Care Home: Gorse Farm

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What the care home does well The home provides sufficient information in an appropriate format for prospective residents to be able to make a choice about moving into the home or not. Pre-admission assessments for prospective residents that involve the person and using appropriate communication are carried out over a period of time to enable the home to decide if they can meet the person`s needs - including communication needs, to enable the person to become familiar with the surroundings and for them and the people living there to get to know each other. There was evidence to support that various forms of communication are used at Gorse Farm to meet each person`s needs and understanding and to enable them to make choices. The care plans looked at were thorough, detailed and person centred in order to give staff the information they required to support the residents in meeting their needs. They are reviewed six monthly involving the resident, the family, staff and other relevant agencies to ensure the person`s needs and aspirations are met. They are also revised in between reviews as circumstances change. The premises are secure to exclude intruders and to ensure the safety of people living at the home, all of whom have been assessed as being at risk if leaving the premises alone. There are extensive grounds that include an adults adventure park, a sensory garden and a home produce garden, all of which are readily accessible to residents. Appropriate assessments are in place in order to minimise risks. Ample activity is planned that is in line with each person`s wishes and abilities. The home has an `Activity Resource Centre` used to provide drama, art and music therapies and training and support is provided in everyday communication and daily living. Residents talked about their holidays to Crete, Portugal an Portsmouth. Residents attend the local church and maintain other links with the community with their trips out to local entertainments including bowling, swimming,, horse riding and visits to pubs. They are known to neighbours and greeted by them when they meet. The home promotes and encourages contact with families and where possible friendships and relationships. Sexuality guidance is available for the residents from a specialist and used when assessed as appropriate. There is a good and comfortable rapport between staff and residents. Staff support and care for residents in a respectful manner and maintain their independence, privacy and dignity. Meals offered are varied, nutritious and to the residents` preferences. Times of meals are flexible. Good records are kept relating to the meals taken by the people living there. All evidence seen in records, in observations made, during discussion and heard in conversation indicates that personal care is provided that respects privacy and dignity and in the way that they prefer. Health care needs of people living at Gorse Farm are met by visits to or by health care professionals. The manager has negotiated with the GP to visit them at home as visits to the surgery caused distress and anxiety. The home has appropriate policies and practices to enable people raise concerns and be confident that they will be listened to and for people living at the home to be safeguarded from abuse. Recruitment policy and practice safeguard residents from the employment of unsuitable people. All evidence indicated that the residents financial interests are safeguarded. Gorse Farm provides comfortable, clean, safe and well maintained surroundings for the people living there, with the opportunity to choose the decor and furnishings of their own space. The impressive grounds are extensive and include a sensory garden, an adult activity park and a home grown produce garden, all of which are accessible to residents. Systems are in place that maintain infection control. The importance of training is recognised. Management and Staff have attended mandatory training related to health and safety and equality and diversity issues, training related to meeting the needs of people with autistic spectrum disorder and National Vocational Qualifications relevant to their role. The manager, senior staff and support staff demonstrate enthusiasm and commitment in supporting the people living at Gorse Farm and are knowledgeable about autistic spectrum disorder. All the requirement and recommendations from the previous key and random inspections had been met. Health and safety practice protects residents and staff at the home. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. What has improved since the last inspection? The medication system now safeguards the health and welfare of the people living at the home, and includes rigorous checks and audits to ensure that the right medication is given to the right person at the correct time. Medication, including controlled drugs, is received, stored, recorded and disposed of safely. Lockable medication refrigerators have been purchased for each bungalow to ensure that medicines requiring refrigeration are stored in compliance with their product license.There have been new carpets provided in the bungalows and new covers for the armchairs and settees, adding to the comfort and appearance of the living areas. All fire safety records were up to date and a fire risk assessment was in place for the premises. Activity programmes have been revised. Mental Health Capacity assessments and Deprivation of Liberty assessments have been completed on all the people living at the home in order minimise the risk of a person being deprived of their basic rights. What the care home could do better: Although there was evidence that one person`s cultural needs was identified and met, a further care file looked at did not show that the cultural needs had been assessed for another person. The care file of each care plan is extensive. The home should consider making the day to day care plan more accessible to staff. Care plans are written in the first person. Whilst this is intended to show that the plans are person centred and the involvement of the person it becomes meaningless if that person is unable to articulate the words used or if speech is not their form of communication. Key inspection report Care homes for adults (18-65 years) Name: Address: Gorse Farm Coleshill Road Marston Green Solihull West Midlands B37 7HP     The quality rating for this care home is:   two star good service 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: Lesley Beadsworth     Date: 1 7 0 7 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care 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 Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Gorse Farm Coleshill Road Marston Green Solihull West Midlands B37 7HP 01217709085 01217709647 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: autism. west midlands care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 14 Date of last inspection Brief description of the care home Gorse Farm is part of the Autism West Midlands group, which provides a range of residential, day care, education and employment opportunities for people with a diagnosis of autistic spectrum disorder. Gorse Farm provides residential and day services to fourteen young adults with learning disabilities, specifically an autistic spectrum disorder. Gorse Farm is located in the village of Marston Green, within easy reach of local amenities. The converted barn facilities and specifically developed buildings comprise of an administration building, two purpose built separate bungalows and a day centre. Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 14 Brief description of the care home The two bungalows comprise of seven single bedrooms, lounge, dining room, and an additional lounge with sensory stimulation equipment, kitchen and a range of toilet and bathroom facilities, laundry and staff facilities. The day service building comprises of art and craft facilities, kitchen, music and drama area, computer room and quiet workrooms. The fully equipped sensory room is currently housed in a portacabin whilst further building development work is considered. The establishment is set in spacious and private grounds and are formed around a quadrangle with a lawned area. The home also has a sensory garden and allotment for the use of the Service Users. There is ample parking to the side of the home. Management should be consulted regarding the fees for living at Gorse Farm. Care Homes for Adults (18-65 years) Page 5 of 36 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: two star good 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 peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to Gorse Farm. The home did not know we were visiting on the first day. A random inspection had taken place since the last inspection when the pharmacist inspector concentrated on looking at medication and found a n improvement in the system. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment [AQAA], which is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Because of the anxiety caused and the difficulty the people living at the home have in completing them surveys were not to service users. five surveys were left for staff but these had not been returned by the time of this report. Information contained within the AQAA, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Two residents were Care Homes for Adults (18-65 years) Page 6 of 36 case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families, where possible, about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place over three visits starting on 10th July 2009, being completed on 17th July 2009 and for a total of fourteen hours. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: The home provides sufficient information in an appropriate format for prospective residents to be able to make a choice about moving into the home or not. Pre-admission assessments for prospective residents that involve the person and using appropriate communication are carried out over a period of time to enable the home to decide if they can meet the persons needs - including communication needs, to enable the person to become familiar with the surroundings and for them and the people living there to get to know each other. There was evidence to support that various forms of communication are used at Gorse Farm to meet each persons needs and understanding and to enable them to make choices. The care plans looked at were thorough, detailed and person centred in order to give staff the information they required to support the residents in meeting their needs. They are reviewed six monthly involving the resident, the family, staff and other relevant agencies to ensure the persons needs and aspirations are met. They are also revised in between reviews as circumstances change. The premises are secure to exclude intruders and to ensure the safety of people living at the home, all of whom have been assessed as being at risk if leaving the premises alone. There are extensive grounds that include an adults adventure park, a sensory garden and a home produce garden, all of which are readily accessible to residents. Appropriate assessments are in place in order to minimise risks. Ample activity is planned that is in line with each persons wishes and abilities. The home has an Activity Resource Centre used to provide drama, art and music therapies and training and support is provided in everyday communication and daily living. Residents talked about their holidays to Crete, Portugal an Portsmouth. Residents attend the local church and maintain other links with the community with their trips out to local entertainments including bowling, swimming,, horse riding and visits to pubs. They are known to neighbours and greeted by them when they meet. The home promotes and encourages contact with families and where possible friendships and relationships. Sexuality guidance is available for the residents from a specialist and used when assessed as appropriate. There is a good and comfortable rapport between staff and residents. Staff support and care for residents in a respectful manner and maintain their independence, privacy and dignity. Meals offered are varied, nutritious and to the residents preferences. Times of meals are flexible. Good records are kept relating to the meals taken by the people living there. All evidence seen in records, in observations made, during discussion and heard in Care Homes for Adults (18-65 years) Page 8 of 36 conversation indicates that personal care is provided that respects privacy and dignity and in the way that they prefer. Health care needs of people living at Gorse Farm are met by visits to or by health care professionals. The manager has negotiated with the GP to visit them at home as visits to the surgery caused distress and anxiety. The home has appropriate policies and practices to enable people raise concerns and be confident that they will be listened to and for people living at the home to be safeguarded from abuse. Recruitment policy and practice safeguard residents from the employment of unsuitable people. All evidence indicated that the residents financial interests are safeguarded. Gorse Farm provides comfortable, clean, safe and well maintained surroundings for the people living there, with the opportunity to choose the decor and furnishings of their own space. The impressive grounds are extensive and include a sensory garden, an adult activity park and a home grown produce garden, all of which are accessible to residents. Systems are in place that maintain infection control. The importance of training is recognised. Management and Staff have attended mandatory training related to health and safety and equality and diversity issues, training related to meeting the needs of people with autistic spectrum disorder and National Vocational Qualifications relevant to their role. The manager, senior staff and support staff demonstrate enthusiasm and commitment in supporting the people living at Gorse Farm and are knowledgeable about autistic spectrum disorder. All the requirement and recommendations from the previous key and random inspections had been met. Health and safety practice protects residents and staff at the home. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. What has improved since the last inspection? The medication system now safeguards the health and welfare of the people living at the home, and includes rigorous checks and audits to ensure that the right medication is given to the right person at the correct time. Medication, including controlled drugs, is received, stored, recorded and disposed of safely. Lockable medication refrigerators have been purchased for each bungalow to ensure that medicines requiring refrigeration are stored in compliance with their product license. Care Homes for Adults (18-65 years) Page 9 of 36 There have been new carpets provided in the bungalows and new covers for the armchairs and settees, adding to the comfort and appearance of the living areas. All fire safety records were up to date and a fire risk assessment was in place for the premises. Activity programmes have been revised. Mental Health Capacity assessments and Deprivation of Liberty assessments have been completed on all the people living at the home in order minimise the risk of a person being deprived of their basic rights. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 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 Care Homes for Adults (18-65 years) Page 11 of 36 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. Information required to make a decision about choice of home is available when needed and in an appropriate format. In depth preadmission assessments are developed over a period of time to assess if the needs of prospective residents can be met. The home ensures that they are able to meet the communication needs of the people living at Gorse Farm. Evidence: A Service User Guide had been translated into pictures and signs by the deputy to assist the people living at the home to understand the information. Each person had been issued with a copy of this, which was kept in their bedroom. The deputy manager advised that they were continually replacing many of these as they were being destroyed by some of the residents. If the management is satisfied that the person has had the opportunity to understand the Service User Guide it is not necessary to replace it each time it is destroyed unless that person requests or is assessed as needing another copy. A new copy should be provided each time the Service User Guide is revised. Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: A copy of the Statement of Purpose was readily available in the reception and is available in other formats on request. The large majority of the people living at Gorse Farm have done so since the home opened. However there has been one transfer to a new independent living service in the organisation and a new person moved into Gorse Farm last year. We looked at the care files as part of the case tracking process for this person. The pre-admission assessments are kept in a file in the administration block, whilst the care files are kept in the bungalows for reference by staff. Social Services are responsible for the financial aspects of the placement for all people currently living at Gorse Farm and they carry out a full assessment of need prior to referral. This was seen in the care files looked at. Gorse Farm carry out their own assessment and this was detailed, informative and covered all the relevant areas of needs but the persons ethnic minority cultural needs had not been addressed. Staff spoken to about this said that there were no specific needs related to the persons culture but there was no evidence that this had been assessed. There was evidence that the cultural needs for another resident who had moved to the UK as a young person had been looked at and had the support of a member of staff who was able to speak the same language. The member of staff had also been supported by the home by being provided with refresher training classes on the language. The pre-admission assessment looked at showed us that the person had been attending day services at Gorse Farm for a year and for a gradually increasing amount of time before he came to live there. This gave the person the opportunity to become familiar with the environment and the other people living there and for them to get to know the person that was likely to be moving in with them. It also gave staff the opportunity to further assess whether they could meet the persons needs or not before the decision to move in was made. Mental Health Capacity assessments and Deprivation of Liberty assessments have been carried out on all the people living at the home. Risk assessments are in place for restraint within the limits of breakaways when for example the person may be held by the wrists or walked alongside for their personal safety or that of others. These will minimise the risks of the people being inappropriately deprived of their basic rights and freedom and assist the service to act in their best interests. The home was able to demonstrate clearly that various forms of communication are used dependent on each residents needs and understanding, including verbal, nonverbal body language, gestures and signing, Makaton (a communication technique Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: that uses speech, facial expression, gestures, signs and symbols to communicate), and the use of photos and pictures for choice. During the transition period the home assesses that they are able to meet that persons communication needs before a decision is made that the person moves in. One of the care files looked at included information regarding the use of an independent advocate, as well as the family, to act in that persons best interests and on their behalf as appropriate. Other residents have also been supported to have an advocate. Care Homes for Adults (18-65 years) Page 14 of 36 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. Person centred care plans are in place that give staff the information they need to meet the persons needs, to manage their behaviour and are reviewed at six monthly intervals or as the persons circumstances change. Residents had choices and control, with limitations to leaving the