Care Home: Whitley Farm Cottages

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What the care home does well Staff continue to encourage people to be independent and to make their own decisions wherever possible. This enables people living at the home to have control over their lives. Staff are respectful to people and sensitive in meeting their needs. This helps in making sure people living at the home receive care in the way they prefer. The way in which information is gathered and kept about people means staff can provide support in a way that people need and prefer. It also means staff have in depth knowledge and understanding about each individual person and so encourage them to develop skills and experiences safely. Although the care plans the home has in place, were cumbersome and a more user friendly way of gathering information would be more beneficial for staff working at the home. Surveys were sent out to relatives and staff. Some of the positive comments made were: “I did in the past speak to an inspector, but back then was different management. Now’s better.” “They look after each individual and they organise the trips to come and see me once a month, my relative looks much settled and content”. “Our relative is able to do more at Whitley Farm Cottage than they would at home with us”. “My relative seems to be very comfortable with their life at Whitley Farm and get on well with the staff”. “All service users have one to one support. All service users have choice of food, clothes and activities. All service users are kept very clean and tidy. All service users have regular dentists, GP if needed, foot care, optical care. All staff know service users very well”. “The staff on the floor provide an excellent service for service users, ensuring all their requirements are met in a professional and caring manner, ensuring dignity and privacy is maintained. Encouraging independence and respecting their cultural backgrounds. Also communicating in their own preferred language”.Whitley Farm CottagesDS0000064380.V378270.R02.S.docVersion 5.3 What has improved since the last inspection? All care plans seen had been reviewed and updated and now identify people’s needs and how they are to be met. Risk assessments have also been reviewed and updated as to how risks are minimised which are now recorded. The management of the home have ensured that everyone now receives appropriate healthcare and advice from health care professionals, which is also recorded in people’s care plans. At the last inspection the registered person was required to make sure the home had a robust safeguarding process. This had almost been addressed, although some recommendations were made at this visit as to how further improvements needed to be made. At the last inspection the registered person was required to make sure the home’s recruitment practices were robust. This had been partly implemented. Staff have received training in various key health and safety areas as well as some specialist training. The parking arrangements were addressed by the home. This has now improved and people have better access. What the care home could do better: Two written references must be obtained prior new staff commencing working at the home. This makes sure that unsuitable people are not employed to work with vulnerable people. Secondary dispensing from the monitored dosage system the home operates must stop as this is not considered a safe medication practice and could potentially put people’s health at risk. The current individual care plans should be looked at and re-organised to make them less cumbersome and more user friendly. This will help make sure that staff have all the up to date and current information to hand when assisting people with their care needs.Whitley Farm CottagesDS0000064380.V378270.R02.S.docVersion 5.3The home should obtain a copy of the Local Authorities Safeguarding protocols. This would help make sure that staff follow the correct safeguarding protocols at all times. This would make sure that in all situations, concerns are always reported appropriately and quickly. The use of a ‘monitor’ should be stopped and more appropriate methods to monitor people’s safety should be found, as this does not respect people’s dignity. The home should have an ongoing rolling programme of works which identifies re-decorating and re-furbishement. This will help make sure people live in a pleasant and reasonably decorated environment. The ‘locked gates’ at the front of the home should be reviewed in light of the recent legislation The Deprivation of Liberty Act and the necessary risk assessments and protocols are carried out that is required as part of this new legislation. This makes sure that people’s rights are not abused. Effective quality monitoring systems should be in place. This makes sure that people’s views are always sought and their best interests are met. Systems should be in place for the purpose of reviewing and developing the service further. Key inspection report CARE HOME ADULTS 18-65 Whitley Farm Cottages Doncaster Road Whitley Bridge Goole East Riding Of Yorks DN14 0HZ Lead Inspector Irene Ward Key Unannounced Inspection 7thDecember 2009 09:00 Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Whitley Farm Cottages Address Doncaster Road Whitley Bridge Goole East Riding Of Yorks DN14 0HZ 01977 663476 01977 663476 themtg.co.uk 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) Wholesbay Ltd. Manager post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th June 2009 Brief Description of the Service: Whitley Farm Cottages is owned by Mary Teresa Care Homes Limited and is registered to provide personal care and accommodation for up to 8 people with learning disabilities. The home is a large detached building and has 8 single bedrooms over two floors. There is a variety of communal space and five activity rooms. There is a private drive to the house with parking facilities for visitors and staff. Whitley Farm Cottages is situated in Whitley Village 10 minutes drive from Selby, where there are many amenities, local shops and a railway station. The home has a statement of purpose that explains information about the care and services on offer at the home. At the key inspection on 1st December 2009 we were given information that the fees ranged from £2238 to £2879 per week and extra charges are made for chiropody, hairdressing and newspapers. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the service has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This is what we used to write this report: We looked at information we have received about the home since it was registered. We asked for information to be sent to us before the inspection, this is called an annual quality assessment questionnaire (AQAA). We sent surveys to people who receive a service, relatives and to staff who work at the home. Two inspectors, one of whom was from the enforcement team visited the home. A management decision was made that this inspection should be announced rather than unannounced. This visit lasted over five hours and included talking to the owner, new manager and staff on duty about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. We looked at two people’s care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people who use the service. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The site visit took place on the 1st December 2009. The managing director, the homes psychologist and new manager were available to assist throughout the visit and available for feedback at the end of the inspection process. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 6 What the service does well: Staff continue to encourage people to be independent and to make their own decisions wherever possible. This enables people living at the home to have control over their lives. Staff are respectful to people and sensitive in meeting their needs. This helps in making sure people living at the home receive care in the way they prefer. The way in which information is gathered and kept about people means staff can provide support in a way that people need and prefer. It also means staff have in depth knowledge and understanding about each individual person and so encourage them to develop skills and experiences safely. Although the care plans the home has in place, were cumbersome and a more user friendly way of gathering information would be more beneficial for staff working at the home. Surveys were sent out to relatives and staff. Some of the positive comments made were: “I did in the past speak to an inspector, but back then was different management. Now’s better.” “They look after each individual and they organise the trips to come and see me once a month, my relative looks much settled and content”. “Our relative is able to do more at Whitley Farm Cottage than they would at home with us”. “My relative seems to be very comfortable with their life at Whitley Farm and get on well with the staff”. “All service users have one to one support. All service users have choice of food, clothes and activities. All service users are kept very clean and tidy. All service users have regular dentists, GP if needed, foot care, optical care. All staff know service users very well”. “The staff on the floor provide an excellent service for service users, ensuring all their requirements are met in a professional and caring manner, ensuring dignity and privacy is maintained. Encouraging independence and respecting their cultural backgrounds. Also communicating in their own preferred language”. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 7 What has improved since the last inspection? What they could do better: Two written references must be obtained prior new staff commencing working at the home. This makes sure that unsuitable people are not employed to work with vulnerable people. Secondary dispensing from the monitored dosage system the home operates must stop as this is not considered a safe medication practice and could potentially put people’s health at risk. The current individual care plans should be looked at and re-organised to make them less cumbersome and more user friendly. This will help make sure that staff have all the up to date and current information to hand when assisting people with their care needs. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 8 The home should obtain a copy of the Local Authorities Safeguarding protocols. This would help make sure that staff follow the correct safeguarding protocols at all times. This would make sure that in all situations, concerns are always reported appropriately and quickly. The use of a ‘monitor’ should be stopped and more appropriate methods to monitor people’s safety should be found, as this does not respect people’s dignity. The home should have an ongoing rolling programme of works which identifies re-decorating and re-furbishement. This will help make sure people live in a pleasant and reasonably decorated environment. The ‘locked gates’ at the front of the home should be reviewed in light of the recent legislation The Deprivation of Liberty Act and the necessary risk assessments and protocols are carried out that is required as part of this new legislation. This makes sure that people’s rights are not abused. Effective quality monitoring systems should be in place. This makes sure that people’s views are always sought and their best interests are met. Systems should be in place for the purpose of reviewing and developing the service further. 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. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 9 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 Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 can be confident that the home can meet their needs. This is because people are properly assessed before being admitted into the home. EVIDENCE: There have been no new admissions into the home since the last inspection. There continues to be four people who live at the home and one person who comes on respite care. The manager confirmed that if there was a vacancy people would be given the opportunity to visit the home and stay for a meal or for the day or overnight whatever they felt comfortable with if that was possible. The organisation’s managing director and the home’s new manager were aware however of the need for comprehensive pre admission assessments and explained that any such admission would be arranged via a planned introductory programme including visits to the home and a trial placement prior to this being made permanent. The assessment would be carried out by either the manager or registered provider or the psychologist who is employed Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 11 by the home. This makes sure that the home is able to meet the person’s needs. Records of two people showed that the home carries out detailed preadmission assessments when referrals are made to the home. They visit people and get information from relatives and other professionals to help them decide if they will be able to meet people’s needs before a place is offered. This is particularly useful for those people who have complex needs. The AQAA (Annual Quality Assurance Assessment) completed by the home states that: ‘ We recognise that communication is the key to any business and we have entered into a lengthy programme of staff development to ensure our staff are enabled and empowered to liaise with families,regulators,commissioners and social workers with tact, knowledge and accuracy’. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are supported to make their own choices about how they wish to live their lives. EVIDENCE: All the people in the home have a comprehensive care plan and there is evidence to show these are reviewed when necessary. Comprehensive daily records are also kept. Staff record for each part of the day morning, afternoon, evening and through the night. Each entry provides detailed information about what the individual did and what they ate how their mood was and how they interacted with other people in the home. This information is then used in the review process and allows the key worker to determine whether the care plan is sufficient. Health records indicated that the staff are good at requesting reviews of specialist services and asking for help when the Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 13 persons needs change. Staff were knowledgeable about the care plans and were able to discuss with inspectors what was actually reflected/written in people’s care plans. Staff said they involve the person and their relatives, where appropriate, in all reviews. The plans included information about the language and behaviours used by the people in the home to communicate. Staff were observed communicating effectively with all the people in the home and this allows people to make their own choice and decisions about their dayto-day activities. Although care plans are well documented the individual files for people were cumbersome and it was difficult to locate some information. In discussion the registered provider said they did not want any information to get lost and this is why they kept it all together in one file. The home may want to consider a more workable way of holding information about people. This could be improved by having one working care plan for staff to follow and any other information could be held separately on a second file. Everyone had up to date risk assessments in place in relation to their individual needs and their differing daily living abilities. These documents are reviewed regularly incorporating specialist assistance when necessary. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 14 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): This is what people staying in this care home experience: People using the 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 are encouraged to make decisions about their daily life. Staff provide appropriate support and encouragement for them to remain independent as possible. EVIDENCE: The case files of three people living at Whitley Farm Cottages were looked at. They all contained information about individual’s likes and dislikes. The introduction of the file shows a brief personal history and their interests, family connections. There was also a diary of planned activities over the week for each person. There are many varied activities happening throughout the week, which are appropriate to the needs, age and abilities of the people living at the home. Activities include personal shopping, walking, bike riding, Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 15 swimming, and bowling, playing squash, pool and golf. People are taken out on trips such as to theme parks. Daily records are kept and these identify each part of the day and what exactly happened with the person concerned covering all aspects of their life. We received three surveys from relatives and this is what they told us: When asked what does the service do well? They said, “I did in the past speak to an inspector, but back then was different management. Now’s better.” “They look after each individual and they organise the trips to come and see me once a month, my relative looks much settled and content”. “Our relative is able to do more at Whitley Farm Cottage than they would at home with us”. “My relative seems to be very comfortable with their life at Whitley Farm and get on well with the staff”. When asked what could the service do better? They said, “I would like the care worker to do more meetings to discuss about things in general. The last one was in august 2008. At least once a year, the rest of the place runs smoothly, better than when they first opened”. “I think they do their best”. “Just keep going and will get better”. When asked is there anything else you would like to tell us? They said, “When the home first opened they were smoking inside and outside the building, which was unhealthy but in 2007 they changed management and everything went right. I am quite happy since then. My relative does look happier. Thank you for sending me this questionnaire, it will be good if you could send me another one next year. Thank you very much indeed”. “They make mistakes like we do sometimes”. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal and healthcare is on the whole provided appropriately and sensitively according to individual needs although people’s health could be put at risk from staff making drug errors due to the secondary dispensing of medication. EVIDENCE: Each person living at the home is registered with a General Practitioner. People living at the home receive support from staff in attending dental and other health care service appointments. Everyone has a care plan, which details how they will be supported with their health care needs with additional step-by-step instructions as to how they wished to be supported. This also included people’s preferences as to whether they wanted a male or female member of staff to provide personal care for them. Daily record entries reflect the care that was being provided by staff at the home. Pontefract and Pinderfields Hospitals are Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 17 used for all Accident and Emergency services and most out patient’s appointments. The home operates a monitored dosage system (MDS). However in discussion with staff in how they administer medication it become clear that they are secondary dispensing. This means that medication from the MDS system is taken out and put into an unlabelled plastic container to give the person their medication. This is called secondary dispensing and is not considered a safe medication practice. This was discussed on the day with the home’s management team who agreed to cease the practice of secondary dispensing immediately. There is a policy in place for the storage and administration of medication for all staff working in the home to follow. The Medication Administration Records show that everyone receives their medication as prescribed. Records were up to date and well maintained. Medication seen in the home was securely stored in a locked cabinet. Controlled drugs are currently held. These were checked for one person and balanced. Two staff signs the controlled drugs book to say this medication had been administered to the person. All staff that administer medication in the home have been provided with medication training. The local pharmacist has recently audited the homes medication and was satisfied with everything. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns will be taken seriously. Although staff were clear as to what they must do if an allegation of abuse is made, a copy of the Local Authorities safeguarding protocols must be in place so that staff can refer to it at anytime. EVIDENCE: The home’s complaints procedure is followed and is made available to people and any other interested parties. Two complaints have been received by the home and one by the Care Quality Commission. One complaint was regarding the excess use of agency staff and the other was regarding the home having sufficient numbers of staff on duty. Both complaints received by the home, were both appropriately investigated. We looked at the staff rota during the inspection to determine if sufficient staffing levels were provided by the home. The owner agreed that there had been some difficulties with staffing levels due to a number of staff leaving and this has now been addressed by the home recruiting new staff. In discussions with staff they told us that where people are not able to verbalize staff observe their behaviours and body language to identify when someone was unhappy. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 19 There are policies and procedures with regard to safeguarding adults and the procedure to take if there is a suspicion of abuse and staff spoken to on the day demonstrated a good awareness of this. Although there were two policies in place for staff to follow. We discussed this at length with the management of the home as this could be confusing for staff. One of the policies stated that if a staff member is accused of abuse that the management would ‘consider’ suspension. The managing director from the organisation said that staff would always be suspended. It was agreed that there should only be one policy, which should be changed to reflect this as it is to safeguard the staff member also. Staff had recently received training in adult protection and safeguarding issues. There have been three allegations regarding safeguarding made to the Care Quality Commission since the last inspection. All had been referred to the appropriate agency. The home did not have a copy of the Local Authorities Safeguarding protocols and were advised to get a copy. Peoples finances were discussed and checked with senior staff on duty. Monies checked did not balance this was discussed with the manager at the time. Receipts are obtained for all purchases made. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 live in a spacious, homely and clean environment. However the use of a listening device such as a ‘baby monitor’ should be removed as this is not in the best interest of people living at the home. EVIDENCE: Accommodation is over two floors and each bedroom has either an en-suite shower or bathroom. There is ramped access to the home to assist people with mobility problems to enter and leave the home, although access between floors is by stairs only. During the tour of the premises a ‘baby monitor’ was seen in one of the lounges. When discussed with the manager it came to light that this was being Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 21 used for one person who lives at the home. This had been introduced as a safety measure to alert another staff member when needed. We were told that this was a temporary measure whilst the person was temporarily incapacitated. Inspectors informed the management that good practice dictates that any listening devices should not be used as this does not respect the person’s dignity and other safety