Inspection on 22/07/05 for 40 Spiders Island

This inspection was carried out on 22nd July 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 14/02/06

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 22nd July 2005 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. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Spiders Island (40) Address Grimstead Road Whaddon Salisbury Wiltshire SP5 3BG 01722 710072 01722 710072 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) SCOPE Mrs Jacqueline Irene Tolley Care Home 5 Category(ies) of PD Physical Disability (5) registration, with number of places Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 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 within 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 adjoining kitchen. Bathing facilities consist of an assisted bath and shower. A range of specialised equipment is provided. Staffing levels are maintained at three or 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) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 22nd July 2005 from 10.30am 3.45pm. There were three service users and three members of staff within the home. Other service users were at their day service. The inspector spoke with Mrs Heather Scott shift leader, toured the accommodation and viewed care planning and daily recordings. Staffing rosters, menus, the fire log book and medication systems were also viewed. It was not possible during the inspection to address matters such as personnel records, as the manager was not available. The inspector also spoke to a senior carer on the telephone who offered, despite her day off, to visit the home in order to give assistance if required. This offer was declined and it was agreed that Mrs Tolley would be contacted following the inspection as appropriate. However later within the inspection Mrs Tolley called the home and a discussion took place regarding requirements identified at the last inspection. Feedback was given to Mrs Scott and some issues were also discussed with Mr Gerrard Browning, senior support worker, who began his shift at the end of the inspection. Due to service users’ limited communication ability it was not possible to gain any feedback about service provision. Interactions were noted however between staff and service users and all were respectful and attentive. What the service does well: What has improved since the last inspection? Attention has been given to the medication systems and all such requirements identified at the last inspection have been addressed. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 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 standard(s) 2 The home has a clear admission policy. Detailed assessments give appropriate information for staff to successfully meet individual needs. EVIDENCE: Since the last inspection there has been one admission to the home. The home’s admission policy was followed and a detailed assessment had been undertaken. Contact with specialised services, such as the physiotherapist and occupational therapist, had been accessed. Mrs Scott reported that assessments are continually being updated in relation to such professional input. Changes are also being noted while staff are beginning to get to know the service user. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 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 standard(s) 6, 7 and 9 Greater organisation with care planning information is required to ensure service users’ needs are fully addressed. The current risk assessment process is insufficient in safeguarding the well being of service users. Decision-making is fully promoted in relation to the abilities of individuals. EVIDENCE: Each service user has a care plan in their room and a more extensive file, which is kept in the office. There are also daily observation forms, daily dairies and activity sheets. While the information is well written it is extremely difficult to determine the most relevant and up to date information. It is also difficult to determine any follow up intervention. Mrs Scott was therefore advised to review the systems of documentation. For example although one care plan was well written it referred to other documentation, which was in a different file. On locating this, further information was stored in another area. This made accessing the information difficult and did not portray a holistic approach to the person. At the last inspection a requirement was made to ensure that all plans were signed and dated. It was not evident that this matter had been fully addressed. A requirement was also made to ensure the service user or their representative signed the plan. Mrs Scott reported that attention is currently being given to this matter. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 10 Service users have detailed programmes devised by professionals. However dates are not always apparent so it is not evident whether information remains relevant. One service user has physiotherapy each day although the written programme is located within a file containing information going back to 2003/2. Mrs Scott was informed of the need to reorganise such and include the programme within the individual plan of care. All service users have a number of risk assessments. These are written in a way, which are general to all service users and would therefore benefit from greater individuality. Many are in need of up dating and some are not relevant. This includes the risks associated with the administration of stesolid as staff do not, at this time undertake this procedure. Mrs Scott was also informed of the need to ensure risk assessments are undertaken in relation to any accident in order to minimise the risk of a reoccurrence. Within a review of risk assessments manual handling assessments must be taken into account. At the last inspection it was noted that some service users have ‘cot sides’ on their beds. A requirement was therefore made to gain a signed agreement for such and to undertake a risk assessment. The risk assessment is in place although the agreement has not as yet been addressed. Within one care plan it was noted that the service user must not be left unattended in the bath. Mrs Scott reported that this was so for all service users and therefore all plans should contain such detail. Decision-making within the home is promoted. Staff appeared to gauge choices in relation to ability and use simple, closed questions to encourage involvement. However due to the nature of some services users’ disabilities, full reliance on staff is required. During the inspection staff appeared attentive and concerned with service users’ wellbeing and the ability to be comfortable. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 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 standard(s) 12, 14 and 15 Service users are supported to access external opportunities. Visitors are welcome and hospitality is evident. EVIDENCE: Service users have day service placements and attendance for some is undertaken depending on how well or alert the service user may be. All placements are regularly reviewed and intervention is received from various professionals during this time. When not attending day services time is generally spent with staff relaxing in the home. External opportunities such as picnics, shopping and places of interest are available and the home has its own transport to facilitate such, as required. Visitors are welcomed to the home and on the day of the inspection hospitality was evident. Family contact is promoted, yet varies according to individual circumstances. Visitors may use the main lounge, external seating areas or the privacy of a service user’s room. Communication with service users’ families is promoted and a formal meeting is arranged on a regular basis in order to meet with staff and management and interact with other families. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 12 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) 8, 19 and 20 Service users’ health and personal care are well managed. Recent attention has established a well-organised medication system, which minimises the risk of errors to service users. EVIDENCE: All service users have profound and multiple disabilities and therefore require full assistance with all daily living tasks and routines. A range of specialised equipment is available and documentation demonstrates certain procedures. Service users are unable to give an opinion regarding how they wish their care to be given and are reliant on staff to assess facial expressions, body language or emotion. Routines are flexible according to individual portrayals. Service users have access to a range of specialised services on a daily basis within their day service. Regular reviews are held and written documentation demonstrates specific programmes. As stated earlier in this report however, such documentation would benefit from review and greater organisation within each plan of care. At the last inspection a number of shortfalls were identified with the medication systems and requirements were made. When viewing the medication it was noted that all matters had received attention although one requirement remained outstanding. This involved developing a protocol for PRN medication. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 13 On the telephone Mrs Tolley confirmed that this was being addressed. The medication cupboard was ordered and did not contain inappropriate items. Labels and administration sheets gave clear instructions and unused medication had been returned. Individual homely remedies signed by a GP had been gained and medication had been signed appropriately. Additional items, however such as prescribed creams were not evidenced. Mrs Scott reported that some creams were not used despite being recorded on the administration sheet. Attention is therefore required to address this matter. Written documentation regarding peg feeding was well maintained. Staff had also signed to demonstrate training received regarding oxygen therapy and suction. Mrs Scott was advised to ensure that all relevant information relating to such procedures, were kept together. The training of such must also be regularly reviewed. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 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 standard(s) 22 and 23 Appropriate complaint procedures are in place yet service users are reliant on staff and family members to determine general well being. Satisfactory systems are in place to minimise the risk of abuse to service users. EVIDENCE: The home has a detailed and comprehensive complaints procedure. Service users involvement with such however is limited and therefore staff must be aware of service users possible discontentment through other measures. Strong family contact assures advocacy and regular communication is exchanged between staff and family members. There have been no complaints since the last inspection. SCOPE has a detailed adult protection policy and a copy of the Wiltshire and Swindon Vulnerable Adults Protocol is readily accessible. A recent matter was appropriately referred to the Vulnerable Adults Unit. Mrs Tolley reported that the process was well managed, yet had a great impact on staff. Staff have received support and further training sessions are in the process of being arranged in order to re-confirm practise and discuss anxieties. Staff are attentive and observe any marks or bruises on service users. At present a daily record of such matters is maintained yet this system does not enable monitoring or an audit trail of follow up action or investigation. Mrs Scott was therefore advised to address any observations within individual files. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 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 standard(s) 24, 25, 28 and 30 The home is homely, clean and odour free. All areas are well maintained and furnished to a good standard. Specialised equipment is in place to meet service user’s needs. EVIDENCE: 40 Spiders Island is a spacious, purpose built bungalow, which is located on a housing estate in Whaddon near Salisbury. There is a local shop nearby. All service users have a single room, which is personalised and furnished to a good standard. A range of specialised equipment is in place including overhead and manual hoists, beds and chairs. There is a large lounge with dining area, which opens onto a patio area. A gazebo has been installed to give shade to service users. It was reported that the curtains within the lounge are due to be replaced as they have shrunk with laundering. There is an assisted bath and shower. A requirement was made at the last inspection to replace the cracked flooring in the kitchen. This has been addressed. A recommendation was also made to remove the files from the dining room table and sideboards. Such items are now stored in cupboards. The laundry is located away from service users’ private accommodation and communal areas. Although small the area was organised and ordered. All areas of the home were cleaned to a good standard and odour free. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 16 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) 32, 33 and 35 Staffing levels are maintained as agreed by the previous Registration Authority. Training is given high priority and various opportunities are available. EVIDENCE: Staffing levels are maintained at three or four members of staff during the day. At night a member of staff undertakes a waking night and another provides sleeping in provision. Training and personnel files were not viewed on this occasion although staff and the senior carer spoken with on the telephone reported that training is given high priority. All staff have NVQ level 2 and two members of staff are also undertaking level 3. All staff were reported to be up to date with their mandatory training and additional topics have been covered. Mrs Scott believed that all staff had received up dated training regarding specific procedures although was advised to check this. Mrs Tolley stated that the staff team are excellent and provide a high level of care and commitment. While admitting that formal supervision has slipped a little due to other commitments, Mrs Tolley reported that attention is being given to get sessions ‘back on track.’ Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 17 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) 42 Fire safety measures are insufficient at this time to ensure the safety of service users. EVIDENCE: On viewing the fire log book it was noted that greater attention was required to maintain fire safety. During some periods the fire alarms had not been tested and the majority of staff had not received fire instruction during the last identified period. The record of fire drills would benefit from the inclusion of staff participants and any defect identified, should be fully recorded when rectified. At the last inspection a requirement was made to connect the smoke detector in the staff sleeping in room to the main fire panel. This has been undertaken. There was no evidence of any fire doors being propped open, which was also raised at the last inspection. Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 18 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 2 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 3 x x Standard No 31 32 33 34 35 36 Score x 3 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Spiders Island (40) Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 19 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 6 Regulation 15 Requirement The Registered Person must ensure that all care plans are signed and dated at each review. This was identified and the last and subsequent inspection. The Registered person must ensure that there is written evidence of service user or representative involvement in the development and review of care plans, or the reason for not doing so must be recorded. This was identified at the last inspection although was reported to be in hand. The Registered Person must ensure that all risk assessments are updated and placed within plans of care. The Registered Person must 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. The Registered Person must ensure that there is a protocol for individual PRN medication use. This was identified at the last inspection although was reported to be in hand. Timescale for action 30th September 2005 30th September 2005 2. 6 15(2)(b) 3. 9 13(4)(a) (b)(c) 13(7)(8) 30th September 2005 30th September 2005 4. 9 5. 20 13(2) 30th September 2005 Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 20 6. 20 13(2) 7. 8. 42 42 23(4) (c)(iv) 23(4)(d) The Registered Person must ensure that all topical creams prescribed by a GP are signed to demonstrate their application. The Registered Person must ensure that the fire alarms are tested on a weekly basis. The Registered Person must ensure that all staff receive fire instruction during each identified period and this is recorded within the fire log book. From 22nd July 2005 From 22nd July 2005 From 22nd July 2005 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 6 Good Practice Recommendations The Registered Person should ensure a comprehensive review of all documentation regarding service users, in order to fully demonstrate that individual needs are being met. The Registered Person should ensure that all marks or bruises currently recorded on observation sheets are documented individually within each service users file. The Registered Person should ensure that all participants within fire drills are recorded in the fire log book. The Registered Person should ensure that any defect noted within regular testing, is recorded within the fire log book when rectified. 2. 3. 4. 23 42 42 Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, 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. Extracts may not be used or reproduced without the express permission of CSCI Spiders Island (40) D51_D01_S28453_SPIDERSISLAND_V227318_220705_Stage4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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