CARE HOME ADULTS 18-65
3 Pendarves Road 3 Pendarves Road Camborne Cornwall TR14 7QB Lead Inspector
Lowenna Harty Unannounced 23 June 2005 09:30 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 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 Stationary 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. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 3, Pendarves Road Address 3, Pendarves Road Camborne Cornwall TR14 7QB 01209 610827 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Spectrum Care Home 3 Category(ies) of Learning Disability (3) registration, with number of places 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20 December 2004 Brief Description of the Service: 3 Pendarves Road is a care home home providing accommodation and care for up to three adults with a learning disability. The registered provider is Spectrum, an organisation that provides specialist services for people with Autistic Spectrum disorders. Spectrum employs a manager and a team of staff to run the home on a day-to-day basis. External, on-call managers are available to provide specialist input, support and advice where necessary.The home is located in the town of Camborne, within easy reach of all the facilities of a small town. There are shops within walking distance of the home and the home has a vehicle to provide transport for service users who need to access resources in the wider community.The home is a two-storey building. All of the bedrooms are single rooms. One has its own lounge and separate bathroom. There is a shared bathroom for the other upstairs bedrooms. Upstairs there is an office that also functions as sleeping in accommodation for staff. Downstairs there is a communal kitchen with dining area and two lounges. The home is set in its own grounds. There are front and rear access points and the home could be readily addapted to meet the needs of people with physical or sensory disabilities if necessary. There is a separate laundry area in which service users are able to do their own laundry. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection as part of the home’s annual inspection programme on 23 June 2005. The inspection lasted for approximately five hours and consisted of the following activities: 1. Inspection of records, including assessment information and care plans 2. Discussion with the person in charge of the home on how it operates on a day-to-day basis 3. Inspection of the building 4. Interview with a member of staff 5. Individual interviews with two of the residents. One was conducted in private and face-to-face and one was conducted in private via the telephone. 6. Observation of the daily life of the home. Overall the standard of care and services provided to residents is good and improving. The inspector would like to thank the residents, registered manager and staff for their kind assistance in the conduct of this inspection. What the service does well:
3 Pendarves Road is a spacious, detached home that is well located to provide residents with access to the nearby town. It is near to shops and public transport services and other public amenities. The home is safe, clean and well decorated inside. It is comfortably furnished and has a large garden so that residents can enjoy a homely environment in which they can develop their skills and independence. The home provides a stable environment for the residents currently living there. New residents are only admitted on the basis of the home’s manager having sufficient information about them to be sure that their needs can be met. Residents are fully involved in most aspects of the running of the home that affect them. They are invited to help in developing their care plans and are helped to take risks in a safe way so that they can try out new things and learn new skills. They are able to take part in a broad range of activities if they wish and are encouraged to take decisions about how they occupy their time. They are helped to maintain relationships and
3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 6 friendships with their families and others from outside of the home depending on their individual circumstances. Residents have good access to the personal and healthcare support they need so that they are able to maximise their independence and stay healthy. They are able to make their views known to staff and assisted to make use of the home’s complaints procedure when they wish to. They are encouraged to take part in all the routines of running the home so that they can achieve their full potential, but with support from staff so that they do not feel unduly pressured. This includes helping out with household tasks and shopping and assisting with the routine safety checks, for example. The home has a small staff-team. Staff recruitment is fair, safe and effective to ensure that they are safe and fit to be employed in a care setting. Staff have good access to ongoing training so that they can develop their skills to work more effectively with the residents. What has improved since the last inspection? What they could do better:
There was one outstanding requirement, in respect of Spectrum’s management of residents’ medication. This has been re-notified with an extended time scale because Spectrum is in the process of updating its written policies and procedures to guide staff following an inspection of two of its homes by the Commission’s pharmacy inspector, and needs further time to fully implement
3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 7 necessary changes across all its services. The home’s previous manager, who was registered with the Commission as a fit person to manage the home has left and the person currently in charge of the home needs to make an application to be formally registered so that service users and their representatives can be fully confident that the home is being managed by a suitable person. The new manager needs to introduce a system of formal staff supervision with records kept so that service users benefit from a wellsupported and professionally supervised staff team. This should link to a formal professional review or appraisal scheme so that staff can work towards achieving specific goals that will result in an improved service for the residents. Although senior managers from Spectrum visit the home on a regular basis, they need to ensure that reports of their visits to monitor the quality of the service are sent to the Commission on a monthly basis to ensure ongoing external monitoring of the management of the home for the benefit of the residents. The outside of the building should be redecorated and the window frames re-painted. This is strongly recommended in light of the fact that both the residents interviewed during the inspection requested that this is done so that they can feel better about living in the home. One of the residents requested the re-introduction of house meetings as an additional forum in which they could discuss any issues or concerns with staff and other residents. There was also a request that residents should be provided with a hot meal alternative to the main evening meal if they do not like what is being cooked. Whilst residents are well protected from harm and abuse the home’s written guidance for staff should be updated in line with current best practice and they should have access to training so that they are fully confident of the actions they need to take if they suspect a resident has been abused. Spectrum should also update its written guidance for staff handling residents’ money to ensure that they are clear about their responsibilities in this respect. Finally, the home’s annual development plan should be shared with residents and their representatives so that they can continue to provide an active input to the ongoing improvement of the service. 