Inspection on 01/06/05 for Bigwig House

This inspection was carried out on 1st June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bigwig House 04/08/09

Bigwig House 29/08/08

Bigwig House 11/09/07

Bigwig House 27/06/06

Bigwig House 15/12/05

Bigwig House 25/01/05

Bigwig House 08/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Bigwig House Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT Lead Inspector Richard Coates Announced 1 June 2005 09:30 st 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. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bigwig House Address Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT 01637 831220 01326 371099 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Spectrum Ruth Colley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 January 2005 Brief Description of the Service: Bigwig House provides care and accommodation for three people with autistic spectrum disorder. It is run by Spectrum, an organisation that provides specialist care to adults with an autistic spectrum condition. The home is situated in Holywell Bay, which is near Newquay. The accommodation is on two levels and consists of three single bedrooms, an office, kitchen, dining room and lounge. There is a sizable garden and adequate car parking for staff and visitors. The home has its own transport. The current residents do not need any specialist equipment or adaptations, and the home is not adapted for a person with a physical disability. Spectrum employs a registered manager and team of staff to run the home.Spectrum aims to provide service users with appropriate support in a small domestic environment in a community setting. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on Wednesday 1 June 2005. The inspection process was not assisted by the provider’s failure to submit a preinspection questionnaire. However, the inspection was facilitated on the day by the kind assistance of the manager, staff and service users. The inspector was on the premises for over 8 hours. The inspector had discussions with the manager and staff, spent time with the residents and staff, toured the premises, observed the daily life of the home and examined documents, records and policies and procedures. The last inspection set five requirements. Two of these have been fully met, one should be met very soon, and for another the timescale has not passed. One requirement is renotified in this report. What the service does well: What has improved since the last inspection? The registered manager has reviewed, developed and improved a number of the systems in the home. There is an impression of improved organisation and planning. There is evidence of active review and care planning to bring records Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 6 and directions for staff up to date and to ensure that risk assessment is thorough and comprehensive. The registered manager has also replaced furniture improving the comfort and appearance of the communal areas. Risk assessments for hot water, hot surfaces and windows have been completed with appropriate interventions implemented to promote the safety of residents. The replacement of double-glazing units which have become opaque through moisture, is due for early in June. The floor in the shower room will be replaced at this time. Supplementary information regarding terms and conditions for the service has been provided to residents and their representatives. 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. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.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 Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.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) 1, 2 and 5 Residents, prospective residents and their families and representatives receive appropriate informative material before and at the time of admission. The individual aspirations and needs of residents are assessed. EVIDENCE: The statement of purpose and the service users guide comply with the standard and regulations. They include the complaints procedure. Versions of the service users guide have been provided in ‘widget’ and discussed with residents. The service users guide and supplementary material provide the terms and conditions for the service and set out financial information. There have been no recent admissions to the home for which assessment records could be inspected. Spectrum has standard policies and procedures for the assessment and introduction of prospective residents to the home. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.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 All residents have written care plans which are regularly reviewed. Residents are supported to participate in the care planning, review processes and to make decisions. Risk assessment arrangements are thorough and support residents in an independent lifestyle. EVIDENCE: Written care plans are in place for all three residents. Summary care plans set out how the needs and aspirations of residents in personal support, healthcare and social activities are met. Risk assessment and safe working practice documents provide a detailed risk assessment, and inform and direct staff in specific interventions for behaviours which challenge, and for self-harm. These interventions focus on positive behaviour. A physical intervention report is recorded when control and restraint of a resident has taken place. Residents are involved in review and care planning at individual six monthly placement plan meetings, and in regular planning meetings. Care plans include clear guidance and information for staff on the communication skills of the residents. Current action plans have been drawn up following reviews for all three residents. Interactions between staff and residents were observed to make Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 10 reference to the action plans. The care planning arrangements enable staff to assist residents to make decisions about their lives. There are specific plans to support residents in some decision- making areas – for example shopping. Residents sign specific contract elements of their care plan. Detailed and specific individual risk assessments are drawn up for individual activities, for example horse riding, outings and skiing. These assessments clearly set out the risks involved and the possible control measures. The residents are supported to participate in the risk assessment process – for example making a preliminary visit to a new activity with the assessing member of staff. A resident spoke with the inspector about his satisfaction with the support he received and the qualities of the staff. He enjoyed using community facilities with staff support. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.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) These standards will be assessed in the unannounced inspection later in the year. EVIDENCE: Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.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) 18, 19 and 20 Staff provide appropriate support to residents with personal care where this is required to meet their needs and preferences. The healthcare needs of residents are monitored and addressed. The systems for handling medicines do not completely safeguard residents. EVIDENCE: Care plans set out the residents’ needs and preferences in respect of personal care. Staff provide verbal prompts and some minimal assistance with personal care where this is required. Residents were taking baths with appropriate and minimal support from staff during the morning of the inspection. Staff encourage privacy and appropriate dress. Times for getting up and going to bed are flexible; two residents get up to attend college on some weekdays. All three residents are registered with a GP. Records include protocols for attending medical appointments and detail visits to GPs, dentists, opticians and specialist health professionals. The registered manager discussed how medical conditions are currently being monitored and addressed. There is a policy and procedure on the handling of medicines which covers required areas. Medicines are stored in a locked safe in the office. No controlled drugs are currently in use. A sample of medicines were checked against the administration records and found to be accurate. The administration records were consistently signed. The registered manager records a weekly audit of medicines. The registered Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 13 manager has completed a course in the safe handling of medicines. No other staff have completed adequate training in the safe handling of medicines, although there is an internal system for confirming ‘competency’. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.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 There are arrangements in place to protect vulnerable adults, but the provider should obtain the policy and procedure from each commissioning authority. EVIDENCE: The Spectrum complaints procedure complies with the standard and is provided in the information material. Residents are supported to express their views at regular review meetings and informally. The registered manager retains a record of complaints. One complaint had been received recently and was still being addressed. The vulnerable adult protection procedure is currently being reviewed and updated. It needs to state that all concerns and allegations about the abuse of a vulnerable adult must be referred to the social services department. Spectrum staff should not begin adult protection investigations but follow local multi-agency procedures. Staff were aware of the procedure and reporting requirements. All staff, with the exception of the registered manager who has training arranged, have completed vulnerable adult training. The home does not currently have a copy of the adult protection procedure for each commissioning authority, but does have a copy of the local Cornwall multiagency procedure. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.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) These standards will be assessed in the unannounced inspection later in the year. EVIDENCE: The shower room is not currently available to residents, as the floor needs a major repair. This is due to be completed in early June 2005. The doubleglazing, which has become opaque is planned to be replaced in early June 2005. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.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, 34, 35 and 36 Staffing levels meet minimum requirements but are not consistently sufficient to support staff training and allow flexibility in activities for residents. The recruitment practices for a recent appointment protected residents. The arrangements for training and personal development of staff need reviewing to ensure that the individual and joint needs of residents are met. Staff are well supervised and supported. EVIDENCE: The registered manager has an NVQ at level two. She is completing her NVQ assessor’s award and is registered for the NVQ at level 4 for management. Two other staff are reported as close to completing their NVQ level 2. A resident reported that there has been a recent period of stability in the staff group following an earlier period of high turnover. The registered manager confirmed this. The resident said that he is more comfortable during periods of settled staffing. There is a roster which details the planned staffing and records who actually worked. There are usually two staff on duty during the early morning, three from mid-morning onwards and four or five staff rostered to provide specific activities and one-to one work. The statement of purpose details the minimum daytime staffing as 2. There is one staff sleeping in at night. The roster details Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 17 that recently there