Care Home: Penrose Farm

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What the care home does well What has improved since the last inspection? Improvements have been made in the receipt, storage and administration of medication. The Commission has been notified when medication errors have occurred and have taken appropriate action to prevent further errors from occurring. During the inspection it was noted that one painkiller tablet was unaccounted for. The manager is closely monitoring the medication system, along with a care support worker and will address this. All staff have attended training in the safe handling of medicines and communication between health agencies has improved. Penrose Farm has received two complaints since the last inspection. The registered manager was able to show that these were investigated fully and that the complainants were satisfied with the findings of the investigation and the action they proposed to take. People who use the service said that they felt able to approach the registered manager or staff if they had any concerns and said that currently they have none. Care plans, via the person centred planning process have helped in making them more individualised and provide people who use the service with more detailed and specific goals so that they can monitor their progress towards independence more easily. Ms Kerry Gardiner registered manager application has been approved by the Commission. What the care home could do better: The registered manager agreed that the Statement of Purpose and Service Users Guide needs to be reviewed, updated and made more personalised so that they accurately reflect the services that are provided at Penrose Farm.Contracts in relation to the placement clearly identify residents` rights and what services they will be provided with. The registered manager agreed that People who use the service individual contracts did not clearly set out their fees, or how their individual contributions are calculated. This meant they could not make fully informed decisions about their placements in the home. The registered manager said that she is aiming to update these, plus the Statement Of Purpose / Service Users guide and therefore a formal requirement to do this has not been issued in this report. It is recommended that the manager attend the Safeguarding course to enhance her knowledge in the area of adult protection. The environment is mainly kept to a satisfactory standard offering homely comfortable furnishings. Improvements could be made in the replacing/ cleaning of carpets and sofa to make the home more attractive. In addition the replacement of a rusty bathroom radiator would promote infection control measures. The staff team are below the national minimum standard of 50% qualified at minimum of NVQ level 2. The registered manager said this is being addressed. The homes manager is aware that staff need to attend specific training courses to assist them in their daily work and is arranging for them to attend such courses. It is recommended that the registered manager develop a staff training overview so that she can easily access what training staff have completed, gaps in training and when refresher courses are due. The staff must ensure that they complete records in line with the Data protection Act i.e. the communications and waking nights book, so that People who use the service are confident that information record about them remains confidential. In addition staff should ensure that they complete records, as per the organisation policies on a daily bases at all times. The registered manager will investigate as to why certain records have been missed and inform the Commission of her findings.The inspector would like to thank people who use the service, staff and the registered manager for their assistance and cooperation during this inspection process.Penrose FarmDS0000041536.V350364.R01.S.docVersion 5.2Page 9 CARE HOME ADULTS 18-65 Penrose Farm Bodmin Road Goonhavern Truro Cornwall TR4 9QF Lead Inspector Lynda Kirtland Unannounced Inspection 24 January & 1 February 2008 09:15 Penrose Farm DS0000041536.V350364.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 Penrose Farm DS0000041536.V350364.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. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penrose Farm Address Bodmin Road Goonhavern Truro Cornwall TR4 9QF 01326 371000 01326 371099 mail@dcact.org 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) Spectrum Kerry Gardiner Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2006 Brief Description of the Service: Penrose Farm is a care home for up to six adults with a learning disability. The registered provider is Spectrum, an organisation that specialises in providing care and support to people who have autism. Spectrum employs a manager and a team of staff to run the home on a day-to-day basis. Senior managers from within the organisation provide additional support and back-up when necessary. The home is on the outskirts of the village of Goonhavern, within a convenient driving distance of Newquay and Truro, which are also accessible by local bus services. The home is divided into two buildings. The main one has four single bedrooms, a kitchen diner, conservatory, activities/sitting room, and a small additional sitting area. Two of the bedrooms are on the first floor. The barn conversion has two bedrooms on the first floor. A lounge/dining room, bathroom and kitchen are on the ground floor. Most of the property is accessible to people with disabilities, or could be readily adapted, if required. The new barn conversion has ramped access. Fees range from £985.000 - £2623.00 per week. People who use the service are expected to contribute to the costs of off-site entertainment and personal items such as confectionary, dry-cleaning and private chiropody. Charges for these things are variable. Copies of previous inspection reports and the home’s statement of purpose are held in the office and are available to people who use the service upon request. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection took place on 24 January 2008 and was unannounced. A further visit to the home on the 1 February allowed the opportunity to meet with the registered manager. The visits lasted for approximately eight hours. Information about the home received by the Commission since the previous inspection was taken into account when planning the inspection. The purpose of the inspection was to ensure that people who use the service needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved interviews with people who use the service, observation of their daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of the residents and the ongoing management of the home. Staff were interviewed and observed in relation to their care practices and there was a discussion with the registered providers. The principle method used was case tracking. This involves examining the care notes and documents for a select number of people who use the service and following this through with interviews with them and staff working with them. This provides a useful, in-depth insight as to how their needs are being met in the home. At this inspection, two people who use the service were case tracked. In talking with some of the people who use the service they said that they were ‘happy’ and ‘its good here’. They cold not think of any improvements on the care and services that Penrose Farm currently provides. The Commission received the Annual Quality Assurance Assessment, which is a questionnaire that the registered provider completed. The AQAA describes the services and facilities that Penrose Farm provide and identifies what areas they do well in and where they want to make further improvements. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: Assessments prior to moving into Penrose Farm are undertaken and based on the individuals health, social and personal care needs, including needs relating to their religious, ethnic and cultural backgrounds, to ensure they can be met in the homes setting. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 6 People who use the service are encouraged and supported to develop their skills and independence in many ways. They are involved in developing their own care plans with assistance and support from staff. People who use the service attend reviews regularly, so that they know why they are placed at the home and via their person centred planning (PCP) process identify what aspirations they are aiming to achieve e.g. developing a particular element of self-care to promote their skills and independence. They have opportunities to make decisions about important aspects of their lives, with assistance from staff, if they need it and are supported to take risks so that they can enjoy fuller and more active lives in and out of the home. People who use the service are encouraged to maintain valued relationships with their families and friends, with staff support as necessary. People who use the service have clear information on what is expected of them and their rights as residents of a care home. They are aware, for example, that they will be expected to help out with household tasks such as cooking and cleaning, so that they can develop their skills and independence and know what to do if they wish to make a formal complaint about something they do not like. There is good access to health agencies and from documentation inspected it was evident that access to specialist services is also available. The home has a robust medication process and procedure, which promotes the safe administration of medicines to residents in the home. People who use the service participate in the planning of the menus and help staff to prepare meals. They have free access to the kitchen so that they can make drinks and snacks for themselves when they wish and are encouraged to live and eat healthily. People who use the service are appropriately supported with their personal care so that they maintain their dignity. Staff were observed to assist them with their needs quietly and unobtrusively. There are adult protection policies and procedures in place to safeguard residents. These are shared with staff so that they are aware of what to do if they have any concerns in this area. Penrose Farm environment is suitable for the people living there. Communal and private areas were clean and tidy throughout at the time of the unannounced inspection. People who use the service are consulted about the décor and furnishings of their bedrooms. The staff team demonstrated throughout the inspection positive interactions with People who use the service and assisted them with personal care needs in a discrete manner. Staff confirmed access to training is available. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 7 The inspector was welcomed to the home in a friendly manner by staff and residents. All were aware of the reason of the inspection. What has improved since the last inspection? What they could do better: The registered manager agreed that the Statement of Purpose and Service Users Guide needs to be reviewed, updated and made more personalised so that they accurately reflect the services that are provided at Penrose Farm. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 8 Contracts in relation to the placement clearly identify residents’ rights and what services they will be provided with. The registered manager agreed that People who use the service individual contracts did not clearly set out their fees, or how their individual contributions are calculated. This meant they could not make fully informed decisions about their placements in the home. The registered manager said that she is aiming to update these, plus the Statement Of Purpose / Service Users guide and therefore a formal requirement to do this has not been issued in this report. It is recommended that the manager attend the Safeguarding course to enhance her knowledge in the area of adult protection. The environment is mainly kept to a satisfactory standard offering homely comfortable furnishings. Improvements could be made in the replacing/ cleaning of carpets and sofa to make the home