Care Home: Paddocks Residential Home

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What the care home does well What has improved since the last inspection? The service has continued to build its links with the community and the opportunities this provides for people who live at the home. What the care home could do better: The opportunities for recording one to one discussions with staff and observance of their practice should be recorded more effectively to provide a greater understanding of how staff are supervised and their development monitored.Greater planning should be given to the staff training programme to ensure that developments in practice are updated. As an example the services understanding of the Mental Capacity Act 2005 will have an impact on the way people are supported in the home and staff should be equipped to understand this. CARE HOME ADULTS 18-65 Paddocks Residential Home Church Road Weybread Diss Norfolk IP21 5TR Lead Inspector Sara Naylor-Wild Unannounced Inspection 7th December 2007 10:00 Paddocks Residential Home DS0000024470.V356359.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 Paddocks Residential Home DS0000024470.V356359.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. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paddocks Residential Home Address Church Road Weybread Diss Norfolk IP21 5TR 01379 852415 01379 852415 grahamofthepaddocks@talktalk.net 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) Mr Graham Robert Gibbs Mr Graham Robert Gibbs Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2007 Brief Description of the Service: The Paddocks is a large detached house, sitting within its own extensive grounds in the village of Weybread, near Diss. In addition to residential care the home also provides day care/work experience. The location is rural and as a result the service users need to travel to visit shops or other public facilities. The home is currently registered for eight adults with a learning disability. This was increased from six in 2001 to enable five young adults, who were adopted and previously cared for by the proprietors parents, to be cared for at the Paddocks. Therefore the owners and residents consider themselves to be a family, as the Registered Manager is their brother. The grounds are increasingly being cultivated and worked by residents and those attending day care placements. This provides fruit and vegetables for the home with excess produce being sold locally. All produce is organically cultivated and where possible recycled materials are used for outbuildings and gardening management. The home also acts as a recycling point for the village. Fees for accommodation are between £463.50 and £1017.00 per week. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Key inspection was carried out on 7th December 2007. The evidence contained in this report was gathered from discussions with the manager, a visit to the home, discussions with people living at the home and observation of their interaction with staff. There was also information taken from the Annual Quality Assurance Assessment (AQAA) provided to the Commission for Social Care Inspection (CSCI). The inspector was assisted throughout the inspection by the registered manager. Feedback on the findings was given to them during the visit with opportunity for discussion or clarification. The inspector would like to thank the manager, staff and people living at the home for their help throughout the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The opportunities for recording one to one discussions with staff and observance of their practice should be recorded more effectively to provide a greater understanding of how staff are supervised and their development monitored. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 6 Greater planning should be given to the staff training programme to ensure that developments in practice are updated. As an example the services understanding of the Mental Capacity Act 2005 will have an impact on the way people are supported in the home and staff should be equipped to understand this. 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. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that they will only be admitted once the service has established it is able to support their needs. EVIDENCE: The service had not had any new people admitted to the home for some years and therefore it was not possible to assess the quality of the admission documents at this visit. The manager was able to discuss the home’s policy in relation to admissions and demonstrated an awareness of how a prospective resident would be assessed and supported through the admission to the home. This included visiting the person in their current setting, an invitation to visit the Paddocks for a meal, involving the people who already live at the home in the decisions about accepting a new resident and a full assessment of the individuals needs. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the service can be confident that their needs and aspirations are understood and will be supported by staff. EVIDENCE: The care plans for two people living at the home were considered at this visit. They provided information about the individual’s abilities and how staff should best support these. The plans were written in the first person and described both the person’s preferences and abilities in their daily lives. The plans also used picture aids to assist people with communication difficulties to understand the elements of the plan. The plans were signed by the individual and had obviously included them in their drawing up. The AQAA states that each person has a copy of their care plan in their room. Some care plans were reviewed and these involved the person they concerned as well as staff, advocates and representatives of social services. The AQAA Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 10 identifies that not all care plans had been consistently reviewed and that this was part of the services planned developments for the coming 12 months. The documents that make up the care planning files contained risk assessments in relation to the activities that form part of the person’s daily lives. These included work based and outside activities. The assessments referred to the task, the risk considered and statements as to how these should be