Inspection on 15/07/09 for 40 Spiders Island

This inspection was carried out on 15th July 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

40 Spiders Island 03/07/07

40 Spiders Island 12/09/06

40 Spiders Island 14/02/06

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 15/11/2009.

Key inspection report CARE HOME ADULTS 18-65 40 Spiders Island Grimstead Road Whaddon Salisbury Wiltshire SP5 3BG Lead Inspector Alison Duffy Key Unannounced Inspection 15th July 2009 12:15p 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 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. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 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 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 40 Spiders Island Address Grimstead Road Whaddon Salisbury Wiltshire SP5 3BG 01722 710072 01722 710072 alderbury@scope.org.uk www.scope.org.uk SCOPE 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) Mrs Jane Maunders (not as yet registered with us) Care Home 5 Category(ies) of Physical disability (5) registration, with number of places 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care Home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: 2. Physical Disability (Code PD) The maximum number of service users who may be accommodated is 5 Date of last inspection 3rd July 2007 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. Mrs Jane Maunders has recently been appointed as the manager. Mrs Maunders has not as yet made an application to be the registered manager. 40 Spiders Island is a purpose built bungalow. Each person has a single bedroom. 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. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. Before visiting 40 Spiders Island, we sent the home an Annual Quality Assurance Assessment (AQAA) to complete. It is a legal requirement to complete the document. The AQAA is their own assessment of how they are performing. The AQAA tells us about what has happened during the last year and about the home’s plans for the future. The service did not return its AQAA when required. We sent the manager a reminder letter explaining the need to return the document. During our inspection, a team coordinator told us that time had been allocated to complete the AQAA and it would be forwarded to us without delay. We emphasised the need to return the AQAA to us within seven days. If the timescale was not met, enforcement action would be considered. The AQAA was received within the seven days. We sent surveys, for people to complete with support if they wanted to. We also sent the home surveys to be distributed to staff and health care professionals. This enabled us to get people’s views about their experiences of the home. To date, we have not received any surveys back. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home. This visit took place on the 15th July 2009 and was concluded on the 17th July 2009. Mrs Maunders was not available for the first part of the inspection but received feedback at the end. Ms Julie Griffiths, team coordinator assisted us throughout the inspection. During our visit, we met two people who use the service. Due to complex disabilities, people were unable to give feedback about the service received. We spoke to staff members on duty. We toured the accommodation and looked at care-planning information, staff training records and recruitment documentation. We also looked at medication administration systems and documentation in relation to health and safety and complaints. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: People benefit from a committed staff team who are very aware of their needs. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 6 People have good access to specialised health care services. People are supported to maintain important relationships. Family members or representatives are kept up to date with people’s wellbeing. The environment is clean, comfortable and homely. People have been supported to personalise their bedroom to reflect their personal preference and interests. A robust recruitment is in place to ensure those staff employed are suitable to work with vulnerable people. New staff work alongside an experienced member of staff and are assessed at being able to competently support each person, before they work on their own. Some agency staff are considered part of the staff team to ensure people have consistency in their support. Clear systems to maintain the safety of equipment and the environment are in place. What has improved since the last inspection? What they could do better: The impact of the manager being responsible for two services and therefore having reduced time within the home must be reviewed. The manager must establish their role as manager and provider clear leadership to the staff team. This must involve providing staff with a clear focus, through building relationships and formal systems such as staff meetings and supervision. Care plans do not reflect the complexity of people’s needs. Care charts do not evidence the support people require to maintain their wellbeing. Fluid charts and charts to show the assistance given with changing a person’s position, to reduce the risk of developing a pressure sore, must be fully completed. Any specialised procedure such as the use of suction to assist a person’s breathing must be fully recorded when undertaken. Some risk assessments are in place yet further risks such as choking must be addressed and be clearly identified within the person’s care plan. While a staff training programme is in place, it is not fully relate to meeting people’s needs. Staff