building, over their daily lives. Risk assessments are in place in order to minimise risk. Evidence: As part of the case tracking process two care files were looked at in relation to care plans. These contained a great deal of paperwork and the home might choose to consider the day to day needs to be kept separately for ease of access. Care plans are devised with the resident and are written in the first person implying that it is word for word what the person said. Whilst this can indicate that a care plan is personalised it becomes meaningless if that person is unable express the words used in the plan or if speech is not their form of communication. The care plans are thorough, detailed and are person centred. They are devised from Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: the most recent assessment and cover all aspects of the persons personal and social support and their health care needs. Procedures for managing any aggressive behaviour is described in depth and discussion with staff further evidenced that this is addressed in an appropriate manner, with restraint used only when necessary and kept to the minimum. The parts of the plan related to care and support are in a format understood by that person. Plans for how they are going to spend their day are displayed in picture form on notice boards in each bungalow alongside their photo and people were seen to be referring to their plan. Care plans are reviewed six monthly with the resident and other interested parties, such as family, social worker and staff at the home. Any necessary revision of the care plan is made. There is evidence in handwritten additions to the plans that they are also updated between reviews as and when circumstances change. This ensures that care plans are up to date and assists in ensuring that needs are met. A visitor told us in discussion that they had been involved with their relatives care plans and their review. Pictures and photographs are used in order to assist the residents to make choices and decisions. A chart with pictures of meals and activities attached with hook and loop fastening tape was seen in one of the bungalows. The person who uses it can remove the appropriate picture to take to a member of staff to let their choice be known. This was evidenced during our visit. The manager and staff told us that the people living at Gorse Farm choose the colour of the decor and the furniture in their own bedroom, unless it has been assessed that this would create anxiety. The care records showed us when individual choices had been made by the resident, the reason if the decision was made by others and if it was in their best interests. The main gates to the bungalows are locked at all times. Apart from making the bungalows more secure from intruders this is also because the people living at Gorse Farm have been assessed as not able to go out unaccompanied and remain safe. The grounds to the Farm are extensive, with several different areas for them to use. We were told and we observed that residents are able to come and go within these secure areas as they please and are able to go wherever they wish if accompanied. Medication that is intended to modify behaviour is only given as required and is not given without the staff having gained permission to do so by a senior member of staff. This is to safeguard the rights of the person. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: Three residents manage small amounts of their own money but the manager tells us that others currently show no interest. The AQAA tells us that Money Training is given in Daily Living Skills both at Gorse Farm and at college in the hope that more may manage a part of their finances in the future. Finances tend to be managed by family or advocates. The manager is appointee for benefits as was set up when the home opened. The manager needs to be aware that this should only be in the case if there is not an appointee that is independent of the service and that we should be advised of any appointeeships at each inspection. This is to further safeguard the financial interests of the people living there. A key worker system is in place. The key worker is allocated to a resident and is expected to have a closer relationship with that person. It is their responsibility to communicate with family as is necessary and to be aware of their needs and any changes in their circumstances. A team chart is displayed to show residents what staff will be around the home and is updated as this changes. Risk assessments are in place for the environment and for individual risks. Those looked at had been reviewed and the AQAA told us that staff develop new ones as required. Also, it tells us that where it is appropriate and practical residents will participate in identifying risks and ways to reduce them. Gorse Farm has a missing person procedure that is included in the staff manual. Care Homes for Adults (18-65 years) Page 17 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a lifestyle that includes ample and appropriate activity and occupation. They are supported in a respectful manner and their rights are also respected. Family contact is encouraged and supported by the home. Visitors are made welcome and their needs considered. The residents are offered a varied and nutritious diet. Evidence: Activities are planned according to each individuals abilities and development. The activity programme has been revised since the previous inspection.Some of the people living at Gorse Farm attend college courses that provide training and support in every day communication, cooking, sports, art and health and beauty. The Farm has its own Activity Centre for residents and is used for drama, art and music therapy which are tailored to the needs of each needs. They are supported by appropriately trained personnel. Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: The AQAA tells us that the residents at Gorse Farm are mostly of the Christian faith apart from one person. The family of this person has told the home that they have not been brought up in the faith of their own culture. As the person chooses to go to Christian services they wish [resident] to continue in their attendance at church if [resident] wishes to. A church service is held at the home every fortnight. The AQAA says that this is on an open door format and that Gorse Farm has a good relationship with the local church who also support them with their fund raising the residents and staff attend the Church for Christian festivals Gorse Farms annual singing/drama production is held in church and this is followed by their carol service. Staff assist and support people living at the home to be able participate in the local community. They enjoy spending time at the swimming baths, horse riding, bowling and visiting pubs and restaurants, travelling in the two smart and appropriately unlabelled vehicles belonging to the home. The daily records show that there are outings most evenings to any of these and other venues. One person chooses to walk to a local cafe each morning for breakfast, with a member of staff. Another person opts to go the airport to watch the planes whenever possible. A visitor spoken with said that her relative is greeted regularly by neighbours when they go out, indicating that the people living at Gorse Farm are known to them and that there is a neighbourly relationship between them. The people living at Gorse Farm can choose to go on holiday and some of them were happy to discuss the holidays to Crete, Portugal and Portsmouth. One resident spoken with told us that Portsmouth had been their choice and the manager confirmed that the destination is always the choice of the residents. People living at Gorse Farm have opportunities to meet with their family and friends and this is encouraged by the staff of the home. Most of them have family that they visit or are visited by. During one of our visits somebody was preparing to go home to their family for the weekend and staff said that this is a regular occurrence. A care plan looked at showed that another resident was visited frequently by their family and a visitor spoken with said that they often visit their relative and are always treated well and made welcome by the home. The home also encourages the of contact with family and friends by telephone, email and letters. Residents and family meetings are also held regularly and a relative spoken with said that they found these useful. The manager told us that guidance is available by a sexuality specialist and used when assessed as appropriate and in the AQAA that the residents needs are such that friendships and relationships are very difficult although, where possible or appropriate, we encourage service users to build friendships, which is evidenced with Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: one person who has a long term friendship outside the home and that staff support them in maintaining. People living there have full access and freedom of movement in the extensive grounds and in the bungalows. Observations and discussion showed that their bedrooms are recognised as their private space and staff asked each individuals permission if we wanted to look at their bedroom. Some people have their own bedroom door key whilst others have risk assessments that suggest it is inappropriate or not in their best interests for them to have one. Doors were knocked before bedrooms, toilets and bathrooms were entered, thereby maintaining their privacy and autonomy. The deputy manager told us that residents mail is received centrally and a decision is made about whether it is opened with the person passed onto family or by the person for example an official looking letter/hospital appointment there would be support at hand from staff, whereas personal mail is given to the resident and assistance offered if needed. Preferred names are used and included in the care file. There was good interaction between staff and the people living at the home was observed and residents were included in all the conversations heard. Observation showed that residents approached and chatted with staff in a natural and comfortable way It was clear from observations, care plans and discussion with managers and staff that there is a choice of where to spend time when living at Gorse Farm. There are smaller lounges and ample garden space for people to spend their time if they wish and they have the choice of spending time alone or with others/ of joining in activities or not. One person chose to spend time alone after lunch by lying on the sofa in the small lounge after lunch each day, whilst another person was seen spending time in the playground of the garden before tea, with no pressure to join the group until they wished to do so. Each of the people living at the home spend a day each week cleaning their own room with any support that they might need. Staff spoken with said that they may also be involved with other housekeeping chores, and were seen to be helping prepare meals. This was included in care plans. The home has a no one living there that smokes but there is a smoking and drinking Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: policy. Social drinking is permitted and they will spend time at the local pubs if this is what they choose to do. Staff were spoken with, and observations were made, about meals. The two bungalows both have a kitchen where food is prepared and cooked. The menu in each was looked at and consisted of nutritious meals that are varied and which include choice. There are pictures and photographs that some residents were using to choose what meal they wanted and staff said that alternatives were available for anyone who did not like or choose the main meals provided. Although there are no residents who currently require special diet for physical, cultural or religious reasons there are two people who have specific requirements regarding meat and these are catered for. Particular preferences and obsessive or phobic behaviour about food or drink is managed by the staff effectively. Good records are kept regarding what meals have been chosen and eaten on a meal to meal basis. Residents are encouraged and supported to help with the meals. When asked staff said that residents are more or less able to choose where and when they eat but that they are encouraged to eat at the table as a good modelling example. One person chooses to always eat alone due to wishing to avoid the noise. We saw that mealtimes are very flexible and are generally taken as when people wanted them and in line with other activities they were involved in during the day. Care Homes for Adults (18-65 years) Page 21 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is provided in a manner that meets the persons wishes and preferences. Physical and emotional needs are met. The medication systems safeguard the health and welfare of the people needing medication. Their health care needs are met by health care professionals. Evidence: All evidence seen in care plans, the AQAA and other records, observed during our visits and heard in conversations with staff and residents indicated that the people living at Gorse Farm are supported in their personal care in a manner that maintains their privacy, dignity and encourages independence within the limits of their autism. The AQAA tells us that staff who give personal care support and assistance are required to follow guidelines and advice set out by the organisation in the Intimate Care and Sexuality Policies and Procedures. It also tells us that these policies advise same gender support so that wherever possible