Care Home: Holt Farm

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What the care home does well The house is clean and there is plenty of space in people’s rooms and shared rooms in the house so that people can have quiet times or share in what’s going on in the house. People can go on outings every day with support workers, to visit interesting places and have their lunch out if they want to. What has improved since the last inspection? Beverly has been the manager at the home now for a year and she and all the support staff have made things better by learning more about the people living here and the things they like to do. The staff learn more about how to keep the people living here, and the house and grounds, safe for everyone. Last year when we visited, most of the people had not lived here very long and were finding it difficult to get to know each other and the staff. Now, everyone seems to get on much better with each other and spend more time doing things and going out. People have been away on holiday and on long days out, that they have liked. The house looks nicer because lots of the rooms have been painted, and new floor covering and some new furniture has been bought. The garden looks better too, because a new person who does gardening and can mend things has come to work here. People living here are asked about what they think about the house and help them plan what they need to do to make sure they have more activities and outings, and do Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 other things to make sure that they, their families and staff all know what is happening each day. The people who live here need to have the way they like to be supported, written down or explained in ways that they can understand - like making peoples’ activity plans easier for them to use by using photos and symbols to show the things they would like to do. The home has got better at doing support plans and helping people to write or draw things to put in them if they can. What the care home could do better: There are still things that need to be mended or painted in the house – like having new work tops in the kitchen that are better for making the food on and keeping clean. The stairs and the top of the stairs need to have new carpet because the old one looks stained and not nice. A new wet room and laundry room are supposed to be built where the garage is now. This needs to be done quickly to give some of the people on the ground floor a bigger room to have a shower in. We still think that some people living here would like to help more around the house and do more choosing of things they want to do and what to buy when they are out shopping. It would be good to have better ways of helping people show what their favourite foods are – like a picture board – so that people could see and pick what they liked when they are shopping and for their meals. We know that the home is already working on some of the things that could be better and we look forward to seeing these new changes when we next visit.Holt FarmDS0000067215.V377599.R01.S.docVersion 5.3 Key inspection report CARE HOME ADULTS 18-65 Holt Farm Hopcrofts Holt Steeple Aston Oxfordshire OX25 5QQ Lead Inspector Delia Styles Key Unannounced Inspection 2nd October 2009 14:30 Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 1 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. 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 home adults 18-65 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. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 2 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 Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Holt Farm Address Hopcrofts Holt Steeple Aston Oxfordshire OX25 5QQ 01869 347600 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) Holt Farm Care Ltd Mrs Beverley Manneh Care Home 5 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 5. Date of last inspection 8th August 2008 Brief Description of the Service: Holt Farm is a five bedroom detached house in a rural location in close proximity to the amenities of the village of Steeple Aston which include a Post Office, shops, a pub and a church. The home is equidistant between Banbury and Kidlington. The home has good links to the city of Oxford. The home has its own transport which it can use to take residents to events of their choice. The home was registered in June 2006 and is privately owned. Entry to the home is by means of a gated entrance off the busy A 4260. The home has gardens to the front and rear and there is a swimming pool at the back of the home. Residents are able to walk into Steeple Aston by means of a safe footpath. The home is registered to provide accommodation and 24-hour support for five adults with either a learning disability or mental health needs. Respite care is not provided. Fees for this service range from £1,520 to £1,950 per week depending on care needs. This fee includes transport and one holiday per year. Extras include toiletries, clothes and personal items. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is what the inspector did when she was at the home. The visit lasted for just over 3 hours on a Friday in October. The inspector met all 5 people who live at the home and was shown around so that she could see the house and some people’s own rooms if they did not mind. The inspector looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. The inspector also asked some of the people who visit the home and know the people who live here, what they think about how well people are supported by the home. She met some relatives who were visiting too, and talked to them about what they liked about Holt Farm. The inspector talked to the manager, Beverly, and two of the support workers about what sort of things they do to help people to go out, and have interesting things to do when they are at home and on outings and holidays. We would like to say thank you for helping us to find out what you think about living at Holt Farm. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 6 What the service does well: What has improved since the last inspection? Beverly has been the manager at the home now for a year and she and all the support staff have made things better by learning more about the people living here and the things they like to do. The staff learn more about how to keep the people living here, and the house and grounds, safe for everyone. Last year when we visited, most of the people had not lived here very long and were finding it difficult to get to know each other and the staff. Now, everyone seems to get on much better with each other and spend more time doing things and going out. People have been away on holiday and on long days out, that they have liked. The house looks nicer because lots of the rooms have been painted, and new floor covering and some new furniture has been bought. The garden looks better too, because a new person who does gardening and can mend things has come to work here. People living here are asked about what they think about the house and help them plan what they need to do to make sure they have more activities and outings, and do Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 7 other things to make sure that they, their families and staff all know what is happening each day. The people who live here need to have the way they like to be supported, written down or explained in ways that they can understand - like making peoples’ activity plans easier for them to use by using photos and symbols to show the things they would like to do. The home has got better at doing support plans and helping people to write or draw things to put in them if they can. What they could do better: There are still things that need to be mended or painted in the house – like having new work tops in the kitchen that are better for making the food on and keeping clean. The stairs and the top of the stairs need to have new carpet because the old one looks stained and not nice. A new wet room and laundry room are supposed to be built where the garage is now. This needs to be done quickly to give some of the people on the ground floor a bigger room to have a shower in. We still think that some people living here would like to help more around the house and do more choosing of things they want to do and what to buy when they are out shopping. It would be good to have better ways of helping people show what their favourite foods are – like a picture board – so that people could see and pick what they liked when they are shopping and for their meals. We know that the home is already working on some of the things that could be better and we look forward to seeing these new changes when we next visit. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 8 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. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 9 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 Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An assessment of the needs of a person who wants to move to the home can be completed following guidelines and a procedure available at the home. EVIDENCE: There have been no more admissions to the home since our last inspection. There are 5 people living here and so no new vacancies. The assessment information for people who were new to the service last year has been steadily built up as individuals have settled in the home and staff and residents have got to know each other better. The home has made good progress in developing person-centred support plans for people. The manager and support staff have been advised and helped by the local NHS learning disability multi-disciplinary team in ways of improving the accessibility of people’s care records to them. The health and support plans we looked at had more evidence to show that on-going assessment and review records had been created with the input of the people living here where possible. The manager gave one example about how much she had learned through working with an individual and talking about the drawings this person has done, with them. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 11 Relatives spoken to on the day of the inspection visit, and another contacted after the inspection said they felt that people living here were now more settled. It was noted that people were more confident about talking with the inspector and communicating with each other and support workers. The homes Annual Quality Assurance Assessment information tells us about the continuing efforts to improve communication between service users and staff through use of pictures, symbols and Makaton. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since our last inspection the people living here are more actively involved in the ways in which they choose and plan their daily activities and their choices and preferences are recorded in more accessible formats in their care and support records. EVIDENCE: At our last inspection we found that support plans for the people living here needed to be more detailed and to show the input of individuals as far as possible. Care managers had had some concerns about the lack of information about whether agreed goals and plans for people’s support had been met. The homes AQAA told us how they had improved in the past 12 months and that the care plans are ‘in depth and include information on health, personal, physical, psychological and social care needs’. The local authority Quality monitoring officer visited the home in April 2009 and again in October 2009. A comment that was made in their report in April were that the support plans Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 13 and other documentation in and around the home need to be in a userfriendly, easy-read format.’ At our inspection, we looked at a sample of the support plans and found that they were much improved and the home has developed more of its own documentation. Some of the new support plans include drawings and writing by the individuals. The Quality monitoring officer also commented in their October report that the ‘support plans continue to improve’. Last year, there was a combination of factors that meant that people living here were not able to participate as fully as they might in making decisions and choices about activities and day to day life in the home. Temporary management arrangements, staff changes, and the fact that several people with complex support needs had moved into the home within a relatively short period meant that individual residents did not always have the individual time and attention from staff to help them develop and settle in their new home. Comments received from social care professionals and relatives and observations made during the inspection visit this year, showed that there have been considerable improvements made to the ways in which staff actively encourage and support people to make choices, plans and decisions. There are still things that should be further developed, such as the use of pictures and photos to help people to be able to contribute to planning and taking part in household shopping trips and choosing from the weekly menu. The home tells us in the AQAA that it is working to improve the range of communication methods so that, for example, flash cards, easy read and photo cues are being developed to offer people more choice over the weekly food. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 14 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): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to make lifestyle choices that generally recognise their individuality and since the last inspection staff have improved ways in which they engage people in activities both inside and outside the home. Important relationships and contact with family members is supported and encouraged. Food in the home is of a satisfactory quality and some work has been done to improve the menu planning with the involvement of residents EVIDENCE: At our last inspection we were concerned that there were limited opportunities for people to get involved in activities that interest them and are suited to their assessed needs and abilities. This was still a concern identified by a local authority Quality Monitoring Officer in April 2009 that was included by the home in their AQAA (June 2009), together with the homes response about the improvements they have made. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 15 Individual staff in the home have been given additional responsibilities for developing activities and interests, both indoor and outdoors. People living here are able to go out a least 3 or 4 times a week. More attention is being paid to make sure that where someone needs or prefers one to one support in an activity or trip out, this is possible. Three residents are going on a Butlin’s holiday to Minehead, with support staff. Another person chose a shorter break earlier in the summer. The manager tries to arrange for longer day trip excursions as well as offering daily opportunities to go out locally using the house transport, or to go for walks and visit the village shop. Some residents are also members of a local club that meet and go on outings to places of interest. Work has just started on making a vegetable patch at the rear of the house so that some of the residents who want to can grow vegetables and get out more in the garden in the better weather. Some of the family of one service user were at the home during the afternoon of the inspection visit. They said they were made welcome whenever they visit and are pleased with the way in which their relative is being supported and helped to do different things. Another relative said that they felt generally there was more going on for residents though sometimes when they visited most people were in their rooms. The atmosphere in the house was relaxed, with far more interaction between residents and staff than was apparent at our last visit. People were more spontaneous and active around the house. The homes AQAA tells us that staff are encouraging people to offer more help around the house with day to day chores like making sandwiches, vacuuming and setting the table times. There is scope for this to be further developed where people are able and want to be involved in the planning, shopping for and preparation of meals. The evening meal was being prepared in the afternoon by a support worker – a fish pie. People are offered a choice about the menu and each person is able to choose their favourite food for inclusion in the planned menu for the week ahead. However, it was not clear whether people had been offered something different if they did not like fish – one person said they had not liked the supper dish and hoped it would not be on the menu again. There was some evidence that people have advice and encouragement about healthy eating and food choices from staff. More visual cues, photos and flash cards would help people to see what is on offer and to make appropriate choices from a picture menu. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live here are supported to meet their personal care needs. Access to additional support from health care professionals is consistent and meets individuals changing health needs. Medication is stored securely and administration and storage systems are satisfactory, ensuring the safety of the people who live at the home. EVIDENCE: We found that there were improvements in the way that people’s physical and emotional needs are recorded and met, compared with our findings last year. Each person has a Health Action Plan and care plans setting out any specific care and support needs and the actions staff need to take to meet these. The home AQAA tells us that there are clinical team meetings every 3 months at the home. The manager and staff work closely with the multi-disciplinary learning disability team to discuss the support needs of the people living here. There was evidence that the home makes relevant referrals for residents’ health care advice and treatment. The deputy manager confirmed that Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 17 residents are assisted to attend the local doctors’ surgery for appointments and that all residents will be supported to have ‘well-person’ checks. Support staff have had training about epilepsy to help them meet the needs of residents with this problem. Feedback from the local NHS learning disability team and a quality monitoring officer was also positive about the improvements in care made since last year. The home manager had reported an incident that had occurred in the home that involved a medication error. A staff member failed to check the signed medication administration records (MAR) which showed the prescribed medicines for 2 people had already been given by the other member of staff on duty. This resulted in the 2 people being given a second dose of night sedation. The home acted promptly and appropriately to seek medical advice about any potential harm to the residents and report and investigate the incident. The residents involved were closely monitored and had no ill effects following this incident. Action has been taken to ensure that there is one named designated member of staff on each shift who gives out the medications to residents. The manager confirmed that all support staff who give out medications have received the appropriate training. The manager has made the changes she planned – such as the introduction of a monitored dosage system of medication, supplied in blister packs from a local large pharmacy company each month. The sample of MAR sheets seen at the inspection were correctly completed and signed for. However, the doctor had prescribed a reduced dose of medication for one person, with a gradual reduction to be made over several days. Though this instruction was written and displayed on a notice on the medication cupboard, the sequence of reduced dosage was not clear from the MAR chart and was confusing for staff. This could have resulted in the doctor’s instructions not being correctly followed and the intended therapeutic effect not achieved for the resident. The manager said she would ensure that the doctor made the appropriate changes to the written instructions to clarify his or her orders. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an effective system in place for responding to, investigating and recording complaints. Satisfactory procedures and monitoring of staff practice ensures the protection of the people who live in the home. EVIDENCE: Since our last inspection the home has improved the ways in which it responds to people’s concerns and complaints. Information about how to make a complaint is now more accessible to residents. Photos of staff, and a key worker system, help people to know who’s who in the home. The system of ‘key-working’ means that each resident has a member of staff with whom they can identify and who will help them communicate any concerns and worries through individual ‘talk time’ with their key worker. We have received one complaint since our last inspection. This was referred to the provider, Meriden Care Ltd, and we consider was thoroughly and satisfactorily investigated, responded to and resolved within the agreed timescales of the homes own complaints procedure. The home has told us about their responses to allegations of staff misconduct or poor practice and this indicates that they have improved in the ways they respond effectively to ‘whistle-blower’ concerns. The home has established a system of staff supervision and monitoring so that if, after an induction and Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 19 probationary period, staff do not provide the level of care and support expected of them, they do not continue to work at the home. All staff receive training in safeguarding of vulnerable adults as part of their induction and on-going update sessions. Staff have also received training in safe physical intervention techniques (PIT) so that they and residents are protected from injury in the event of someone becoming physically aggressive towards others. Residents have individual cash boxes kept in a locked area and accessible when they want money for shopping or trips out. The cash balance is checked daily. The manager introduced an improved recording system with 2 staff signing the balance records. Several people have assistance with their finances from the local authority Money Management service, and this gives an added external safeguard to ensure residents money is correctly accounted for. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements have been made to the environment since the last inspection and generally the home presents a clean, comfortable and domestic environment that meets the individual needs of the people living here. EVIDENCE: At our last inspection we found there were several areas of improvement that needed to be made to the environment – for example, through re-decorating, replacing worn soft furnishings, carpets and undertaking repairs and replacing damaged equipment. We found that much of this work has been done through a planned programme of improvement. A tour of the building, including looking at 4 out of 5 of the bedrooms was undertaken. All the communal areas of the home have now been re-decorated and service users were involved in choosing colour schemes for this, and their own rooms. The redecoration of people’s own rooms is Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 