are not up to date with specialised training such as using a suction machine, oxygen and artificial ‘peg’ feeding. There was no evidence 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 7 that staff had completed training in areas such as learning disability, communication or tissue viability. Staff required refresher training in safeguarding vulnerable people and the safe handling of medicines. Despite requirements being made at the last two key inspections, the home continues not to have a formal quality assurance system in place. Systems to enable people to give their views have not been implemented. People are encouraged to make decisions yet systems cold be expanded upon to further enable people’s involvement. Consideration should be given to how systems such as complaints and care planning, could be produced in ways that people understand. People’s life books should be kept up to date with further consideration given, as to how they could be expanded upon. 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. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2. 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 have a comprehensive transition plan to enable them to settle into the home. EVIDENCE: We saw that there had been one new person to the service since the last inspection. Staff told us that they had attended the local day service run by the organisation. They were therefore very well known to staff. Staff told us that the person initially visited the home with their family to have a look around. They then stayed for longer periods with a member of staff who supported them in a previous placement. Further visits were planned without the member of staff and a short stay was arranged. This enabled the person to be sure the home was right for them. Staff told us that they received information about the person’s needs from their family. The person was also able to say what they wanted. Staff told us that the transition period had gone well. They said they believed that knowing the person and the planned admission process had helped the person settle quickly. We looked at the care documentation of the person who had recently moved into the home. We did not see an up to date assessment of need yet a care plan was in place. Staff told us that due to knowing the person well, they were 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 10 aware of the support the person needed. They said that comprehensive assessments would be completed in relation to people who were new to the service. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 11 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): 6, 7 and 9. 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. Care plans do not reflect the complexity of people’s needs. People are encouraged to make decisions yet greater focus on communication would further enhance people’s opportunities. EVIDENCE: As identified at the last inspection, we saw that some parts of a person’s care plan were detailed. The support a person needed with their morning routine, for example, was clearly stated. There were also clear details about the support people needed to eat. Specific utensils, the need to cut food into manageable pieces and providing support at the person’s own pace were stated. However, specific risks such as choking were not identified. This was despite a specific incident whereby one person began choking on their meal. Following the incident, there were instructions regarding what the person should not have to eat. These were not highlighted with the person’s care plan. Other areas of the person’s care plan, such as medication identified ‘requires full assistance.’ It was not clear what this meant although later in the care 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 12 plan, there was a medication regime. In relation to personal care, terms such as ‘requires full assistance’ and ‘all personal hygiene needs are met by staff’ were used. We said that specific information was needed to ensure staff were fully informed of the person’s needs. This was particularly apparent due to people’s complex health and personal care needs. We said the care plans did not reflect the complexity of the person. One staff member told us ‘we probably know people too well, as many us have been working with individuals for years. We know what they need so we support people without always having the information written down.’ Another person told us ‘the care here is very good. Staff are committed to doing their best for people. They always come first.’ Another person had a very detailed written morning routine within their care plan although it was dated June 2007. The evening routine was also very detailed yet it did not reflect the changes, recently made to the person’s positioning at night. Staff told us about the changes in detail. They were concerned that the person’s wishes, as well as their health care needs were taken into account. At the back of a person’s care plan, there was information about good posture whilst sitting in a wheelchair. The documentation was not dated so it was not clear whether its content remained current. We advised that the information be reviewed and be put towards the front of the care plan so it was more visible. People had up to date manual handling assessments in place. Other assessments such as the risk of self harming and injury during a seizure had been undertaken. Documentation stated that people were not to be left alone at any time whilst having a bath. We saw within the AQAA, that as an improvement for the next twelve months, the care plans were due to be ‘overhauled.’ The service had recognised that care planning was something they could do better. The AQAA stated ‘that care plans are more detailed to reflect the specific care needs of individuals and how they are to be accomplished.’ Staff told us that some people could make every day decisions without support. This included aspects such as what time they got up, what they wore and what they did in the day. Other people could make decisions with staff support. Staff told us that for one person in particular, they would show the person a selection of items such as breakfast cereals. The person would then point or use eye movements to identify, which one they wanted. One new staff member said ‘I was surprised at just how much people communicated without speaking. One person is amazing at using their eyes. You can tell just what they want. Another person has a picture board, which they are good at using.’ Staff told us that some people relied fully upon staff to make decisions on their behalf. They said ‘people have lived here for a long time so staff have all got to know what people would prefer. Sometimes you just have to work out what you believe is the best for the person or what you think they might like. It’s 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 13 often trial and error.’ We said that while people are encouraged to make decisions, more focus could be given to communication systems. This would enable a more person centred approach to people’s support. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 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: 12, 13, 15, 16 and 17. 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 be involved in social activity provision yet further opportunities could be undertaken with increased staffing. People are supported to maintain important relationships and their rights are respected. People’s preferences are taken into account when arranging meals. EVIDENCE: Two people were at home during the main part of our inspection. Other people were at their day service but returned later in the afternoon. Staff told us that some people attended the local day service run by the organisation on a Monday to Friday basis. Others attended on a sessional basis depending on their need. Staff told us that one person attended another day service in order to use a sensory room. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 15 We saw that people had life story books, which contained pictures of activities or outings, people had enjoyed. We saw that the books did not contain any up to date pictures. We said the books should be added to and be further developed. Staff told us that they tried to enable people to go out on a regular basis. However, they said that each person needed the support of one or two members of staff so staffing levels could be a challenge. They said that there were also limited numbers of staff who could drive the home’s vehicle. This restricted the flexibility of spontaneous outings. We saw that one on occasion there was not a driver available so people could not go to their day service. Staff told us that this situation could arise although it would not be often. Within daily diaries, we saw that one person had gone to the pond in the village to feed the ducks. Other documented activities included the local pub for lunch, a garden centre, lunch at a superstore and a picnic in the New Forest. We saw that in May, there was a trip to an owl and otter centre. Staff told us that family relationships continue to be supported. They said they had built good relationships with people’s families and kept them informed of events and the person’s well being. Some people regularly went out with their family members and had weekends away. One person enjoyed hydrotherapy. Within the AQAA, it stated ‘all staff respect the choices made by a service user and welcome the chance to learn more to meet their needs.’ As stated earlier in this report, greater focus on communication systems would further increase people’s involvement in their day-to-day choices. We saw that staff were respectful in their interactions with people. Staff told us that due to people’s complex disabilities, they were generally not involved in housekeeping tasks. They said that greater consideration was being given to promoting people’s individuality. Individual medication cabinets in people’s bedrooms had assisted with this. Staff told us that there had been no changes to the meal arrangements. There was an informal menu, which could be changed, as required. People continued to have a snack at lunch time and then had their main meal in the evening. Staff had recorded what people had eaten in their daily diary. Within one diary, it stated that the person had eaten potato and leek bake. Their dessert was trifle followed by a banana. Staff told us that people sometimes went out for a meal or had a take away. They said they continued to be responsible for all food shopping. Sometimes people using the service accompanied them and then had a coffee or lunch in the food store. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 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): 18, 19 and 20. 