more attractive. In addition the replacement of a rusty bathroom radiator would promote infection control measures. The staff team are below the national minimum standard of 50 qualified at minimum of NVQ level 2. The registered manager said this is being addressed. The homes manager is aware that staff need to attend specific training courses to assist them in their daily work and is arranging for them to attend such courses. It is recommended that the registered manager develop a staff training overview so that she can easily access what training staff have completed, gaps in training and when refresher courses are due. The staff must ensure that they complete records in line with the Data protection Act i.e. the communications and waking nights book, so that People who use the service are confident that information record about them remains confidential. In addition staff should ensure that they complete records, as per the organisation policies on a daily bases at all times. The registered manager will investigate as to why certain records have been missed and inform the Commission of her findings. The inspector would like to thank people who use the service, staff and the registered manager for their assistance and cooperation during this inspection process. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 9 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. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 10 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 Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 11 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): 2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service needs are assessed with a planned transitional programme occurring so that they are consulted before moving to a new home. People who use the service contracts should identify what financial costs are involved in the placement. EVIDENCE: The registered manager stated that she is in the process of updating the Statement Of Purpose and Service Users guide and is reviewing its presentation. Therefore this was not inspected on this occasion. As she is in the process of addressing these issues no requirements or recommendations have been identified at this time. Managers of Spectrum homes undertake assessments and seek professionals’ views that are involved in the individuals care. From this a decision is made as to the suitability of Penrose Farm being able to meet the individual’s needs. It is evident from documentation seen that prospective residents to the home were consulted through their transitional programme about their wishes to reside at Penrose farm. One person who recently moved to the home said ‘people are kind here’. The registered manager said that she is in process of ensuring that individual contracts in relation to the placement clearly identify residents’ rights and what services they will be provided with. She will also ensure that the contract will clarify what costs the resident needs to pay and identify their benefit Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 12 entitlements. As this was raised at the last inspection, a requirement has been identified for the registered manager to address this. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 13 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, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service care plans address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds. They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. Records are in the main satisfactory but need to improve to ensure that people’s confidences are kept. EVIDENCE: When case tracking two individuals, both care plans were out of date on the first visit to the home. However staff were knowledgeable and verbalised to the inspector the individuals care needs. On the second visit the registered manager stated that one care plan had been updated and that the other was in process. As they were being updated no statutory requirements to this effect have been made. A recommendation is identified to ensure that regular updates of the care plans are undertaken. People who use the service, their family, advocate and relevant professionals are involved in the development of individual care plans and their subsequent reviews. People who use the service said they attended meetings to discuss Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 14 their care needs. The care plan has specific headings to address their health, personal and social care needs, including their individual and diverse needs. Care plans provide residents with specific goals to work towards, and inform and direct staff in how to support the resident to achieve this goal to encourage them to fully maximise their skills for independent living. Individual care plans consider their skills in making choices for themselves and people who use the service provided examples of how they are able to make decisions about things that are important to them, such as their daily activities and meals. They were observed freely accessing their own rooms and the shared facilities in the home and the manager said that they are encouraged to make their views known by drawing up their own care plans and in regularly held house meetings. There is a key worker system in place so that service users have a nominated person to refer to. Staff were observed supporting people who required it, to make decisions about what to do during the day. Peoples written care plans formally consider their abilities to make decisions for themselves and daily care records provide further evidence of the choices they make in their daily lives. People who use the service can choose the level of privacy they wish to enjoy in their private accommodation. The manager said that the risk assessment process is being reviewed. People who use the service are able to take managed risks, backed up with written risk assessments and risk management plans, particularly with regard to their engagement in higher risk activities. The majority of records were kept to a satisfactory standard. However, further improvements