practically reduced. These assessments provided information that would protect people and assist staff in supporting people to manage the risks involved. However the details of all the considerations given to the way in which a risk could be managed was not included in the assessments. The first principle of risk management is to support the individual to make choices and therefore a risk assessment should reflect why the steps taken are the most appropriate without over protecting the individual. This issue has a greater significance under the Mental Capacity Act 2005. The records relating to the resident’s health care were detailed and provided the reader with an understanding of the issues and outcomes of the consultation and would assist in monitoring the individual’s health needs. Observation of the staffs interaction with the residents during the inspection provided evidence of their positive relationship. The atmosphere within the home are naturally reflective of the unique relationships between the people living there and as such there is a strong sense of family. This is extended to staff, most of whom have worked at the home for a number of years and who are obviously held in fond regard by the people living there. During the inspection visit friendly banter was exchanged between staff and people living at the home, during the lunchtime meal and in a snooker game afterwards. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 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. People living at the home benefit from opportunities to take part in leisure and employment that suits their interests and abilities. EVIDENCE: People are supported in their personal development and enjoy a number of opportunities to participate both inside and outside the home in activities that promote them. Each person has an individual Monday to Friday programme of occupations. These include working in a dog groomers, a supermarket, a hairdresser, a charity shop, a conservation project, day services for older people and the smallholding at the home. People were working on the smallholding on the day of inspection carrying out a variety of tasks including preparing wood for construction of a gate and attending to the gardens. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 12 The people living at the home participate in the local community activities and belong to clubs such as the Gateway club (where one person is on the committee), line dancing classes, aerobics, swimming, bingo and church groups. They are part of the local neighbourhood community and participate in village events such as the annual fete, Christmas celebrations in the church and a recent three-day village celebration. The manager is also involved in a number of committees linked to the village. The AQAA states that “ we have played an active part in the local community for many years and the family are accepted as neighbours, as fellow villagers, not as the home down the road.” People spoken with during the inspection were keen to tell the inspector about their work and social life and spoke enthusiastically and with pride about the things they participated in. These included the annual pantomime in which many people were either playing or offering backstage support. The lunchtime meal was vegetable soup with bread, fruit and cakes. There was a choice of hot or cold drinks. The meal was taken in the large kitchen/diner at the refectory table. The food stores were well stocked with a vegetable store used for surplus produce from the smallholding. People said they enjoyed the meal and helped to plan the weekly menu together with the staff. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. People living at the home are supported in ways that meets both their strengths and abilities. EVIDENCE: People living at the home are supported to make choices and the level of staff interventions varies according to the residents’ abilities. This is supported by the information in care plans and the consultation with people through meetings and on a daily basis. People told the inspector about their interests and how they fulfilled these and were clear about how they spent their time. As with everyone there are obligations and tasks to be fulfilled during the week, such as work and education placement. However at the weekend and evenings people are able to chose how they spend their time, and the service has facilities to support this. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 14 Medication is stored in a locked cupboard in the kitchen. The medication administration records (MAR sheets) were inspected and showed that staff correctly completed the signature boxes, as none of the people living at the home are responsible for their own administration of their medication. Homely remedies such as paracetamol or cough linctus were recorded separately. One resident uses homeopathic remedies and there was an agreement for them to do this from their GP and they too were recorded separately each time they were administered. All the records and systems of administration were to a good standard. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the service can be confident that their views will be listened to and acted upon, and that staff understand how to protect them from abuse. EVIDENCE: The home has a complaints policy and procedure but the manager said they had not had a formal complaint for a long time. In keeping with the family orientated philosophy any concerns are discussed, often at mealtimes, by everyone. One resident spoken with said they could always approach the manager or they had a social worker they could talk to if they wished. The service also promotes advocates from the local community to support people if they chose. The home has an abuse policy cross-referenced to the guidelines issued by the vulnerable adult protection committee of Suffolk. The home has a whistle blowing policy to protect staff who exercise their duty of care. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home enjoy facilities that support their needs and choices in daily living. EVIDENCE: The Paddocks is a large family house set in its own extensive grounds. During the inspection a tour of the home was undertaken with the owner of the Paddocks. The premises are a large family house with extensive grounds that are worked by the people living at the home as a smallholding. There are numerous communal rooms downstairs made up of a comfortable lounge, a music room equipped with drums, an electric organ and a karaoke machine and a games room with a pool table and second television. There is also a formal dining room and a large kitchen with a breakfast area for informal meals. The windows throughout the home are large and offer views Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 17 over the gardens and surrounding countryside. The patio outside of the games room has space for seating and a checkerboard effect included so people can play giant draughts. Peoples’ bedrooms were individually decorated to reflect the interests and taste of the individuals living there. This includes collections of items they had an interest in such as dolphins, teddy bears or pop star posters. All the rooms were of a good size and provided suitable levels of furnishings. There is an ongoing programme of decoration with a local person employed for set periods to carrying out a list of work each year. The laundry was clean and tidy. People living at the home are responsible for bringing their own clothes to the laundry but the staff do the washing. Some people do some of their own ironing. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 18 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): 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are supported by a staff group with a good understanding of their needs and who hold key skills in meeting these. EVIDENCE: There is a very low turnover of staff working at the home and only one temporary staff member had been recruited since the last inspection. The file for this individual was examined and contained evidence that their identity had been checked and a criminal records bureau (CRB) check had been received before they commenced in post. People living at the home had been consulted as part of the recruitment process and copies of their comments about the proposed post holder were included in the file. There was also copies of employment contracts and an induction had included fire awareness and procedures, food handling, control of substances hazardous to health (COSHH) regulations, infection control and risk assessments. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 19 The Staffing numbers had not altered from previous inspections with the duty rotas showing that in the mornings and evenings there were two care staff on duty. In addition there were two part time domestic staff and a full time cook employed and a day care assistant who works on the smallholding alongside people living at the home. One carer sleeps in over night and the manager is on call. There was evidence that mandatory training is updated and the manager cascades training he attends to the rest of the staff team. The staff supervision is generally on a informal basis with discussions taking place as part of the working day between the manager and staff. How this could be included in the staffs’ documentation was identified within the service’s AQAA returned to the CSCI and this was further explored with the manager during the inspection visit. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 20 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. People living at the home can be confident in the management and leadership provided by the manager. EVIDENCE: The registered manager has known the people living at the home since they were small children, and grew up with them as family members. In addition to this knowledge of them as individuals he has developed a number of years experience in care work and has owned and managed the Paddocks for the last sixteen years. He holds an NVQ level 4 in management and a Higher Diploma in Management of Care Services as well as being an NVQ assessor. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 21 Staff and residents spoken with said the manager was approachable and generated a family style philosophy in the home. There is an annual questionnaire for the residents to give their views of the service they receive. The next round of questionnaires was due for distribution at the time of the inspection and therefore those comments identified in the last inspection report of the December 2006 questionnaires were the most recent. The residents were helped, when needed, by their advocate or befriender to fill in the forms. The responses to questions such as ‘Are you happy at the Paddocks?’ and ‘Is there anything you don’t like at the Paddocks?’ were all very positive. To the question ‘What do you like best at the Paddocks?’ there were a number of answers. One resident said, ‘Being all together’ and another said, ‘The office in my bedroom’. The AQAA return stated that on the whole discussions with people living at the home happen as and when required around the dining table when everybody is present at meal times. The evidence of the inspection visit confirmed this, when the mealtime included lively discussion of the days events and what each individual had planned. Staff meetings likewise tend to be mainly informal and although there are minutes held of some meetings these are not always produced as regularly as the National Minimum Standards recommend. The minutes that were available demonstrated that a full discussion takes place with staff they showed discussion took place about a job vacancy, planning for the summer holiday, how the arrangements had gone over the Christmas period and staffs annual leave. Maintenance records were held for the annual servicing and safety certification of equipment such as fire equipment and electrical appliances. These were within date and demonstrated that equipment was in good working order. Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 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 3 X Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA6 Good Practice Recommendations Risk assessments relating to daily living should indicate what options have been considered to support the individual’s choices as far as possible. Staff are supported through formal supervision at least 6 times a year that is documented. 2. YA36 Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Paddocks Residential Home DS0000024470.V356359.R01.S.doc Version 5.2 Page 25 - 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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