Care Home: Valley House

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What the care home does well Valley House is located in an idyllic setting within the grounds of a vineyard close to the rural village of Barham. The house is well decorated and furbished providing a comfortable and homely atmosphere. Service users have the benefit of a very active lifestyle that revolves around occupational activities in the pottery, tea rooms and vineyard on site and the organisation`s day centre in a neighbouring village. There are further opportunities explored in the local community such as voluntary work and college courses. Service users also stated that they partake in a lot of leisure activities supported by staff. Residents are supported to develop their independent living skills with an acknowledged goal for many to move on to more independent living. Service users are responsible for cleaning duties, the up keep of their own personal needs and the preparation of meals and are offered staff support as required in these tasks. Health and safety issues in the home are well maintained with all safety certificates reviewed as required. Staff receive a good training package including opportunities to progress through National Vocational Qualifications and all mandatory training and service specific courses. What has improved since the last inspection? The home has addressed all requirements and recommendations made at the last inspection. Service user plans and risk assessments have been reviewed and updated providing a good summary of needs and clear, detailed actions to enable staff to suitably support resident`s individual needs. Medication processes have also been reviewed and all records were well maintained and up to date. Staff receive regular supervision and staff members spoken to stated that they feel well supported by the management of the home. There have been no new admissions to the home since the previous inspection, but the manager has reviewed pre-admission assessment processes, which are suitably detailed. The staff in the home have received training in adult protection issues and addressing the Mental Capacity Act 2005. The Service Users Guide has been updated and improved and a copy is provided to all prospective service users and their families. What the care home could do better: One recommendation has been made as result of this inspection process that relates to the review of the employment application form to ensure that a full employment history is gained prior to appointment and any gaps explored. The manager states within the AQAA and through discussion that she has plans for further development in a number of aspects of service delivery including reviewing documentation to improve accessibility for service users. CARE HOME ADULTS 18-65 Valley House Elham Valley Vineyard Breach Canterbury Kent CT4 6LN Lead Inspector Joseph Harris Unannounced Inspection 29th August 2008 10:30 Valley House DS0000023287.V370877.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 Valley House DS0000023287.V370877.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. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Valley House Address Elham Valley Vineyard Breach Canterbury Kent CT4 6LN 01227 832230 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) Family Investment (Five) Ltd Annette Norton Care Home 8 Category(ies) of Learning disability (0) registration, with number of places Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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 category: 2. Learning Disability (LD) maximum number of places 8. The maximum number of service users to be accommodated is 8. Date of last inspection 6th September 2006 Brief Description of the Service: Valley House provides residential care for up to 8 adults with a learning disability. It is situated in the beautiful rural setting of Elham Valley vineyards. There are no amenities in the immediate area, but the small village of Barham is a few miles away. Buses provide links to Canterbury and Folkestone. A small parking area is available at the home with further parking nearby. The home is owned and managed by Family Investment Limited. The families of residents buy shares in the company. Family Investment Limited also operate a pottery and tearoom on the same site. The home is on two floors. It has been extended to provide two additional ensuite rooms and has eight single rooms with en-suite facilities. There is a bathroom with toilet and shower facilities on the second floor and a shower room for visitors on the ground floor. The communal space consists of a main lounge and dinning room. The current fees are £506.78 per week. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection process culminated in a site visit to the home on 29th August 2008. The site visit commenced at approximately 10.30am and concluded at 3.30pm, lasting for around 5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the registered manager, staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: Valley House is located in an idyllic setting within the grounds of a vineyard close to the rural village of Barham. The house is well decorated and furbished providing a comfortable and homely atmosphere. Service users have the benefit of a very active lifestyle that revolves around occupational activities in the pottery, tea rooms and vineyard on site and the organisation’s day centre in a neighbouring village. There are further opportunities explored in the local community such as voluntary work and college courses. Service users also stated that they partake in a lot of leisure activities supported by staff. Residents are supported to develop their independent living skills with an acknowledged goal for many to move on to more independent living. Service users are responsible for cleaning duties, the up keep of their own personal needs and the preparation of meals and are offered staff support as required in these tasks. Health and safety issues in the home are well maintained with all safety certificates reviewed as required. Staff receive a good training package including opportunities to progress through National Vocational Qualifications and all mandatory training and service specific courses. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Quality in this outcome area is good. Prospective service users are provided with all the information required to make an informed decision about moving into the home. Individual needs and expectations are assessed during the referral process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and service users guide in place covering all required information. These documents have been reviewed in the past 12 months. The manager is currently reworking a number of documents to improve their accessibility for service users to include simpler terminology, signs and images. She stated that she plans to extend this to the service user guide and related information. No new service users have been admitted into the home for a number of years, but it was reported that key information is discussed with residents and family members where appropriate. The home has clear and detailed pre-admission assessment processes in place that involve liaison with care managers, family and the prospective service users themselves. Background information is obtained as well as copies of care management care plans and risk assessments. The home completes an inValley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 9 house assessment form covering all aspects of healthcare needs and support issues. Referral criteria are in place and adhered to. No new admissions have been received by the home since the last inspection. A clear contract of terms and conditions of residency is in place, which has been reviewed and updated to include fees and other essential information. A signed copy of the contract is retained on file. The contract is signed by a representative of the service user where understanding and capacity is impaired. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 10 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 and 9. Quality in this outcome area is good. The care and support needs of each individual is clearly planned for and risks assessed. Service users are able to make decisions affecting their day-to-day lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two service user individual files were examined both of which contained support plans tailored to specific needs. The plans were well organised and covered a wide range of issues and support requirements. The plans are reviewed on a regular basis and residents are involved as far as possible in their development. Actions and guidance are set out to enable the staff team to consistently meet the assessed needs. Both residents concerned were spoken to by the inspector and staff were able to demonstrate that they had a good understanding of the individual and collective needs of the service users. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 11 Risk assessments have also been developed in a positive and enabling way. These assessments promote responsible risk taking and focus on ways in which staff can support residents to continue to engage in chosen activities. The risk management plans are reviewed on a regular basis and updated as required. Residents are enabled to make decisions affecting their day-to-day lives including control over choice of activities, leisure pursuits and finances. A number of the service users are working towards living in more independent settings and, to this end, are supported with daily living skills such as budgeting, cooking and transportation amongst other things. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. All service users are able to have a diverse and meaningful lifestyle with support. Residents are assisted and encouraged to take responsibility for their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have an extremely varied and active lifestyle that provides a range of opportunities on a daily basis. These opportunities range from working in the teashop and pottery within the grounds to picking the grapes in the vineyard and attending the organisations own day centre located in a nearby village. Every resident spends one day per week in the home to attend to personal and household chores providing the chance to develop independent living skills with close support from staff as required. Residents are also encouraged and assisted to find gainful employment if this is a personal goal Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 13 including paid and voluntary work. Some service users attend college courses and residents said that they also take public transport into Canterbury when they want. The goal for a number of residents is to move towards a more independent lifestyle therefore structures and routines are built into the activity programme, but there is flexibility within this as required. One resident was able to stay at home because he had felt ill on the previous evening. Another resident was working in the tea rooms and showed the inspector the cakes that she had baked that day along with other produce made by residents that was for sale. One resident was keen to stress that people have a lot of fun both during the day and when there is free time saying that he goes to the cinema, swimming and bowling amongst many other things. One relative was spoken to who had high praise for the quality of the home, the staff and the way his son had been helped since he had lived at Valley House. He said, “I remember when we first visited, this was the only place we wanted and it was an excellent decision.” Residents work with staff to plan, shop for and prepare meals. Each person takes turns to cook meals with staff support promoting independent living skills. Residents have a healthy and balanced diet and meals are taken in a convivial atmosphere. Mealtimes are considered to be a social time and are reportedly relaxed and unhurried. Residents said that the food in the home is good. The home uses local, good quality produce where possible. The kitchen is well appointed and domestic in size. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. Service users personal and healthcare needs are met. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The vast majority of service users require minimal support with meeting personal needs and staff mainly provide encouragement to assist. Support plans clearly identify preferences and the level of assistance required. Service users independently stated that the staff are helpful and supportive. The home maintains clear healthcare records detailing information about appointments and consultations and the outcomes of these visits with actions required to be followed up in the home. Each resident is registered with a local GP and it was reported that the home receives good support from the local community learning disability teams and care managers from further a field. Complimentary healthcare needs are also met including chiropodist, dentist and optician appointments. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 15 Medication systems were examined and advice from the previous inspection has been taken on board and addressed. Medication Administration Charts are well maintained and complete. Storage facilities are suitable for the needs of the home and records are maintained of all received, returned and destroyed medication. Staff have all received appropriate medication training to their roles. Policies and procedures are in place addressing all aspects of the medication process. A number of service users have been supported to become self-medicating and risk assessments are completed relating to this. The manager was advised to introduce a periodic skills assessment for selfmedicating service users to provide evidence that abilities in this area have been maintained or improved. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. Service users views are listened to and acted upon and they are protected from forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received in relation to the home and no Safeguarding Adult referrals have been made since the last inspection process. A complaints process is in place, which is displayed and included in the service user’s guide. The manager stated that the home aims to address any concerns or complaints on an informal basis in the first instance. This is managed through one to one meetings and resident meetings, however should this prove unsatisfactory then there is recourse to the formal complaints process. Policies and procedures are in place relating to all aspects of protection from abuse and adult protection protocols. Staff have received training covering these topics and have recently had further instruction on the Mental Capacity Act 2005, which is pertinent to the service users living in the home. Discussion with the manager and staff on duty demonstrated that there is a good understanding of the issues that impact on residents in this regard. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The premises meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Valley House is located in the rural village of Barham in the grounds of a working vineyard. There is parking available outside the house and further spaces nearby. The house itself is set over two floors and is decorated to a good standard throughout. All bedrooms are single occupancy with en suite facilities. The rooms have been personalised according to individual taste. There are conveniently situated toilets throughout the building. The residents have two main communal areas consisting of a large and comfortable lounge and a substantial dining room. Service users spoken to stated that they like the house and grounds. One resident showed the inspector his room and saying, “It’s a nice room, I really like it.” Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 18 The kitchen and laundry areas are domestic in size and suitable for the needs of the home. The house is kept to a high standard of cleanliness with staff and residents responsible for cleaning. Universal infection control measures are in place and adhered to. All hazardous substances are stored appropriately. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 19 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 and 35. Quality in this outcome area is good. There is an effective and well trained staff team. Recruitment processes are appropriately managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff in the home have been supported to achieve National Vocational Qualifications in care. 2 staff members amongst a team of 6 have gained NVQ level 3 and 2 have completed level 2. The remaining members of staff have been enrolled on NVQ level 2 courses. The senior support worker is planning to work towards his NVQ level 4 in the near future. New staff work through the Common Induction Standards and the homes own induction programme. All staff complete mandatory training within the first 6 months of employment. The staff training matrix was examined and crossreferenced against certificates held within staff personnel files evidencing that training schedules are up to date. Staff complete updates and refresher Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 20 courses as required. Additional training is provided including adult protection, mental capacity act and other service specific topics. 2 staff recruitment files were examined both of which contained all the required information including CRB checks, two references and proof of identity. It was suggested to the manager that the application forms should be reviewed to ensure that a full employment history is gained prior to appointment. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. The home is well managed in the best interests of the service users. Health and safety issues are addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for approximately 3 years and is registered with the Commission for Social Care Inspection. She has achieved the required qualifications and has substantial experience in the field of learning disabilities. Staff, service users and visitors commented positively about her management style and effectiveness in her role. In discussion with the inspector she demonstrated a good understanding of the needs of the home, staff and Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 22 service users. She has also introduced and developed improved processes in the service covering a range of topics. Quality assurance issues are addressed on an on-going basis. Service users have opportunities to provide feedback about the service through surveys once a year and continually through 1:1 meetings, resident meetings and informal discussions. Directors of the service visit the home on a monthly basis to complete Regulation 26 monitoring visits. The directors are made up of family members of the service users. The manager audits key aspects of the service on a regular basis and the home keeps the Commission for Social Care Inspection informed of issues and occurrences of note. A range of health and safety documentation was examined including service safety and maintenance certificates, environmental risk assessments and policies and procedures. All information in maintained in an orderly fashion, was up to date and complete. Fire safety logs are well maintained and accident reports completed. All staff receive mandatory and induction training in accordance with current guidance. Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X 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 3 X 3 X 3 X X 3 X Valley House DS0000023287.V370877.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA34 Good Practice Recommendations To review employment application forms ensuring a full employment history is obtained and explored prior to appointment. 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