Care Home: Harkstead Barn Residential Home

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What the care home does well The people living in the home are supported to lead ordinary and meaningful lives, both in the home and within the community.The staff team know the men well, they are good at helping them to make choices and support them to do what they want to do.People who live in the home told us they are happy living there and that staff help them to take part in activities, of their choice in the community.A relative of a person living in the home told us, "I am very happy with service, my relative enjoys using the day care facility, it keeps them active".They also told us, "the staff are really good, they do not assume, that things will go wrong, when escorting my relative out in the community, they assume they will be OK and because of this my relative is able to take part in activities in the community".Staff working in the home have received training to ensure they have the skills and knowledge to meet the needs of the people living there.A lot of effort is put into making sure staff have the skills to communicate with the men living in the home. What has improved since the last inspection? At our last visits in April 2007, we asked the service to make improvements to people`s care plans and to review plans to help people manage their behaviour. We also asked them to make sure that each person had an up to date contract.A `Service Users Charter`, has been given to each of the men, which tells them about the service they should expect and how much money it costs for them to live there.New care plans are being written, which the individual can understand and provide staff with information about the care and support they need and what is important to that person. Behaviour Support plans are better as they look at what is important to the individual, rather than their behaviour. These make staff aware that people`s behaviour is often as a result of their `feelings and emotions`. What the care home could do better: The manager is aware of some things that need to improve, such as the decor, gaps in staff training and to make sure people are given the chance to feedback how well the service is meeting their needs. The manager is taking steps to address these issues. Key inspection report Care homes for adults (18-65 years) Name: Address: Harkstead Barn Residential Home Brick Kiln Lane Harkstead Ipswich Suffolk IP9 1DF The quality rating for this care home is: three star excellent 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: Deborah Kerr Date: 0 8 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 38 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 38 Information about the care home Name of care home: Address: Harkstead Barn Residential Home Brick Kiln Lane Harkstead Ipswich Suffolk IP9 1DF 01473327380 F/P01473327380 harksteadbarn.info@unitedresponse.org.uk None United Response care home 5 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: Date of last inspection The building and gardens allow the people who live at Harkstead Barn to have maximum space and freedom. Care Homes for Adults (18-65 years) Page 4 of 38 The home currently provides accommodation for up to five adults with a learning disability. Each person has their own room. An on site activities centre, was completed in late 2003, and provides a wide range of activities for people who use the service. Two of the people have their own transport to access the community. The service also has a mini bus. The cost for people to live here will vary according to their individual needs. Care Homes for Adults (18-65 years) Page 5 of 38 The charges range from £1,117.73 to £1,320.36 per week, with an additional fee for day care services. This was the information provided at the time of this key inspection. People considering using this service may wish to obtain more up to date information from the home. Care Homes for Adults (18-65 years) Page 6 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 38 How we did our inspection: Time was spent with all of the people living in the home and a relative. We also spoke to the manager and three staff. We looked at some staff files, peoples care plans and records about health and safety in the home. We also looked at information provided about what the home offers to the people who live there and some policies and procedures. Care Homes for Adults (18-65 years) Page 8 of 38 Policies are rules about how to do things. Procedures tell people how to follow the rules. What the care home does well The people living in the home are supported to lead ordinary and meaningful lives, both in the home and within the community. Care Homes for Adults (18-65 years) Page 9 of 38 The staff team know the men well, they are good at helping them to make choices and support them to do what they want to do. People who live in the home told us they are happy living there and that staff help them to take part in activities, of their choice in the community. A relative of a person living in the home told us, I am very happy with service, my relative enjoys using the day care facility, it keeps them active. Care Homes for Adults (18-65 years) Page 10 of 38 They also told us, the staff are really good, they do not assume, that things will go wrong, when escorting my relative out in the community, they assume they will be OK and because of this my relative is able to take part in activities in the community. Staff working in the home have received training to ensure they have the skills and knowledge to meet the needs of the people living there. A lot of effort is put into making sure staff have the skills to communicate with the men living in the home. Care Homes for Adults (18-65 years) Page 11 of 38 What has got better from the last inspection At our last visits in April 2007, we asked the service to make improvements to peoples care plans and to review plans to help people manage their behaviour. We also asked them to make sure that each person had an up to date contract. A Service Users Charter, has been given to each of the men, which tells them about the service they should expect and how much money it costs for them to live there. Care Homes for