Inspection on 03/07/07 for 40 Spiders Island

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 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 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 09/07/2008.

CARE HOME ADULTS 18-65 Spiders Island (40) Grimstead Road Whaddon Salisbury Wiltshire SP5 3BG Lead Inspector Alison Duffy Key Unannounced Inspection 3rd July 2007 09:30 Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 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.V337048.R01.S.doc Version 5.2 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.V337048.R01.S.doc Version 5.2 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 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) Vacant Care Home 5 Category(ies) of Physical disability (5) registration, with number of places Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 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. Until a year ago, Mrs Jacqueline Tolley was the registered manager. Mrs Tolley left her post and as yet, SCOPE has not advertised the position. Ms Sandra James, is currently undertaking the role of Acting Manager. Ms James was previously the Team Leader within the home. She is therefore experienced and has a clear awareness of service users’ needs. 40 Spiders Island is a purpose built bungalow, with full disabled access. Each service user has a single room. 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. Fees for living at the home are based on individual need and currently range between £1307 and £1730 a week. Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on 3rd July 2007 between the hours of 9:30am and 7pm. Ms Sandra James, Acting Manager, was available throughout and received feedback at varying times of the inspection. The Inspector was able to meet with four service users and members of staff on duty. A number of staff members discussed their designated area of responsibility such as menus, risk assessments and medication systems. Discussion took place with Ms James regarding current care provision and the developments made since the last inspection. A tour of the accommodation with a member of staff was made and various forms of documentation were viewed. This included care plans and risk assessments, quality assurance, recruitment and staff training information. Due to complex disabilities, service users were unable to give feedback about the service received. Interactions between staff and service users were observed and all were noted to be attentive and respectful. One service user responded well to light hearted banter from staff. All service users appeared relaxed, content and well groomed. As part of the inspection process, Ms James was sent an Annual Quality Assurance Assessment to complete. Ms James completed this thoroughly and in detail. Some of the document’s content is taken into account within the evidence sections of this report. Comment cards were forwarded to the home to distribute. Ms James reported that these were distributed to all relatives and health care professionals, who regularly visit the home. One comment card was returned. The feedback gained from this comment card is detailed within the main text of this report. Due to the limited response from comment cards, the end date of the inspection process was extended. Ms James reported that she would send contact details of other health care professionals to CSCI. This would enable additional comment cards to be distributed. This information was not received. The inspection has been conducted therefore with minimal involvement from service users’ representatives. 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 the visit to the service and taking into account the views raised on behalf of service users. What the service does well: A clear admission policy and robust assessments ensure that service users’ needs are met when newly admitted and when discharged from hospital. Ms Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 6 James has a clear understanding of the criteria for admission and ensures additional support is in place, as required. Service users receive a high level of support with their care needs, which is undertaken with regular advice and intervention from a range of specialised services. Staff have good access to specialist training in order to meet service users’ needs. This includes matters such as peg feeding, oxygen and oral suction. Staff demonstrate confidence in the procedures and are responsive to the responsibility. Medication systems are well managed, which reduces the risk of error. Service users benefit from an established, motivated staff team who are committed to providing a good service and ensuring their wellbeing. Staff support service users during a hospital admission, to ensure consistency. Positive links have been built with the local advocacy service. This service is requested at times of need, such as a service user’s discharge from hospital. A robust recruitment procedure is in place, which provides a clear system for safeguarding service users. What has improved since the last inspection? What they could do better: Care plans are well written and contain a high level of information. However, greater detail should be applied to evidence the complex support, service users require. This could be achieved by adapting the existing written format of the ‘morning routine’ to other areas. The management of particular health issues, such as sore areas of skin, need to be identified more clearly in the care plan. An area designated to a short-term care plan could enable this. While the district nurse may support service users’, the service user’s care plan must Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 7 detail the reason for the involvement. The care plan must also state what support, staff are required to give. The support