female residents are supported and assisted by female staff. This was confirmed by observations and staff who told us that people receive the support from a member of staff of the same gender. Care plans looked at gave instructions about the persons preferred routines and how they like their care to be carried out. There was evidence in care plans and in observations Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: made that residents are guided and supported as they would choose. One residents care plan said that the person should be guided by the member of staff holding their arm. This was seen to be happening and for the person to be happily agreeing to be guided to another location. All the people living at the home were met and all were appropriately dressed and looked well groomed. Care plans showed that they choose their own clothes, for instance an entry in the care file referred to a person having a new jacket that they had chosen; one of the female residents told us that she had just returned from the hairdresser and that she had chosen the hairstyle and colour. These observations showed that people were enabled to choose how they looked and dressed. Residents on going health care needs were being met with evidence of visits by the GP who has agreed to visit the residents at Gorse Farm rather than for them to attend the surgery as this had caused distress and anxiety. There was evidence of visits to or by other health care professionals including psychiatry, psychology, occupational therapy, speech and language therapy and who interlink and communicate in order to have a holistic approach to the person. Residents health is monitored by regular health checks that are not necessarily related to their primary health care needs. There was evidence of residents being seen by an optician and a chiropodist identified in the care files looked at and the AQAA tells us that four people with epilepsy are reviewed and monitored by a local nurse specialist in epilepsy and passes on any concerns to the relevant specialist. Staff also receive training about epilepsy from this nurse giving them the knowledge and skills they require to support the needs associated with epilepsy. Where practical residents are encouraged to take responsibility for their own medical needs and this was witnessed when one resident was heard in discussion with a member of staff about the supply of their support stockings. The medication system was inspected. The importance of a safe system was recognised by all management and support workers spoken with. A random inspection had taken place since the last inspection when the pharmacist inspector concentrated on looking at medication and found an improvement in the system. All residents are assessed with regard to their capacity to administer their own medication but currently all medication is assessed as being required to be administered by trained staff. Each of the two bungalows have their own locked room for storing medication. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: Steps had been taken to ensure that homely remedies were given with the approval of the individuals GP and a signed agreement has now been obtained. The medication system of receiving, storing, administering and recording is robust and rigorous audits are carried out at each staff handover. Medication is received from the pharmacist in multi dose system cassettes, in order to make administration more straightforward for staff. Some tablets and all liquids cannot be stored in these cassettes and are therefore dispensed to the home in original packets and bottles. Staff check the medication into the home against the Medication Administration Records (MAR) and copies of the prescriptions that were sent to the pharmacist. Any errors are reported to the pharmacist for correction. The MAR sheets are completed regarding the amount received and signed by the member of staff checking in the medication. MAR sheets looked at showed that handwritten instructions are witnessed and signed by the two members of staff involved and that any medication left over from a previous cycle are carried forward onto the current MAR. This enables accurate auditing to be carried out. There were no gaps or inappropriate codes in the MAR sheets looked at and observations showed that there are rigorous checks of medication remaining against the MARs and that the MARs have been completed accurately. Any disposal of medication is carried out in a safe way and recorded on the MAR. Each bungalow has its own medical room where medication is stored. This is kept locked and the windows made secure. All medication is also in locked cupboards in these rooms. A lockable refrigerator is provided for any medication that needs to be stored at lower temperatures but were not needed to be used. As they have not been in use since they were purchased nine months previously the home should consider leaving them turned off as they are very noisy and create a lot of heat in the small room, and be turned on again as soon as they know that medication requiring cool storage has been prescribed. The home should also be able to show us that the fridge, when in use, and the medical room remain at the appropriate temperature for the storage of medication. The controlled drugs(CDs)are kept in an appropriate cupboard and an audit and examination of records showed that they were being administered and recorded correctly. However medication that is given to modify behaviour when required is also stored in the same cupboard. The CD cupboard should only be used for CD drugs. The as required medication records were well documented and accurate. Support staff are unable to give this medication without consulting with and having permission from a senior member of staff. The label on one of these bottles was almost unreadable having been worn by the frequent handling when medication is checked each day. The Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: home needed to return it to the pharmacist to redispense and arrangements were made to do this. Apart from some minor shortfalls the medication system safeguarded the health and welfare of the people at Gorse Farm. Medication is administered from the medical room by two people, with both checking that they are giving the correct medication at the correct time and to the correct person. However only one of the members of staff takes the medication from the room to the person, as for both people to do so would be cumbersome, time consuming and increase the risk of the room being left unlocked. The home should consider a way of administering medication where the second person can ensure it is taken to the right person and for that medication to be quickly and safely returned to a safe and secure place if there is an emergency to which