Adults (18-65 years) Page 12 of 38 New care plans are being written, which the individual can understand and provide staff with information about the care and support they need and what is important to that person. Behaviour Support plans are better as they look at what is important to the individual, rather than their behaviour. These make staff aware that peoples behaviour is often as a result of their feelings and emotions. Care Homes for Adults (18-65 years) Page 13 of 38 What the care home could do better The manager is aware of some things that need to improve, such as the decor, gaps in staff training and to make sure people are given the chance to feedback how well the service is meeting their needs. The manager is taking steps to address these issues. Care Homes for Adults (18-65 years) Page 14 of 38 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Deborah Kerr CQC East Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 0300 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website 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 15 of 38 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 16 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Harkstead Barn has a range of information, in different formats to ensure people living, or planning to live there, have access to information about the services provided and to help them make a decision if this is the right place for them. Evidence: Information provided in the AQAA and verified at the inspection confirmed Harkstead Barn has a wide range of information about the service, in user friendly formats, including peoples contracts and the complaints procedure. A copy of the statement of purpose was provided at inspection, which provides up to date information for prospective people, to assist them in making a decision if this service would meet their specific needs. The service continues to develop how they provide information, they have extended the use of photographic prompts to aid choice making and have plans to produce a video of life in the home, for people considering using this service. The Service Users Guide, is a United Response document, specified to Harkstead Barn, called Supporting People with Learning Disabilities in Suffolk. This includes all the information about the service, referral process and funding, however the guide needs some updating, to reflect the revised amount of personal allowance each person receives and staffing numbers, as these have changed. Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: The service user group has remained the same, with no new admissions, since opening in 1992 and accommodates five men at present. Therefore it was not possible to assess standard 2, with regards to pre admission assessments. The AQAA does however reflect the service works closely with the commissioning team to ensure detailed information is received before considering any new tenant, including a review of their support needs. To address the issues of compatibility, a number of planned visits by the potential new tenant would be arranged. Additionally, to ensure the existing men were involved in the process their feedback would be sought, before a decision was made to accept a new tenant into the home. A requirement was made at the previous key inspection in April 2007 for the contract and individual service agreement between each of the men and United Response to be reviewed and updated to reflect the individual’s current fees. Each of the men have been issued with a Service Users Charter, which has been set out in a format, which is easy to read and understand, with symbols, pictures and photographs, supported by easy read writing. These provide the men using the service with information about the support they can expect to receive from United Response, their fees, who is responsible for maintaining the property and how to complain. Care Homes for Adults (18-65 years) Page 18 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service know they will receive care and support, which meets their individual needs and preferences and will be supported to take risks and make choices about their every day lives. Evidence: Information provided in the AQAA and verified at the inspection confirmed that United Response have adopted and fully supports the principles of the person centered approach. This was demonstrated by staff during the inspection, who are dedicated to ensuring each person lives a purposeful and meaningful life. The men were observed being supported to make choices and decisions of how they spent their time throughout the inspection. A requirement made following the last key inspection in April 2007, was for care plans to be developed with the individual, focusing on their strengths, personal preferences and changing needs. Two of the mens support plans were looked at as part of the inspection process. These are in various stages of being reviewed and updated, however there has been a significant improvement to implement person centered plans, Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: which focus on the individual. The plans have been drawn up with the involvement of the individual, relevant agencies, family and other people that know them well. The plans are written in a format, which the individual can understand and provide staff with a living description about that person. The information with in the care plans is detailed and informative, whilst reflecting a range of information that is important to the individual, such as plans to support feelings, things that don’t make sense in my life, what is important to me and what I like around me. Each individual has a communication summary, which reflects how I see and hear, and how I communicate. These plans provide information in a way that can be easily understood by new members of staff or people not familiar to the individual, to deliver a personalised and consistent person centered service. People living in the home have a range of communication needs, staff have attended training to learn British Sign Language (BSL) and makaton to facilitate communication. Additionally, communication tools such as photographs, symbols, signing and verbal or physical prompts are used to ensure the