must be made. From inspection of records it was observed that certain records i.e. the waking night book, communications book did not at times adhere to the Data Protection Act as it recorded personal information on a individual in a shared document. It was also noted that in individuals daily records that there were gaps of any records kept of what the individual person had done that day. Dates of these gaps were given to the registered manager. It was also noted that when these gaps occurred that other records that the organisation had asked to keep i.e. food records, bath temperatures etc also had gaps on the same day. The registered manager said she would look into why these records were not up to date; the Commission request that she informs them of her findings. As the majority of records were kept appropriately this section remains rated as ‘good’ on this occasion as the registered manager agreed to address this immediately. However, a requirement has been made to ensure that records are kept accurately, confidential and in line with legislation. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 15 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, 15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service access a wide range of age, peer and culturally appropriate activities in and out of the home and maintain contact with their families and friends so that they enjoy a good quality of life. Active steps are taken to inform them of their rights and responsibilities so that they know what to expect and what is expected of them. They are provided with a healthy diet so that they stay well and enjoy their meals. EVIDENCE: People who use the service said they were ‘happy’, ‘thumbs up’ and expressed general satisfaction with the varied and individual activities they take part in, in and out of the home, which was observed throughout the inspection. Their care plans set out their preferences, likes and dislikes. Daily care records and activity rotas demonstrate how their care plans are carried out. Activities are appropriate to their ages and cultural backgrounds, including access to voluntary work and local colleges. Certificates of their achievements are held on their personal files. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 16 People who use the service access a wide range of community resources individually or with staff assistance, depending on their confidence and risk assessments. They assist with shopping for the home, attend social clubs, voluntary work placements and local colleges, for example. This was observed during the inspection and confirmed by individuals daily care records. People who use the service, confirmed in discussion with staff and records showed that they are encouraged to maintain friendships and relationships with people from outside of the home so they are not isolated. There are facilities for people to make telephone calls in private and their individual records demonstrate how Spectrum supports them to maintain appropriate friendships and relationships with people of their own age. People who use are informed of their rights and responsibilities in their service users’ guides, which also function as placement contracts. The registered manager said that she is currently updating them so that they have improved information about their fees and welfare rights. The manager said that service users without relatives to advocate for them are actively supported to access local advocacy service and gave examples of this. People who use the service said that they are satisfied with the food provided to them. They confirmed that they are encouraged to assist with planning meals, shopping for food, preparing and serving food, which was observed during the inspection. They are encouraged to eat healthy, home prepared meals so that they stay well. Meals are based on their individual preferences, likes, dislikes and nutritional needs, which are in the main set out in their care plans. People who use the service were observed accessing the kitchens independently, to prepare breakfasts and snacks for themselves, at various times during the inspection. Penrose Farm has a copy of the ‘Safer food better business’ pack. This is meant to be completed on a daily bases in respect of any issues in relation to food in the home. However this has not been completed since 15/10/07. The registered manager who has completed training on the use of this document said she would address this at the next team meeting. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 17 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. People who use the service personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. Medication systems are in place to ensure that individuals are not placed at risk. EVIDENCE: People who use the service healthcare needs are considered as part of the care planning process and regularly reviewed. Documentation showed that people who use the service have access to external healthcare providers, including specialists, when they need to. People who use the service said that access to doctors, dentist etc are regular and that staff attend these visits with them which they find supportive. There are suitable medication storage facilities. People who use the service do not currently self-administer medication. Spectrum has a medication policy that was present in the home. Staff administer medication following relevant training and following a competency assessment. Penrose Farm uses the Monitored Dose System (MDS) so that medication in the main is received in blister packs. From inspecting the medication process it was evident that staff receive and administer medication safely. MAR sheets recorded medication the home had received, and when administered. An audit of loose medication showed that, with the exception of one tablet the numbers Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 18 recorded as present in the home tallied with the tablets stored in the cabinet. Records of medication disposed of are kept. Advice was given during the inspection on the storage of certain medications, immediately staff contacted Boots and ordered a controlled drugs book to ensure this is recorded correctly. During the inspection, following advise, the staff arranged for the medication cabinets to be fixed to the floor and brought a thermometer to ensure that the temperature of the room was correct for the storage of medication. A copy of the latest medicine guidelines for care homes, for reference, by the Royal pharmaceutical company is available. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 19 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. People who use the service are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. Records of all financial transactions for people who use the service should be monitored more closely to prevent abuse. EVIDENCE: People who use the service said that if they had any concerns they would be able to talk with the staff or manager of the home. They said they had no concerns. People who use the service are provided with written and pictorial copies of the home’s formal complaints procedure and have formal and informal opportunities to raise any concerns with staff before they become serious complaints. The home has received two complaints since the last inspection, one from a member of public and one from a person who uses the service. Records indicate that both complaints were managed sensitively and that the complainants were satisfied with how the issues were resolved. The home has written procedures to guide staff on what to do if they suspect an individual is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. People who use the service are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. Spectrum has a whistle blowing policy. The registered manager is arranging to attend a Safeguarding course. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 20 People who use the service monies are audited on a monthly base at Spectrum headquarters, evidence of this was seen. From two records inspected it was noted that there was more money in the individuals cash tin then there was recorded (by a few pounds) this was raised with the registered manager who said she would address this immediately. A recommendation to monitor this more closely has been identified. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 21 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Penrose Farm provides a safe, homely and comfortable place to live, work or visit so that people who use the service can develop their skills and independence in a non-institutionalised setting. Some redecoration, refurbishment would improve the environment further. There are suitable systems in place so that they are adequately protected from health risks associated with cross-infection. EVIDENCE: People who use the service said they were pleased with the homes physical environment. They said that they were involved in choosing the décor and furnishings of their rooms and allowed the inspector to visit their personalised rooms. Staff were in the main satisfied with the homes physical environment. They felt that improvements that could be made were in relation to needing a larger cooker and an industrial washing machine. The registered manager echoed this and said that a larger cooker is being considered and estimates are being Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 22 sought. She stated a washing machine has just been purchased and she will review if this is sufficient. The registered manager agreed that in the main the home’s physical environment was to a good standard. However she acknowledged that carpets in the lounge in particular needs either cleaning or replacing. The registered manager acknowledged that the homes environment would benefit from new carpets, particular in communal and some bedroom areas. It was also observed that in the ‘Barn’ that the sofa and chairs needed replacing as they were ripped – the registered manager stated that a order had been made to replace these. It was also noted that in one of the bathrooms the radiator was rusty – this needs replacing due to the risk of infection control Penrose Farm provides a variety of communal spaces, including a very large, attractive garden, in addition to their private accommodation. They are able to freely access all parts of the home, which provides them with opportunities to develop their skills and independence through participation in household tasks and preparing meals, for example. This was observed during the inspection. The home looked clean and tidy throughout at the time of the inspection and the staff described the systems in place to protect People who use the service and staff from cross-infection. Staff records indicate that they have access to training in infection control. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are qualified or working towards achieving qualifications in care so that people who use the service can be confident that the staff working with them are competent to do so. Recruitment is fair, safe and effective so that people who use the service benefit from staff that are suitable to work in a care setting. The supervision arrangements should be improved so that staff are able to reflect on and improve their working practices for the benefit of people who use the service. EVIDENCE: The registered manager said that approximately 32 of the current staff team are qualified to at least NVQ level 2 and the rest are working towards achieving formal qualifications in care. The home’s records and AQAA confirmed this. What is of concern is that the previous inspection report identified the level of NVQ qualification was 33 so there has been no increase in this qualification at the home. Therefore this will be monitored. People who use the service said that they ‘like’ staff and felt able to approach them if they had any worries and found them to be ‘friendly’. One said ‘the nicest thing about being here is the staff’. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 24 Staffing levels are 6 –7 carers on duty during the day, 5 carers in the evening with 1 waking night and 1 sleeping in member of staff. Staff and People who use the service felt there were sufficient staff on duty at all times. Staff recruitment records indicate that appointment is on the basis of a formal written application, interview and checks to ensure they are suitable to work with vulnerable adults in a care setting. The registered manager has stated in her AQAA that she hopes to involve people who use the service more in the recruitment process. All staff working in the home undergo formal induction training at Spectrum’s head office prior to commencing work in the home and induction training specific to the home once they start there, with records held in the home and a staff member who was interviewed confirmed. Staff have good access to ongoing training to update their skills so that they can work safely and effectively with service users. It is recommended that the registered manager produce a staff training overview of what courses staff have completed and when they are due for a refresher course as currently this information is time consuming to access as it is held on individuals files. The registered manager found this to be a positive suggestion. The registered manager acknowledged during the inspection and in her AQAA that regular 1:1 supervision needs to be improved. Staff also confirmed this. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run so that people who use the service can be confident it is managed in their best interests, and their views are taken into account in its ongoing planning and development. There are systems in place to protect people who use the service from avoidable harm and injury. EVIDENCE: In December 2007 Ms Kerry Gardiner registered manager application was approved by the Commission. Ms Gardiner has gained her NVQ4 in care and aims to undertake the NVQ 4 in management. She has attended updated training relevant to her work. Miss Gardiner has worked at Penrose farm as manager since November 2006 and therefore knows the people who use the service, staff and home well. People who use the service and staff interviewed expressed confidence in the management arrangements in the home. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 26 There are formal and informal systems in place so that people who use the service can contribute their views to the ongoing planning and development of the service. People who use the service were articulate and able to clearly make their opinions known in interviews during the inspection. Some confirmed that they attend formal reviews with regard to planning their individual care. The registered manager and people who use the service said that there are regular house meetings, and there are records of regular monitoring visits by Spectrum’s senior managers, to ensure that good quality of care is maintained. Staff meetings are also held. Documentation in respect of these meetings was seen. A recent fire risk assessment has highlighted minor works that needs to be carried out, these are being addressed and some have been completed in full. All fire training and fire checks are undertaken on a regular bases. The home’s environment appeared safe and there are written individual and environmental risk assessments in place to minimise risks to people who use the service, visitors and staff working in the home. Maintenance of the home and its equipment are all satisfactory. Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 27 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 2 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 4 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 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 2 LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5(1)(b)(c) Requirement Contracts for people who use the service individual contracts must clearly set out their fees, or how their individual contributions are calculated. This meant they could not make fully informed decisions about their placements in the home. Timescale for action 30/04/08 2 YA10 YA41 17(1)a)(b) All records must adhere to the (2)(3)(a)(b) Data protection Act to ensure that People who use the service are confident that information recorded about them is confidential. 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 YA7 Good Practice Recommendations Care plans should be regularly updated so that they hold current information on the person who uses the service. DS0000041536.V350364.R01.S.doc Version 5.2 Page 29 Penrose Farm 2 YA10 The registered manager should monitor closely people who use the service monies to ensure that the money in the cash tin is accurate and reflects the cash records. The registered manager should ensure that PRN medication is accounted for in the home to prevent medication errors. The registered manager should attend the Safeguarding course to enhance her knowledge in the area of adult protection Carpets should be cleaned or replaced. The bathroom radiator should be replaced. This will make the home more attractive for people who use the service should be cleaned or replaced. The bathroom radiator should be replaced. This will make the home more attractive for People who use the service and promote infection control. A minimum 50 of staff should achieve the NVQ level 2 qualification so that people who use the service have the confidence that staff have the necessary skills to meet their needs. It is recommended that the registered manager develop a staff training overview so that she can easily access what training staff Individual staff supervision should occur a minimum of 6 times a year so that staff have the opportunity to reflect on their work practice. Daily records should be completed daily so that people who use the service have access to all information needed about their care. The registered manager should investigate in to this and forward her findings to the Commission. 3 YA20 4 YA23 5 YA24 6 YA32 7 YA36 8 YA36 9 YA10 YA41 Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Penrose Farm DS0000041536.V350364.R01.S.doc Version 5.2 Page 31 - 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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