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 are at risk of not having their health care needs met because of poor recording and/or inadequate focus on hydration and tissue viability. People have good access to health care professionals and specialist provision. People are safeguarded from medication error through clear medication administration systems. EVIDENCE: Staff told us that people continued to need the full assistance of either one or two staff members, to support them with all their personal care routines. One male member of staff told us that they generally supported the male people using the service. They said that they would definitely not support one female person using the service, due to the person’s religion. We saw that ‘only to be supported by female staff’ was recorded within the person’s care plan. As stated earlier in this report, some personal care routines were recorded in detail within the person’s care plan. We saw that one person was receiving a high level of support from the Community Nursing Team. They had advised an 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 17 alternative sleeping position for the person. Staff had taken photographs to show the position advised. This enabled them to see clearly, how they needed to support the person, to promote their health. Staff told us that the photographs were very useful and ensured accurate support. At the last inspection, we made a requirement to ensure that care plans, daily records and turning charts, must correspond and identify the support the person required. We said the documentation must also identify the actual support given. We saw that this had not been addressed. Documentation showed that one person had a small area of broken skin. Staff had applied a topical cream. There was no further information as to how the wound should be managed or any liaison with the Community Nursing Service. One person had been assessed as having a very high risk of developing a pressure sore. Documentation showed that they needed to have their position changed on a four hourly basis during the day and night. The person’s turning chart did not reflect this. The person had developed a rash. This was identified on a body map yet there was no further detail. They also had a ‘small red mark’ on their inner heel. The potential reasons for this or how it was to be managed were not identified. Within another care plan, we saw that the person needed to have their position changed every five hours. Within the risk assessment it highlighted the need for ‘four hourly turns.’ We saw that the chart, which evidenced the person’s change in position, gave varying time spans. Within the most recent staff member’s induction, skin care was identified. It stated ‘[staff member] is aware of the need to wash and dry/skin and apply creams as directed where necessary.’ It did not detail the parts of the body most commonly affected by pressure, which the staff member should monitor. Preventative measures such as equipment, changing the person’s position or monitoring friction from clothing etc, were not identified. We saw that people had fluid charts in place. One chart had not been completed from 14.50pm in the afternoon until 09.15am the next day. We said that this could be a recording error yet more concerning they may not have had a drink between these times. There were other gaps in the chart showing that people were potentially at risk of dehydration. Within one person’s daily records it was recorded ‘awake all night.’ There was no evidence within the fluid chart that they had been supported to have a drink. The charts had not been totalled on a daily basis and did not show an amount that was considered satisfactory for the person. Without the evaluation, we said that the chart was not fit for purpose. We saw that another person’s fluid intake was ‘under constant review to ensure s/he receives the correct amount.’ There was no detail in relation to the review or who was responsible for completing it. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 18 One person required support with a colostomy. Documentation stated that the flange and stoma site should be checked daily. There was evidence that this had been done but not on a daily basis. Another care plan stated ‘can experience pain in stomach due to constipation.’ There was no detail as to how the risk of constipation could be minimised. Within another plan, as good practice, a timescale was identified for when ‘as required’ medication could be given for constipation. Documentation showed that one person was supported with their continence through the use of continence pads. The plan stated ‘wears pads, change regularly.’ We said that specific timescales should be identified. Within documentation we saw that people had access to a range of health care intervention. During the inspection, a member of staff supported a person to the dentist. They said that some people found this intervention difficult to accept. Some people were also resistant when having their teeth cleaned on a daily basis. Staff told us that many attempts were often needed to brush a person’s teeth and even then, their teeth might not be cleaned properly. We did not see any information about supporting people with this task, within their care plan. We saw that an up to date record of people’s weight was maintained. One person had epilepsy. Their care plan stated ‘seizures are controlled by medication.’ A record of the person’s seizures was maintained yet there were no other details about the management of the person’s epilepsy. Mrs Maunders told us that epilepsy profiles were in the process of being developed. One person needed to have regular suction to help them with their breathing. Staff told us that sometimes, the procedure needed to be completed at regular intervals throughout the day. Documentation did not demonstrate this. There was limited information within the person’s care plan regarding the procedure and potential complications. Staff told us that people require full support to manage their medication. Since the last inspection, a small medication cabinet had been installed in each person’s room. This was to enable a more person centred approach. Topical creams were also stored individually in the person’s room. We saw that the records had been signed appropriately, when each medication had been given. We saw that one person was prescribed a medication of one to three tablets, ‘when required.’ A GP letter stated that medication was prescribed for agitation. Over a two day period, staff had given the person two tablets twice. There was no guidance on the person’s care plan as to why the medication was given or the criteria for giving one, two or three tablets. We said that this must be clearly stated. People had a documented medication regime, which detailed how the medication was to be administered. At the last inspection we made a requirement to ensure that clear instructions regarding the use of topical creams be clearly documented. We said that there must also be documented evidence that the creams had been applied. We saw that this requirement had 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 19 been addressed. Staff told us that keeping the medication record in the person’s room had assisted them to immediately sign the record, after a topical cream had been applied. Training records demonstrated that staff had received training in safe handling of medicines yet not all staff had received refresher training. We saw that there was a letter in each person’s care plan regarding the administration of homely remedies. The GP had signed this. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 20 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): 22 and 23. 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 rely on their representatives to recognise any form of discontentment yet the development of a user-friendly complaint procedure may enable some people to raise their own concerns. People are not safeguarded from harm as staff have not had up dated safeguarding training. EVIDENCE: Staff told us that some people would be able to verbally tell a member of staff or their family if they were not happy. Other people would be unable to verbally express their discontentment yet may use body language or sounds to express themselves. Staff told us that parents were strong advocates for people using the service. They said that they aimed to enable parents to raise any issues they might have by being friendly and approachable. Staff told us that they would aim to address any concerns through general discussion. They would also inform them of their ability to make a formal complaint by using the home’s complaint procedure. We saw that complaint training formed part of the staff training plan. Some staff had received this training although it was not up to date. Other staff had not completed the training. There was a complaint file in the entrance hall. It was titled ‘Complaining isn’t wrong, it’s right.’ We saw that one complaint had been logged. Within a person’s daily diary we saw that a family member had documented their concern about the person not attending their day service. This was not 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 21 documented within the complaint log. Documentation showing the investigation and the response to the complaint could not be located. We saw that there was an adult protection file in the hallway. This contained adult protection policies and procedures yet much of the information was titled ‘Wiltshire County Council.’ The policy identified people to contact in the event of an allegation. The information was in need of updating, as the previous regulatory body, the Commission for Social Care Inspection was stated. There was an ‘easy read’ adult protection policy, which showed pictures to aid the reader. The team coordinator told us that staff were given a copy of the local Wiltshire and Swindon adult protection protocols, ‘No Secrets.’ They showed us a list of staff signatures, which demonstrated this. Staff told us that they had not received recent adult protection training. Training records confirmed this. The team coordinator told us that they had contacted the local safeguarding team to ask if they provided training. They said the safeguarding team would arrange training for the whole staff team, in the future. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 22 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): 24 and 30. 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 benefit from a comfortable, clean, well-maintained environment that is conducive to their needs. EVIDENCE: 40 Spiders Island is a detached, purpose built bungalow within the village of Whaddon. There was a small car park to the front of the property and gardens to the rear. There was a raised garden where people were supported to grow their own vegetables. People had a single room, which was decorated and furnished to a good standard. People had been supported to personalise their room with posters and sensory equipment. All rooms were individual in style and reflected the person’s preferences, interests and/or personality. People had home entertainment equipment such as televisions and music centres, at a height, which they could see. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 23 Communal areas consisted of a large lounge with a dining area that adjoined the kitchen. The lounge was large enough to enable people to relax on bean bags if they wanted to. Some people had their own specialised armchairs. There was a fish tank and a number of mobiles to increase sensory awareness. When looking around the home, we saw that the separate toilet was used to store items such as continence aids and the manual hoists. We said that this should be cleared to enable people to use the toilet if required, rather than using the main bathroom. We saw that the home was cleaned to a good standard and was odour free. Staff had access to disposable gloves and aprons, which were stored in people’s rooms. Staff told us that there had not been any changes to the environment since the last inspection. Other than one person having a new specialised armchair for relaxing, staff said that no new equipment had been purchased. They said there had been no changes to the home’s decoration. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 24 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): 32, 34 and 35. 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. A major staff restructuring process has impacted upon staff morale and service provision. A recruitment procedure, which ensures staff are suitable to work with vulnerable people is in place. People may be at risk through staff not being up to date with their training in specialist procedures. EVIDENCE: Since the last inspection, the organisation had undergone a major restructuring process. Staff told us that the post of senior support worker was withdrawn and two team co-ordinators were introduced. Staff said that the role of the team coordinator was similar to that of the previous manager. Rather than directly supporting people, the team coordinators completed general administration and systems such as risk assessments, medication administration and liaising with health care professionals. Staff told us that since the introduction of the team coordinators, their workload had been significantly increased. They said they were expected to now take on more responsibility yet they had not been trained for the role. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 25 Staff told us that there were generally four staff on duty in the morning. They said that this level would reduce if people were at their day service. There were three staff on duty during in the evening. There were some ‘middle’ shifts whereby a staff member worked from approximately 10am to 8pm. While being responsible for supporting people with their personal care routines, staff also completed all housekeeping tasks. This included cleaning, cooking and the laundry. Some staff were able to drive the home’s own vehicle and so provided people with transport to their day service. At night there was one waking night staff and a member of staff provided sleeping in provision. Staff said there had been discussion about having two waking night staff but this had not been implemented. Staff told us that agency staff were used due to a part time vacancy and general annual leave and sickness. They said the same agency staff were called upon to complete shifts, so that people had consistency. The agency staff were considered part of the staff team and completed the home’s training programme. The team coordinator told us that she was in the process of setting up new staff training files. We saw that staff were generally up to date with their training in health and safety, first aid, manual handling and epilepsy. Documentation showed they were not up to date with food hygiene or safeguarding. Mrs Maunders told us that staff had completed food hygiene training in June 2009 yet the certificates had not been received. We saw that staff had not received training in the prevention of pressure sores, eating and drinking, catheter care, learning disability, physical disability or communication. We saw that many staff were not up to date with specialised training such as the use of suction to assist a person with their breathing, oxygen and artificial ‘peg’ feeding. The team coordinator told us they were trying to organise such training yet were finding it difficult find suitable training providers. They said the home did not currently have a manual handling trainer so accessing regular training in this area, was also a challenge. Within the training profiles, we saw that refresher courses were identified as ‘when needed.’ We advised that specific dates be stipulated. One member of staff told us that they had recently started at the home. They said their induction was comprehensive. It involved aspects such as health and safety and adult protection, as well as detailed information about the support each person needed. They said they had a mentor in order to discuss any issues. They worked alongside a member of staff and supported each individual before being able to work on their own. They said they had completed first aid and manual handling training. We looked at the personnel files of the two most recently appointed members of staff. We saw that a robust recruitment procedure was followed. The files contained an application form and two written references. One reference however showed an employer that was not identified within the person’s 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 26 application form. Documentation showed that a Protection of Vulnerable Adults check (POVAFirst) and a Criminal Record Bureau disclosure (CRB) had been undertaken before the staff member commenced employment. There was a medical declaration although one declaration did not state whether the person was fit for work or not. A staff member told us that their recruitment process was very thorough. They said they had to wait for their CRB to come back before commencing employment. The staff member told us that they found this to be positive, as they could immediately support people, rather than being solely involved in domestic tasks. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 27 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): 37, 39 and 42. 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. The manager must spend more time in the home to ensure clear leadership is in place and the home is well managed. Systems are not in place to ensure the ongoing development of the home. The building and equipment are well maintained, which minimises potential risks to people. EVIDENCE: The previous registered manager left his position in April 2009 after being in post for approximately a year. Mrs Jane Maunders was appointed manager in April 2009. She told us she had a period of induction with the previous manager, which lasted for two weeks. Mrs Maunders told us that she was in the process of applying to become registered with us. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 28 Shortly after the last inspection, an application was made to us, requesting that the registered manager be responsible for 40 Spider’s Island and another care service. The other service was located on the other side of the city centre. It was anticipated that the manager would split their time equally between the two services. Mrs Maunders told us that in practice, this had not been easy to maintain. She said that due to certain priorities, she had needed to give her focus to the other service. In addition, training and meetings had reduced her time at the home. Staff told us that in their opinion, the organisation’s decision to have one registered manager for two services was detrimental to the overall service. They acknowledged that Mrs Maunders was new to her post and to the organisation. They also said that they were aware she had many other commitments and ‘was being pulled in different directions.’ However, despite these acknowledgements, staff raised concern about the lack of leadership due to the time available to Mrs Maunders. One member of staff told us ‘she is very nice and I feel sorry for the amount of things she needs to do but we are just carrying on from day to day. People’s care has not been affected but I’m sure other things will start to slip.’ Another staff member said ‘Jane’s here when she can be but the overall management is falling on the team co-ordinators. They haven’t been trained and it takes them away from supporting people. Jane just doesn’t have the time to spend time with the people that live here. She hasn’t had time to get to know people, which isn’t good.’ We saw that Mrs Maunders’ timetable within the staffing roster file was not current. The contact telephone number showed the previous manager. The team coordinator printed off an up to date work schedule of Mrs Maunders. They told us that the telephone number of the previous manager was also that of Mrs Maunders, as it was a ‘work’ mobile. They were not sure if staff were aware of this. We asked staff about Mrs Maunders’ expectations and her vision for the service. Staff were not aware of this. They said ‘I’m not sure. I know she has lots of experience but I’m not sure what she would like to do here.’ Another person said ‘I really don’t know. We’ve not seen her enough to be able to discuss things like that.’ The team coordinator told us ‘we have worked together in the office and I’ve tried to show Jane where things are and how we do things. We can always contact her if we need to.’ We asked the team coordinator if they had had supervision to discuss their role under the new management. They said they had not had formal one-to-one supervision yet a session had been booked. We asked staff whether a focus for the service had been discussed at a recent staff meeting. Staff told us that a meeting had not as yet taken place although a date had been arranged. A date for a parents’ meeting was also planned. Staff agreed that meetings were required so that people could be informed of the expected leadership. Documentation showed that the last staff meeting took place in February 2009. This was before Mrs Maunders’ appointment. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 29 When we arrived at the service, the team coordinator apologised, as they had opened a letter from us, reminding the manager of the need to send their AQAA in. The team coordinator told us that they had informed Mrs Maunders of the arrival of the letter over the telephone. They said they had started to complete the AQAA but needed Mrs Maunders to finish it off. They offered to do an additional shift to complete it with Mrs Maunders. Mrs Maunders told us ‘Sunday has been designated to get it done. It’s just been so busy that I haven’t got around to doing it.’ We said that priority must be given to the document as its return, was a legal requirement. Mrs Maunders told us that she was aware of this and would ensure its completion. The AQAA was returned to us within the seven days. At the last and previous inspection, we made a requirement to fully implement a formal quality assurance system. We asked Mrs Maunders about this but she was not aware of any system currently used. She said she had not been told about quality assurance and had not seen any documentation such as surveys, which could be sent out to people to gain their views. While acknowledging that Mrs Maunders was relatively new to the service, we said this area must be addressed, as the requirement had already been repeated once. The AQAA acknowledged the need for feedback about the service. It stated ‘there needs to be more formal feedback with reference to the quality of the service we provide from external stakeholders, systems need to be put in place for this to happen.’ The organisation had a range of health and safety policies and procedures in place. The safety of all portable electrical appliances had been tested in August 2008. They were therefore due for re-testing. Mrs Maunders told us that this was in the process of being arranged. Checks to minimise the risk of legionella had been undertaken. Equipment such as the hoists had been serviced as part of a contract. Up to date gas and electrical safety certificates, were in place. There were a large number of environmental risk assessments. Those in need of being updated had been identified. The team coordinator told us that they were working through the file to ensure information was accurate and current. The fire log book identified that not all staff had been involved in a recent fire drill. Mrs Maunders told us that this had since been addressed. Within one account of a drill, we saw that two staff had not followed procedures. Documentation highlighted that they needed more training. There was no evidence that they had received this. We saw that the fire risk assessment had recently been updated. The fire safety systems had been regularly tested although they were missed in March 2009. Documentation showed that external contractors regularly serviced the fire alarm systems. We saw that the fire safety procedures did not reflect the complexity of people’s needs. The procedures were also dated June 2006 so were in need of review. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 30 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 X 33 X 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 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 2 1 3 X 1 X 1 X X 2 X Version 5.2 Page 31 40 Spiders Island DS0000028453.V375492.R01.S.doc 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 2 Standard YA6 YA6 Regulation 12(1)(a) 12(1)(a) Requirement Care plans must be sufficiently detailed to reflect people’s complex care needs. Care plans, daily records and turning charts, must correspond and identify the support the person requires and the actual support given. This was identified at the last inspection but has not been addressed. Potential risks such as choking must be identified and addressed within the risk assessment process. Measures to minimise the risk must be put in place, be fully documented and reviewed. Care charts must be fully completed and show that a person has had sufficient fluid intake and has been supported to change their position at identified intervals, that are conducive to their needs. Epilepsy management plans must be in place for those people who have epilepsy. Guidance for any medication to be taken ‘as required’ must be DS0000028453.V375492.R01.S.doc Timescale for action 31/12/09 17/07/09 3 YA9 13(4)(c) 17/07/09 4 YA19 12(1)(a) 17/07/09 5 6 YA19 YA20 12(1)(a) 13(2) 31/10/09 30/09/09 40 Spiders Island Version 5.2 Page 32 7 YA35 8 YA39 9 YA42 stated within the person’s care plan. The guidance must state what triggers an administration and at what intervals the medication could be given. 18(1)(c)(i) Staff must receive up to date training in safeguarding and specialist procedures such as suction, the use of oxygen and ‘peg’ feeding. 24 A formal quality assurance system must be developed and implemented within the home. This was identified at the last and previous inspection but has not been met. 13(4)(c) Fire safety procedures must be kept up to date and be specifically related to the service. 30/11/09 31/10/09 30/09/09 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 Consideration should be given to apply the detailed ‘morning routine’ format within care plans in other areas, in order to give staff clear, specific information. This was identified at the last inspection but has not been addressed. All specialised programmes, such physiotherapy should be regularly reviewed. If there is no change to the programme, this should be documented. This was identified at the last inspection but has not been addressed. Guidelines regarding adequate levels of fluid intake should be agreed with the District Nurse. Food and fluid charts should be totalled daily and regularly evaluated. This was identified at the last and previous inspection, but has not been addressed. Consideration should be given to a more user-friendly complaint procedure to enable greater service user DS0000028453.V375492.R01.S.doc Version 5.2 Page 33 2 YA19 3 YA19 4 YA22 40 Spiders Island 5 6 YA24 YA35 7 YA35 8 9 YA35 YA39 10 YA42 involvement. This was identified at the last inspection but has not been addressed. Consideration should be given to moving the hoist out of the separate toilet so that the room could be used rather than it being a storeroom. Consideration should be given to offering training sessions with regard to peoples’ physical disabilities. This was identified at the last inspection but has not been addressed. Staff should receive training in relation to people’s needs. Such training should include learning disability, communication, eating and drinking, tissue viability and catheter care. The timescales of refresher training should be specific rather than stating ‘when needed.’ Consideration should be given to how people may be more involved in the home’s quality assurance system. This was identified at the last inspection but has not been addressed. When it is identified that staff need more training in fire safety, the additional training and an assessment of staff’s competence should be stated. 40 Spiders Island DS0000028453.V375492.R01.S.doc Version 5.2 Page 34 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@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). 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