Care Home: Stallcombe House

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What the care home does well There are sufficient numbers of experienced and well trained staff on duty to make sure people receive the support they need with all health and personal care tasks. Those people who have diagnosed health problems have received good treatment from health specialists and the home have good systems in place for recognising potential signs of illness and referring people appropriately to their GP or relevant medical practitioner. There is an excellent range of educational and development opportunities at Stallcombe House. People lead interesting and busy lives and have a wide choice of things to do each day both within the house, in the gardens or farm, or in the wider community. The accommodation has been well maintained throughout and offers people a comfortable and modern home to suit their individual needs. Each person has their own single bedroom that has been furnished and decorate to suit their tastes, interests and preferences. The home is clean, bright, airy, and safe. We received 5 completed survey forms from relatives and advocates of people who live in the home. They were full of praise for the home and comments included: "Stallcombe is the most wonderful place for our daughter and the level of care should bea benchmark for similar accommodation." "I would like to comment particularly how the staff supported my son during a period of severe anxiety which lasted more than a year. he has made a full recovery and is fit and enjoying life again. The management team and care staff were simply brilliant and I cannot thank or praise them enough." "Very caring people and a happy place for the people living there." What the care home could do better: The home should continue to develop the care plans to provide one consistent system of care planning for each person. The plans should be written through close consultation with the person each plan relates to, and people should have a copy of their own plan in a format that is relevant to their communication skills (for example, using pictures, symbols, video or audio recording methods). There should be a robust accounting system in place for medications that are not supplied in four weekly blister packs. This should enable the home to provide evidence of the amount of each medication carried forward at the end of each four weekly medication cycle. The level of information on each medication administered in the home should be improved to give staff all of the information they need about each medication, how it should be stored and administered, and any side effects. The information about creams and lotions should be improved so that staff know where each cream should be applied, and how to monitor the condition and decide when the creams or lotions are no longer required. New staff must not be confirmed in post, or begin working in the home until at least two satisfactory written references have been received, in addition to Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA) checks. There should be at least 50% of care staff who hold a relevant nationally recognised qualification. Random inspection report Care homes for adults (18-65 years) Name: Address: Stallcombe House Sanctuary Lane Woodbury Salterton Exeter Devon EX5 1EX three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Vivien Stephens Date: 0 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: Stallcombe House Sanctuary Lane Woodbury Salterton Exeter Devon EX5 1EX 01395232373 01395233351 stallfarm@eclipse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Christopher Robert Thistle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Stallcombe House Farm Trust care home 33 Number of places (if applicable): Under 65 Over 65 27 0 27 0 0 learning disability learning disability mental disorder, excluding learning disability or dementia physical disability physical disability Conditions of registration: 27 33 27 9 33 The maximum number of service users who can be accomodated is 27 The maximum number of service users who can be accomodated is 33 The registered person may provide the following category of service only: Care home only (code PC) to service users of either gender whose needs on admission to the home are within the following category: Learning Disability - (Code LD) - Maximum 33 Care Homes for Adults (18-65 years) Page 2 of 11 places, Physical Disabilty - (Code PD) - Maximum 33 places The registered provider may provide the following category of service only: Care home providing personal cae only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Learning disability over 65 years of age (Code LD(E)) Physical disability (Code PD) - maximum 9 places Mental disorder, excluding learning disability or dementia- Code MD Mental disorder, excluding learning disability or dementia, over 65 years of age (Code MD(E)) Date of last inspection Brief description of the care home Stallcombe House Farm is home to 26 adults with learning disabilities. The home provides personal, educational and supportive care. All residents living at Stallcombe House Farm have single bedrooms. The house sits in 55 acres of land on the outskirts of Woodbury. The property consists of a main house and cottage, which are the main living areas for the residents. There are a variety of out buildings, which are used for such things as woodwork and chicken farming. There is a large working garden, which is kept attractive and well tended. Stallcombe House Farm is a registered charity. The home has achieved The Investors in Peoples Award. The home offers a wide range of educational and leisure activities. Arts and crafts, weaving, woodwork, cookery, music, drama, dance and horse riding are some of the therapeutic activities that can be enjoyed daily. The residents help with the maintenance of the homes organic garden and the hen houses, egg collection and delivery. A copy of this inspection report can be seen at Stallcombe Farm on request. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: On the day of this inspection there were 27 people living in the home. The Commission had recently allowed the home to admit one person in addition to the 26 people the home had been registered for, in anticipation of the completion of a new building. That person has been temporarily using a room usually used by families visiting the home who may need overnight accommodation. The care plan and admission documents were seen for the last two people who had moved into Stallcombe. They both had limited verbal communication skills and the staff had been developing ways of improving communication with them using signs and symbols. The care plan files showed good information had been gathered about each person before they moved in. We talked to three members of staff and were satisfied that the home takes good care to get to know people thoroughly before they move in. There were two different styles of care plans in place. One care plan format had been developed by a member of staff and the other was a commercially printed document. The document developed by the member of staff gave much greater detail about the person and the support they needed. We heard that the home is planning to develop new person centred care plans for each person in the near future. Since the last key inspection the range of educational and leisure opportunities for people has increased to an even higher standard. They now have move animals including horses, pigs, alpacas and rare breed chickens. New stables and animal housing have been built. A new garden room has been built. This is a large timber clad building with level access, kitchen and toilet facilities and also provides a large space for people to use in a variety of ways, including as a training room, and is intended mainly for use by those people who work in the gardens. We saw people busy around the farm doing a variety of activities including animal care, horse riding, and maintenance of farm machinery. We talked to a person who was very proud of their recent achievement in a successful theatrical production at a theatre in Exmouth. We also saw framed photographs on display in the home of a number of events people had taken part in. Each person had their own weekly timetable of the things they wanted to do each day. The timetables showed that people lived busy and fulfilling lives. One relative who completed a survey form before this inspection took place told us They treat each resident as an individual. This is very important to me - I want X to develop at her own pace and for HER interests and hopes to be realised as much as possible. Stallcombe offers a safe, yet vibrant environment. Cant praise it high enough. The two care plan files we looked at contained good evidence of each persons personal and health care needs. Daily recording sheets had been developed setting out the persons personal care needs. There were letters on file from health professionals and a member of staff told us about forthcoming appointments with specialists. Accident reports forms were seen files in individual files. Care Homes for Adults (18-65 years) Page 4 of 11 The two people whose records we looked at were not receiving any prescribed medication at the time of this inspection. We looked at the way medications were stored and administered for the remaining people living in the home. The medicines were stored in a locked wooden cupboard inside larger cupboard that was also locked. We suggested that the home should seek advice from their pharmacist about the security of the cupboard to ensure it meets current legal standards. The home used a monthly monitored dosage system supplied by a local pharmacy. The home had developed their own medication recording sheets providing larger boxes than the sheets provided by the pharmacy. The records had been well maintained for those medicines supplied in the monthly blister packs. Administration records for medicines not in blister packs were satisfactory with the exception of the lack of an ongoing accounting system for those medications held in the home at the end of each 4 week period. We talked to the manager about introducing a brought forward system to show the amounts held in the home and carried forward each month. There have been no complaints or serious concerns about the home since the last key inspection. A new self contained 6 bedroomed bungalow has recently been built and was just in the process of finishing touches at the time of this inspection. This will increase the number of people the home is registered to accommodate by 6. The new building was bright, modern, spacious, with an exceptionally high standard of fittings. There were card activated locks on bedroom doors enabling people to open and lock their own bedroom doors easily, while at the safe time giving them privacy and security from unwanted intrusion. Fittings such as kitchen units, door surrounds and bathroom fittings had rounded edges to reduce the risk of harm for those people whose mobility and disabilities may place them at risk of hurting themselves if they accidentally fell against the corner of a fitting. Each bedroom has a large en suite bathroom with both a bath and a level access shower. each bedroom is a good size with well designed built in wardrobe and a cupboard with a specially designed space above for a television enabling the television to be secured behind a PVC panel to prevent accidental damage. Each bedroom also has a good outlook from large triple glazed windows. We also looked in one bedroom in the main building a lounge and the main dining room. All areas had been well maintained and were bright, attractively decorated, comfortable and homely. We looked at the recruitment files for the last two members of staff recruited by the home. We saw the home had obtained criminal record checks and there was evidence to show that the Protection of Vulnerable Adults (POVA) checks had been carried out through the Independent Safeguarding Authority (ISA) before the staff had started work. Two satisfactory references had been obtained for each person, but these references had not always been