means should be looked at. The managing director said that additional staffing was already in place at night and agreed to remove the monitor. People have plenty of communal rooms to use. There is a lounge, dining room, conservatory, sensory room and activities room. The activities room is used for recreational purposes but also has kitchen facilities and a computer. The home was clean, tidy and free from any offensive odours. The home has a garden with furniture and seating so that people can sit outside if they want to. People have plenty of communal rooms to use. There is a lounge, dining room, conservatory, sensory room and activities room. The activities room is used for recreational purposes but also has kitchen facilities and a computer. The environment is reasonably well maintained although some areas are ready for decorating, as there was some damage to walls in the dining room and in the hallway. Two of the sofas one in the lounge and one in the conservatory had damaged arms. The owner said that this had only recently occurred. The home has entrance gates that are fitted with security locks to promote people’s safety and there is a driveway to the house with car parking. This is a busy area and the amount of car parking space that is available is very limited. We made a recommendation at the key inspection in July 2007 to look at parking because it could affect access to the home for people working at the home, relatives and emergency services. The parking has now been addressed. However in discussion with the management team we requested that the management look at this area of ‘locked gates’ in light of the recent legislation The Deprivation of Liberty Act and carry out the necessary risk assessments and protocols required as part of this new legislation. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported on the whole by staff that are sufficient in numbers and have now had the necessary training. However people who live at the home are potentially put at risk because of the lack of rigorous recruitment procedures being followed by the management of the home. EVIDENCE: Staffing levels on the day of the site visit were excellent for meeting the needs of people. The duty rota showed that people either have one to one staffing or two to one depending on individual support that people need both through the day and at night. This also makes sure that people’s social activities are not compromised. However it was noted that on some days on the rota for that week only two staff were on duty. The new manager gave assurances that these gaps in the rota would be filled and the appropriate level of staff would be covered on each shift. The manager was asked to ring inspectors the following day to confirm that this had been done and that the rota had been covered. The manager rang the following day with the details we asked for. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 23 The organisations managing director said that they had recently experienced difficulty with staffing levels as several staff had left and the home had to employ agency staff or redeploy staff from within the company. We were informed that this has been resolved through a recent recruitment drive and several staff had been employed. The AQAA (Annual Quality Assurance Assessment) completed by the home states that: ‘We have appointed a new service manager, 4 senior support workers and 5 support workers. During acute staff shortages we have redeployed staff from within the company to ensure continuity of care. The advantage is that staff from within the company are aware of policies and procedures that are similar across the company and hence provide more homogenous care as compared to the agency staff. We have appointed a full time group medical director and a part time psychologist, both with specialist experience in Autism and Learning Disability.’ The staff records of three staff were looked at all of which were recently appointed. These showed that only one staff member had most of the necessary pre-employment checks carried out prior to the new worker starting in post. This included a completed application form and two written references. A CRB (Criminal Records Bureau) check had not been obtained for any of the newly recruited staff. The three recent recruits had started work on an ISA Adult first check as the home has had severe staffing problems. The other two staff files did not hold two references. One was faxed through to the home on the day we were there. This was discussed with the owner and the manager, that staff should not commence working in the home without any references being obtained first as this, could potentially put people living at the home at risk. The home should always make sure that they are not employing unsuitable people to do the job. The staff have received a wide range of training over the last two months. A lot of this was generic such as fire, first aid, moving and handling, food hygiene and safeguarding but specialised training from the Autistic society had been provided. Staff were very appreciative of this and one staff member said, “The training was excellent, I feel I have really benefited and have a better understanding of the service users needs.” We received five surveys from staff some of which were positive. These are some of the comments staff made when asked what does the home do well? “The clients are not mistreated”. “All service users have one to one support. All service users have choice of food, clothes and activities. All service users are kept very clean and tidy. All service users have regular dentists, GP if needed, foot care, optical care. All staff know service users very well”. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 24 “The staff on the floor provide an excellent service for service users, ensuring all their requirements are met in a professional and caring manner, ensuring dignity and privacy is maintained. Encouraging independence and respecting their cultural backgrounds. Also communicating in their own preferred language”. “Making sure all the clients’ needs are met accordingly to care plans. 