must be evidenced within daily records. Care plans, daily records and other documentation such as ‘turning’ charts, must correspond and clearly evidence the support given. Greater detail regarding topical creams, the reason for their prescription and their application, must be documented. Records must identify, how and where the cream is to be applied. There must be evidence, that the cream is being used, as directed. SCOPE has clear systems in place for managing complaints. However, documentation is not conducive to the needs of service users. Pictorial formats may enable some service users to raise possible discontentment, rather than relying on others to recognise this. While SCOPE has introduced a quality assurance system, it is not apparent how this will be applied in practice. The system is linked to performance indicators, which do not give the home, potential challenge. Qualitative measures are also not apparent. The system does not appear to take into account, how service users will be involved in the process. Questionnaires, which have been sent to service users’ family members, cover basic information and promote a ‘yes’ or ‘no’ response. This gives limited information to use, as feedback or for future planning. Clear guidance is needed, as to how staff should respond to the system, in practice. 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. The summary of this inspection report can be made available in other formats on request. Spiders Island (40) DS0000028453.V337048.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 Spiders Island (40) DS0000028453.V337048.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from an organised admission procedure, which ensures their needs, will be met within the home. EVIDENCE: Spiders Island continues to provide long-term care provision and therefore new admissions, to the home are extremely rare. Due to this, it was not possible to assess the admission procedure in practice. SCOPE has detailed admission policies and procedures in place. These include a detailed assessment undertaken by the home manager and the receipt of a community care assessment, undertaken by the placing authority. Various visits to the home would be encouraged and the prospective service user would be met with, within their own environment. Family members and other interested parties, such as specialist health care personnel, would be invited to contribute to the assessment process. The need for any specialised equipment would be assessed. If the placement were agreed, the equipment would be arranged and in place, before the service user was admitted. Due to the long-term nature of the service, Ms James reported that the assessment process is generally used when a service user has been admitted to hospital and they are ready to be discharged. Ms James reported that staff Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 10 always like service users to return to the home, after a hospital admission. Ms James explained that before considering their return, an assessment would ascertain, if the service user’s needs could be met. An alternative placement is decided upon, only with detailed consultation and consideration and an emphasis on the best interests of the service user. Ms James continued to report that the assessment process has to be thorough and comprehensive. Any shortfalls must be resolved successfully otherwise it raises the need for an alternative placement. Ms James also commented that due to the very complex needs of service users, the support received from specialist health care services is key. Suitable strategies, for assistance out of hours, must always be in place before the discharge is agreed. This enables issues, which are beyond the remit of the home to be addressed, quickly and efficiently. Spiders Island (40) DS0000028453.V337048.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from well-written, up to date care plans, yet additional detail would ensure the complexities of their disabilities are fully addressed. Service users are encouraged to be involved in decision-making and a variety of systems are in place to assist with this. Service users are safeguard from potential hazards through clear, considered risk taking. EVIDENCE: Since the last inspection, staff have spent considerable time on further developing care plans. Much of the information has been reviewed and has been coordinated into a consistent approach. The information is well written and in many areas, contains good detail. However, some of the information does not demonstrate the high complexity of service users needs. Discussion took place with a number of staff regarding the needs of two service users. Detailed information was given. This included how the service user communicated without speech and how pain was recognised. However, Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 12 these aspects were not clearly identified within care plans. Detailed programmes related to eating and drinking were in place. Very detailed, comprehensive, morning routine schedules were also identified. These ensured, the reader knew exactly, what support each service user required. However, evening routines were much less specific. While it is acknowledged that staff have worked hard in improving care plans, developing this level of detail would be invaluable. Within discussion with Ms James, it was agreed that staff have extensive knowledge of service users needs, yet this is not always presented within written documentation. Ms James reported that consideration would be given to this area, as all staff wanted to give their best and ensure all systems in place, worked successfully. There were aspects of care provision, which were identified in other parts of the file, yet not on the care plan. For example, a sore area was detailed within the medical intervention