received before the staff began working. We talked to Chris Thistle, registered manager and explained the importance of meeting the requirement to obtain satisfactory written references before new staff begin working. He agreed to make sure that the home meets this requirement in future. Before this inspection took place the home completed an Annual Quality Assurance Assessment (AQAA). This document showed that the home employed 53 permanent staff. Care Homes for Adults (18-65 years) Page 5 of 11 Of these only 15 staff had obtained a nationally recognised qualification known as NVQs. We talked to Chris Thistle about the low level of staff with a relevant qualification. He said that a number of staff work in the gardens and on the farm and their main role is not in the provision of personal care. The ratio of staff directly involved in personal care who held a relevant qualification appeared to be higher, as some held other qualifications such as nursing qualifications. We were given evidence of the staff training programme that showed that staff have received a wide range of ongoing training on health and safety topics and on subjects relevant to the health and personal care needs of the people living there. One person has responsibility for overseeing the training needs of the staff team and this person has good records to show the training each person has received. We received 10 completed survey forms from care staff before this inspection took place. Their responses were mainly positive and showed that all staff were satisfied with the way they had been recruited and trained at the start of their employment. They all felt the home provided a good standard of care, accommodation and facilities for the people living there. most staff felt there were always or usually enough staff to meet peoples care needs, although one staff commented Sometimes more staff are required to facilitate each individuals needs, likes and dislikes especially when working outside and on occasion within the house. Most staff said they were well supported and met regularly with their manager. One person said Communication can be a bit muddled at times. I also feel that greater use could be made of staffs past experience. During our inspection we talked to two members of staff who told us they were very happy in their work and felt the communication and support systems in the home are very good. Chris Thistle has managed the home for a number of years. There is a stable management team. What the care home does well: There are sufficient numbers of experienced and well trained staff on duty to make sure people receive the support they need with all health and personal care tasks. Those people who have diagnosed health problems have received good treatment from health specialists and the home have good systems in place for recognising potential signs of illness and referring people appropriately to their GP or relevant medical practitioner. There is an excellent range of educational and development opportunities at Stallcombe House. People lead interesting and busy lives and have a wide choice of things to do each day both within the house, in the gardens or farm, or in the wider community. The accommodation has been well maintained throughout and offers people a comfortable and modern home to suit their individual needs. Each person has their own single bedroom that has been furnished and decorate to suit their tastes, interests and preferences. The home is clean, bright, airy, and safe. We received 5 completed survey forms from relatives and advocates of people who live in the home. They were full of praise for the home and comments included: Stallcombe is the most wonderful place for our daughter and the level of care should be Care Homes for Adults (18-65 years) Page 6 of 11 a benchmark for similar accommodation. I would like to comment particularly how the staff supported my son during a period of severe anxiety which lasted more than a year. he has made a full recovery and is fit and enjoying life again. The management team and care staff were simply brilliant and I cannot thank or praise them enough. Very caring people and a happy place for the people living there. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 New staff must not be 04/06/2010 confirmed in post, or begin working in the home until at least two satisfactory written references have been received, in addition to Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA) checks. This is to ensure that people living in the home are safe from the risk of harm or abuse at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The home should continue to develop the care plans to provide one consistent system of care planning for each person. The plans should be written through close consultation with the person each plan relates to, and people should have a copy of their own plan in a format that is relevant to their communication skills (for example, using pictures, symbols, video or audio recording Page 9 of 11 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations methods). 2 20 There should be a robust accounting system in place for medications that are not supplied in four weekly blister packs. This should enable the home to provide evidence of the amount of each medication carried forward at the end of each four weekly medication cycle. The level of information on each medication administered in the home should be improved to give staff all of the information they need about each medication, how it should be stored and administered, and any side effects. The information about creams and lotions should be improved so that staff know where each cream should be applied, and how to monitor the condition and decide when the creams or lotions are no longer required. 3 32 The number of staff who hold a relevant qualification should be increased. There should be a minimum of 50 of staff who hold a nationally recognised qualification known as an NVQ, or equivalent. Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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