men living in the home are able to have their say and make choices in their lives, including the opportunity to participate in the day to day running of the service. Two of the men attended a staff meeting, which took place during the afternoon of the inspection and made contributions to the meeting. The inspector was advised that the men are also fully involved in the recruitment of new staff by meeting them and giving their opinions at interview. Positive Behaviour Support plans are now in place for each individual, which link in with Individual Reactive Strategies. These reflect the types of behaviour the individual may exhibit, things that may trigger behaviour to occur and staffs approach to deal with the situation. The content of the behavioural support plans has improved and provides good detail, which has been personalised to each individual, with excellent guidelines of how to support that person. These are person centered, in that they focus on what is important to the individual, rather than the behaviour itself and recognise that behaviours are determined by feelings and emotions and to prevent behaviour from escalating, these need to be understood. Individual and generic risk assessments have been completed, which are enabling for the men. These ensure each of the men are supported to live their life to the full, in the least restrictive manner possible. The assessments state life is a risk and that things will happen, however wherever possible the assessments reflect actions to deal appropriately with these events, to ensure their safety. Care Homes for Adults (18-65 years) Page 20 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service continue to be supported to take part in appropriate leisure and work related activities within the local community and have the opportunity to mix with other adults. Evidence: Information provided in the AQAA and verified at the inspection confirmed that staff at Harkstead Barn work hard to facilitate social interaction within the service and in the wider community. The service makes full use of the range of community resources and opportunities available. The relationship with the community is given a high profile and relatives and neighbour’s are invited to interact with the service and the men by attending various fund raising functions. This was confirmed during the inspection. Time was spent talking with the day opportunities manager. Ipswich Day Opportunities is a separate service, referred to as Day Ops, it is on site and was originally set up for two of the men, where due to their perceived behaviours, no other day care options were available to them. Another of the men uses the facility one day a week. The day opps manager advised they are looking to further develop the day service, opening it up to Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: other United Response and Mencap services. Discussion throughout the day with the day opps manager, staff and a relative confirmed that the ethos of the home is to ensure that each of the men are supported to achieve their goals, follow their interests and to be integrated into society. This is an area where the staff have achieved excellent results. With the right support and planning, staff have been able to fully integrate one of the men into the community, where previously their aggressive and autistic tendencies had caused problems, where they have wanted to explore and was not aware of their environment. The individuals relative and staff confirmed they have gained in confidence and that they are happy to access places in community. The individual will now go into petrol stations and pay, rather than be restricted to staying inside the vehicle. Additionally, they have been on holiday’s to France, sailing, attends the gym, eats out regularly, and goes shopping in supermarkets on a weekly basis. A separate staff team is employed to facilitate the day care on the premises and offers the men a programme of activities. A running log of all activities that have taken place, is kept alongside individual men’s diaries, containing a written account of activities and level of participation. Inside the day opps building, photographs are on display showing the men enjoying activities in the community. The photographs and the screen saver on the computer reflects pictures of holidays and outings the men have been on, these include holidays, in Portugal, Amsterdam and France, visits to Legoland, an aviation museum, swimming, McDonalds, shopping, picnics, walks, solar bowl and Brandon Park. Additionally, a pen picture of the people who use the day service, is on display, which reflects their favorite hobbies and activities, and provide staff with an immediate view of what the individual likes to do. The men also use the day care facilities in the evenings and at weekends for their own entertainment. There is a range of musical instruments, including a full set of drums, a sensory corner, a computer and play station, a pool table, table tennis and table football. Being in a rural location the service is creative in utilising all forms of public and commercial transport to access the community. There is also a service vehicle minibus and two of the men have their own Motorbility vehicle. One of the men continues to attend a work placement at a unit called Growing places, which grows and sells vegetables and fruit. They attend Monday through to Friday helping to plant, grow and sell the produce. Another of the men, receives funding for a community based program of activities. The individual is supported by two staff, five days a week, which enables them to go out safely and to integrate in the community. Time was spent talking with one of their carers who confirmed the individual has enjoyed activities such as, going to the theatre, cinema, the seaside, restaurants, horse riding and swimming. They have also been on canal boat holidays in Reading, Aldermaston and Newby. Staff commented, arranging activities is trial and error for the individual, as they have very limited communication, however through the continuity of staff, the individuals, trust and confidence in them has increased and that they have managed to build a good relationship, to ensure they enjoy a full and stimulating lifestyle. Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: Staff and the men are in the process of preparing to undertake a fundraising event, to raise money for a summerhouse. The summerhouse will provide additional facilities for the men to enjoy the outdoors in the good weather and enable them to make more use of garden, creating a BBQ area. Three of the men and a group of staff are preparing to climb Snowden. The other two men who are less mobile are going to the top of Snowdon via train. Staff and the men have been in training, for this event and the activity log showed a member of staff and one of the men have walked up to 43 miles, as part of the challenge. The men and staff are to stay in a bunkhouse hotel as part of the event. People living at the home are supported to maintain relationships with their families and often spend the weekend at their parental home. This was confirmed in discussion with a relative. They commented, I am very happy with service, my relative enjoys using the day care facility, it keeps them active. The staff are really good, they do not admit defeat, they do not assume, that things will go wrong, when escorting my relative out in the community, they assume they will be OK. Because staff trust my relative they respond better and therefore their behaviour is much better, and staff are better prepared. My relative has no hearing or speech and has over time built good relationships and trust with staff and the other men. The staff are very flexible, polite and will do anything for you. They provide good outcomes for my relative and are also very supportive of me, I only have to phone and staff are very accommodating to my wishes and needs, as well as my relatives. The AQAA reflects the organisation actively supports people to practice their right to vote and practice their faith. United Response is collecting data on a corporate basis to further facilitate people using the service to vote. This is called Every Vote Counts. All of the men are on the Electoral Register. People are helped to follow their preferred faiths and supported to attend the place of worship, when required. The men are encouraged to contribute to the day to day running of the home, which includes keeping their rooms clean and tidy, and helping to prepare the table for mealtimes and clear away afterwards. The men were observed moving freely around their home spending their time as they chose. The AQQA states Harkstead Barns provides varied and flexible menus that cater for peoples personal preferences. This was confirmed during the inspection, mealtimes are relaxed and informal and people have the choice whether to eat with others or on their own and alternative meals are provided, if required. The men are helped to make informed choices regarding menu planning, using visual aids. Care Homes for Adults (18-65 years) Page 23 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service receive effective personal healthcare and support using a person centered approach which is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Information provided in the AQAA and verified at the inspection confirmed each person living in the home has a detailed support plan, which identifies their individualised healthcare needs and where to access support. These plans enable staff to provide a consistent approach in the men’s daily lives. The principles of respect, dignity and privacy are put into practice, the delivery of personal care is responsive to the needs and preferences of the individual. Intimate and personal support plans identify what each of the men can do to meet their own personal care needs and the level of support they need to achieve this, which can be either physical help, encouragement, observation or prompting. They are encouraged to choose their own clothes and attend to their personal hygiene as independently as possible. The AQQA reflects the organisation provides staff training on equality and diversity, to ensure the service is provided in a non discriminatory manner. Observation and discussion with staff confirmed that they are fully aware of the individual needs of people using the service and were able to provide a verbal account of each person’s health and well being. Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: The men are supported to access routine healthcare appointments, such as the dentist, opticians, doctors and other primary and specialist healthcare providers, where required. Letters and correspondence seen on the men’s files confirmed the service works closely with healthcare professionals to ensure people’s physical and emotional wellbeing is monitored. Whenever necessary and with the individuals consent, families are consulted and kept informed of the health and wellbeing of their relative. Additionally, the AQAA states, when required, people using the service are assisted to access specialist support, such as input from the Learning Disability Specialist Health Team, they have recently used this service around a specific area of loss and bereavement. Due to the high and complex needs of the individual’s none of the men self medicate. Medication is kept locked in the office. At the front of the Medication Administration Record (MAR) charts folder is a copy of the homes policies and procedures for administering medication. The policy covers the arrangements for the safe ordering and returns of unused or soiled medication. The home does not currently hold any controlled drugs. At the front of each MAR chart is a photograph of the individual for identification. The MAR charts for all the people living in the home were checked, these had been recorded, signed and dated appropriately. Where identified, established protocols for administering PRN (as and when required) medications are in place. Records reflect that additional staff training and improved behaviour support plans, has helped staff to recognise and deal with symptoms of behaviours at earlier stage, which has lessened the need to use PRN medication, to manage peoples anxiety and behaviours. Training records reflect all staff have received medication training and are only permitted to administer medication, when considered competent