record and specific prescribed creams were documented within the medication administration record. Both aspects were not identified within the care plan. There was limited evidence of the management of both matters. Within discussion with Ms James, it was agreed that short-term care plans might assist with this area. Detailed, up to date manual handling assessments were in place. These had been completed with the input of specialist health care personnel. There was also a range of detailed, well written individual risk assessments. All had recently been updated and a number of additional assessments had been added. Ms James reported that the high level of service users’ disabilities often restricts the ability to take risks. Staff often need to make decisions on a dayto-day basis on behalf of service users. More complicated matters are discussed with residents’ families or their representative. However, due to the responsibility of this, staff often work to the ‘side of caution’ and would not promote any activity, which may present a detrimental effect to the individual. Trips out, for example are short, conducive to need and often familiar so that service users are not at risk of potential environmental hazards. Places such as theme parks would not be promoted, with some service users due to their health conditions. Staff are also subjected to health and safety restrictions, which may in turn, restrict the ability to take risks. Ms James gave horse riding as an example. While some service users may enjoy this activity, there are strict criteria for the member of staff to adhere to. This includes manual handling guidance. Due to this, the activity is not encouraged. Risk taking is generally based on general day-to-day activity such as the possibility of going out and becoming unwell. Service users are encouraged to make decisions, which are linked to their ability. When some service users returned from their day service, all were asked if they would like a drink. Individual styles of communication were evident. For example, one service user was asked if they would like tea or coffee. A hand gesture determined their choice. Signs portraying a drink were used with another service user. Another service user nodded in response to Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 13 their choice. One member of staff explained that some service users use a picture board to promote communication. Choosing an item of clothing, for example is often undertaken through showing a selection of items. This also applies to cereals at breakfast time, when cereal packets are placed on the table. This enables, some service users to make an easier, visually informed choice. Another member of staff reported that they are in the process of gaining pictures to evidence meal choices. Ms James reported that significant work is currently being undertaken to promote service users’ individuality and their rights. This has included discussion with family members. For example, it is planned that all service users will access the external door to their room, with their own key, when returning to the home. This will enable greater independence and individuality, rather than all congregating in the main lounge, as a group. Greater consideration is also being given to the use of the television. This is to ensure that service users really want to watch the programme, rather than just sitting in front of it. Some aspects of decision making such as choosing clothing is identified within care plans. Ms James confirmed however, that decision-making is an area she wishes to develop further. Spiders Island (40) DS0000028453.V337048.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): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are assisted to undertake meaningful activity and maintain important relationships. Service users benefit from menus that are developed according to individual preference and healthy eating. EVIDENCE: During the morning of the inspection, two service users were in the home. One spent time in their room and another was in the lounge. One service user was in hospital and two service users were at the local SCOPE day service. They returned at approximately 4pm. Some service users attend the day service on a full time, Monday to Friday basis. Others attend on a sessional basis, depending on their health. There was little activity in the home during the inspection as both service users were unwell and tired. One member of staff reported ‘moments are seized, so when XX has a good day, a trip out would be arranged. It just depends on how people are feeling, although we try to get out at least once, over the weekend period.’ On the evening of the inspection Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 15 two service users went out to have fish and chips. The home has its own transport although Ms James reported that public transport is also utilised. Restrictions with this however were explained, as the buses with accessible facilities, are minimal in their operation. Service users are assisted to buy their own toiletries and clothing. Other trips to various pubs, cafes, the New Forest and seaside resorts are undertaken. A member of staff explained that all trips must be within a reasonable distance of the home. Successful destinations with disabled access and facilities are often repeated, as safety is assured. All service users have a separate activity file. This contains photographs of various trips out, which are regularly used to aid communication. All service users have a key worker and also a key team. Regular one-to–one work with service users is undertaken. This may involve going out for a coffee or individual support, such as a foot spa. Some service users have sensory equipment in their bedrooms. A corner of the lounge has also been converted into a sensory