the staff have to attend. All staff responsible for medication have undertaken medication training. Those staff spoken to showed a good awareness of the reasons for the use of most of the medication asked about. Care Homes for Adults (18-65 years) Page 25 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate policies and procedures to respond to complaints and to safeguard residents from abuse. Evidence: The complaints procedure is produced in the homes statement of Purpose and also in their service user guide in picture, symbols and simple language form so that residents can understand it more easily. The procedure is also explained to them. Observations, the AQAA and discussion with staff told us that staff take every opportunity to check that residents are happy with the services being offered and that they are encouraged to air any concerns, for example meals, outings, bedroom decor. A relative said that they can be confident that they can raise concerns without fear of any repercussions. There is a compliments and complaints log maintained at the home. We have not received any complaints about the service or any safeguarding referrals. The manager demonstrated a good knowledge of safeguarding and described a previous incident and how this had been addressed. This showed us that she would act appropriately in the event of any suspected or witnessed abuse. The home uses the organisation and local authority policies and guidelines for safeguarding. A current series of incidents between two residents have been appropriately addressed by the manager and appropriate specialists and social workers involved. We have been Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: notified of each incident. Recruitment practice safeguards residents from the employment of unsuitable people. There was ample evidence in policies and procedures, care plans looked at, in notifications sent to us, and in discussion that there is an understanding around any aggressive behaviour shown by a resident and that restraint (physical and/or medication) is kept to the minimum and last resort. The AQAA says Any physical intervention is only used as a last resort and when the service users, their peers or staff are at risk of injury. Gorse Farm keeps good records about any incidents and send us a notification to inform us of what action was taken. Any marks, bruises or other injury caused as a result of the incident or the intervention are also recorded on a body map, the residents care file and on a notification to us. Finances held on behalf of residents and relevant records are the responsibility of a finance officer and an administrative assistant. In their absence staff can use money from petty cash held on the bungalows for any unplanned spending - otherwise administration are advised of money needed/wanted by a resident. Each has a bank account, which is high interest for those with large amounts of money. The accounts are spot checked on proprietor visits and a financial audit is carried out annually by an accredited finance company. All evidence indicates that the residents financial interests are safeguarded. Care Homes for Adults (18-65 years) Page 27 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gorse Farm provides comfortable and pleasant surroundings that are safe and well maintained, for the people living there. There are appropriate systems in place that ensure cleanliness and infection control. Evidence: Gorse Farm is made up of converted farm buildings and two purpose built bungalows. A converted barn forms the administration block and houses offices and a meeting room. Other outbuildings consist of the Activity Resource Centre (ARC) and a sensory room. The two bungalows are well maintained, decorated and furnished within the limits of the destructive behaviour that is a symptom of some of the people living in them. The manager showed us several innovative ideas that prevent damage occurring, such as guards over the fire alarm glass and curtain rails that cannot be pulled away from the walls, to ensure safety and comfort for the people living there. Shared living/dining areas are bright and comfortable, and new covers had just been fitted on the living room furniture. There are smaller sitting areas where residents can spend time away from the main group. There is sufficient space available in both shared and private areas. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: There are seven people living in each of the two bungalows and each person has their own bedroom. These are decorated and furnished in line with the residents wishes and their needs and those visited had been personalised with such things as soft toys, pictures, posters and ornaments. The washbasins in the bedrooms looked at were sealed off to prevent their use. We were told by staff that this was because the home has experienced floods from taps being left on and because of inappropriate urinating. The bedrooms are lockable from the inside by the occupants with a master key that can be used by staff in case of an emergency. Not all residents have been assessed for it to be in their best interests to have a key to lock the door from the outside. All areas visited were clean and free of any offensive odours. There is a laundry facility in each bungalow with appropriate equipment to maintain infection control. Soiled laundry is placed in a dispersible bag, which is then placed directly into the washing machine to avoid contamination. There are toilet and bathing facilities in each bungalow on the bedroom corridors. Showers have been adapted to meet the needs of those using them. All are fitted with appropriate locks that meet the recommendations of the Fire Service. Staff are provided with lockers to use when they are on duty in order to keep their belongings safe. There are appropriate hand washing facilities in all communal hand washing areas, including the kitchens and the laundries. The premises are safe and secure with extensive grounds for residents to spend time as they please. All areas of the bungalows and gardens are accessible to residents. The grounds include a sensory garden, which is said to be well used and a vegetable garden where home grown produce is used by the kitchen. Neither of these areas was visited due to time constraints. There is also a large adult adventure playground provided for the residents use. The premises are very much in keeping with the semi rural area and surrounding houses. They provide attractive and pleasant surroundings for the people living there. Care Homes for Adults (18-65 years) Page 29 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Gorse Farm are supported in a respectful manner by competent and caring staff. Their rights are also respected. Recruitment practice is robust and the importance of training is