and confident to do so. Care Homes for Adults (18-65 years) Page 25 of 38 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. People who use this service have access to a complaints procedure which is in a format they understand and which enables them to make their views known and are protected from abuse or being placed at risk of harm or abuse. Evidence: The organisation has a robust complaints procedure in place that is designed around the people they support. Each person is provided with a copy of the complaints procedure, which has been developed in a format incorporating a flow chart, using symbols and pictures to guide the individual, should they wish to make a complaint. The AQAA reflects the men are actively encouraged to express themselves and their opinion is recorded and acted upon in a timely manner. All complaints are recorded and investigated thoroughly and within the specified time constraints. The complaints log was seen, which confirmed there have been no complaints made about the service since 2005. The complaints log contained a letter of compliment from a United Response, senior personnel acknowledging all work being done at Harkstead Barn. They commented on how well each person had integrated in to the local community and the very person centered way staff are working with the people living in the home. Other compliments had been received from the mens families for the support they receive and for looking after their relative on holiday. Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: Policies and procedures are in place to protect the people using the service from neglect and abuse, which identifies the actions staff should take if an incident of abuse is discovered or reported to them. Staff spoken with were clear about their role and their duty of care to raise any concerns they may have about other members of staff conduct and in reporting of incidents of poor practice and suspected situations of abuse, including reporting to incident to the local authority safeguarding team via Social Services, Customer First service. Staff files reflected there are some gaps in Adult Protection training, however this has been identified by the manager who is in the process of booking training sessions. Staff are fully aware of the needs and behaviours of each of the men and the need to be able to work flexibly, pre plan shifts and activities and have really good communication. Staff told us, restraint techniques are only ever used if person is in danger of harming them self or others. They confirmed they have received accredited training, by a qualified instructor, for managing challenging behaviour and diffusing situations, with annual refresher training in breakaway techniques. Information provided in the AQAA and verified at the inspection confirmed the organisation operates a stringent screening process that requires new employees to be cleared through enhanced Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks and have satisfactory references and Right to Work in the UK prior to commencing employment. Care Homes for Adults (18-65 years) Page 27 of 38 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. The physical layout and design of the home enables people to live in a safe and comfortable environment, which encourages independence. Evidence: Harkstead Barn provides accommodation, which has been specifically designed, for the people who live there. Interactions between the manager staff and the people living in the home reflects a domestic, non working environment with a homely atmosphere. The home is accessible by all the men and meets their individual and collective needs in a comfortable and safe environment. A courtyard style garden is central to the house and day care facilities. This area is maintained by the men and the staff, who have recently developed a sensory garden in remembrance of a member of staff. Garden furniture has been painted nice bright colours and provides a range of seating and tables for people to use. There are ample parking facilities and additional gardens. The AQAA reflects the main garden area is both accessible and spacious for the men to walk around, it has the benefit of a new perimeter fence. This area is secured by a gate which in turn provides a good environment to supervise the men and presents minimal risk. This area is used frequently in the summertime for garden activities and eating outside. There is also a use of a private swimming pool for the men and staff to access in the summertime, which provides a good area for BBQs. Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: As previously mentioned in the daily life section of this report, the men are planning a fund raising trip to raise money to purchase a summer house to make further use of the garden. The service has already obtained funding from a well known DIY store to develop a garden patio, rose beds and an arbor. There are further plans to develop the outside environment, by make better use of the garden, incorporating a manageable vegetable garden and flower beds. Information provided in the AQAA and verified at the inspection confirmed the environment is spacious and has the advantage of everything being on one level, which provides both a practical and functional place for the men to live and staff to work. The home receives a lot of wear and tear, although re decorating of communal areas has been completed, within the last year, some parts of the home require attention. The flooring in the shared bathroom near to the manager’s office is stained and is in need of decorating. It was noted that sample colours had been applied to the walls for the men sharing the bathroom to make a choice of colour. The skirting and flooring is coming unstuck in the shower room. The lounge has new curtains, sofa and armchairs, however the old sofas remain, and with the loose covers not fitting properly and zips are broken due to continuous washing. The lounge carpet is dirty and stained and the overhead lighting has no shades and a number of bulbs need replacing. The AQAA reflects staff involve the men when making decisions about their home, including the choice of decor, furniture and outside environment. The home has five individual