporting risk assessment. We discussed that the record chart could be annotated when staff are involved for example in monitoring or prompting to make sure the person continues to be able to manage this for themselves. Written guidance on records shows that the manager needs to be contacted to authorise any medication that is needed only occasionally. There are specimen signatures and initials of all staff who administer medication. We saw records for one staff member confirming they had training in epilepsy and one person told us about this. Records also showed training for some staff in the administration of rectal diazepam that might be needed to control Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 16 seizures in an emergency. Staff have training to help them support someone with diabetes. The records also showed an assessment of their competence to administer medication. We know from previous visits that these assessments are repeated from time to time. We spoke to one newer staff member who confirmed that they had gone through the home’s policies and procedures during their induction, including that for medicines management, and had attended a course on medicines for carers run by the University of East Anglia. The cupboard used for storage of medicines is not adequate to allow for the storage of controlled medication should this be prescribed for people. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their concerns would be taken seriously and there are measures in place to help protect them. However, people’s rights to freedom from bullying and abuse have been compromised in the past and since our last visit. EVIDENCE: Most people who live at the home have good verbal communication. The provider’s quality audit shows that people were able to identify who they would talk to if they had concerns. There is a complaints record showing when concerns have been raised and what action has been taken to address them. People living at the home have not been wholly safe from emotional or physical abuse by another service user. Records show that there have been assaults on residents and that some people were being targeted. Recent records show one person being hit, another being pushed in the chest. One person had been followed and threatened. We asked a staff member whether they felt that the behaviour seen had amounted to physical abuse of residents and were told they felt it had done “in the past”. The director acknowledged this. The providers own quality audit in relation to residents’ rights to be safe from bullying and abuse shows “not all the time.” However, staff and the management team have tried hard to maintain people’s rights and told us that the situation had improved recently. Staff we spoke to were clear about the kinds of concerns they would report and what they would look for when they were delivering personal care that Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 18 might give rise for concerns. One person recently recruited gave very clear outlines of this including not just the presence of unexplained bruising, but also the reaction of the person to staff assisting them with personal care and any changes in personality. They were also able to outline who they would contact if they felt the management team had not responded appropriately to concerns. Issues of concern about interactions between staff or members of the public and residents, are taken up (seen in records in relation to incident notified about visitor to the service.) The management team are known, from previous inspections, to be aware of procedures and to engage in discussion with professionals from the adult protection team. Staff are aware of the need to intervene in the interests of protecting people and have had very recent training (the day before we visited) to help them understand and respond appropriately to behaviour that challenges. Funding for additional hours has recently been secured to help minimise the risk and staff have been identified for this. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 19 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 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, well-maintained and hygienic environment that is suited to their needs and contributes to their independence. EVIDENCE: We did not look round the whole building because we know that the service has a good history of meeting the standards. We did look at one bedroom and at communal rooms. There were no concerns about décor, condition of furnishings or flooring. The sitting room, sun lounge and dining room are all furnished in a homely manner. In response to declining mobility for one person, a stair lift is in place to help the person access their first floor room. There is infection control guidance available for staff and we know that a recent viral outbreak of infection was contained. The director had also sought Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 20 advice from the environmental health officer and was told that this was managed properly. However, we did have concerns that attempts to resolve the situation of providing supervision for someone and getting them to rest and bed quickly had meant that the director made the decision to let the person sleep in the staff room during the afternoon. We saw this in the person’s daily records. As the person has some difficulties relating to continence, and was also experiencing a stomach upset, this could have presented a risk of increased infection to staff (even though their own bedding was used). It is also an intrusion on the facilities available to staff. We asked about the arrangement and the director told us that she was aware of staff concerns and felt she had made “a wrong call”. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 21 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 and 35 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by competent staff who understand their needs. EVIDENCE: The staff members we spoke to say that they have had good training including National Vocational Qualifications. However, we know that the ratio of people with this includes the registered manager and director, not just the care staff. The director has subsequently clarified the information to show us that half the staff have qualifications and two more are registered. There is a range of other training accessible to people and staff files include training plans. We asked staff about their induction. One person told us what it covered, including a period of familiarisation with the shift system and the home’s policies and procedures as well as working with each of the other more experienced staff. They said they “thought it was very good”. A second staff member told us it was “very thorough”. They went on to say that it provided “good grounding information about what needed to happen for people.” Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 22 We saw evidence of training on staff files that included epilepsy, medication, food safety, and emergency first aid. One person told us about training and learning opportunities during induction including manual handling, health and safety, food safety (by questionnaire), and use of fire extinguishers. Changes in the needs of people have resulted in recent training being secured in relation to understanding and managing challenging behaviour. The director says that the home is now fully staffed but acknowledges that there have been difficulties and increased turnover arising from people coming who were then unable to cope with the situation as it presented earlier in the year (dealing with more challenging behaviour). She felt this had contributed to staff turnover identified in information she supplied to us earlier in the year, as some people had not stayed very long. There has been some increase in the hours of part time staff to allow for the increased support needs of two people at this time. In addition, there are specific staff to support daytime activities. This shows a commitment to reviewing staff hours to make sure they are adequate to meet people’s needs. There are recruitment procedures that involve all the relevant checks to ensure staff are safe to work with vulnerable adults and to explore any issues arising from this, their application or interview. This includes explanations of any gaps in employment history. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 23 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, 39 and 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively run, taking into account the views, safety and welfare of people living there. EVIDENCE: The management team (director and registered manager) have appropriate qualifications. Both have undertaken the “Registered Manager’s Award” and the registered manager is a qualified nurse in learning disabilities. They both undertake periodic training that is relevant to the running of the home. People who live at the home have opportunities to express their views via weekly residents meetings and records are kept of their ideas and suggestions Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 24 showing that these are taken up where possible. (for example for activities, meals, holidays etc). Additionally, a director of Fenners Limited makes monthly visits to the home and provides written reports about any issues arising. These visits include discussions with both staff and residents. The Friends of Fenners carry out an annual quality audit of what are considered key indicators of service quality. This audit is carried out over a series of visits and provides opportunities for staff and residents present to comment on a wide range of issues such as records, independence, privacy and dignity. The director has provided us with a copy of this showing it was carried out by two people (not employed by the home), in visits during July and August this year. Staff confirm training in fire safety, first aid and food safety. We know from previous visits that safety issues are addressed promptly and that the manager carries out health and safety audits. The administrator organises fire drills and tests. There is underpinning policy guidance about health and safety matters, including fire procedures, use of cleaning materials, infection control and accidents. The information the manager sent to us before shows that these are reviewed regularly. The premises and equipment is well maintained and we saw no immediate concerns for the safety of people living and working in the home. The key standard about safety has been met at each of the last four inspections before this one. This shows that the management team continue their efforts to make sure the health and safety of people living and working at Fenners Farmhouse is promoted. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 25 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 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 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 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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 YA9 Regulation 17, Schedule 3 Requirement Timescale for action 30/09/08 2. YA23 13 Where people are involved in an incident which affects their welfare it must be recorded in their notes. This is so there is a true reflection of incidents when considering whether people’s needs are wholly being met, and so any remedial action to help protect people or support them emotionally can be put in place promptly. The management team must 30/09/08 continue to review whether the needs of everyone in the house can be met following the increase in staffing. This is so they can see whether this is successful in ensuring people can live without infringements of their rights to be free of bullying and harassment. Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 27 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. 2. 3. Refer to Standard YA6 YA6 YA18 Good Practice Recommendations Individual care plans should improve how they show people or their representatives are involved making decisions about their care when their needs change. Basic information from care plans should be presented in alternative formats to make it more accessible to people who might want to hold copies of their own plans. Assessments and care plans should be updated where there have been many changes noted at review. This would help make it clearer what is the most recent information about how staff are to support people properly. Medication records for people administering their own medication should show when staff make checks or prompts. This is so the manager can show that the person is monitored to make sure they are still able to manage their own medicines safely. Medication storage should meet standards that would allow for storage of “controlled” drugs. This is so that, if someone needed such medicine, it would be able to be received and stored properly in the care home rather than the treatment not being available because existing storage does not meet standards. 4. YA20 5. YA20 Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Fenners Farmhouse DS0000027455.V370507.R02.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!