1-1 support for service users. Training provided.” When asked what could the home do better? Staff made the following comments: “Have staff trained proper. Employ more staff instead of having majority of agency. Be willing to do what is best for our clients. Team leaders don’t even have the right training or NVQ’s to do their jobs correctly”. “Better rates of pay. Service users and staff should eat the same meals, sometimes this causes behaviours when staff are eating what service user wants”. “Work more as a team and hire more staff, make it friendly”. Staff spoken to on the day said that currently staff morale was low. We spoke to the managing director about this who said that she felt that the morale in the home would get better now they have employed a new manager and some new staff. This would benefit people living at the home as some of the staff had been unhappy because changes had been made to their working hours. Staff had previously worked long days/hours so that they would have several days off together. This had been changed when the managing director realised this and a number of staff then left. We agreed that to build up staff morale would take time. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home overall, meets the needs of people living at the home. Some further developments are needed regarding the management of the home. This is so that everyone including staff, benefit from good leadership and a clear management structure which operates in the best interests of people living there. EVIDENCE: The home has a new manager who has not been in post very long and is to apply to be registered with the Commission. The home has had several changes regarding managers and staff. This has contributed to the low morale felt by some staff and because there has been a lack of a consistent staff team Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 26 the home has undergone difficulties in providing a stable environment. However the managing director said she had been based at the home until the employment of the new manager. The new manager said that he hoped with time this would change and improvements would be made especially now they have a new staff team. Both the manager and the managing director recognised that work needed to be done in achieving this. The home needs to foster an atmosphere of openness and respect to ensure that people’s needs and best interests are always met. People living at the home, family and friends and staff should feel valued and that their opinions matter. Because of the high staff turnover there was little evidence that the home had carried out any quality monitoring i.e. surveying people about the service and so on. Both the owner and the manager were advised that when the new management structures had been put into place then they needed to implement the homes quality monitoring systems to ensure that people living at the home, relatives and other interested parties are satisfied with the service. Regular staff meetings continue to be held. Comments received from relatives were all positive such as: “Our relative is able to do more at Whitley Farm Cottage than they would at home with us”. “My relative seems to be very comfortable with their life at Whitley Farm and get on well with the staff”. All accidents are recorded as required and an accident book is maintained in line with the requirements of Data Protection. One person’s money was checked at this site visit. The person’s money did not balance although it was more than stated on the balance sheet. This was discussed with the manager who said that people’s monies are checked regularly. The managing director said that the home employs an accountant who also checks finances regularly. Information provided from the (AQAA) Annual Quality Assurance Assessment and the examination of selected health and safety documents show that regular checks to electricity, oil and fire safety equipment are regularly undertaken. Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Version 5.3 Page 28 Whitley Farm Cottages DS0000064380.V378270.R02.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 19 Requirement Two written references must be obtained before staff commence working in the home. This makes sure that unsuitable people are not employed to work at the home. Secondary dispensing of medication must cease as this is not considered a safe medication practice. Timescale for action 30/01/10 2. YA20 13 30/01/10 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 YA6 Good Practice Recommendations The current individual care plans should be looked at making them less cumbersome and more user friendly. The home should obtain a copy of the Local Authorities Safeguarding protocols. This will help make sure that staff follow the correct safeguarding protocols at all times. 2. YA23 Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 29 3. 4 YA24 YA24 The use of a ‘monitor’ should be stopped and more appropriate methods to monitor people’s safety should be found. The home should have an ongoing rolling programme of works which identifies re-decorating and re-furbishement needed in the home. This will help make sure people live in a pleasant and reasonably decorated environment. The ‘locked gates’ at the front of the home should be reviewed in light of the recent legislation The Deprivation of Liberty Act and the necessary risk assessments and protocols be carried out as required as part of this new legislation. Effective quality monitoring systems should be in place. This makes sure that people’s views are always sought and their best interests are met and for the purpose of reviewing and developing the service. 5 YA24 6. YA39 Whitley Farm Cottages DS0000064380.V378270.R02.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. Copyright © (2009) Care Quality Commission (CQC). 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. 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