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. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home has satisfactory pre-admission information on residents to ensure their needs can be met. EVIDENCE: Two of the residents have lived at the home for several years. Copies of their initial assessment information are held on their files, with their most recent care plans and risk assessments as a record of the progress they have made and their achievements whilst at the home. The home has appropriate information pertaining to a resident who was more recently admitted, from another Spectrum home and an interim care plan. The home’s statement of purpose contains information on the admission procedure and confirms that residents undergo detailed pre-admission assessments to ensure the home is suitable to meet their needs. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Residents assist in drawing up care plans, which are regularly reviewed, reflect their views, their individual achievements and set goals to enable them to maximise their skills. They have opportunities to make decisions about their lives although one resident had a suggestion for an improvement in this. Residents are helped to take appropriate risks towards developing their skills in independent living. EVIDENCE: Residents have individual care plans, which focus on their achievements, aspirations and goals. They are reviewed at least once every six months and residents are invited to attend and sign them as evidence of their participation and agreement. Their care plans are detailed and thorough and consider all aspects of their health, social and personal support needs. Care plans are linked to individual risk assessments, which are similarly detailed. Detailed daily care records are kept where appropriate, to inform care planning and reviews of risk assessments. Residents’ abilities to make informed decisions are considered as part of the care planning process and they are encouraged to develop these skills appropriately and safely although one resident said that they would like there to be more regular house meetings. There was written
3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 11 evidence that residents have made significant achievements since the previous inspection, which has involved them taking risks with encouragement from staff. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13. 15, 16, 17 Residents take part in a wide range of activities to suit their needs and aspirations, including activities in the local community. They are encouraged to maintain relationships with families and friends outside the home. Their daily routines reflect their rights and responsibilities. Meals are generally satisfactory although residents should be provided with a greater degree of choice over their main meals. EVIDENCE: Residents choose and plan their activities individually with staff on a weekly basis. Their care plans set out their interests and preferences and consider their cultural backgrounds. Their daily care records list the activities they have been involved in and these were confirmed in individual interviews with staff and residents and observations made during the inspection. At the time of the inspection one resident was returning from a home visit. There are records of residents’ contacts with relatives. They are able to make and receive telephone calls in private. They are able to come and go from the home independently and develop friendships and relationships from outside of the home according to their individual abilities and risk assessments. Spectrum’s senior managers
3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 13 provide specialist support and advice, where necessary for residents and staff, with regard to helping them to develop appropriate relationships and friendships with people outside of the home. Residents are encouraged to be fully involved in the day-to-day running of the home and participate in household tasks to develop their skills in independent living. They have the option of locking their bedroom doors and their privacy is respected. There are records of meals provided to them, which are nutritious and varied. Currently they are able to take turns in choosing the main course for the evening meal, which is their main, cooked meal for the day. Residents’ food likes and dislikes are recorded and respected but one resident requested that there should be an option of an alternative, cooked meal available in case they do not want what is on offer. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Residents’ personal support and healthcare needs are fully considered and appropriately met. The home’s policies for dealing with medicines need to be improved. EVIDENCE: Residents are encouraged to maximise their skills and independence with regard to their personal appearances, hygiene and self-care. They were all individually and fashionably dressed at the time of the inspection and the home has suitable facilities to ensure their privacy with regard to maintaining their grooming and personal hygiene. Bathroom doors are lockable and suitable guidance is provided to residents who require it. Their written care plans appropriately reflect their personal care skills and support needs. Residents’ individual files provide evidence that they are helped to access a range of NHS healthcare providers and their care plans reflect their individual physical and emotional healthcare needs. Spectrum is in the process of updating its written guidance for staff managing residents’ medication following a recent inspection of two of its properties by the Commission’s pharmacist inspector. This work needs to be completed to ensure that residents are fully protected from medication errors. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 There are satisfactory systems in place for listening to residents’ views and appropriate action is taken. Systems for ensuring residents are fully protected from abuse, neglect and self-harm would benefit from some improvements. EVIDENCE: The home has an easily accessible written complaints procedure, which residents are familiar with. They are assisted to use it appropriately and full records are kept of any complaints they have. Residents were able to talk to the inspector in private during the inspection. The home’s written policy for the protection of vulnerable adults from abuse needs to be reviewed. Spectrum should also obtain copies of the written procedures for multi-agency working to protect vulnerable adults from the local authority in which the home is located and from the placing local authorities of each of the residents and make sure they are readily available for staff to ensure they are confident of what to do should they suspect that a resident has been abused. Staff should also have access to multi-agency training on the prevention of abuse of vulnerable adults to complement the in-house training they receive from Spectrum. Written procedures in respect of staff handling residents’ money should be reviewed and updated so that staff and residents are clear about what is expected of them and there is a clear audit trail for residents’ personal finances. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Residents have a comfortable and safe home although some specific improvements could be made to improve the quality of their environment. The home is clean and hygienic throughout. EVIDENCE: The home looked spacious and comfortable inside although the exterior of the building needs to be redecorated and both the residents interviewed requested that this should be done. Some of the window frames need to be re-painted also. Inside, the home looks well decorated, is comfortably furnished and well equipped to provide residents with a homely, independent lifestyle. There are written policies and procedures to ensure staff know how to keep the home safe and they are provided with access to suitable training in this respect. There are records of safety checks and written risk assessments in respect of fire and environmental safety. The home looked clean and tidy throughout at the time of the unannounced inspection. There is suitable equipment provided to ensure that staff and residents are protected from risks of cross-infection. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 & 36 Residents are protected by a staff recruitment practices that are fair, safe and effective. Residents benefit from a small, well trained staff team although systems for formally supervising them need to be set up. EVIDENCE: Spectrum has invested in a computerised record system that ensures that personal information relating to staff is both securely stored and available to the managers of the homes they work in. All the information needed to reassure managers that the home’s staff are suitable to work there is now available to them. This includes records of the training they have done. Staff have good access to training and are encouraged to achieve training to a minimum of NVQ level 2. They all undergo induction training at Spectrum’s head office prior to commencing work in the home. The home’s new manager needs to set up formal individual supervision sessions with his staff team. These should be linked to a formal appraisal system so that staff training, development and professional objectives clearly relate to the best possible outcome for the residents and are subject to ongoing review. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 42 & 43 The home’s current systems for monitoring and reviewing the quality of the services it provides to residents would benefit from some improvement. Residents’ health, safety and welfare are well protected. The home is mainly well managed for the benefit of the residents although some improvements are needed to ensure this. EVIDENCE: Residents are able to state their views through their active involvement in their individual care planning reviews. They can also access the home’s complaints procedure. The home’s previous manager completed an annual development plan for the home that includes residents’ views and costs. This should be shared with staff, residents and their representatives. Whilst there are records in the home to prove that Spectrum’s senior managers visit the home regularly, they should send monthly updates to the Commission as evidence that quality is monitored on an ongoing basis by the organisation. A manager who is registered with the Commission needs to be appointed so that residents
3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 19 and their representatives can be confident that they are a fit person to be in charge of the home. 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 4 4 x 4 3 2 Standard No 31 32 33 34 35 36 Score x x x 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
3 Pendarves Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 2 D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 21 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 20 Regulation 13(2) Requirement The registered person must make suitable arrangments for the recording, handling, safekeeping, sare administration and disposal of medicines received into the home. This requirement is re-notified. The timescale for action has been extened from 31/03/05 because Spectrum is currently taking advice from the Commissions pharmacist on improving its written policies and procedures for medicines and needs additional time to ensure full compliance in light of this. There must be recorded evidence that staff are appropriately supervised. The registered provider must send monthly reports to the Commission in accordance with this regulation. The registered provider must appoint a registered manager to undertake the day-to-day running of the home. Timescale for action 01/08/05 2. 3. 36 43 18(2) 26(5)(a) 01/08/05 01/08/05 4. 43 8(1) 01/10/05 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 22 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. 2. 3. 4. Refer to Standard 7 17 23 23 Good Practice Recommendations There should be regular house meetings for residents with records kept, subject to their agreement. Residents should be provided with a choice of a hot meal alternative if they do not wish to have the main evening meal provided. The homes written procedures for the protection of vulnerable adults from abuse should be reviewed and updated. Copies of the local authority multi-agency procedures for the protection of vulnerable adults from abuse should be held in the home, together with the procedures of each of the service users placing authorities. Staff should be provided with access to local multi-agency training on the prevention of abuse of vulnerable adults. The homes written procedurs for the handling of service users money should be reviewed and updated to provide clear guidance for staff and a satisfactory audit trail in respect of service users personal money. The outside of the building should be redecorated and window frames re-painted. A system of staff appraisal should be introduced. The homes annual development plan should be shared with staff, service users and service users representatives. 5. 6. 23 23 7. 8. 9. 24 36 39 3 Pendarves Road D52-D04 S9115 3 Pendarves V232860 230605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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