Care Home: The Farthings

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What the care home does well Given that there is impending significant change that will occur as a result of the social care change programme it is highly encouraging to note that improvements continue to be made. A lot of work has been done to maximise the involvement of the people who use the service and to seek their views about the future. What has improved since the last inspection? Care planning and review procedures are improved as too is staff support and supervision. The trust has also improved the regular monitoring of the service through monthly visits and reporting on the quality of the service. What the care home could do better: There is still no permanently appointed or registered manager in post, and this is a matter that the Commission will be exploring further with the registered provider. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Farthings Geoffrey Harris House Coombe Road Croydon Surrey CR0 5RD     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: James Pitts     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: The Farthings Coombe Road Geoffrey Harris House Croydon Surrey CR0 5RD 02086867649 02086805318 peter.kinsey@surreyoaklands.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Surrey and Borders Partnership NHS Trust care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users who can be accommodated is: 5 he registered person may provide the following category of service only: Care Home Only (CRH - 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 - Code LD Date of last inspection Brief description of the care home The Farthings is a residential home for up to five adults with profound learning disabilities, autism and challenging behaviour. It is owned, managed, and staffed by the Surrey and Borders NHS Trust, a specialist health provider for people with learning disabilities. The Farthings is in a semi-rural setting, on a campus style site shared by a Day Centre and other residential homes. It is close to Lloyd Park and local transport links including the Tram, which gives the home easy access to shopping and leisure facilities. The premises consist of a lounge, dining room, five bedrooms, a small office and bathroom facilities. The home has a garden to the front and rear of the building. The home provides respite care for a regular group of people. Care Homes for Adults (18-65 years) Page 4 of 25 Care Homes for Adults (18-65 years) Page 5 of 25 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: two star good 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 inspection involved a review of information received by the Commission, including the annual service review that was carried out in July 2008. A visit to the service was also carried out that involved discussion with people using and working at the home, the acting manager and examination of care planning and other records. Care Homes for Adults (18-65 years) Page 6 of 25 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 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 8 of 25 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. The people who use this service can feel confident that the home has historically made the right decisions when considering new admissions to the service. Evidence: The home has not, and will not, be admitting anyone new for permanent use of the service. The reason for this is that the home is included in Surrey and Borders NHS Trusts social care change programme which will result in either the service transferring to another provider on a new site or being taken over by a new provider at the same location. Care Homes for Adults (18-65 years) Page 9 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that the home run using a person centred approach, they can be involved in making decisions about their lives, and play an active role in planning the care and support they receive. Evidence: The acting home manager confirmed that (as stated at the previous inspection) they have worked with Croydon Councils Person Centred Planning Coordinator in developing Person Centred Plans for people who use the service. The acting home manager demonstrated that person centred plans are being further developed and samples of this work were seen. These plans included videos, pictures, word and music. The acting home manager was able to show that nearly all of the staff team have now attended training with Croydon Council on Person Centred Planning and more training is planned. All people who use the service have had their placement and needs assessed by their Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: placing authority, in this case everyone who uses this service has the same care manager from LB Croydon Social Services Department. It was reported at the previous inspection that one person had not had an annual review of their placement. This is no longer the case as everyone has had a placement review within the last six months and these reviews have focused of the social care change programme and its implications for those who use the service. Each person has a file, the file includes a My Plan, a health action plan, a communication dictionary, a Person Centred Plan including an action plan and up to date risk assessments. Each file includes a Surrey and Borders NHS Trust residents risk assessment. This risk assessment procedure is wide ranging and covers situations in the home and in the community. These assessments cover not only common risks but also those which are relevant in response to the specific needs of each person who uses this service. The care planning records also included a person profile that included the persons weekly activities, likes and dislikes, communication profile, independence, spirituality, behaviours and emotional needs, preferred activities and routines. The acting home manager provided further evidence of progress to improve communication and the Speech and Language Therapy Team are involved in supporting the development of communication passports. Further work and training has occurred to improve the way in which the service responds to the unique and diverse needs of those who live here. Training in specialised communication techniques, for example Makaton, as well as other awareness training has been occurring. As commented upon at the previous inspection there was more work necessary in order to show that the diverse needs of people who use the service are considered. Specifically it was highlighted that care plans and person centred plans could include reference to how the service will meet their needs and preferences in relation to race, religion, gender, sexual orientation, age and disability. This is positive to note. People continue to hold meetings are on a regular monthly basis. Minutes of these meetings are completed in words and pictures for the benefit of people who use the service and indicate that people are offered opportunities to participate in the day-today running of the home. An independent advocate has also recently started to work with the people who use this service, not least in terms of seeking views about the social care change programme and the changes this will mean. Care Homes for Adults (18-65 years) Page 11 of 25 Care Homes for Adults (18-65 years) Page 12 of 25 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. The people who use this service can continue to feel confident that much is being done to seek their views and acknowledge their preferences. Opportunity to engage in preferred activity, social and leisure interests is available and reflects the preferences of each person as a unique individual. Evidence: On the day of the inspection three people had gone to day services or were out doing other things, although all returned later. There is a detailed activity plan for each of the people who use this service, reflecting individual choices and preferences for meaningful daytime and other activities. All but one of those who live here attend a day service 4 or 5 days per week. The activity plan acknowledges the interests of each person as an individual rather Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: than just being written for the