recognised. Evidence: During each visit observations showed us that staff treated residents with every respect, for example by knocking on doors before entering, the manner in which they spoke to them. The AQAA further confirmed this with the comment, Respect for service users is of fundamental importance and is displayed and promoted in all ways possible. All observations, records and discussion indicated that there were sufficient staff to meet the needs of the people living at the home. Staff greeted residents warmly and were generally greeted positively in return. A comfortable and very friendly family type rapport and continual interaction was seen between all staff and residents. Discussion and observations strongly indicated that staff were committed and enthusiastic about their work at Gorse Farm. They were knowledgeable about supporting people with Autism and were confident and willing to share their knowledge. The AQAA says that staff joining the organisation are required to undertake induction training that is specific to supporting people with autism. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: Professional relationships are built between the staff and other health care professionals who they work with on a regular basis, such as speech and language therapists, psychiatrists, psychologists and district nurses and other specialist nurses. The organisation has a recruitment policy and procedure. Three staff files were looked at in order to assess this. All of them had two appropriate written references, a Protection of Vulnerable People check, Criminal Records Bureau (CRB) disclosure, a history of the persons employment, proof of their identity and a physical and mental health check. The CRB disclosure is updated every three years. Contracts of employment and the General Social Care Council code of conduct are given to all staff and their signed receipts of these documents were on file. All new staff are initially employed on a six month probationary period after which their employment is reviewed before a decision is made about the their employment being made permanent. This evidence indicated that the recruitment policy and practice had minimised the risk of the employment of unsuitable people. The importance of training is recognised by the organisation and the deputy manager is responsible for the organising, monitoring and authorising of staff training. The training records are held by the deputy on a database and is well organised. All staff receive induction during the first six weeks of their appointment, and further training related to the residents needs including Basic Autism Awareness, Mental Capacity, Medication, risk assessment, Sexuality and Autistism, Food, Eating and Autism and Challenging Behaviour.The home has achieved the required 50 of care/support staff to have gained the National Qualification Certificate which shows that they have been assessed as competent to carry out their role. Training has also been undertaken by staff related to equal opportunity and cultural diversity. Care Homes for Adults (18-65 years) Page 31 of 36 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. The home is managed by a person with the appropriate experience and qualifications and supported by competent senior staff. The people living and working at the home benefit from her leadership. The health and safety of residents is safeguarded by safe working practices. Evidence: The registered manager has achieved the Registered Managers Award and has worked at Gorse Farm for twelve years and has been in the post of manager for eight years. The organisation provides periodic and appropriate training to maintain and update her skills. Discussion with her showed that she had enthusiasm and commitment to managing and further raising the standards of the home. All requirements and recommendations from the previous inspection had been met. The manager is supported by competent senior staff and those met showed the same commitment to supporting the people who lived at Gorse Farm. The home is reviewed and accredited by the Autistic Society every three years, the Care Homes for Adults (18-65 years) Page 32 of 36 Evidence: last time being in 2007, with a report tells us is designed to provide a concise and focused insight into the organisations performance against accreditation standards. The report stated that the home had achieved an Accredited status. A copy of the report was available in reception. The appropriate insurance and registration certificates were also on display in the administration/reception area. There are ongoing opportunities for residents and family to feed back their views of the service at relatives meetings, when visiting the home and at the six monthly reviews held for each resident which is held with them, their family, key staff and management, the social worker and any other relevant person. These were evidenced in the persons care plan. As our visits are now unannounced the people living at the home are not pre-warned about our visits but the staff ensured that we were introduced to them an an explanation given to them as to who we were and why we were there. Training records and staff records showed us that staff had undertaken mandatory training such as fire safety, food hygiene, health and safety, adult protection (safeguarding) and first aid giving them the knowledge and skills to be able to work safely and effectively. The security around the premises safeguards the people living and working at the home but the home should ensure that windows restrictors are in place to minimise the risk of intruders. There were no other health and safety concerns noted during our visits. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. Care Homes for Adults (18-65 years) Page 33 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 34 of 36 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 Requirement 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 Requirement Timescale for action 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 3 7 The care file should demonstrate that a persons cultural needs have been assessed. The home might consider that the day to day care needs are kept in separate records from the care file for ease of access. The use of the first person in care plans should be avoided if not used in direct quotes. The controlled drug cupboard should only be used for storing controlled drugs. A way of administering medication where it can be transported to individuals more safely and be witnessed by both members of staff involved with the administration should be considered. All windows should be fitted with restrictors to minimise the risk of intruders. 3 4 5 7 20 20 6 38 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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