Care Home: Heath Farm House Care Centre

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What the care home does well The home is well managed and there are positive and supportive relationships between staff and the service users. The staff are well trained. The care planning system is good with evidence of input from other professional agencies. Meals are handled well with a number of choices always on the menu. What has improved since the last inspection? The recruitment procedure has been improved and is now more robust. There is improvement in the way complaints are managed. Although the quality monitoring system has improved the home must be more demonstrative in the way it re cords how it meets the outcomes for the people using the service. What the care home could do better: The home needs to address the way in which staff communicate with one another using a two-way radio system to prevent breaches in service user confidentiality and intrusion.The home needs to develop ways to encourage the service users to be deployed in more meaningful activities and motivating families to become more involved within the community of Heath Farm. Some minor adjustments need to be made to ensure that the anomalies found to be present in the handling and administration are addressed. CARE HOME ADULTS 18-65 Heath Farm House Care Centre Norwich Road Little Plumstead Norwich Norfolk NR13 5JG Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 27th November 2007 09:30 Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heath Farm House Care Centre Address Norwich Road Little Plumstead Norwich Norfolk NR13 5JG 01603 721521 01603 722365 heathfarm@swantoncare.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Swanton Care and Community Ltd James McCready Care Home 11 Category(ies) of Learning disability (11), Mental disorder, registration, with number excluding learning disability or dementia (11) of places Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents may have, in addition to their mental health needs, have learning difficulties. One service user over the age of 65 years, named in the Commission`s records, may be accommodated. 24/01/07 Date of last inspection Brief Description of the Service: Heath Farm is a care home offering accommodation for up to eleven adults with mental health and mild learning disability needs. The building has been extended and modernised to provide single bedrooms with en-suite facilities throughout. The home is situated a few miles to the north east of Norwich near the village of Little Plumstead. Fees range from £1,800 - £6,500 per month. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been compiled after an unannounced inspection. The home has completed an Annual Quality Assurance Assessment that has been taken into account as were the comment cards received from three service users and one relative. The newly registered manager was on annual leave during the inspection process, however the deputy manager ably conducted the inspection with us. A tour of the premises took place and selection of care plans, personnel files, medication records and training records were examined. What the service does well: What has improved since the last inspection? What they could do better: The home needs to address the way in which staff communicate with one another using a two-way radio system to prevent breaches in service user confidentiality and intrusion. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 6 The home needs to develop ways to encourage the service users to be deployed in more meaningful activities and motivating families to become more involved within the community of Heath Farm. Some minor adjustments need to be made to ensure that the anomalies found to be present in the handling and administration are addressed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents needs are assessed fully prior to admission to the home. EVIDENCE: Case tracking confirmed good practice, it also confirmed that the process for assessing the prospective resident’s needs was done over a period of time and settling in period to ensure that the home is able to meet the assessed needs of people wishing to live at the home. We noted that one resident had been admitted as an emergency and the home had obtained very detailed information about this person from other professionals in order for them to admit him to the home and demonstrate that they could meet his needs. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The individual needs and choices of the residents are fully reflected in their care plans; the plans contain clear targets and goals and are regularly reviewed. The service users are encouraged to take risks as part of their move to wards more independence. EVIDENCE: We examined five case files; the assessment process had been used to formulate the plans of care and any therapeutic intervention that was needed. The care plans were detailed and related to the assessed needs of the residents. It was noted that there had been continued review of care and changes made to the plan if needs had changed; the plans also evidenced resident involvement in their care. The care plans contained data relevant to behaviour and any trends that might trigger disruptive behaviour. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 10 The care plans we looked at had evidence that when some service users enter the home other agencies work closely with the home to plan the care. Those residents that we spoke with indicated that they were encouraged to take responsible risks in their move towards a more independent lifestyle and that they were involved with their care all the time. The risk assessments that were seen had evidence that they were compiled with other agencies involved in the residents care such as Social Workers and Community Psychiatric Nurses. Excellent daily notes are kept and these were extremely detailed and informative with some relevant entries being made on care plans when needs have changed. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home has provided more activities for the residents many of them require more meaningful and purposeful occupation. The home needs to find more ways of motivating its residents to become more involved in creational work. The residents are treated with respect and dignity although more thought needs to be taken in protecting their confidentiality and carrying out actions that can be intrusive to them. Meals are handled well. EVIDENCE: Discussion with the residents evidenced that the home had started to improve in relation to the activities it is providing. A number of residents told us they Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 12 had had a four-day holiday in Great Yarmouth, some had visited Duxford, Sandringham and the Zoo. Others talked of fishing trips they had been on and another resident had started swimming. On the day of inspection there were a number of residents just sitting inside the house; one resident told us about the vegetable garden he has started and another showed us the bird aviary that he tends, he appeared very knowledgeable about all the birds that he feeds and keeps clean. Those staff spoken with said that it was very difficult getting the residents motivated and also family involvement in the home. Although there have been many events that the residents have been able to participate in there is a lack of therapeutic stimulation for them with the provision of more meaningful and purposeful occupation. There is very little activity by the residents in the local community, although it has to be acknowledged that the home is fairly isolated. We noted that the staff had a good rapport with the residents and treated them with respect and dignity; however we did note the use of very large twoway radios that the staff use to communicate with each other, these could be seen to be intrusive and impinging on resident confidentiality. The daily routine within the home took into account the residents needs and it noted that one resident had one to one care. The menus that were examined looked inviting and nutritious and the residents told us that there were always choices and that they felt the food was good. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A few anomalies need attention with regard to the handling and administration of medicines. The residents do receive care in the way that they wish and their health care needs are met. EVIDENCE: Discussion with the residents confirmed that they were well supported by all levels of staff and this was confirmed on examination of their care plans. It was also evident by looking at the care plans and records that the residents are able to access a G.P. when they wish and also are supported by Community Psychiatric nurses. The medication record charts were nice and clear; we noted that those residents who self medicate do not have risk assessments in place for this activity. It was also noted that those residents who have p.r.n. medication do not have care plans in place to confirm and justify why a medication is being Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 14 continually given. Some ointments had been used with no date of opening recorded on them, this is to ensure that they are not being used beyond their shelf life once opened; one tube of ointment that was being used had no label on it to give a guide for prescription. Examination of the MAR charts revealed that those residents who are prescribed Clozaril did not have care plans in place for this, this will allow for the correct care to be given. A random audit of medicines was carried out and all medicines in use tallied with the medicine records. It is recommended that spot audits be carried out for medicines; this helps to continually monitor and prevent medication errors. The cupboard for containing controlled medicines is on an outside wall, it is recommended that consideration be given to citing it on an inside wall. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel their views are listened to. The staff have had training in safeguarding adults. EVIDENCE: The deputy manager informed us that they had had one complaint from a relative, unfortunately we were unable to access the documentation for this so we could not assess if the complaint had been dealt with in a satisfactory manner. It is recommended that all records are available for inspection purposes. We noted that a copy of the complaints procedure was on the notice board in the entrance hall. The service users who we spoke with all said that they new who to speak with if they had any concerns, one said that they shared their concerns with any member of staff and knew it would be dealt with appropriately. The staff members that we spoke with confirmed that they had received training in relation to safeguarding adults; staff records verified this. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a comfortable, clean and safe environment. EVIDENCE: The home was found to be clean and tidy, no hazards were detected during the tour. Residents are able to personalise their rooms. All room are single. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The system for recruitment is robust. Staff are trained appropriately but would benefit from extra training in relation to medication used for mental health needs. EVIDENCE: Records for newly appointed staff records were examined and were seen to reflect a robust checking system. The staff spoken to stated that they felt the provision of training opportunities in the home were good and training records indicated this; new staff members confirmed that they had been given an induction. How ever it would appear that the staff would benefit from medicine training in relation to those medicines used in mental health. Formal supervision is in place but does not happen as frequently as it should, it is recommended that formal supervision sessions are carried out at least six times a year and records made of this activity. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s benefit from a well run home. The health, welfare and safety of the residents is promoted. EVIDENCE: The inspection process, discussion with staff and service users led us to believe that the home continues to be well run. It would appear that the service users benefit from the ethos of the home and the staff. The staff and service users generally feel that they are well supported. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 19 Although an Annual Quality Assurance Assessment was completed by the home it is recommended that it be expanded in order to demonstrate in a more meaningful manner how it is meeting the outcomes for people who are using the service. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 2 x Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13.2 13.4 Requirement People who use the service must have medicines prescribed on a p.r.n. basis (as required) given to them by staff only when clinically justified and this can be demonstrated by record keeping practices, i.e. Care Plans. Timescale for action 04/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA12 YA15 YA26 YA20 Good Practice Recommendations Consideration must be given to offering the residents more meaningful occupation. It is recommended that the home encourages families and friends to become more involved. Consideration must be given to the use of the two-way radio system, something that is far less intrusive. It is recommended that care plan guidance be developed for the management of those people who are prescribed Clazapine. This is to include management of symptoms that may occur. It is recommended that consideration be given to ensure that all staff have some training in medicines related to DS0000069237.V355658.R01.S.doc Version 5.2 Page 22 5. YA20 Heath Farm House Care Centre 6. 7. YA20 YA39 mental health. Consideration should be given to placing the controlled drug cabinet on an inside wall. It is recommended that consideration be given to expanding the AQAA to demonstrate how outcomes are met for people using the service. Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heath Farm House Care Centre DS0000069237.V355658.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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