Care Home: Merrivale Farm

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What the care home does well The residents are supported to access local health care. There are enough staff to support the residents with their chosen lifestyles. They can choose what activities and college courses they want to do and are encouraged to be independent. The residents are supported to have friends and stay in touch with their families. The residents live in a homely and safe house as a family group. They benefit from the large grounds and the animals. The home is well run and the residents` views are listened to.The staff team is small and staff stay in their jobs a long time. This means they get to know the residents very well. The residents like the staff and managers. The staff are trained and supported to do a good job. What the care home could do better: The managers have plans to improve the service and these should all be actioned. These include: - finishing the building work so all the residents have better bedrooms and bathrooms and all parts of the house are warm. - better support to help the residents to plan their own goals. - for their care plans to be presented in a way they understand.- for the residents to be given more information in a way they understand. More of the staff should gain a qualification in Care. The staff team need to become trained in the Mental Capacity Act to make sure the residents have their rights protected. CARE HOME ADULTS 18-65 Merrivale Farm Eastwood Tarrington Ledbury Herefordshire HR8 2RN Lead Inspector Jean Littler Unannounced Inspection 18th December 2007 09:30 Merrivale Farm DS0000024724.V350088.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 Merrivale Farm DS0000024724.V350088.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. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merrivale Farm Address Eastwood Tarrington Ledbury Herefordshire HR8 2RN 01531 670220 01531 670914 mvale@btinternet.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alphagrange Limited Mrs Teresa Kate Loveridge Mrs Jacqueline Armitage Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named resident has a mental disorder in addition to a learning disability. 10th November 2006 Date of last inspection Brief Description of the Service: Merrivale Farm is situated in a rural location, on the outskirts of Tarrington village, between Hereford and Ledbury. The home is set in 20 acres of land and comprises a traditional farmhouse that has an annexe and other outbuildings. It is the only service owned by Alphagrange Ltd. There are two managers, one of whom is also one of the two company directors. The Home is registered to accommodate up to seven adults whose primary care needs are their learning disabilities. Horses are kept on the land and residents are encouraged to help with their care and other tasks in the garden. Information about the Home and the range of fees is available from the Home on request. Additional charges are made for personal items such as clothes and toiletries, personal services such as haircuts and chiropody, holidays, some activities and vehicle costs. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 3 hours. The two managers and the responsible person for the company were all on duty and helped with the process. The inspector looked around the house and spoke with two of the residents. Some records were looked at such as care plans, medication and money. The residents and their relatives were asked their views in surveys before the visit. The managers sent information about the Home to the inspector before the visit. What the service does well: The residents are supported to access local health care. There are enough staff to support the residents with their chosen lifestyles. They can choose what activities and college courses they want to do and are encouraged to be independent. The residents are supported to have friends and stay in touch with their families. The residents live in a homely and safe house as a family group. They benefit from the large grounds and the animals. The home is well run and the residents’ views are listened to. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 6 The staff team is small and staff stay in their jobs a long time. This means they get to know the residents very well. The residents like the staff and managers. The staff are trained and supported to do a good job. What has improved since the last inspection? What they could do better: The managers have plans to improve the service and these should all be actioned. These include: - finishing the building work so all the residents have better bedrooms and bathrooms and all parts of the house are warm. - better support to help the residents to plan their own goals. - for their care plans to be presented in a way they understand. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 7 - for the residents to be given more information in a way they understand. More of the staff should gain a qualification in Care. The staff team need to become trained in the Mental Capacity Act to make sure the residents have their rights protected. 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. Merrivale Farm DS0000024724.V350088.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 Merrivale Farm DS0000024724.V350088.