area. Ms James reported that further equipment is anticipated. Screens are also planned to separate the area and provide privacy. As stated earlier in this report, service users are encouraged to make decisions in relation to their ability. Ms James is currently working with the staff team in order to further develop individual rights of service users. Known likes and dislikes are identified within care plans. Preferred routines are also stated. One member of staff explained that service users are involved in matters such as tidying their room. While service users may not be able to physically assist, the social interaction and involvement is deemed a positive factor. Interactions between staff and service users were observed. All were attentive yet varied, depending on the situation. Staff were softly spoken to the service user who was unwell. Clearer speech was used when explaining a situation or encouraging a choice. Light-hearted banter also took place with one service user. Staff appeared clear about service users’ needs and positive relationships were evident. Ms James explained that staff are committed to service users’ well being and want the best for them. As service users are unable to express their wishes, family members are strong advocates. Staff reported that families and friends are welcome at any time. A parents meeting is also held. Within a comment card, a relative stated that they are always kept informed of events. They stated ‘carers telephone me regularly to inform us of any changes or what they are doing. Also we visit our XX at his/her home – we are always made welcome.’ Ms James reported that good relationships have been established with the local advocacy service. An advocate is currently involved with a service users’ discharge from hospital. Ms James reported that the service has become invaluable. One member of staff continues to have the responsibility of menu planning. The menus are regularly reviewed to promote healthier eating and greater choice. At breakfast and lunchtime, options for the meal are not stipulated on the menu. Service users have a choice of what they would like. If service users Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 16 are unable to choose, staff will prepare something that has been enjoyed before. Menus demonstrated a varied evening meal. Mealtimes are flexible and full assistance is given to all service users. Requirements such as specialised utensils and the need to have food cut up are stated within care planning information. Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ very complex health care needs are met through an experienced, well-trained staff team and specialised health care personnel. Service users are safeguarded from medication errors through an organised medication system. EVIDENCE: Due to very complex needs, service users are unable to express how they wish their care to be given. Staff regularly discuss support with service users’ family members and other health care specialists. Established routines such as getting up are detailed within each service users’ care plan. One member of staff explained that general signs, which service users portray are observed. These are then interpreted using known preferences and a process of elimination. The member of staff continued to report that it is often difficult to explain, how each service user communicates their needs. They felt it was often through knowing the service user extremely well and intuitively sensing what was required. Another member of staff confirmed that at times, ‘especially for those service users who are unable to communicate, doing what is best for the service user, is undertaken.’ Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 18 Service users receive a high level of support with their health care needs on a daily basis. This includes matters such as specialised feeding, oxygen and oral suction. All staff have received training from a specialist health care professional in these areas. Staff spoken with were confident in these procedures. They reported that they had had full training and guidelines were also in place within the service users’ care plan. Staff confirmed that additional support and advice were available, as required. Service users are reliant on staff to recognise any signs of ill health. One member of staff said ‘you can tell if anyone is just off colour. Its important to monitor this, as often it becomes something more apparent, such as an infection.’ The presentation of pain was discussed with staff. One member of staff reported ‘although it may not be clear to an ‘outsider,’ when you know service users well, you can just tell they are in pain. You may not be able to determine, which part of the body is affected, but their body language shows there is something wrong. In such cases, pain relief is given.’ As stated earlier in this report, pain relief should be addressed within care planning. Within comment cards, a relative confirmed that staff always meet the needs of their relative. They stated ‘staff always do a very good job.’ They confirmed staff always keep in touch with them. Specific comments included ‘I am always kept up to date. I am informed straight away if my XX has to see a Doctor or is admitted to hospital. Staff stay with him/her’ and ‘a carer telephones me regularly to inform us of any changes or what they are doing. Also we visit our XX at his/her home – we are always made welcome.’ Relatives continued to report that staff always give the support or care they expect or have agreed. Specific comments included ‘they are very caring and always wiling to help – could not ask for better care’ and ‘provides a happy/caring home for our XX and the other residents – for which we are very grateful.’ Service users who attend day services have regular access to specialist provision, such as physiotherapy, occupational therapy and speech and language therapy. Within one care plan, a physiotherapy programme dated October 2004, was stated. Ms James reported that the programme remained current although agreed that regular review, should be evidenced. Appointments with other specialist services, including the dietician are made as required. Regular consultation is held with the nurse who has designated responsibility for peg feeding. One service user is receiving a high level of support from the district nursing service. While the district nurse maintains their own documentation, the issues were less evident within the service user’s care plan. Ms James was informed of the need to fully stipulate the district nurses instructions in the care plan. The support given in relation to the identified need must also be stated within the plan and daily records. This should correspond to other documentation such as ‘turning charts.’ A record of fluid intake was in place. However, the amounts were not being totalled. There were also no guidelines, to identify the service user’s usual (adequate) level of fluid intake. Ms James reported that the district nurse would be contacted if Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 19 the service user was refusing drinks or only drinking minimal amounts. Ms James reported that she would speak to staff regarding the formalisation of the documentation. Discussion took place with the member of staff responsible for the medication systems. This includes the ordering and the accurate receipt of all items. The member of staff was able to list medication each service user was prescribed. They also explained the reasons for much of the medication. All staff have recently undertaken detailed medication training. In order to minimise potential errors, two members of staff are involved with each medication administration. Two signatures demonstrate this, within the medication administration records. A monitored dosage system is used, which is orderly stored in a locked wall cabinet. Records regarding receipt and medication administration were satisfactorily maintained. However, some service users had been prescribed a number of creams. Many displayed instructions, such as ‘use as directed’ yet it was not clear, what they were used for. Many had also not been signed for, so it was not evident, if they were in use, or not. Ms James was advised to clearly specify the reason for the cream and the area of the body it should be applied to. Staff must also demonstrate its use through signing the medication administration sheet. As good practice, medication with a short shelve life, was being dated when opened. Staff were also identifying variable doses within the medication administration record. The organisation has clear medication policies and procedures. Patient information sheets relating to specific medications were easily accessible for staff reference. Spiders Island (40) DS0000028453.V337048.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users rely on their representatives to recognise any form of discontentment yet the development of a user-friendly complaint procedure, may enable some service users to raise their own concerns. Service users are safeguarded from abuse by the home’s comprehensive adult protection policies and procedures. EVIDENCE: SCOPE has formalised systems for the management and reporting of complaints. Ms James reported that she has recently completed complaints and satisfaction training. She is planning to cascade this to the staff team. Ms James confirmed that she is encouraging staff to record any issues that are raised. Anyone who raises an issue is then given a copy of his or her concern, its investigation and outcome. Ms James reported that as good practice, this procedure is followed for all matters, however small. Ms James explained she is also aiming to raise the profile of complaints. This is to enable families, for example, to clearly see that matters are taken seriously. Ms James also views complaints, as a means to develop the service. Regular discussion is held with family members so that their involvement is promoted. This enables matters to be discussed and resolved informally. Within a comment card, a relative confirmed that they were aware of the home’s complaint procedure. However they did not anticipate, that they would need it. There is a formalised complaints procedure, which is readily available to visitors. There are leaflets near the visitors’ book in the entrance hall. Posters, Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 21 encouraging complaints to be raised are displayed in the office. There is also complaints book, to enable comments. The procedure is not however, conducive to service users needs. At present, service users rely on staff, relatives or other advocates to recognise potential discontentment through general signs. A user-friendly format would give staff an additional tool to use in order to promote service users’ involvement and independence. Two members of staff have the designated responsibility of adult protection. Both have received initial training and receive regular up dates. Ms James confirmed that all staff have received a copy of the ‘No Secrets’ documentation and have undertaken adult protection training. During the inspection, a number of staff were asked a hypothetical question about abuse. All reported that they would immediately inform the adult protection representative or the manager. If they were not available, contact would be made either with CSCI, senior managers within SCOPE, the service users placing authority or the Safeguarding Adults Unit. Ms James and staff spoke of service users’ vulnerability due to their complex needs. They felt staff had a clear responsibility to recognise potential signs of abuse. Any marks, scratches or bruising noted on service users, are documented. If there is no apparent cause, all matters are investigated. Spiders Island (40) DS0000028453.V337048.