Care Home: The Farmhouse

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What the care home does well Provides an excellent standard of care for service users. Provides a safe and homely environment for service users. Supports and encourages service users to lead an independent life according to their needs and strengths and to fulfil their potential as far as possible. Service users benefit from a committed and competent staff team that ensures continuity of care. The manager and staff fully involve service users in all aspects of the running of the home. What has improved since the last inspection? A new conservatory has been installed for the benefit of service users. The staff team with the support of the manager is now working more cohesively and this provides more consistency of staffing for service users. What the care home could do better: To continue to maintain the good standards of care for the benefit of service users. Ensure that the deployment of staff does not compromise the plans of care for service users or opportunities to access the community. Key inspection report Care homes for adults (18-65 years) Name: Address: The Farmhouse Ravenswood Village, Nine Mile Ride Crowthorne Wokingham Berkshire RG45 6BQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Sally Newman     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Farmhouse Ravenswood Village, Nine Mile Ride Crowthorne Wokingham Berkshire RG45 6BQ 01344755533 01344773174 farmhouse@norwood.org.uk bucketsandspades@norwood.org.uk Norwood Ravenswood Ltd T/A Norwood The registered provider is responsible for running the service care home 8 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service uses who can be accommodated is: 8 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The Farmhouse provides care and accommodation for up to eight people with moderate and complex learning disabilities, and is situated within Norwood Ravenswood Village. Ravenswood Village is a community setting providing care and accommodation within individually managed group homes to people who have a learning disability. The Farmhouse aims to provide high quality care that will Care Homes for Adults (18-65 years) Page 4 of 27 8 Over 65 0 Brief description of the care home maximise peoples personal development and develop a strong sense of religious and cultural identity. The home is a detached two-storey building with eight single rooms, a large communal lounge, dining room and kitchen that is furnished to a high standard; patio doors open from the dining room through to a sensory garden where seating is provided. There is a village shop and community hall within Ravenswood where various clubs for the service users are held. Ravenswood owns their own vehicles that assist service users to access services outside of Ravenswood. Public transport is not readily available within the village, but the village of Crowthorne and towns of Wokingham, Bracknell and Reading are within a short drive. The fees are £46,685 to £70,085 per annum. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a routine unannounced inspection conducted over the course of 4 and a half hours duration. Time was spent in discussion with the senior staff member on duty and two members of staff were spoken to in private. Observations of activities within the home were conducted and other staff and service users were spoken to. A tour of the communal areas was undertaken and some bedrooms were seen. A range of documentation was examined. Information provided by the service prior to the visit has been used in the evaluation of outcomes for service users. Eight completed service user surveys were returned to the Commission together with three staff surveys. Six service users received some assistance in their completion. Overall responses were positive about the service. More detailed feedback has been incorporated into the main body of the report. The home has been through a period of change over the last year partly as a result of home closures in the village. This has led to some staff changes and the team as a Care Homes for Adults (18-65 years) Page 6 of 27 whole has experienced some uncertainty. No recommendations or requirements were made as a result of this inspection. The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, cultural and racial needs. No complaints have been received by the Commission about this service since the last inspection. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can be confident that their needs will be thoroughly assessed before they are offered a place and these needs will be met. Evidence: Three assessments and care plans of people living in the Home were examined. No one has moved in to the home within the last year but assessments seen showed that people did have their needs comprehensively assessed prior to moving into the home. This information also included a care manager assessment and relevant information from other interested parties. Assessments included mobility, personal care, incontinence, communication, social activities and general likes and dislikes. Risk assessments were also in place for all key areas of need. Assessments also included aims and objectives and care assistance required and this information was reflected in the peoples care plans. Observation on the day of the site visit and records seen showed that care plans are followed and the home is able to demonstrate that it can meet peoples specialist needs. The home is small and has good consistent staffing which enables an individual Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: person centred approach to care to be provided. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service ensures that the assessed and changing health and social care needs of service users is well understood by involving individuals in their care plans and by maintaining accurate records. All service users are encouraged to live as independently as possible within identified and managed risks. Evidence: Individual care plans were detailed and comprehensive and included all needs as detailed in their assessments. A new care plan format was being introduced and all care plans would eventually conform to the new requirements. Records showed that care plans were being regularly reviewed. Good detailed daily reports are also maintained. Health records show that access to routine and specialist health services are provided and people living in the home confirmed that they had regular access to Doctors, dentists, optians and chiropody. Feedback from people who use this service through returned surveys and from discussion and observation at the site visit showed that people living in the home are Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: treated with the dignity and their choices are respected and acted upon. Staff took time to respond and interacted sensitively to peoples needs and it was clear that people felt able to ask for support. On staff member within a returned survey did indicate that consistency is not always optimum due to the periodic reliance on agency staff, although all efforts are made to ensure that these are regular personnel and well known to the service users. Some typical responses included: nice food nice people I have lots of choice, I choose my clothes and have nice food Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who use the service are supported to make choices about their lifestyle and are encouraged to develop their life skills. Social, educational, cultural and recreational activities are varied and offer individual choice and meet aspirations and expectations. Evidence: A range of evidence was provided by the service to demonstrate that positive outcomes for individual service users is aspired to by the manager and staff in respect of their lifestyle. This evidence included information provided prior to the visit, a range of documentation maintained within the home, together with discussions with staff and observation undertaken throughout the visit. All service users have an individual timetable of activities that is reviewed together with the service user on a regular basis. The range of activities participated in is varied and includes, animal care, arts and crafts, music, walking, films, cooking and trips to the local pub and gardening. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Individually tailored holidays are organised and have been enjoyed by the service users. Two staff members indicated within completed surveys that they felt there could be more opportunity for service users to access the community if more staff hours were available. It was, however, recognised that financial restraints impacted greatly across the industry. Service users are supported to maintain family links and evidence of contact details and family information was clearly recorded within those care plans seen. The service does have access to its own vehicle. It was clear from observations and from discussion with staff and service users that the routines in the home are flexible and meet with individual preferences. There are no hard rules about bedtimes or meal times and service users are able to decide for themselves whether to engage in activities or not. The kitchen facilities were seen and were found to be clean and tidy. Menus are planned on a regular basis with service users. However, it was confirmed that this was not rigidly adhered to if service users had changed timetables or collectively or individually wanted to eat an alternative. All service users had the opportunity to plan, shop and cook themselves a meal on a weekly basis. Specific dietary needs are met and healthy eating and portion control is promoted. Further documentation confirmed that regular checks are undertaken on food temperatures, fridge and freezer temperatures and food dates. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of service users are met. The arrangements for medication are robust and protect service users. Evidence: The health and personal care needs of service users are clearly documented in their care plans. The range of health care professionals called upon to assist with meeting individual health care needs was provided within information made available by the service prior to the visit and included a wide range of health care professionals. Examples were provided where the manager and staff had gone to great lengths to advocate on behalf on service users to ensure that they received the medical they required. This information was in evidence from examination of the 3 care plans seen. The plans detailed individual needs comprehensively and recorded health care contacts. The advice given was incorporated into individual plans of care and where appropriate guidelines for staff had been provided. The medication storage facilities were seen within service but a full audit was not undertaken on this occasion. No one living in the home currently administers his or her own medication. A medication inspection was scheduled to be undertaken by the local PCT and information from the home confirmed that feedback from this pharmacist was positive with only minor Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: issues raised and they were to receive a standard met rating. All staff that administer medication have received appropriate training and medication care plans gave good guidance and information relating to individual medication needs. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that their views and concerns will be listened to and acted upon and that they are protected from abuse and neglect. Evidence: Information provided by the service prior to the visit confirmed that one complaint had been since the last inspection. This had been dealt with appropriately following the organisations policies and procedures. The Commission has received no complaints or concerns about the service. It was confirmed that service users are encouraged and supported to air their views both on an individual basis and within daily meetings. Due to some communication difficulties issues occasionally rely upon the skill of staff to interpret the needs of service users and to recognise problems. There is a robust complaints procedure that is made known to the representatives of service users and this is referred to in regular staff meetings. It was confirmed that all staff had received instruction in the safeguarding of adults. This was confirmed by the two staff spoken to who demonstrated a sound understanding of the principles of safeguarding and the potential for abuse. The interagency policy on safeguarding adults was available in the home and the senior staff member on duty was clear about the action that needed to be taken should an allegation or suspicion of abuse come to their attention. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. Evidence: Service users benefit from a well maintained and comfortable environment that is safe, clean and hygienic. A tour of the communal areas was undertaken and all areas seen were tidy and clean. It was confirmed that there is a rolling programme of replacement in place for furniture, fittings and decoration. Some bedrooms have been redecorated whilst service users have been away on holiday, but all have involved individual service users in choosing colour schemes and furniture and fittings . Each bedroom door is lockable but only one service user currently chooses to use a key. The bathroom has also been refurbished and provides specialist equipment. A conservatory has been built and overlooks the garden. This provides additional living space in the home and is being enjoyed by all the service users. The garden is of a good size and is used by service users, sometimes with the support of staff. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: There is a comprehensive cleaning schedule in place in which service users do participate. Laundry facilities were seen and were considered to be appropriate to meet the needs of the current service users. It was confirmed that the principles for the Control of Substances Hazardous to Health are adhered to and are supported by comprehensive policies, documentation and staff training. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the support of well trained and competent staff and are protected by the organisations policies on recruitment. Evidence: Information provided by the service indicated that all staff are subject to an extensive recruitment programme that complies with the regulations. This was confirmed by all staff spoken to. All prospective staff must complete an application form and are subject to written references and formal interview. A recently appointed member of staff confirmed that she had been subject to a rigorous recruitment process. The organisation maintains staff files centrally on the village sight. The inspector has examined a sample of staff files on many occasions and did not therefore conduct a examinations of the files for staff employed within the home on this occasion. It was confirmed in information provided by the service that all prospective staff have a POVA 1st check undertaken prior to a full Criminal Records Bureau check. All staff have individual training profiles and it was confirmed that all staff had received training in core activities such as fire training, food hygiene and health and safety. All current staff the exception of the newest recruit are trained to NVQ 2 standard. The organisation has a dedicated training coordinator who oversees all training arrangements and ensures that updates are provided for those staff who require them. Overall the arrangements for staff training were described by those new staff Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: spoken to as very good. Staff spoken to confirmed that the staff team work well together, are supportive of each other and communicate and share the needs of service users efficiently. Staff meetings are held regularly. It was reported that staff hand-overs and the use of a communication tool within care plans ensured that important information was passed on. It was confirmed that one to one supervision is provided on a 6 weekly basis and all staff have an annual appraisal. There is usually a minimum of 3 staff on duty and information seen confirmed that the deployment of staff is under constant review to ensure that the needs of service users is always met. Some staff indicated that there are occasions when staff numbers are down and this can impact on the quality of interaction provided because staff can be overstretched. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well run home where their views are taken into account with regard to the development of the service. Service users are protected by the homes policies and procedures for health and safety. Evidence: It was apparent from available evidence that the manager is competent, well qualified and experienced in managing the home and is highly regarded by staff. Staff found her to be supportive and approachable with an open management style. Information provided prior to the visit indicated that the management support role had been important in the light of some home closures in the village, which had caused some anxities and had left some staff feeling vulnerable. The service evaluates its effectiveness primarily through the formal annual care plan review process when feedback from interested parties is sought. All views and feedback are taken account of and internal reviews are conducted more regularly to ensure that the needs of service users are continuing to be met. Regular seniors meetings are conducted in all aspects of the running of the home. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: There are robust health and safety practises within the home that are underpinned by comprehensive policies and procedures. A range of checks are undertaken and documentation was seen in respect of fire safety checks, hot water outlets and electrical appliance checks. Care Homes for Adults (18-65 years) Page 24 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 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, Care Homes 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 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 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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