21 underway. Individual’s rooms looked personalised, spacious and set out as preferred by each person. The appearance of the front ground floor lounge has been much improved with new laminate flooring and new leather furniture. Repairs to the kitchen ceiling were undertaken and a new oven has been installed. However, the kitchen work surfaces are unsuitable and should be replaced as soon as possible to make them more hygienic for food preparation and cleaning. The wooden step access to the shower in the small ground floor shower room has been removed – the manager said it posed a trip or injury hazard for people using the adjacent toilet. Concerns have been expressed by the occupational therapist (NHS learning disability team) about the access to bath and shower facilities for less physically able people in the home. The manager said that both of the people this related to were able to use the current facilities with assistance and that the stair access for one person was no longer a problem for them. Plans to convert the garage to a new en-suite bedroom have been shelved by the proprietor. The home says that a resident, who is accommodated in what was termed a ‘temporary’ bedroom on the ground floor, is settled there and would find the change too disruptive. There are now plans to convert the garage area to a walk-in wet room, and a separate laundry room. These plans should be progressed as soon as possible to improve the accessibility and flexibility of use of a ground floor shower for all residents. The first floor bathroom has a large mirror above the washbasin. The mirror is cracked across and should be replaced as there is a risk that the glass could fall out and injure someone. The first floor shower room has been redecorated. There is no privacy lock or sign on the door. The home should provide a privacy shower curtain and or signage to protect people’s privacy and dignity when using this facility. These observations were shared with a support worker and the manager who said she would make sure they were addressed. The home owners have appointed a ‘handyman’ who works between Hawthorns (the other Oxfordshire home run by Meriden Care) and Holt Farm. The provider has told us that the kitchen upgrading work and other upkeep and gardening will be undertaken by this person. The garden and grounds look much less unkempt than they did last year and other external improvements – for example, repair of the turning and parking area at the front of the home and the patio area by the (covered swimming) pool – give the house a more ‘cared for’ appearance. The house was clean, tidy and more homely than noted at our last inspection. The AQAA tells us that a cleaning schedule is in place and each person has a Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 22 specific day on which they clean their bedroom and do their laundry, if able, with support from staff. The double garage is used to house the laundry machines and chest freezers. The problems with the washing machine noted last year has been resolved and a new tumbler drier has been added to the laundry equipment. The home has undertaken risk assessments and put up signs to remind people about hand hygiene especially with the current concerns about swine flu. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safe recruitment practices are in place that safeguards the people who live at the home. Staff are offered mandatory training, that should ensure that the needs of people who live at Holt Farm are met by appropriately trained staff. Since the last inspection some progress has been made in improving the continuity in care and support for residents through continued recruitment for more permanent staff and having a registered manager in post. EVIDENCE: Staffing numbers and skill mix have been more consistent than they were last year, when the manager had only just come into post. According to the homes AQAA (completed in June 2009) there are 10 permanent and one part time support staff. No staff had left in the 12 months prior to June 2009 and 11 support worker shifts had been covered by agency staff in the preceding 3 months. However, at the time of this inspection, the home had 2.5 whole time equivalent staff vacancies. One vacancy was due to be filled and further interviews were planned for more applicants. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 24 Most staff work 12-hour shifts (0800 – 20:00), which gives continuity of care and support to residents. During the day there are 3 support workers and the deputy manager or senior support worker. Overnight there are two waking support staff and a senior staff member or manager on call. One person did comment that they were not always confident that staff continued to follow the planned support and activities with residents when the manager was not there to supervise. They were also concerned that the length of shifts, especially if staff had worked all day and then were disturbed during their ‘sleep in shift’ could have an adverse effect on the staff member’s energy and alertness the following day. The proportion of staff with a nationally recognised qualification in care, such as the National Vocational Qualification in Care, or Health and Social Care at level 2 or its equivalent, exceeded the minimum of 50 of the total support staff recommended by the Commission. However, recent staff turnover may have reduced this proportion. A sample of staff files looked at showed that the homes’ recruitment and screening processes for new staff are satisfactory. There was evidence that new staff attend induction training that meets the national standards, and have to satisfactorily complete a probationary period before they are confirmed as permanent employees. The local authority Quality Monitoring officer’s assessment from April 2009 (cited in the homes AQAA) indicated a further need for development of a staff team to create a ‘culture of enablement’ with residents. Evidence seen in the home AQAA, at the time of our inspection, and the comments we received from visiting health and social care professionals and relatives, indicate that the staff team are developing their skills and confidence in their roles. The manager and staff members work done through developing ‘person-centred plans’ with individual residents has resulted in improved understanding of people’s abilities and preferences. The manager said that recent staff training included Principles of Care, Mental Health awareness, First Aid, Communication Skills, Health Promotion, Infection Control, and Safeguarding of Vulnerable Adults (SoVA). All support workers have completed a course ‘How to be a Support Worker’ with a local authority training organisation. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since our last inspection, the registered manager and area manager have improved the local organisation, training and supervision of staff, which in turn means that service users, their families and representatives can be confident that the focus of care and support is on the people living here. EVIDENCE: The manager for the home who had just started work at the home at the time of our last inspection visit, successfully applied to the Commission to become the registered manager in June 2009. She is currently undertaking the Registered Manager award, the formal qualification for people who manage services registered with us. She has experience in working with older people and children and is now developing knowledge and skills in working with people with learning disabilities and mental health needs. She has relevant qualifications in care (NVQ 3) and is an assessor in NVQ. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 26 In September 2008, the home appointed an area manager who has extensive experience with working with people with learning disabilities especially those with autistic spectrum disorder. The home has now had a manager in post and involved in the day to day running of the home for the past 12 months. This, together with the support and input of the area manager, who oversees the running of both Hawthorns and Holt Farm, has improved the organisation in the home, planning and training for staff, and the support of people living and working here. We have received positive feedback from health and social care professionals about the way in which the home has improved – for example, ‘I have observed that the service continues to improve and I feel that Beverley (the manager) and Julia (the area manager) are really committed to continual improvement of the service’. There are monthly staff and managers meetings to discuss how the home is running and any concerns. All staff have regular one to one supervision meetings to discuss their work, progress and development needs. All staff have regular appraisals to ensure their practice meets a good standard and that people living here benefit from a committed and enthusiastic staff team There still appears to be no formal quality assurance system in place that captures the views of residents and their family members. Last year Mr Wood one of the proprietors, said that now that Holt Farm is fully occupied, he intended to use the same independent audit company that has provided quality assurance reports about the sister home, Hawthorns. The manager said this has not happened yet. The home should develop or access its own independent quality assurance system, to demonstrate that it is aspiring to ‘best practice’ standards to meet the varied needs of people using the service. However, the development of the ‘person-centred plans’ (PCPs) with people, allocation of key workers to work with individuals and staff improving the range of ways of communicating, are all helping staff to get a better understanding of how people want to lead their lives and how their aspirations can be met by the service. The home has acted upon the reports of a local authority Quality Monitoring officer, and the advice and work with other visiting learning disability team members, to guide and develop good practice in the home. The area manager and providers undertake the monthly visits and write a ‘provider’s report’ as they are required to do under Regulation 26 of the Care Homes Act 2000. The most recent copy of a provider visit report available at the home was June 2009, but the registered manager confirmed that visits had been done. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 27 The homes policies and procedures and systems for monitoring the practices of staff have all improved since our last visit. This was seen from checking a sample of maintenance and fire safety records. The homes AQAA tells us that support staff have more individual responsibility for example, health and safety and vehicle maintenance. Monthly health and safety checks are undertaken. Health and social care visitors and a relative expressed some concern about the safety of residents when the main gate is left open. The gate is no longer on an automatic closer and visitors are requested to open and close the gate on arrival and departure. As stated above, based on current risk assessments for people living here, the manager said it is felt that there is a low risk of people accessing the drive and busy road beyond without staff presence. Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 28 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 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X X 3 Version 5.3 Page 29 Holt Farm DS0000067215.V377599.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holt Farm DS0000067215.V377599.R01.S.doc Version 5.3 Page 30 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southeast@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. 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