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, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the Home is available for any prospective residents, but this is not up to date. A prospective resident’s needs would be carefully assessed and they would be given the chance to trial the service. Each resident has a contract and Terms and Conditions of Residency. EVIDENCE: A Statement of Purpose and Service User’s Guide are in place. They include information on complaints, confidentiality, privacy and the Home’s values. This information is presented in a suitable format for the residents. Keyworkers have gone through the information with each resident and they have their own pack. There are no vacancies in the Home so the packs have not yet been used to provide information to a new resident. The information has not been reviewed since 2005. There have been major changes to the environment that need to be covered. The Guide does include information about the things the residents have to pay for, but this should also state the weekly fees for the service. The review of these documents should be included in the annual quality assurance system. The managers are aware that a new resident should only be admitted following a full assessment being made. There have not been any new admissions in the last seven years, however the managers would ensure any new person was compatible with the group who have lived as a family for a long time. Several Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 10 trial visits would be arranged and the residents would be consulted before a new person was offered a place. A Terms and Conditions document is in place and this has been agreed with each resident in conjunction with the Residency Agreement. Contracts are in place between the providers and the local authorities that fund each resident’s placement. Merrivale Farm DS0000024724.V350088.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, 8, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents can be confident their needs are reflected in their care plans. They are being involved more in planning their own support and recording their achievements in a way that is meaningful to them. The residents are being supported to make decisions and to take appropriate risks. EVIDENCE: Positive feedback was received from residents and their relatives about how the residents are supported with their needs and enabled to make choices. The managers reported in the AQAA, (this is the Annual Quality Assurance Assessment that managers have to send to us to tell us about the service), that all residents have a care plan that shows how their assessed needs are being met and that records and charts are summarised monthly to monitor changing needs and progress. The care plans seen at successive inspections have shown that care planning practices continue to be developed. The one sampled this time showed that the resident’s support needs and risk assessments have been kept under review. The managers agreed to show more clearly when the level of staff support needed has increased. Records Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 12 showed that this resident is being monitored closely and the information health professionals’ need is being recorded clearly in charts. Due to recent staff sickness recording has not been summarised for the last two months but the managers are very aware of the current situation and the daily notes held all the essential information. The staff have attended training on Person Centred Planning. The level of consultation with the residents is being improved with the introduction of regular meetings between a resident and their keyworker. The managers agreed to add independence and empowerment to the agenda for these meetings. They should also consider having the meetings recorded in a more accessible format. The care plans have not yet been developed into an accessible format. This is an aim for the coming year. Residents do have Life Books and pictorial activity timetables. Some now keep these in their rooms and add to them by using the computer. A digital camera has been purchased and this is being used to enable residents to record important events such as their recent holiday to Tunisia. Review meetings are held regularly and these are another area where using technology should be able to support involvement and help the residents to plan their own goals Life choices are being offered regularly such as what activities and outings the residents want to take part in, the way their new rooms are being decorated and fitted, daily routines and menu options. The residents are supported to attend self-advocacy meetings and are being encouraged to voice their opinions at the regular residents’ meetings. Where possible they are supported to take risks to maximise their independence, for example two residents use the bus unaccompanied and one of these has recently learnt a new route. Merrivale Farm DS0000024724.V350088.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): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents have opportunities for personal development and are being consulted about their wishes and goals. They have busy lives attending activities they enjoy and benefit from. They are mixing with local people and are supported to maintain links with friends and family. Their rights are being respected and they are being provided with healthy home cooked food. EVIDENCE: The residents and their relatives gave positive feedback about the lifestyle led and the activities and social opportunities on offer. Around the Home the residents are involved in cleaning their rooms, shopping and cooking, doing their laundry, growing fruit and vegetables, looking after the horses and dogs and feeding the birds. People’s interests are taken into account as well as their skills. The managers reported in the AQAA that the residents continue to have busy and stimulating lives. All have personalised activity timetables. Activities Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 14 accessed include college and day centre sessions, weekly sports and swimming sessions, outings to buy personal items as well as food shopping, trips to pubs and cafes etc. It is positive that their personal plans are now being produced in a format they can better understand. They continue to go on trips that are discussed at the residents’ meetings such as to see Aston Villa play, to see live music, concerts