Inspection on 14/02/06 for 40 Spiders Island

This inspection was carried out on 14th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

40 Spiders Island 15/07/09

40 Spiders Island 03/07/07

40 Spiders Island 12/09/06

40 Spiders Island 22/07/05

40 Spiders Island 01/02/05

40 Spiders Island 07/05/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Spiders Island (40) Grimstead Road Whaddon Salisbury Wiltshire SP5 3BG Lead Inspector Alison Duffy Unannounced Inspection 14th February 2006 10:05 Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 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 Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 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. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Spiders Island (40) Address Grimstead Road Whaddon Salisbury Wiltshire SP5 3BG 01722 710072 01722 710072 alderbury@scope.org.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) SCOPE Mrs Jacqualine Irene Tolley Care Home 5 Category(ies) of Physical disability (5) registration, with number of places Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd July 2005 Brief Description of the Service: 40 Spiders Island is a residential care home registered to care for five adults with a physical disability. The home is situated in Whaddon, a small village near Salisbury. The home is managed by SCOPE and the Registered Manager is Mrs Jacqueline Tolley. 40 Spiders Island is a purpose built bungalow, with full disabled access. Private accommodation consists of five single rooms. There is a spacious lounge with dining area and an adjoining kitchen. Bathing facilities consist of an assisted bath and shower. A range of specialised equipment is provided in relation to individual need. Staffing levels are maintained at generally four members of staff during the day. At night one member of staff undertakes a waking night and another provides sleeping in provision. An on call management system is also available. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 14th February 2006 from 10.15am – 2pm. On arrival at the home two service users were being assisted with daily routines. There were three members of staff on duty and Mrs Tolley also gave assistance as required. All other service users were at their day service. The inspector met with service users and undertook a tour of the building with Mrs Tolley. Care planning information, daily records, personnel information and the fire log book were viewed. Discussion also took place with Mrs Tolley and staff members regarding current provision and developments made within the service since the last inspection. Due to complexity of need, it was not possible to gain feedback about the home from service users. Interactions between service users and staff were viewed however and all were noted to be attentive and respectful. Staff demonstrated a clear awareness of need and appeared experienced in recognising individual forms of communication. Both service users appeared content and well cared for with regular assistance and interaction from staff. What the service does well: What has improved since the last inspection? What they could do better: Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 6 Care planning information requires greater detail in order to ensure that complex needs of service users are met. The plans also need to demonstrate service user and/or representative involvement and be dated and signed appropriately. A systematic review of care planning information is in need of development in order to ensure that all information is accurate and up to date. Risk assessments require a full review so that all are up to date and portray an accurate reflection of risk and identified control measures. Manual handling assessments also require updating. While fire safety is improved, a fire drill is required within each identified period and details of such should be included within the fire log book. Staff should also sign to demonstrate their receipt of fire instruction. 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. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 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 Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home has a clear admission procedure, which takes into consideration the needs of other service users. EVIDENCE: Since the last inspection there has been one new admission. This was undertaken following careful consideration of staffing levels and the implications for other service users. Mrs Tolley discussed required care provision in detail with various personnel and gained a range of documented information. This included a Community Nursing Assessment and a previous placement assessment. Hospital discharge information was transferred with the service user although this was poor in content and required significant follow up in order to enable adequate and accurate information. Mrs Tolley reported that staff now feel competent with the complexity of need and the placement is proving successful. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 6 While a significant amount of information is available, care plans are limited in their content and therefore do not reflect individual need. Greater attention must be given to the risk assessment process, in order to maximise service users’ safety. EVIDENCE: At the last inspection it was noted that a significant amount of information was maintained in relation to each service user. The information was held however within many different files and it was difficult to ascertain prominent information from documentation that was out of date. It was therefore recommended to comprehensively review all documentation. In relation to this, staff worked hard and a summarised plan is now available. The plans detail matters such as preferred routines and basic care provision. They do not however demonstrate the complexity of service users’ needs. For example a bathing routine states what is needed yet it doesn’t highlight additional detail, which is important within the task. Matters such as physiotherapy programmes are also mentioned yet there is no evidence of the programme’s content. Through discussion it was evident that staff have a clear awareness of need. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 10 Mrs Tolley was therefore informed that such knowledge should be documented, as currently, the care plan does not give sufficient information. At a previous inspection, a requirement was made to ensure service user and/or family involvement within the plan. Mrs Tolley reported that it was not advisable to send personal information through the post and therefore staff were awaiting visits to facilitate such involvement. It was noted that some plans had been signed although this was not the case for all. The requirement is therefore repeated yet must be fully addressed before the next inspection. A requirement was also made to ensure that all information is dated. This is taking place on review of documentation. It was identified at the last inspection that many risk assessments were out of date and many referred to general care provision rather than individual need. A requirement was therefore made to address this area. In response, a member of staff reported that a review is currently taking place although due to the amount of work, progress is slow. While this is acknowledged, with particular attention to service users’ complex needs, such assessments must be accurate and kept up to date. This also includes prominent practices such as manual handling assessments. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 13 and 17 The home has its own transport, which enables the flexibility of spontaneous external activity and involvement within community circles. Service users are supported to maintain a healthy diet, which is conducive to individual need. EVIDENCE: 40 Spiders Island is located within a residential housing estate in Whaddon near Salisbury. The property is a spacious bungalow that gives the appearance of a domestic dwelling. Due to being within a village, amenities are limited and therefore the homes’ own transport is used for journeys as required. At present mini buses with tail lifts are used although Mrs Tolley reported that it is hoped in the future, smaller vehicles will be available. Staff view external activity as part of their role although due to complexity of need, events are tailored to individuals. This may affect the frequency and duration of such. Through discussion it appeared that due to need, some service users are now staying at home more, rather than five days a week at their day service. This was reported to work well and not be so challenging on the health and general well being of some service users. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 12 Staff undertake all catering arrangements although on occasions, some service users may join staff when undertaking the shopping. The home has a rolling menu, which is currently under review. Suggestions for new dishes that are low in fat and high in fibre are being sought and these will be introduced into the menu. Service users are given support to eat and peg feeding is also accommodated. In such cases, procedures and records are clear. Regular input and advice is also received from specialist services. As full staff support is required during peg feeding, meal times are flexibly adjusted in order to ensure all service users receive the support they need. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 18 Service users require a high level of assistance with all daily living tasks. This is undertaken efficiently yet documentation does not portray such. EVIDENCE: Service users continue to receive full assistance from staff in all aspects of daily living. Such provision is highlighted in part within individual plans of care although as stated earlier in this report greater detail is required. Some service users are unable to express how they wish their care to be delivered. In such instances staff rely on gestures, facial expressions, general contentment and individual communication systems. Advice is gained on a regular basis from specialised services and staff also request information from family members as appropriate. All service users have a range of individualised equipment to enable safe care provision. Some plans detail the procedures for the use of such equipment, although consistency is required. The home operates a key worker system, which was reported to work well. The medication systems were not assessed in full on this occasion as apart from the documentation of topical creams, all other matters at the last inspection, were satisfactorily maintained. The medication administration sheets were therefore viewed and such documentation had been addressed. Mrs Tolley was advised however to ensure that staff countersign any hand written medication instructions. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 2 The home has a clear, well-managed complaint procedure that encourages complaints to be successfully resolved at an early stage. EVIDENCE: Service users generally rely on staff, family members or representatives to identify any form of concern or dissatisfaction. SCOPE has a detailed and comprehensive complaints procedure and the right to complain is advertised in poster format and within leaflets displayed in the entrance area. A formalised reporting structure is in place and all matters are taken seriously with an aim to resolve at an early stage. Communication is therefore key and Mrs Tolley aims to be approachable and discusses matters with parents and/or representatives on a regular basis. The CSCI has not received any formal complaints regarding the service. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 24, 26 and 29 The home is spacious, comfortable and conducive to service users needs. Private accommodation is decorated and furnished to a high standard, with emphasis on individuality and personal preference. EVIDENCE: 40 Spiders Island is a detached, purpose built bungalow with full disabled access. All service users have a single room, which is decorated and furnished to a good standard. Despite varying levels of specialised equipment, all rooms remain personalised and reflect personal preference and interest. All are individual in style and address aspects such as visual stimulation. Within one room Mrs Tolley reported that a crack near the ceiling had developed and the plaster had become loose within an area on the wall. A surveyor had been contacted and staff were awaiting further work to address the problem. Rooms do not have en-suite facilities yet an assisted bathroom is located within close proximity. The facilities meet the needs of service users and the room is also warm, lockable and comfortable. As with private accommodation, attention has been given to visual stimulation within the room. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 16 There is a large lounge with dining area that has ample room for service users to move around freely and use items such as wedges and beanbags. The room appears ‘tired’ however and is not to the same standard as other areas. Refurbishment would therefore be of benefit. Mrs Tolley reported that thought has been given to this and it is anticipated that funding will be available within this year’s budget. Apprehension regarding the work is prominent however, with particular concern associated with paint odour and the general disturbance to the homes only communal area. Such matters will need further consideration nearer the time. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 34 Staffing levels are maintained as agreed by the previous Registration Authority yet careful consideration needs to be given to such levels in the event of an additional service user with significant need. The home follows a robust recruitment procedure which minimises the risk to service users. EVIDENCE: The staffing rosters demonstrated that there are generally five staff on duty within the early shift and this reduces to four in the afternoon. Mrs Tolley is also available to assist as required. At present the home has three vacancies, which include a full time senior post and two part time support workers. Due to these vacancies and additional staff sickness and annual leave, a high level of agency staff is currently required. On the morning of the inspection two agency staff were required to maintain staffing levels. It was reported that a key team of agency staff have been developed and these individuals are requested in order to ensure continuity. Once fully staffed however, Mrs Tolley reported that further development within the home will be made easier and greater flexibility will be available. Through discussion it was evident that one service user has recently been in hospital. During this time, the home’s staff supported the service user in order to ensure all needs were met and a familiar face was available. At night, there is one waking member of staff and another provides sleeping in provision. An on call management system is also available. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 18 Discussion took place with Mrs Tolley regarding the very high care needs of two individual service users. It was evident that such complexity of need and associated health difficulties, involved a high level of input from staff. In order to address the needs of all service users, some adjustments to routines had been made. It was evident that Mrs Tolley had considered the collective needs of service users and was therefore aware of the level of need that can be accommodated within the home. This must however be reconsidered in the event of another admission or during any significant deterioration of a service user. Mrs Tolley confirmed that since the last inspection a member of bank staff and another support worker had joined the team. The personnel files of both members of staff were viewed and ordered information was evident. The files contained an application form, two written references, a medical declaration, documentary evidence and a photograph. CRB disclosure and interview notes were also apparent. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 A formal quality assurance system is not available within the home although the development of such is expected to be in line with the forthcoming requirements of the CSCI. While health and safety is given consideration within practise, up to date, detailed documentation needs to demonstrate this. EVIDENCE: The home does not have a formal quality assurance system although there are various systems in place to encourage feedback and promote development of the service. Mrs Tolley reported that a meeting to discuss an organisational format has been requested although to date this has not been arranged. A requirement would normally be made to address this area, although in light of future changes with CSCI, direction with required quality assurance measures will be given. It was therefore agreed that the home’s system needed to be developed in relation to the requirements of the CSCI and therefore greater information of such would be of benefit. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 20 At the last inspection, shortfalls within fire safety were noted. This included insufficient testing of the fire alarm systems and there was no evidence of fire instruction for staff. On this occasion, documentation demonstrated that all testing had been undertaken as required. A fire drill however had been missed within the period of July/September. Participants of fire drills were also not evident. The fire log book highlighted that all staff had been given fire instruction during the identified period. Staff had not however signed to demonstrate their receipt of this. It is therefore recommended that all staff should sign on receipt of instruction and participants of fire drills should be identified. The building is well maintained and on a tour of the accommodation there were no apparent health and safety issues. However as stated earlier within this report, risk assessments require greater attention in order to ensure accuracy and the reflection of complexity of need. While staff are aiming to review all documentation, greater progress is required and additional matters of risk require consideration. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 21 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 X 3 3 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 X ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 3 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X X X X 2 X X 2 X Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 22 Yes 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 YA6 Regulation 15(1) Requirement Timescale for action 31/05/06 2. YA6 15(2)(b) The Registered Person must ensure that each plan of care contains sufficient detail in order to meet individual need. All plans must be signed and dated. 31/05/06 The Registered person must ensure that there is written evidence of service user or representative involvement in the development and review of care plans. The reason for not doing so must be recorded. This was identified at the last inspection and while some involvement has been evidenced, other plans are waiting for the representative to visit. The Registered Person must 30/04/06 ensure that all risk assessments are updated and placed within plans of care. This was identified at the last inspection yet progress has been slow. A revised timescale has been set which must be adhered to. The Registered Person must ensure that an up to date DS0000028453.V283209.R01.S.doc 3. YA6 13(4)(a) (b)(c) 4. YA6 13(5) 30/04/06 Spiders Island (40) Version 5.1 Page 23 5. YA9 13(7)(8) manual handling assessment is in place for each service user. The Registered Person must 31/05/06 ensure that there is a signed agreement in place for all service users who use cot sides on their bed. This was identified at the last inspection although evidence of such was not seen on this occasion. The Registered Person must 14/02/06 ensure that a fire drill is undertaken within each identified period. The conduct of such must be identified within the fire log book. 6. YA42 23(4)(e) 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 YA20 YA28 YA42 YA42 Good Practice Recommendations The Registered Person should ensure that a member of staff countersigns any hand written medication instruction. The Registered Person should ensure that consideration is given to the refurbishment of the lounge and dining area. The Registered Person should ensure that all staff sign to demonstrate their receipt of fire instruction. The Registered Person should ensure that all participants within fire drills are recorded in the fire log book. Spiders Island (40) DS0000028453.V283209.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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