bedrooms decorated to each person’s requirements and needs. Three out of five bedrooms have recently been decorated, which involved the men choosing colours and purchasing fixtures and fittings for their rooms. All of the mens rooms were viewed, these reflected their individual personalities, hobbies and interests. The curtain in one of the mens rooms was hanging down and the waste bin in one of the bathrooms had the lid broken. The home has a range of communal areas consisting of a lounge, dining room and kitchen and diner. There are sufficient toilets and bathrooms and shower facilities for the occupants of the home, these consist of three bathrooms each with a bath, shower and toilet. All bathrooms are lockable to provide appropriate privacy, however these can be overridden, if the need arises. There is a separate staff toilet. The home was found to be generally clean and tidy with no unpleasant odours. The laundry facilities have the appropriate equipment to launder clothing and bedding, and when required, soiled linen. Systems are in place to minimise risk of spreading infection, the home has red dissolvable bags, in which soiled laundry is put, which is placed directly in the washing machine, on a sluice cycle prior to washing. Appropriate protective equipment, such as aprons and gloves and hand washing facilities of liquid soap and paper towels are provided in all bathrooms, and where staff may be required to provide assistance with personal care. Page 29 of 38 Care Homes for Adults (18-65 years) 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. People using this service are protected by the homes recruitment procedures and are supported by a staff team that are trained, skilled and in sufficient numbers to meet their assessed needs. Evidence: Observation during the day, examination of the duty roster, discussion with staff, people using the service and a relative confirmed information in the AQAA that the service has retained a consistent staff team, who work very hard and flexibly to provide support, around individuals needs and to involve the men in activities and protocols of their home. Harkstead Barn has a total of eleven staff who work full and part time hours, plus three activities staff. Between them they provide 24-hour care based on the individual needs of the people living in the home. The use of agency staff is very limited, however if agency staff are used, the home has access to a pool of staff known to the people using the service. The daily rotas are flexible and are designed around the men’s needs and where ever possible staff skills and interests are matched to maximise the experience for each person. Staff spoken with confirmed that they felt there was sufficient staff on duty to meet the needs of the people living in the home. Staff also told us in Have your Say surveys, that, I have support in all aspects that I need, I am so pleased and happy working at Harkstead Barn and the home delivers person centered care to all service users and I Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: believe the day service has dramatically improved the quality of life of all of the men using the service. Another person commented, “I enjoy working at Harkstead Barn, the staffing levels are good, most of the time, however sickness can sometimes be an issue. The AQAA reflects that the organisation provides detailed job descriptions for staff so that they know their own roles and responsibilities. They also have access to all policies and procedures which are available in written formats or on the organisations intranet. Staff surveys and discussions with staff confirmed they had been recruited fairly and that they received good training and support to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. Most recent training has included health and safety, protection of vulnerable adults, fire safety, moving and handling, medication, first aid, food hygiene, mental capacity act and depravation of liberty. Other training specific to the individuals has consisted of Suffolk total communication and British Sign language (BSL). There are some gaps in training, which the manager has identified and is in the process of making arrangements for these to take place. A team leader has been appointed as a designated coach to train staff in Developing The Way We Work. Coaches from different areas within United Response meet up for learning and reflection days and are being supported to cascade training to staff in their own services. A training session for staff was held at the team meeting during the inspection. The training has been developed by United Response to provide staff with the skills and tools to work together, to provide person centered approaches, care and support based on what is important to the individual. Training certificates in staff files and information provided in the AQAA confirms that 50 of the staff has achieved or are working towards a National Vocational Qualification (NVQ) 2 or above in care. A team leader has recently completed the NVQ 4 Registered Managers Award. New staff are provided with an employee induction pack, which covers the six core principles of the Skills for Care Common, Induction standards. The new employee is required to attend two induction training days and further training to assist them to complete their induction workbook. Additionally. they will have a shadowing period with a relief or permanent member of staff. The AQAA reflects the homes recruitment process ensures that all safety checks and eligibility to work with venerable adults are in place and cleared prior to taking up new posts. Examination of three staff files confirmed this, all appropriate checks had been taken up prior to them commencing employment, however there was no photograph of the staff for identification. Also the staff files could be better organised, as information was not filed in any particular order making it difficult to locate the required documents. Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: United Response has a corporate agreement with us, CQC to maintain the original Criminal Records Bureau (CRB) disclosures at their head office, however there was nothing on file to reflect that staffs CRBs had been returned. The manager advised they are sent an e-mail confirming receipt of the CRB however they normally destroy this. They agreed they would in future keep a copy of the e-mail as verification, on staff files. The team leader told us, that United Response using the person centered approach for staff. Developing Excellence Portfolios are being issued to staff, which covers all aspects of their induction, personal development and competencies. These will also include a one page profile about the member of staff, which will include a photo, and will reflect how best to support them, as an individual. The AQAA reflects values and principles of the service are effectively communicated through supervision and appraisal meetings and these are conducted in an open manner with honest exchanges of points of view. Staff files confirmed that supervision and performance and development appraisals are taking place. Supervision records reflect a staff competencies system is in use, which covers team working, values and equality, communication, problem solving, professional knowledge and judgement, personal development, organisation and planning. Care Homes for Adults (18-65 years) Page 32 of 38 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 management and administration of the home is based on openness and respect and is run in the best interests of the people living there by a competent and qualified manager. Evidence: The manager has been in post since June 2002. They have a National Vocational Qualification (NVQ) level 4 in Management and Health and Social Care. They demonstrated that they have a clear sense of direction for the service in line with United Response aims and objectives. An Annual Service Review (ASR) was completed by us, in April 2008. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. Using all the information we had about the service our judgement was that the service continued to provide good outcomes for the people living there. Information provided in the AQAA and verified at the inspection confirmed the manager is committed to staff development and senior staff mirror this ethos providing strong role models for other members of the team. They are supported by a team Leader who is a Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: qualified nurse with specialist field in learning disabilities. They have recently attended the Professional Training Certificate course in which a credit was awarded. There experience and qualifications are being utilised in Developing The Way We Work, which is at the forefront of United Responses work practice. The AQAA states people using the service are supported to be actively involved in the running of their home and their views are taken seriously. Their opinions and those of other major stakeholders help to plan the aims and objectives and delivery of the service and that service quality audits are in place and are stringently applied, however the last quality assurance was completed in 2007. These should be completed at least annually. The manager advised the results were assessed for United Response as a whole, however it was discussed that feedback would be more helpful if collated for individual services to reflect where improvements could or need to be made. Each of the men using the service have their own building society accounts, which they are supported to manage and access their money. The men are well known at their local branch and only the manager and the team leader have access, to the building society accounts. None of the men have been issued with bank cards. All of there benefits are paid directly into their account, for them to withdraw as and when they need it. Records examined confirmed the home takes steps to safeguard the health safety and welfare of people living and working in the home. There is no gas supply on premises, the heating is oil powered, and the electrical safety certificate is held by Orwell as the housing provider. A copy of a management briefing was provided to the inspector reflecting a change in legal requirements for the testing of Portable Electrical Appliances (PAT). The guidance requires the service to complete a risk assessment and testing will depend on the outcome of the risks identified. The guidance recommends earthed equipment, such as kettles and microwave ovens are PAT tested two yearly. The homes maintenance folder contained appropriate procedures and provided evidence that routine monitoring of systems, such as monitoring hot water temperatures are completed to ensure compliance with health and safety requirements. Temperatures in bathrooms and toilets were checked and found to be within the recommended temperature of near to 43 degrees centigrade. Weekly checks are carried out by staff, such as household chores, checking fridge temps, food and contents and cleaning shower heads to prevent legionella. The fire logbook showed that the fire alarm is serviced regularly and tested weekly. Regular fire training and drills take place. The homes fire risk assessment was seen which is up to date and complies with current legislation. Information provided in the AQAA and verified in records seen at the inspection, confirmed the service has a robust process for incident recording and this is used effectively to monitor, review and develop safe ways of working. Additionally, staff Care Homes for Adults (18-65 years) Page 34 of 38 Evidence: receive training in safe working practices at induction and this is updated at regular and specified intervals that conform with accepted models of safe working. The home undertakes monthly hazard inspections identifying where there are areas of the home that need repair and maintenance to ensure the safety of the people living in the home and staff. The most recent inspection was completed in April 2009, which noted issues with flooring in shower room. Care Homes for Adults (18-65 years) Page 35 of 38 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 36 of 38 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or 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. Care Homes for Adults (18-65 years) Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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