and specific films like Harry Potter. Some of these are funded through the Friends of Merrivale Farm. All but one had chosen to go to Tunisia in May and the trip was a great success. The other resident had gone away with friends. Some residents had also enjoyed a recent short break camping in an area that facilitated one resident visiting his family. The group decided to take out a joint National Trust membership and have enjoyed visiting places of interest. There is limited local community life in Tarrington for the residents to get involved in, however they do go to church events, fetes etc. Their involvement has increased recently as some have joined a group who voluntarily clean the church. Local links have been developed over time from residents visiting the same hairdressers and pubs in Ledbury. The residents are being given the opportunity to become more independent and develop their skills. Examples of progress include people becoming better swimmers, two residents learning to look after their new en-suite facilities and one resident now has a lap-top that helps him write letters to his family. The managers plan to support residents to develop their own goals through personal centred planning. One has mentioned to the inspector during previous visits that he wants the opportunity to go on fishing trips. These still have not been arranged. His planning meeting should try to find a way of enabling him to achieve this ambition. Some of the residents’ relatives live long distances from the Care Home so contact is mainly by telephone. The staff support contact and sometimes provide transport. For example, one worker went with a resident to Eastbourne and stayed overnight to enable him to visit a relative. Socialising with friends is promoted e.g. friends were invited to the recent carol concert held at the Home. Residents are also offered the chance to attend the Ross-Leisure-Link activities held each month where they see friends. The food is purchased locally and cooked fresh for each meal. The residents help shop and prepare food if they want to. Some enjoy this and will help with the regular baking sessions. One resident competently peeled the potatoes for the evening meal. The range of meals cooked are discussed at residents’ meetings and if on the day a resident does not want the meal being prepared they have the opportunity to prepare something else of their choice. Meals are relaxed and flexible. One residents now prefers to have breakfast in his new ground floor bedroom. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 15 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, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are being supported with their personal care in a way they prefer and require. Their health needs are taken seriously but better networking with local professionals may further improve outcomes for residents. The staff are safely managing medication on the residents’ behalf. EVIDENCE: The residents and their relatives gave positive feedback about how health and personal care needs are being met. The managers reported in the AQAA that daily routines are flexible and that the residents’ privacy and dignity are respected. The majority of residents are quite independent with their personal care but when direct support is needed same gender care is provided where possible for the men and always for the one woman. Discussions with the managers demonstrated that self-help skills are being promoted where possible. The care plans contain information about the support people need and how they prefer to be assisted. Care notes are being written in a respectful way and staff were observed to interact with the residents in a pleasant manner. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 16 One resident’s behaviour has changed significantly over the previous year. His records showed that good efforts had been made to access the health care he needed, both physical and emotional. Discussions highlighted some further action that should be taken e.g. a referral for psychology and occupational health input, which the managers agreed to do. They also agreed to review the terminology used to describe residents’ behaviours and ensure this is in line with current good practice principles. All residents attend regular appointments with the dentists and annual wellmans or well-woman’s checks with the GP. The care plan seen showed that clear records are made following all appointments. The managers reported in the AQAA that all residents now have a completed Health Action Plan. All also have a ‘When My Life Ends’ plan that the residents are going to be supported to complete this year. The medication continues to be appropriately stored and the keys held securely. The medication is mainly supplied in a monitored dose system. The monthly records showed that doses had been administered as prescribed. One resident has had several changes to his medication recently and these had been safely managed. Deliveries are counted and signed in and changes to instructions on the charts are now mostly being checked and signed by two staff to help with accuracy. The managers reported that only one resident is on medication on an ‘as required’ basis and that clear instructions about this are in his care plan. The supplying pharmacist had audited the system and at the most recent visit she just recommended a lockable tin was available in case medication that needs to be kept in the fridge is prescribed. The managers reported in the AQAA that all staff have now attended accredited training. The residents have signed a form to say they do not want the responsibility of selfmedicating. This should be discussed with them periodically as several have the ability to be involved and their wishes may change. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 17 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, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ views are listened to and they are being protected from abuse. EVIDENCE: A complaints procedure is in place that has been written in a clear format with some visual images to aid the residents’ understanding. No complaints have been received by the Home or by us since the last inspection. The residents have relatives who can advocate on their behalf, however some are elderly now and some live in other parts of the country. All residents have a keyworker who can support them to express their views and they also have links with people in day services who they could inform about problems. The residents meetings also provide opportunities for people to raise any concerns they have. Feedback from relatives and the residents’ surveys showed that people were aware of how to make a complaint and felt their views are listened to. A brief and clear ‘Abuse’ policy is in place. This makes clear reference to the local multi-agency procedure for dealing with ‘Vulnerable Adult’ concerns. A ‘Whistle Blowing’ policy is also in place that states staff will be protected if they report a concern. No adult protection issues have occurred since the last inspection. The records relating to how residents are spending their money are now clearer and better protect residents from financial abuse. The managers reported in the AQAA that all staff have attended adult protection training. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 18 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, 26, 27, 28, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents live in a clean, comfortable and homely environment that is being improved each year. EVIDENCE: Feedback from residents and relatives about the environment was positive. The accommodation has been changed significantly over the last two years. An extension was passed as complete by building control and the fire authority in May 07. One resident now has a ground floor room with an en-suite toilet. He has some mobility difficulties so this is a safer arrangement for him. He said he liked the room very much and is looking forward to a shower room next door being completed as he is currently still going upstairs to bath. In the new area in the first floor the only female resident has a new bedroom. She has contributed towards new furniture and a double bed and the room was very attractive and personal. The en-suite bathroom increases her privacy, as she no longer has to share bathing facilities with the men. The managers agreed to fit approve locks to these new doors to give the residents more privacy but allow easy staff access in an emergency. The resident who used to live in a bedroom with his own entrance has moved into his own one bedroom house. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 19 He said he is very happy and comfortable and had personalised it nicely. The kitchen is not yet fully fitted but he eats meals with the group. He is using stacked breezeblocks as steps to the front door. These could pose a risk so the work to complete this area should be prioritised. The laundry has been refurbished and was clean and appropriately equipped. The managers reported in the AQAA that suitable infection control arrangements are in place and that all staff have been trained. The handy person is employed two days a week. The rooms vacated in the main house have allowed some residents to move into bigger rooms. Others have moved temporarily to allow their rooms to be made bigger or redecorated. The lounge, dining room, kitchen and other communal areas were homely, clean and tidy. One landing area is very cold and the replacement of the draughty fire door should be made a priority. There are plans to upgrade the heating system in the old house, which is positive as some areas were cold and others cosy. The staff facilities have been improved and there are plans to refurbish the bathrooms. Four residents have new beds or mattresses and a system to periodically check the quality of mattresses has been set up. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 20 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): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are being supported by a small and committed team of staff who are appropriately trained. The residents are being protected by the home’s recruitment procedures. EVIDENCE: No staff have left since the last inspection. The managers reported in the AQAA that the team of seven is settled and work well together. They span a wide age range and have a variety of skills and experience e.g. one worker enjoys supporting the residents to develop the grounds and follow outdoor pursuits. The team is made up of four support staff, two managers and the responsible individual. There are usually two staff on at peak times but there is a good degree of flexibility to accommodate the residents’ activities and health needs. One resident’s needs have increased and he now needs a lot more staff support. A request for increased staff funding has been made to his funding authority but this has not yet been provided. Because of this and some recent staff sickness the managers reported that they found it challenging to complete required records while meeting the residents needs. They hope to increase the number of staff to enable the team to better respond to such events. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 21 Feedback from the residents and relatives was positive about the staff. The residents said they liked them and they listened to them. The recruitment records seen at the last inspection showed that appropriate checks had been carried out before the new worker had started. The managers reported in the AQAA that robust procedures are in place and a new worker would not carry out any duties until a satisfactory CRB check had been received. An induction process is followed and local Learning Disability Award Framework training accessed. The managers reported that all staff are up to date as training refreshers have been attended this year. Courses included in the training programme includes autism awareness, a four day first aid qualification, safe handling of medicines, person centred planning and positive approaches to challenging behaviour. Both managers have relevant qualifications. None of the care staff are qualified but the responsible individual (RI) and one worker are working towards gaining an NVQ 3 award. The managers and RI work on shift regularly as part of the support team. Mental capacity training needs to be arranged as a priority. Only the managers were on duty so none of the care staff were available to be interviewed as part of the inspection. The worker spoken with at the last inspection was positive about the support and training he had received. He found the manager approachable and felt valued. Regular staff meetings are held and the managers provide supervision sessions to staff. They plan to provide these more frequently in the coming year. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 22 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, 38, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are benefiting from a well run home where they are listened to and their welfare is prioritised. EVIDENCE: The management arrangements have not changed since the last inspection. Both managers have relevant qualifications including the NVQ 4 in Care. One also holds the Registered Managers Award. The management team are proactive and they continue to work to improve the standards in all areas of the service. All are in the Home on almost a daily basis and the residents are very comfortable with them. The residents spoken with over several inspections consistently say they feel able to tell any of these three people their views and problem. Feedback from residents and relatives’ surveys was again very positive. All records requested were available and these are being held securely. The record keeping system for residents’ monies has been improved following a recommendation at the last inspection. The managers Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 23 have a good record of trying to implement any recommendations made. The AQAA provided clear information and showed that the management team put the residents’ needs first, they continue to invest in the premises and are aware of the areas of the service that need to be further developed. The responsible individual completes monthly monitoring checks and forwards the reports to us. As well as these checks a quality assurance (QA) system has been implemented. The system is linked to the national minimum standards and it consists of a series of audits that should identify any areas for improvement. The findings from this and the annual feedback surveys were not linked into the AQAA information. The managers agreed to link the systems in future. The residents are being consulted through the regular meetings and many of their ideas are actioned. A periodic newsletter is produced to inform relative of events and future plans. A set of policies and procedures are in place and the managers reported in the AQAA that these have all been reviewed during 2007 as part of the QA system. The managers provided evidence in the AQAA that equipment has been serviced and health and safety checks are being carried out regularly e.g. hot water and fridge temperature checks. Staff have been provided with all core safety training such as fire safety, food hygiene and the full first aid qualification. Regular fire drills are being held. The risk assessment for the storage of chemicals has been reviewed since the last inspection and more dangerous fluids are now locked away. Safety has been well managed while the building work has been carried out. As mentioned access to one resident’s self-contained accommodation should be finished to reduce the risk of injury which will be increased during the winter. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 X 4 3 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 2 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 4 13 4 14 4 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 3 3 3 x Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NA 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. 1 Refer to Standard YA1 Good Practice Recommendations Update the Statement of Purpose and Service User’s Guide annually as part of the quality assurance system to ensure residents have access to accurate information about the service. The Service User’s Guide should contain information about the fees so the residents and interested parties can see how much the service costs. 2 YA24 Prioritise completing the planned work at the entrance to one resident’s self-contained accommodation to reduce the risk of him injuring himself. Replace the draughty fire door on one of the landing to stop the area being so cold. Fit approved locks to bedroom doors. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 26 3 YA35 YA32 Mental capacity act training needs to be provided to all staff and managers so the guidance for care homes can be implemented. Encourage other care staff to become qualified to meet the 50 minimum target. 4 5 YA33 YA36 Increase staffing resources so the team is better able to respond to residents changing needs and to staff absence. Provide all staff with at least six formal supervision sessions each year. Brought forward. Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Birmingham Office Commission for Social Care Inspection 77 Paradise Circus Queensway Birmingham B1 2DT 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 Merrivale Farm DS0000024724.V350088.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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