convenience of the service. All but one of those who use this service have only intermittent, or no, contact with their family, although it is evident that attempts have been made to establish firmer and more regular family links. As referred to earlier in this report there is now regular advocacy contact and much is being done to seek their views and to safeguard the interests of those who live here. A great deal of emphasis continues to be placed on effective communication, not least as this is a time of significant change for those who live here. The aims and objectives of the service are written in both word and picture formats, staff on duty each day are displayed with a photograph on a notice board and communication boards or flashcards are used when discussing more complex matters. The staff team use Makaton sign language to assist communication where this is of benefit. The visitors book showed that friends, sometimes family members, do visit as well as others including an advocate. The home has a four week rotating menu which is compiled with input from those who live here, and is also reviewed by a dietitian to ensure that nutritional balance is maintained. It is evident that the menu reflects the preferences of those who use this service and alternative choice to the main meal each day continues to be available. Care Homes for Adults (18-65 years) Page 14 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that their health care needs will be acknowledged and met, as well as receiving the right support to take any medicines that are required in order to remain healthy. Evidence: The needs and preferences about the way that each person is supported and cared for are properly recorded in their individual plan. No one who lives here permanently suffers from epilepsy or other serious medical condition. One person who uses the respite care service does, but has not been known to have suffered a seizure for a number of years. It was previously recommended that the continence adviser be requested to assess one of those who use this service. It has subsequently been identified that the concern that had been raised was not due to a physical condition and appropriate resolution has been successfully implemented. Medication is delivered to the home by a local pharmacy although it is not in a Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: monitored dosage format, which the acting manager said was due to cost. Given that the cost is met from health authority funding there is no budgetary implication for the home and it would be advisable to consider establishing a monitored dosage medication system. If PRN (as required) medication is prescribed then the reasons for this are clearly given. It is positive to note that additional medication is not given frequently. The policies and practises at this home indicate that medication is managed appropriately by trained staff. Care Homes for Adults (18-65 years) Page 16 of 25 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. The people who use this service can feel confident that they are living in a home where the staff know what to do to keep them safe from harm, neglect or abuse. Evidence: No complaints or concerns about the well being or safety of the people who use this service have been recorded. The Commission has not received any notifications of concerns about the care and support that is offered by the home. It was recommended at the previous inspection that the staff team be made aware of the whistle blowing procedure, which has now occurred. Ongoing awareness training in respect of safeguarding vulnerable adults also takes place and it is evident that the staff team take these matters seriously and know what to do if any concern were to be raised. Care Homes for Adults (18-65 years) Page 17 of 25 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. The people who use this service can feel confident that they are occupying a home that is comfortable and appropriately laid out to meet their needs. Evidence: It was required at the previous inspection that bedroom doors should not be wedged open, and this was not seen to be happening at this inspection visit. The building, although of quite an old design, is internally well decorated and furnished. Each persons own bedroom is decorated and furnished in a style that reflects individual taste and preference and the property overall has a homely atmosphere. The home is kept clean and is generally well maintained. Care Homes for Adults (18-65 years) Page 18 of 25 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. The people who use this service can continue to feel confident that staff are recruited, trained and supervised properly and are effective at meeting their care and support needs. Evidence: Staff personnel files are kept in a central department, although supervision and training records are kept at the home. As there are no new staff in post since the recruitment records were last seen by the Commission it can be said that historically the NHS trust has properly carried out the background and other pre-employment checks that are necessary. Almost all of the staff team are qualified to NVQ level 2 or higher. Core training, as well as training in specific areas (e.g autism), is provided and there is an evident commitment to keeping the staff team up to date with current best practise. Staff who spoke during this inspection demonstrated their knowledge and awareness of the needs of the people who use this service and were seen to interact with these people in a respectful, friendly and appropriate way. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Staff supervision has much improved and everyone is targeted to have one session per month. Obviously this is not always possible to achieve but at the very least the service is more than achieving the minimum six supervision sessions per calendar year that is required. Care Homes for Adults (18-65 years) Page 20 of 25 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. The people who use this service can feel confident that the home is managed well day by day. Evidence: The homes acting manager has been in this post since before the previous inspection, having formally been the deputy manager. Even though it is known that the social care change programme will result in a new service provider taking over the service there is no reason why the acting manager has not been confirmed in post and has not subsequently applied for registration with the Commission. This is an outstanding requirement from the previous inspection and must be addressed without further unnecessary delay. The Commission may consider enforcement action if there is no resolution or agreement made in respect of there being no registered manager in post. Having said that the permanent manager position needs to be resolved, the current acting manager continues to manage the home effectively and has worked on further improvements to the service. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: The previous inspection highlighted that monthly visits (under Regulation 26) were not occurring. The records of visits, and subsequent reports, were seen for the last 12 months and show that these are being completed as required. Service users have also been surveyed by the trust to seek their views about the service and the changes proposed under the social care change programme. The previous inspection identified that fire alarm bells were not being checked regularly to ensure that they were working properly. This has now been resolved and fire alarm bell tests and drills are occurring as required. Other safety checks have also been completed within the necessary timescales. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 37 8 (1) & (2) The registered providers, the 01/08/2007 Surrey and Borders NHS Trust, are required to inform the Commission in writing without delay of its plans for the management of the home. Care Homes for Adults (18-65 years) Page 23 of 25 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 1 20 It would be advisable to consider establishing a monitored dosage medication system. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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