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can enjoy a comfortable, clean, well-maintained environment that is conducive to their needs. EVIDENCE: 40 Spiders Island is a detached, purpose built bungalow with full wheelchair access. All service users have a single room, which is decorated and furnished to a good standard. One room however had an area, whereby the wallpaper had been peeled off, showing the bare wall. Ms James was aware of the situation and explained it had been reported to the organisation. Ms James expected the room to be redecorated shortly. Rooms contained varying levels of specialised equipment, including overhead hoisting. All were individual in style and personalised to a high degree. 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 has been redecorated and the curtains are in the process of being replaced Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 23 with blinds. The carpet, which is stained, has not as yet been replaced although Ms James reported that plans to do so are in place. There have been no changes to the laundry facilities. A member of staff explained that the facilities continue to be adequate to meet existing need. Although small the area was clean, tidy and ordered. The laundry is located next to the office. Soiled linen does not therefore need to be transported through any communal areas. All areas of the home were cleaned to a good standard and odour free. Spiders Island (40) DS0000028453.V337048.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well-established, staff team who are committed to their wellbeing. Robust recruitment procedures assure service users’ protection. Service users’ health care needs are met through the home’s emphasis on providing regular specialist training sessions. EVIDENCE: Staffing levels are currently maintained at generally four staff on duty throughout the day. Sometimes there are three members of staff with an additional 10am – 7pm shift. Staff are currently supporting the service user in hospital. When the service user returns to the home, staffing levels will be increased to five staff on duty in the morning. At night there is one waking night staff. A member of staff also provides sleeping in provision. Staff are responsible for all housekeeping tasks such as cooking, cleaning and the laundry. Many of the staff have worked at the home for many years and therefore know service users well. Since the last inspection, a number of staff have been recruited. Local advertising within shops was used, which proved successful. Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 25 Minimal agency staff are now used. Ms James reported that a CRB disclosure is being awaited before one member can work unsupervised. The recruitment documentation of the last two members of staff was examined. The files were ordered and demonstrated an organised process. Both had the required information including an application form, references and documentary evidence of their identity. Written notes of the applicant’s interview, were also evident. Within the information sent prior to the inspection, Ms James reported that fifteen out of the sixteen care staff have NVQ level 2 or above. Three bank staff also have NVQ level 2. Within discussion, Ms James reported that six staff are currently working towards NVQ level 3. The acting deputy manager is doing her Assessor’s Award. Within a comment card, a relative said that staff always have the right skills to support service users properly. The relative stated ‘if the residents need any special treatment or help – the staff have specialised training.’ Staff confirmed that there are various opportunities for training. One member stated ‘SCOPE are very good in this area, a varied programme is in place.’ Ms James reported that priority has been given to ensure all staff are up to date with all their mandatory training. A number of courses have been arranged and following this, Ms James reported that the yearly training matrix would be updated. Staff reported that they had undertaken specialised training in peg feeding, oral suction and oxygen. There was a record of this training although greater organisation within the documentation would be of benefit. Ms James confirmed that all information would be renewed when developing the homes training matrix. One member of staff reported that due to the wish of responding to a service user’s immediate health care need, rectal diazepam training is planned. At present the medication is stored within the home but can only be administered by a specialist health care professional. Undertaking the training would enable, the service user to receive a more immediate response. Staff have completed, a recent, care of the colostomy training session. Disability awareness training has been planned for August 2007. While it was acknowledged that a range of training is offered, sessions addressing service users individual health care conditions is not available. Ms James reported that information is often taken from the Internet yet more formal training sessions would be of benefit. Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a manager who promotes a good standard of user focus and service provision. The existing quality assurance system does not promote clear improvement or service users views. Service users’ welfare is safeguarded through established, well-managed health and safety systems. EVIDENCE: At the last inspection, Mrs Tolley was on sick leave and Ms James had been seconded to the post of acting manager. Mrs Tolley has since left her post and Ms James has continued in her role of acting manager. SCOPE has not as yet formally advertised the post. Ms James has worked at the home for many years and has nearly completed her Registered Manager’s Award. Ms James is very aware of service users’ needs and preferences. Ms James has made significant developments in areas such as care planning, risk assessments and staff supervision. Focus has also been given to further recognising service Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 27 users’ individuality and promoting issues of importance to them. Ms James explained that the staff team have been excellent. All are committed to service users and their wellbeing and want to further develop service provision. Staff gave positive feedback about Ms James and her style of management. A requirement was made at the last inspection to ensure that a formal quality assurance system was implemented. This requirement was made, as the organisation had not given any directive, as to what they wanted the home to implement. In response to the requirement, the organisation has developed a quality auditing policy. The documentation links a series of areas, to performance indicators. It was not clear however, how this was to be introduced in practice. It was also not clear how qualitative aspects of the service would be measured. For example, one aspect required the service manager to be responsible for ensuring the National Minimum Standards (NMS) were on site and available. Another expressed the need for all service users to have a care plan. Although relevant performance indicators, the knowledge of the NMS or the content of the care plans were not addressed. Questionnaire for relatives had been developed and distributed. The questionnaires contained a number of basic questions, which were set at a low level. Such questions included ‘are you made to feel welcome and able to meet your relative in private? Is your relative’s room clean and tidy? Are you aware of the complaints’ procedure?’ The structure of the questions also encouraged a ‘yes’ or ‘no’ answer. All questionnaires were returned with a series of yes and no answers. A questionnaire for service users in a user-friendly format was not available. Discussion about the quality assurance system took place with Ms James, as it appeared the home would clearly meet the level, which was being targeted. However, qualitative issues and how an annual development plan could be developed from the findings were less clear. Ms James explained that she had discussed the system with staff and they had not, as a team decided a way forward. As there had not been any specific feedback from the questionnaires, views had not been coordinated. Ms James reported that she would discuss the system with senior managers. In the mean time, Ms James reported that she would develop an auditing system within the home. SCOPE has a range of policies and procedures regarding health and safety. The subject also forms part of the organisation’s training plan. The home has a health and safety representative and regular refresher sessions are given, as support to the role. Since the last inspection, further work has been given to develop risk assessments. There are now, detailed comprehensive generic and individual assessments in place. Each member of staff has also identified potential risks to their well being, within their role. Ms James reported that this has been valuable in supporting staff with personal difficulties. Regular checks to maintain the safety of the environment are in place. These include the monitoring of hot water and refrigerator temperatures and fire alarm, vehicle and equipment checks. The home has a manual handler trainer and therefore Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 28 regular training sessions are undertaken in house. Comprehensive, up dated manual handling assessments are in place. These have been completed with the support of specialist health care professionals. Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 29 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 3 X Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 30 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 YA19 Regulation 12(1)(a) Requirement Timescale for action 03/07/07 2 YA20 13(2) 3 YA39 24 Care plans, daily records and turning charts, must correspond and identify the support the service user requires and the actual support given. Such documentation should complement those of the district nurse. Clear instructions regarding the 03/07/07 use of topical creams must be clearly documented. There must also be documented evidence that the creams have been applied. A formal quality assurance 30/09/07 system must be developed and implemented within the home. This was identified at the last inspection. (While a quality assurance system has been devised, it has not as yet been fully implemented. A revised timescale has therefore been set. Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 31 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 Refer to Standard YA6 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. 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 inspection, but has not been formally addressed. Strategies to identify when service users are in pain should be identified within care plans. All specialised programmes, such physiotherapy should be regularly reviewed. If there is no change to the programme, this should be documented. Consideration should be given to a more user-friendly complaint procedure to enable greater service user involvement. Consideration should be given to offering training sessions with regard to service users’ physical disabilities. Consideration should be given to how service users may be more involved in the home’s quality assurance system. 3 4 5 6 7 YA6 YA19 YA22 YA35 YA39 Spiders Island (40) DS0000028453.V337048.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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