have been some difficulties in maintaining daytime staff above the minimum level because of sickness and annual leave. The registered manager has access to ‘bank’ staff, but these are not always available. There have been occasions over recent months when a lack of sufficient staff has limited staff access to training and restricted flexibility in residents’ activities. The records for the recent recruitment of a new worker complied with the regulations and schedule 2. A Criminal Records Bureau disclosure and POVA check had been obtained. The registered manager has completed training in recruitment and selection and will be involved in future staff recruitment. Staff report that there are good training opportunities within Spectrum. However, a number of staff at Bigwig appear reluctant to attend required training courses. The registered manager has drawn up a training matrix which summarises training completed by staff and training outstanding. All staff complete the basic induction which complies with the industrial standard set by ‘Skills for Care’. All staff also complete positive response training (Spectrum’s methodology for control and restraint) and most have completed autism awareness. However, there has been a lack of training for staff in health and safety, first aid, food hygiene and the safe handling of medication. Staff reported that they receive regular supervision from the registered manager and they were positive about the support provided. Records show that formal supervision has been taking place recently at the two-month interval set by the standard. There are regular staff meetings. However, staff do not have annual appraisals with a manager. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 41 and 42 There are a small number of regulatory issues which require addressing, but the home is, essentially, well run. The record keeping generally safeguards the rights and best interests of the residents. Staff need to receive training in some areas in order to fully protect the health and safety of residents. EVIDENCE: The registered manager meets the experience requirement and has begun the NVQ level 4 managers award. She has a detailed job description. The provider has recently sent out a quality assurance questionnaire to residents and their representatives. A summary of the responses and views should be made available. There are individual development plans for each resident. The registered manager completes a three monthly environmental audit and risk assessment and a regular ‘house evaluation’. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 19 A sample of records required by regulation were examined and found to be satisfactory. However, the provider is not regularly submitting to the commission copies of reports of monthly visits made to the home under regulation 26. The records for residents complied with regulations. Staff records are now accessible remotely at care homes through the Spectrum computer system. Those sampled complied with regulations. Staff were positive about the health and safety training that they had received during induction. However, staff have not completed training in some health and safety areas as previously noted. Risk assessments are detailed and provide directions and interventions for staff. Satisfactory records were available for servicing of fire equipment and weekly detector tests. The fire risk assessment has been completed. Satisfactory records were also on file for the electrical wiring, portable electrical equipment and the servicing of the heating and hot water system. The accident books contained recent records of accidents and incidents. The toilet seat in the upper floor toilet is very loose and a potential hazard. An immediate requirement was set for this to be repaired or replaced. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x 2 2 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bigwig House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x 2 2 x D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 21 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 35 and 42 Regulation 18(1)(c) Requirement Staff must receive training appropriate to the work that they are to perform. This must include food hygiene, health and safety, first aid and the safe handling of medicines. These requirement has been modified. Renotified - previous timescale of 1 May 2005 not met. The registered provider must make available a summary of the views of service users and their representatives. This requirement has been modified. Previous timescale has not expired. The registered person must review whether staff are working at the home in such numbers as are appropriate for the health and welfare of service users at all times. This must take account of sickness, leave and training, and enable flexibility and choice in activities for service users. The registered peron must arrange a monthly visit in accordance with regulation 26 and supply a copy of the report to the home. The registered person must Timescale for action 31.12.05 2. 39 24 1.07.05 3. 33 18(1)(b) 31.08.05 4. 41 26 1.06.05 5. 42 13(4)(a), 8.06.05 Page 22 Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 6. 23 (b) and (c) 13(6) secure correctly the loose toilet seat in the upper floor toilet. The adult protection procedure must direct staff clearly to follow local multi-agency procedures and report all incidents and concerns to the social services department. 31.08.05 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 23 36 Good Practice Recommendations The registered person should obtain the adult protection procedures from each commissioning authority. The registered person should introduce a formal system of staff appraisal. Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Bigwig House D52-D04 S9102 Bigwig V224510 010605 Stage 4.doc Version 1.30 Page 24 - 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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