Care Home: Little Smugglers Barn

Similar services:

• Southfields
• Thorndene
• Insight - Eastchurch
• Magenta
• Seabourne House
• 33 St John`s Church Road
• Dovedale Court
• Lyncol House

What the care home does well Little Smugglers Barn is a well managed service that is run in the best interest of residents. The recently appointed Manager is skilled and efficient in providing clear direction to the staff team in order to meet the needs of residents. The organisation have been innovative in making sure that the Service Users` Guide is presented in an easy to read and understand format, which incorporates the use of colour pictures, symbols and photographs. This helps to make sure that information about the home is meaningful and interesting to residents. Residents lead active lifestyles and are supported to take part in a number of different meaningful activities such as going to college and local learning disability clubs, swimming, trampolining, the cinema and shopping. Residents are supported and encouraged to maintain important friendships and relationships with others. Residents and others can be assured that the home will listen to and act upon any concerns or complaints they may have. There is a relatively low turnover of staff. Many of the staff team have worked at the home since it first opened and have therefore got to know each of the residents well. Feedback from relatives was very positive. Some of their comments include: "There is a good structured daily programme of activities in place. The young people are always busy doing things" "The accommodation and rural setting is fantastic. He would not get this if he moved anywhere else" "The new Manager has been brilliant, we were all so relieved when she got the job. I have never had to speak with anyone higher up as she has always properly dealt with any concerns that I have had" "The home has a good strong core team`. What has improved since the last inspection? Relatives confirmed that the home keeps them informed and up to date of most matters that affect their relatives. All confidential information relating directly to individuals are now stored securely and in line with the Data Protection Act. All records seen during the course of this inspection had been signed and dated by the person responsible for their upkeep. What the care home could do better: One requirement and five recommendations have been made as a result of this inspection: None of the radiators throughout the home are covered or protected to safeguard residents and staff from burning themselves. The Manager must make sure that the appropriate action is taken as necessary in order to safeguard residents and staff. The staff team should consider different ways in which they can empower and support residents to manage their own medicines and handle their own finances based on individual risk assessments. This would help to empower residents and help them to work towards achieving their personal goals, wishes and aspirations. Clearer guidelines need to be in place for all medicines that are prescribed on an as and when required basis (PRN). This will help to support staff in determining when such medicines should be given. The home should not be reliant on care staff to handwrite a high number of medicines onto the medication administration records each month. The Manager needs to make sure that fail-safe systems are in place to reduce the risk of errors being made and to make this practice safer. As only two residents are able to read, the Inspector recommends that the home consider making the white board in the dining area user-friendly for all residents, perhaps by using photographs and/or pictures. This would help to inform residents of forthcoming events and activities and let them know which staff are on duty and when. Whilst the home is generally well maintained, the Manager should consider introducing clearer recording and monitoring systems for reporting any maintenance issues. This will help to make sure that any repairs or issues are properly dealt with appropriately and in a timely manner. CARE HOME ADULTS 18-65 Little Smugglers Barn Snow Hill Crawley Down West Sussex RH10 3EF Lead Inspector Niki Palmer Unannounced Inspection 19 March 2008 10:15 th Little Smugglers Barn DS0000064323.V359376.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 Little Smugglers Barn DS0000064323.V359376.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. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Smugglers Barn Address Snow Hill Crawley Down West Sussex RH10 3EF 01342 718991 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) littlesmugglers@consensussupport.com www.caringhomes.org THF Care Estates Limited Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 2007 Brief Description of the Service: Little Smugglers Barn is a registered to accommodate up to five people with learning disabilities aged between 18 and 65 years of age. It was first registered with the CSCI in August 2005. The home’s literature states that it aims to provide a high standard of care to people with additional care needs such as Autism, Aspergers Syndrome, emotional problems and challenging behaviour. The Registered Provider is THF Care Estates Limited. The Responsible Individual is Miss Sylvia Lee. Mrs Karen Tolton has recently been appointed as the Manager in charge of the day-to-day running of the home, although is not as yet registered with the CSCI. The property was built and finished to a high standard prior to opening. It is an attractive detached house in a rural setting, set in enclosed grounds on a site of approximately four acres. It is close to the village of Crawley Down and within easy travelling distance of Crawley and East Grinstead. All rooms are for single occupancy with en-suite facilities and are located over two floors. Within the grounds there is a stable block, yard and fields that house a variety of farm animals, including chickens, goats and pigs. The animals and a vegetable garden are cared for on a daily basis by the staff and residents at Little Smugglers Barn. Car parking is available at the home. There is also a second care home in the grounds that houses four residents known as Smugglers Barn. They are two separate homes and are inspected separately by the CSCI. The home provides personal care and support to residents who are funded by Social Services. The home’s fees as of the day of inspection ranged from £1800 to £2075 per person per week. Written and pictorial information regarding the services and facilities provided at the home are available on request from the home. Further information can be found on the organisation’s website. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Little Smugglers Barn will be referred to as ‘residents’. This unannounced inspection took place on Wednesday 19th March 2008 and lasted just under five hours. This enabled to Inspector to observe the daily routines and interactions within the home and hold individual discussions with one of the residents and two members of staff. Five residents were living at the home on the day of the inspection, four male and one female aged between 21 and 35 years of age. The appointed Manager facilitated the majority of the inspection. All communal areas and one individual bedroom were seen. Two care records were looked at for the purpose of monitoring care. Other records and documents seen include: the home’s Statement of Purpose and Service Users’ Guide, medication procedures, complaints procedure and the systems in place to safeguard people from harm, staff recruitment checks and the provision of training, the home’s quality assurance systems and some health and safety records. Following the inspection telephone contact was made with a small number of relatives. An Annual Quality Assurance Assessment (AQAA) was completed by the appointed Manager and returned to the CSCI in September 2007. This gave the service the opportunity to say what the service does well, identify any barriers to improvements that have been faced over the past 12 months and how the service plans to make improvements within the next 12 months. A number of their comments have been reflected throughout this report. What the service does well: Little Smugglers Barn is a well managed service that is run in the best interest of residents. The recently appointed Manager is skilled and efficient in providing clear direction to the staff team in order to meet the needs of residents. The organisation have been innovative in making sure that the Service Users’ Guide is presented in an easy to read and understand format, which Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 6 incorporates the use of colour pictures, symbols and photographs. This helps to make sure that information about the home is meaningful and interesting to residents. Residents lead active lifestyles and are supported to take part in a number of different meaningful activities such as going to college and local learning disability clubs, swimming, trampolining, the cinema and shopping. Residents are supported and encouraged to maintain important friendships and relationships with others. Residents and others can be assured that the home will listen to and act upon any concerns or complaints they may have. There is a relatively low turnover of staff. Many of the staff team have worked at the home since it first opened and have therefore got to know each of the residents well. Feedback from relatives was very positive. Some of their comments include: “There is a good structured daily programme of activities in place. The young people are always busy doing things” “The accommodation and rural setting is fantastic. He would not get this if he moved anywhere else” “The new Manager has been brilliant, we were all so relieved when she got the job. I have never had to speak with anyone higher up as she has always properly dealt with any concerns that I have had” “The home has a good strong core team’. What has improved since the last inspection? What they could do better: Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 7 One requirement and five recommendations have been made as a result of this inspection: None of the radiators throughout the home are covered or protected to safeguard residents and staff from burning themselves. The Manager must make sure that the appropriate action is taken as necessary in order to safeguard residents and staff. The staff team should consider different ways in which they can empower and support residents to manage their own medicines and handle their own finances based on individual risk assessments. This would help to empower residents and help them to work towards achieving their personal goals, wishes and aspirations. Clearer guidelines need to be in place for all medicines that are prescribed on an as and when required basis (PRN). This will help to support staff in determining when such medicines should be given. The home should not be reliant on care staff to handwrite a high number of medicines onto the medication administration records each month. The Manager needs to make sure that fail-safe systems are in place to reduce the risk of errors being made and to make this practice safer. As only two residents are able to read, the Inspector recommends that the home consider making the white board in the dining area user-friendly for all residents, perhaps by using photographs and/or pictures. This would help to inform residents of forthcoming events and activities and let them know which staff are on duty and when. Whilst the home is generally well maintained, the Manager should consider introducing clearer recording and monitoring systems for reporting any maintenance issues. This will help to make sure that any repairs or issues are properly dealt with appropriately and in a timely manner. 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. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 8 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 Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 9 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): 1, 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can visit the home and get full, clear, accurate and up to date information about whether the home can meet their needs and expectations. The home has good systems in place to make sure that no person moves into the home whose needs cannot be met. EVIDENCE: The home has a detailed Statement of Purpose and Service Users’ Guide in place, both of which have been recently updated. The Statement of Purpose provides the reader with an introduction to the organisation, details of the appointed Manager, the number, relevant qualifications and experience of staff working in the care home and overall service provision. The Service Users’ Guide is presented in an easy to read and understand format. It includes information in respect of the accommodation, the arrangements for residents to engage in social and leisure activities, the systems in place for dealing with concerns or complaints and the arrangements for making sure that residents’ needs are identified, met and regularly reviewed. In addition it makes clear what the processes are for moving into and out of the home and the role of the CSCI. Both documents are on display in the main entrance area of the home. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 10 Most of the residents have lived at Little Smugglers Barn since it first opened. Staff said that although each of the residents have varying levels of ability and understanding, they do on the whole get on well with each other. Albeit that there have been no new admissions to the home for some time, the Manager explained that the organisation’s Referrals Team based at head office would deal with all initial referral queries. She said that she is hoping to attend training that will better equip her to undertake assessments in the near future, as this is something that is new to her. Details of the home’s pre-admission assessment procedures are clearly outlined within the home’s Statement of Purpose and Service Users’ Guide. It is stated that all prospective residents will be given the opportunity to visit the home prior to moving in; this could involve staying at the home for a day, overnight or several shorter visits. Individual terms and conditions of contract were seen in individual care records. These clearly outline how much each person will pay and what they can expect for their money. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding of residents’ needs, however both residents and staff will benefit from a clearer, person centred approach to care planning. The ethos of the home promotes the rights of residents to make choices in all aspects of their lives to the best of their abilities. EVIDENCE: The Manager wrote in the AQAA that new care records would be put into place for each resident in line with person centred planning. On the day of inspection, the Manager explained that this work is yet to be completed for all residents; therefore both care records looked at were in the same style and format to that of the last inspection. Each person has two care files in place in addition to daily records. The first file includes a pen portrait of the person and an overview of their likes and dislikes, goal plans and risk assessments, whilst the second file includes skills assessments, medical appointment records, medication profiles and Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 12 correspondence. One resident said that his key workers does sit down with him on regular occasions and explain and discuss what is written. The Inspector and Manager spoke in some detail about the new format of person centred plans and how these could best be implemented. The home’s progress with this will be followed up at the next inspection. One person talked openly with the Inspector about how the staff team support him to make individual choices and decisions. He said that he is given a choice of activities, what food he would like to buy and eat and where he would like to go on holiday and who with. He explained that that all residents are kept informed about any changes within the home that may affect them through regular house and 1-1 key worker meetings. The Manager wrote in the AQAA and explained on the day of inspection that she will be implementing a new risk assessment format, although risk assessments are currently in place for most activities of daily living. Throughout the duration of the inspection it was noted that some residents could be better supported by the staff team to build on their independence skills particularly in areas such as managing their own medicines and handling their own finances. A recommendation has been made in respect of this. All confidential information was found to be stored securely and in accordance with the Data protection Act. This is improved since the last inspection. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests. They are supported to maintain positive relationships with family and friends. EVIDENCE: The organisation owns a nearby working farm (Tandridge Hill Farm), which some residents are supported to work on some weekdays. In addition, care staff from the home support residents to look after the animals kept at Little Smugglers Barn (cleaning out the chicken shed and feeding the pigs etc.). Some residents attend local colleges and study subjects such as arts and crafts, cooking, sound and rhythm and communication. One person explained that he is studying agriculture and livestock at Guildford College in the evenings, which he is supported to attend by staff from Tandridge Hill Farm. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 14 Three of the residents were at home on the day of the inspection; two were supported to healthcare appointments in the morning, whilst the third person was on his allocated ‘daily living skills day’ (this offers each person the opportunity to receive 1-1 support once a week from their key worker to undertake some domestic chores such as cleaning their bedroom and attending to laundry duties followed by shopping for personal items, lunch out and/or just taking it easy at home). Staff interactions with residents throughout the duration of the inspection were observed to be variable. For example, it was noted that on return from the doctor’s in the morning, one person spent the rest of their time in their bedroom, whilst staff were observed to spend time reading in the lounge and dining area. The Inspector commented that this time perhaps could have been used more effectively for this person to engage in a 1-1 activity with staff in light of the fact that the home was reasonably quiet that day and staff were available. The home has a white board in the dining area, which is used by staff to write daily activities and which staff are on duty and when. As only two residents are able to read, the Inspector recommends that the home consider making this board more user-friendly, perhaps by using photographs and/or pictures. This could also be extended to the weekly food menus that are currently in written format. One of the residents has his own workshop within the grounds of the home. He said that he uses this regularly to make things such as feeding troughs for the animals and flower baskets. He said that he has on occasions been asked to help out the maintenance person as he has his own tools and equipment available in the workshop. The home has access to it’s own vehicle, which some staff are able to drive. Residents and staff said that this is used most days to support residents to appointments, college, the Bewbush and Gateway Club (local learning disability clubs), swimming, trampolining, the cinema and shopping. One person said that all residents and staff recently went to the local pub/sports bar for a Guinness on St Patrick’s Day. Most of the residents are supported to go on holiday together each year to Center Parc resorts or Butlins, although last year one person chose to go to Warwickshire with his key worker and stay in a hotel for an agriculture and horticulture show. One resident went to Florida for a two week holiday last year and was supported by two staff. Residents and their relatives said that the home is good at supporting people to maintain contact with others. Some residents choose to stay with their families at weekend and holidays. Relatives also said that communication between the home and them is improved since the last inspection. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 15 Residents are supported to plan the menus for the week and purchase the food from the local supermarket (usually on a Friday). In addition, it was explained that residents take it in turns to prepare a meal for their housemates and staff. All residents are encouraged to eat together with staff. Residents said the variety and provision of food is good. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive support from staff in the way they prefer and want and are supported to access a range of healthcare services to meet their individual needs. Residents are mostly safeguarded by the home’s policies and procedures for the safe administration of medicines. EVIDENCE: Care staff offer support and assistance where needed in respect of meeting personal care needs. Each person has their own room with en-suite facilities, which helps to make sure that their privacy and dignity is maintained. There is only one female living at the home and staff ensure that personal care and 1-1 time is provided by a female member of staff. All residents are registered with a local GP and dentist and are supported to all healthcare appointments as necessary. Input from the local Community Learning Disability Team (CLDT) is requested on an individual basis as required. As already mentioned, records of all healthcare appointments are kept in individual care records, however the Inspector recommends that in line with Valuing People, Health Action Plans be implemented. This will help to Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 17 monitor resident’s healthcare needs, as it was noted that the current recording methods are not particularly easy to follow in respect of how some people’s healthcare needs are being met. The home’s medication records and storage systems were seen. The home uses pre-packed blister packs issued by the local pharmacy, which are easy to use and monitor. At present, no residents self-administer their medicines at the home (although one person does when he is on social leave). The Inspector recommends that the home consider different ways in which this could be facilitated and supported at the home. This will help to empower residents and support them to develop and maintain their independence skills. Whilst medication administration records (MARS) were mostly sufficient and there was evidence to show that all medicines are dispensed, administered and signed for by two members of staff, two minor shortfalls were identified: - Some residents are prescribed medication on an ‘as and when required’ basis (PRN). Whilst guidelines were in place for some of these, the Manager must make sure that clear guidelines are in place for all. - A high number of MARS were handwritten. The Manager explained that this is because they are sometimes ‘forgotten’ to be included on the MARS on behalf of the chemist, although they are regularly prescribed. This means that care staff have to handwrite them on to the MARS each month. Not only is this time consuming for staff, but it also increases the risk of potential errors being made e.g. the wrong time, dose or medication being recorded (as they are currently not being countersigned or checked by another person). The Manager said on the day of inspection that she would write directly to the chemist in order to rectify this as a matter of priority. The home needs to make sure that in the event of this matter occurring again, fail-safe systems are in place to deal with this. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others can be assured that the home will listen to and act upon any concerns or complaints they may have. The home has good systems in place to protect people from harm, neglect and abuse. EVIDENCE: The home has a detailed complaints procedure in place, which is on display within the home and included within the home’s Statement of Purpose and Service Users’ Guide (in a simplified pictorial format). It gives clear guidance with regards to how a complaint can be made and how the complainant can expect it to be dealt with. No complaints have been received by either the home or the CSCI since the last inspection. Residents and staff spoken with said that any concerns are usually raised at that time by one of the residents to their key workers, or at one of the regular residents’ meetings. Relatives spoke positively of the way in which they can raise any concerns (no matter how minor) with the Manager of the service. The home has a detailed Safeguarding Vulnerable Adults and whistle-blowing policy and procedure in place in accordance with local multi-agency guidelines. Staff said that recent training has been provided by the organisation and that they would know the appropriate steps to take if they suspected someone was at risk of harm or being mistreated. One alert has been appropriately raised by the home since the last inspection. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 19 All residents’ personal money tins are stored in the staff office. Through discussions with staff and residents, it would appear that this decision has been based on historical reasons as opposed to individual needs, choices and wishes. How the staff team could support this process was discussed in length on the day of inspection and a recommendation made. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Little Smugglers Barn offers a friendly and relaxed environment that is kept in good decorative order. It presents as clean and well maintained. EVIDENCE: The property was built and finished to a high standard prior to opening in August 2005. One of the residents kindly showed the Inspector around the home and his bedroom. He confirmed that he had chosen his own bedroom furniture and décor. Some residents have chosen to hold their own key for their bedroom doors. All rooms are for single occupancy with en-suite facilities and are located over two floors. Two bedrooms are located on the ground floor alongside a domestic kitchen, dining area, sun lounge, laundry, lounge and staff office/sleep-in room, whilst three bedrooms are upstairs. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 21 Although all areas seen were noted to be clean and well maintained, it was noted that there were no pictures, photos or personal belongings of any the residents around the home and therefore some areas did appear quite sparse. The dining area and sun lounge have been repainted since the last inspection. One person said that residents were given a choice of colours to choose from a colour chart. Residents said that they are responsible for keeping their own bedrooms clean and tidy although waking night staff tend to make sure that the communal areas are well maintained. Residents and staff said that the organisation employs a ‘handy person’ to make sure that any faults, repairs or maintenance issues are dealt with fairly quickly. Whilst all areas of the home were noted to be clean and hygienic on the day of inspection, some concerns were raised in respect of unguarded radiators throughout the home. These matters are further discussed under the Conduct and Management section of this report. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 22 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): 31, 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a knowledgeable and well trained staff team who know each of the residents well. EVIDENCE: Rotas confirmed that in addition to the appointed Manager, the home employs a total of seven care staff. A new Deputy Manager was due to start working at the home within two weeks of the inspection. Only one member of staff currently holds NVQ Level 2 in Care, although one person is working towards this qualification. Three people are due to start working towards this in the near future. The Manager is aware of the need to make sure that at least 50 of staff are trained to this level. Rotas showed that there are normally three staff on each shift in the daytime and one waking night and sleep-in person each night. Two were on duty in the morning when the Inspector arrived (in addition to the Manager). One was a Senior Support Worker, whilst the second person was agency staff. The Manager explained that the home does use agency and ‘bank’ staff (temporary workers) to cover annual leave and staff sickness, although she did say that Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 23 they tend to only use people who have worked at the home before and are known to the residents in order to maintain a degree of consistency and familiarity. As previously mentioned under the Lifestyle section of this report, the home should consider using photos of staff on the white board in the dining area in order to help residents know who is on duty and when. Most of the staff team have worked at the home since it first opened and have therefore got to know each of the residents well. No new staff have been employed since 2006, although the home is currently in the process of advertising, recruiting and selecting new staff. One of the residents did say that he has been asked to attend interviews in the past for new staff, but said that he chose not to at that time. Feedback from residents and relatives was positive about the staff team. Staff were generally very positive about working for the organisation and said that a good level of training is offered. Individual training needs are identified through regular staff supervision sessions. Recent training includes: autism, fire safety, Safeguarding Vulnerable Adults, First Aid and food hygiene. The Manager said that she is trying to arrange additional mental health training. The Manager explained that the organisation is in the process of reviewing their induction programme. This will be e-learning in line with Skills for Care Common Induction Standards. The home’s progress with this will be followed up at the next inspection. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A skilled and experienced Manager provides clear direction and support to enable the staff to provide a high standard of care to residents. Both residents and staff benefit from a well managed and organised home. EVIDENCE: The previous Registered Manager of the home, who was in day-to-day charge since the home first opened, left the service in July 2007. Since this time Karen Tolton has been ‘acting up’ from her Deputy Manager’s role and has recently been successful in her application to become the appointed Manager. She has worked at the home since it first opened and has over seven years experience of working in care including working with people with learning disabilities and epilepsy and older people. She has achieved NVQ Level 2 in Care and is due to complete Level 3 in the very near future. She explained that she is also due to start working towards a City and Guilds Diploma in Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 25 Learning Disabilities and then complete her Registered Manager’s Awards (RMA). She was knowledgeable about the needs of the residents and feedback from staff and residents about her management style was very positive. She is in the process of submitting an application to the CSCI to become registered as the Manager. The Responsible Individual visits the home on a regular basis to meet and talk with residents and staff and do ‘spot checks’ on the premises, care records, incident/accident reports, complaints and the provision of daily activities. This enables her to monitor what the home is doing well and to identify areas of strength and areas that need improvement. In addition to this, the home’s AQAA stated that they gain feedback from residents through regular 1-1 key worker meetings, house meetings and feedback questionnaires from relatives and other health and social care professionals (although feedback from others has not been sought since 2006). The home’s AQAA gave a fair account of how the service is performing. A sample of the home’s health and safety records and checks were seen, which raised some minor shortfalls: - None of the radiators throughout the home are covered or protected to safeguard residents and staff from burning themselves; nor were there risk assessments in place for these. The Manager must ensure that risk assessments are undertaken for all unguarded radiators throughout the home. The appropriate action must be taken as necessary. - Staff undertake monthly health and safety checks and complete forms to say that they have done so. It had been recorded that the First Aid box was in need of restocking, but no further information had been included such as who was responsible for doing so, who the matter had been reported to or that it had indeed been restocked. In addition, it was noted that one person had written that an area of carpet needs replacing, although it did not state where. The Manager was unaware of this, as it had not been reported to her. The Manager explained that all maintenance issues are usually verbally reported either to herself or directly to the maintenance person. In light of the above concerns, the Inspector has recommended that clearer recording and monitoring systems be introduced in respect of reporting maintenance issues. Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 26 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 4 2 3 3 X 4 X 5 3 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 2 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Not applicable 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 YA24 YA42 Regulation 13(4)(c) Requirement That risk assessments are undertaken for all unguarded radiators throughout the home. The appropriate action must be taken as necessary. Timescale for action 30/04/08 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. Refer to Standard YA9 YA20 YA23 Good Practice Recommendations That the home considers different ways in which staff can empower residents and support them to learn independence skills such as: - Being more involved in managing their own medication - Being more involved in handling and looking after their own monies. That the white activities board in the dining area is made more user-friendly and meaningful for residents including: - Forthcoming daily events and activities DS0000064323.V359376.R01.S.doc Version 5.2 Page 28 2. YA12 YA17 YA31 Little Smugglers Barn - Staff availability This should also be extended to the weekly food menus. 3. YA19 That in line with Valuing People, Health Action Plans are implemented. This will help to monitor resident’s healthcare needs. That clear guidelines are in place for all medicines that are prescribed on an as and when required basis (PRN). That fail-safe systems are in place to ensure that all prescribed medicines accurately appear on the medication administration records (MARS). 5. YA24 YA42 That clearer recording and monitoring systems be introduced in respect of reporting maintenance issues. 4. YA20 Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Little Smugglers Barn DS0000064323.V359376.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!