CARE HOME ADULTS 18-65
Bigwig House Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT Lead Inspector
Lynda Kirtland Unannounced Inspection 11th September 2007 9:30 Bigwig House DS0000009102.V345115.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 Bigwig House DS0000009102.V345115.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. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bigwig House Address Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT 01637 831220 01326 371099 mail@dcact.org 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) Spectrum Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. 3. Learning disability (Code LD) The maximum number of service users who can be accommodated is 3. One service user who will be 18 years old on 18/11/07 may be admitted prior to his 18th birthday. This condition will cease thereafter. 27th June 2006 Date of last inspection 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 homes 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. Fees range from £1242.00 - £2630.25 per week. Additional charges are made to service users for hairdressing, Newspapers and magazines, alcoholic drinks, confectionary, private chiropody, dry cleaning, entertainment provided outside of the premises and stationary. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place on 11 September 2007. It lasted for approximately six hours. Information about the home received by the Commission since the previous inspection was taken into account when planning the inspection. The homes manager completed the Annual Quality Assurance Assessment and information from this was incorporated in the inspection process. The purpose of the inspection was to ensure that service users’ needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved talking with service users and observation of the daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of the service users and the ongoing management of the home. Staff were interviewed and observed in relation to their care practices and there was a discussion with the home’s acting manager. The principle method used was case tracking. This involves examining the care notes and documents for a select number of residents and following this through with interviews with them and/or their relatives and staff working with them. This provides a useful, in-depth insight as to how residents’ needs are being met in the home. At this inspection, two of the service users were case tracked. The day of the inspection was the last working day for the home manager as she was leaving the organisation. An interim home manager has been appointed and information regarding his suitability to take on this post has been forwarded to CSCI. Service users were asked if they would like to speak to the inspector, on their own or with staff support, but they decided not too. What the service does well:
Admission to the home is based on a detailed assessment so that service users can be confident it will be suitable for them. They are provided with written information about the home, what it provides and what is expected of them, which is available in translated formats so that they can access it directly, if they wish. Service users have detailed written care plans, which set out how the home will meet their personal, health and social care needs, including needs relating to their individual backgrounds and culture, age, sex, religion, individual abilities and sexual orientation. These are regularly reviewed and shared with their representatives so that they can be kept informed of their progress in the home. Staff help them to make important decisions about their lives and enjoy
Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 6 a good quality of life. They are supported and encouraged to take risks to develop their skills, independence and confidence, but in ways which are safe for them and other people. Service users enjoy a good quality of life in the home. Staff support them to take part in a wide range of activities in the community. They are encouraged to go out to a local social club one evening a week and to maintain valued relationships with their friends and families outside of the home. Staff support service users with their personal care so that they look smart and fashionably dressed, which they appreciate. They are helped to access a range of NHS healthcare providers, such as doctors, opticians and community nurses so that they maintain good general health and d receive any specialist services they need. The staff team is selected fairly and on the basis that people employed to work in the home are fit and suitable to work with vulnerable adults in a care setting so that service users and their representatives can have confidence in the people caring for them. Staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting. At the time of the inspection, during the daytime there were enough of them on duty to be able to work individually with the service users in and out of the home. What has improved since the last inspection?
Service users are provided with written statements of the terms and conditions of their placement, in translated formats, so that they can access the information directly. This is shared with their representatives and relatives. Since the previous inspection there has been a review of nighttime staffing in the home. Due to current service users dependency needs the level of staffing has increased to two staff members over night. Staff and the manager commented that this level of staffing is sufficient and expressed concern if this was reduced as this could impact on service users health and welfare. CSCI has requested that if this level of staffing is reduced that they are informed so that it can be discussed further. The majority of staff have completed first aid training so that at member of staff is on duty who has completed this course. The system is more robust with accurate records of what medication is home tallying with the actual stock of medication kept in the cabinet. all times a medication kept in the medication The broken door to service users has been repaired. Other essential maintenance works has been completed since the previous inspection and new furnishings brought.
Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 7 Staff now ensure that soiled laundry is taken out of the front of the property and into the garage where the washing machine is kept. Therefore no soiled laundry is transported via the kitchen, which promotes infection control. The homes manager said that a written policy in how soiled laundry is to be transported would be done so that staff are aware of what process to follow. Induction records are kept at the home. Due to the increase in staff training it is now evident that staff left in sole charge of the home are competent to meet the health and safety needs of Service users. The fire system has been updated and new fire doors installed. What they could do better:
The homes Statement Of Purpose and Service Users guide needs to be updated to reflect accurately the services, facilities and staffing arrangements of the home so that service users and their representatives can have accurate information on what Bigwig provides. Care plans must be updated so that they reflect current care needs. The homes manager said that the care plans are all in the process of being updated. The homes manager also confirmed that risk assessments are being reviewed by Spectrum, as they need to be more detailed and relevant to the individual Service user. It is recommended that when transcribing medication two staff members to prevent errors in handwriting medication instructions witness this. The manager confirmed that five staff have not attended medication training. This must be completed An adult protection issue was identified during the inspection. This had not been referred to the Department of Adult Social Care under the Adult protection remit and CSCI required this be done immediately. The management team of Bigwig must in future ensure that all adult protection issues are reported using the correct procedure as outlined in Cornwall Multi Agency Adult Protection procedure and the homes policy. The policy and procedure in respect of the management of Service users monies needs urgent review, as it does not specify to staff how they should manage service users monies in sufficient detail. CSCI are happy to discuss this further with Spectrum. Less than the recommended 50 of care staff are qualified to NVQ level 2, although this situation should improve as more staff are due to complete it in the near future. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 8 An up to date overview of staff training is recommended so that the management team can ensure that staff receive regular training to assist them in their work. Staff commented that whilst there is the communication course available they feel more training in the use of Makaton is needed. Records of individual one-to-one supervision of care staff showed it last occurred in May 07. The home’s manager was aware that this needed to be reinstated. An interim manager, Mr Morgan has been identified to manage this service but it is unclear if he will be applying for the registered manager position. Spectrum must appoint a permanent manager for the service and the application for the registered manager post must be made to the Commission. A quality assurance process was completed in April 07. The findings of this audit and any actions the home are intending to take must be forwarded to the commission. It is recommended that the fire risk assessment be reviewed to ensure that it meets current legislation. The inspector would like to thanks Service users, staff and the manager for their time and cooperation during this inspection process. 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. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 9 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 Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 10 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): 1,2,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Statement of purpose needs to be reviewed and updated so that it accurately reflects the service that Bigwig provides for service users and their representatives information. Service users’ needs are assessed prior to their admission so that they can be confident it will meet their health, personal and social care needs, including needs relating to their age, religion, cultural and ethnic backgrounds, abilities, gender and sexual orientation. EVIDENCE: The home’s Statement Of Purpose and Service Users guide needs to be updated to reflect accurately the services, facilities and staffing arrangements of the home. Service users and their representatives can then have accurate information on what Bigwig provides. There has been one recent admission to Bigwig since the last inspection. From documentation inspected it was evident that admissions are made following a full assessment and in consultation with the service user, their family and relevant professionals. Transitional work had also taken place so that all the service users and staff could meet each other prior to the Service user becoming a permanent resident of the home. From observations it was evident Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 11 that service users are settled in the home, and that they get on fairly well with each other and with the staff. Service users are provided with written statements of the terms and conditions of their placement, in translated formats, so that they can access the information directly. This is shared with their representatives and relatives. Two of them included the total cost of their placement and a detailed breakdown of how their personal contributions towards the total cost is calculated. For one Service user this was missing. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 12 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): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users care plans address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds. The care plans need to be reviewed so that they accurately reflect the Service users current care needs and inform staff what interventions are needed to provide consistent care for the individual. They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. EVIDENCE: Service users, their family, advocate and relevant professionals are involved in the development of individual care plans and their subsequent reviews. The reviews record service users views so that they are aware of the purpose of their placements in the home and are able to contribute to the ongoing care planning process. A review occurred on the day of inspection. The care plan has specific headings to address their health, personal and social care needs, including their individual and diverse needs. These are in written form plus in Widget (pictorial) form. Personal Care plans provide service users with specific goals to work towards, and inform and direct staff in how to support the
Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 13 service user to achieve this goal to encourage them to fully maximise their skills for independent living. Staff confirmed they were able to understand the care plans and that the detail of how to assist in a particular task allowed consistency of care. The inspector noted, confirmed in discussion with the homes manager, plus a recent regulation 26 visit that some of the care plans were out of date, and did not reflect current care needs. The homes manager said that the care plans are all in the process of being updated. Service users participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. Staff were observed supporting service users who required it, to make decisions about what to do during the day. Service users’ written care plans formally consider their abilities to make decisions for themselves and daily care records provide further evidence of the choices they make in their daily lives. Service users can choose the level of privacy they wish to enjoy in their private accommodation. Service users are able to take managed risks, backed up with written risk assessments and risk management plans, particularly with regard to their engagement in higher risk activities. The homes manager commented that the risk assessments are being reviewed by Spectrum, as they need to be more detailed and relevant to the individual Service user. For information regarding Service users monies please refer to complaints and protection section. Bigwig House DS0000009102.V345115.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): 12,13,14,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in a wide range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social and family relationships so that they are not isolated or institutionalised. They are informed of their rights and responsibilities so that they are aware of what is expected of them. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy EVIDENCE: At the time of the inspection, service users were engaged in a range of different individual activities. Their individual needs and preferences are considered as part of the assessment and/or care planning process so that they can be provided with activities that are appropriate for them. They have information, in pictorial formats about the different activities available to them so that they can plan and choose what they will do each week with staff. A list
Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 15 of weekly activities the Service users has participated in is sent to the families for their information. Service users were continuously in and out of the home during the inspection: walks, swimming at the beach and school with staff support. In the home they were listening to music, watching DVD’s and managing some household chores. Their daily care records confirm that they make use of a wide range of community resources. There are records of their contact with their families, including regular visits home, or visits from relatives to them at Bigwig. Needs in relation to their developing personal relationships are considered as part of the ongoing assessment and care planning process, including specific risks. The homes manager did refer Service users to the advocacy service to ensure that they had an independent voice. However the advocacy service felt that they did not meet their criteria at this time. Service users do have regular contact with family members and the homes manager felt that they would raise any issues with them if and when they arose. A service user was preparing his breakfast during the inspection. The menu showed that Service users have a day’s choice of menu each week. They can assist, with staff support in the preparing and cooking meals and can help with the shopping. Staff supports them according to their individual needs and abilities and they are able to independently access the kitchen, depending on their individual risk assessments. There are clear records of food provided to service users so that staff can monitor their nutritional intake and encourage them to eat healthily. Referrals to dieticians are made when a care need has been identified. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. Medication systems are safe to ensure that medication errors are prevented. Staff should attend medication training to ensure they are knowledge in this area. EVIDENCE: Service users individual care plans address their personal care needs. They appeared to be attractively and fashionably dressed so that they can comfortably take part in community life. The home has suitable bathroom facilities so that they can attend to their personal care in private. Service users healthcare needs are considered as part of the care planning process and regularly reviewed. Documentation showed that access to external healthcare providers, including specialists, occurs when needed. There are suitable medication storage facilities. Only one Service user is in receipt of prescribed medication from the Monitored Dose System. From inspection of these records it was evident that staff are recording medications they receive, administer and dispose of. There has been one medication error,
Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 17 which was identified quickly and resolved. With PRN medication (loose medication) the homes manager has ensured that the number of tablets in the medication cabinet corresponds to the MAR sheets, a tablet count occurred and the records were accurate. Spectrum has a medication policy that was present in the home. It is recommended that when transcribing medication two staff members to prevent errors in handwriting medication instructions witness this. The manager confirmed that five staff have not attended medication training. This must be completed First aid training is completed on staff’s induction period and there is always a first aider on duty. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 18 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, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. Adult protection issues must be referred to the relevant agencies. Service users financial systems need to be improved to ensure that they are protected from abuse. EVIDENCE: Service users were encouraged to speak to the inspector if they wished in private or with staff present so that they could make their views known or raise any concerns. They choose not to on this occasion. Service users and their families are provided with written copies of the home’s formal complaints procedure and have formal and informal opportunities to raise any concerns with staff before they become serious complaints. The home has not received any complaints since May 2005. The home has written procedures to guide staff on what to do if they suspect a resident is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. Residents are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. Spectrum has a whistle blowing policy. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 19 Service users or their representative’s consent must be sought if the home is assisting Service users with their money. It was noted during the inspection that there had been a recent issue regarding finances. Due to confidentiality the details are not included in this report. CSCI required that the matter be referred to Department of Adult Social Care under the Adult protection remit immediately. The homes manager agreed to do this and to keep CSCI informed of the progress. In addition the home did not have a copy of the policy and procedure in respect of the management of Service users monies, this was e mailed to the home when requested. The policy needs urgent review, as it does not specify to staff how they should manage service users monies in sufficient detail. CSCI are happy to discuss this further with Spectrum. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 20 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, 26, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment provides service users with an ordinary, domestic setting so that they can develop their skills and independence in a noninstitutional setting. It is safe and clean so that service users are protected from risks of cross-infection. EVIDENCE: The home looks like an ordinary, domestic dwelling. It is well decorated and comfortably furnished throughout and service users had personalised their private rooms and choose the décor and furnishings. Since the previous inspection some of the home has been redecorated, had new furnishings and at the time of inspection maintenance jobs were being done. The home appeared clean and tidy throughout at the time of the inspection, which was unannounced. Staff have or are due to attend basic food hygiene, and infection control courses. The policy in respect of moving laundry through the home needs to be made clearer so that staff do not take it through the kitchen area. In addition paper towels should be supplied in the kitchen area for staff to promote infection control.
Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 21 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): 32,33,34,35,36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff levels have increased at night to reflect current dependency needs. Staff in the main are employed in sufficient numbers and reflect the individuals risk assessments. Less than half of the staff team are qualified to the level recommended in the National Minimum Standards so that service users can have confidence that people working with them are competent to do so. Staff are recruited fairly, safely and effectively on the basis that they are suitable to work with vulnerable adults in a care setting. They have access to ongoing training. Staff are well supported but should be provided with more regular, formal supervision so that service users can be assured that they are properly supervised. EVIDENCE: Four staff were on duty plus the homes manager during the inspection. Staff felt that within the home there were generally sufficient staffing levels. Rotas showed that there are usually four staff members on duty during the day/ evening and due to current dependency needs there is an increase of waking night staff to two people. The homes manager said this remains under review. CSCI must be informed if the waking night staffing is reduced. Current
Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 22 sleeping arrangements for staff (in lounge and office on futons) is not sufficient and needs to be reviewed. The homes manager confirmed that most days there are 5 staff members on duty so that each service user is able to take part in his activities with appropriate staffing levels/support in the community as per their risk assessment. According to the manager and records held in the home, less than the recommended 50 of care staff are qualified to NVQ level 2, although this situation should improve as more staff are due to complete it in the near future. Newly recruited staff files were inspected and demonstrated that appropriate checks had been completed in line with legislation. Staff records confirmed that an induction package is undertaken for all new staff to the home. Care staff have individual training records that are kept on the computer system and takes some time to access. The homes manager had an out of date overall training plan for the home, and this should be updated. Staff confirmed that when training occurs it is beneficial. Staff commented that whilst there is the communication course available they feel more training in the use of Makaton is needed. Records of individual one-to-one supervision of care staff showed it last occurred in May 07. The homes manager was aware that this needed to be reinstated. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 23 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): 37,39,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Spectrum must appoint a manager to the home and he/she must apply to the Commission to be the registered manager. The home is mainly well managed for the benefit of service users. There are formal and informal systems in place to ensure that service users’ views are accounted for in the day-to-day running and ongoing development of the home. There are systems in place to protect service users and staff from avoidable harm and injury. EVIDENCE: The registered manager Mr Wilcox transferred to another care home in April 2007, Ms Lake then became home manager, but has resigned and today is her last day of work. An interim manager, Mr Morgan has been identified to manage this service but it is unclear if he will be applying for the registered manager position. Spectrum must appoint a permanent manager for the service and the application for the registered manager post must be made to the Commission.
Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 24 A quality assurance process was completed in April 07. The findings of this audit and any actions the home are intending to take must be forwarded to the commission. Monthly regulation 26 visits occur to oversee the quality of the service. Records are stored confidentially, staff need to be conscious of their recordings to ensure that it adheres to the data protection act i.e. communications book. The home’s environment in the main appeared safe and there are written individual and environmental risk assessments in place to minimise risks to Service users and staff working in the home. Maintenance of the home and its equipment are satisfactory. The home’s fire safety records were completed and up-to-date. There are records of regular tests and checks of safety. It was recommended that the fire risk assessment be reviewed to ensure that it meets current legislation. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 25 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 2 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 3 X X 2 X Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 26 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 YA1 Regulation 4,5,6 Requirement The home’s Statement Of Purpose and Service Users guide must be updated to reflect accurately the services, facilities and staffing arrangements of the home so that service users and their representatives can have accurate information on what Bigwig provides. Individual care plans must be updated so that they reflect current care needs Timescale for action 30/01/08 2. YA6 15 30/10/07 3. YA9 12(2) (3) 13(4)(a) (b) (c) 13(6) Risk assessments must be 30/11/07 reviewed, as they need to be more detailed and relevant to the individual Service user. The management team of Bigwig 12/09/07 must in future ensure that all adult protection issues are reported using the correct procedure as outlined in Cornwall Multi Agency Adult Protection procedure and the homes policy. The policy and procedure in respect of the management of Service users monies needs urgent review, as it does not
DS0000009102.V345115.R01.S.doc 4. YA23 5. YA23 16(l) 17(2) Sch 4 (9)(a)(b) 30/10/07 Bigwig House Version 5.2 Page 27 6. YA37 8,9 specify to staff how they should manage service users monies in sufficient detail. Spectrum must appoint a 30/11/07 permanent manager for the service and the application for the registered manager post must be made to the Commission. 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 YA20 Good Practice Recommendations It is recommended that when transcribing medication two staff members to prevent errors in handwriting medication instructions witness this. Staff should attend medication training to ensure that they are aware of how to receive, administer and dispose of medication safely. 2 YA30 The homes manager should produce a written policy in how soiled laundry is to be transported through the home to promote infection control. The registered provider should ensure that at least 50 of the staff team are qualified to at least NVQ level 2. An up to date overview of staff training is recommended so that the management team can ensure that staff receive regular training to assist them in their work. Staff should be able to attend relevant communication courses available especially in the area of Makaton. Formal supervision of staff should be reinstated and records kept of this. It is recommended that the fire risk assessment be reviewed to ensure that it meets current legislation.
DS0000009102.V345115.R01.S.doc Version 5.2 Page 28 3 4 YA32 YA35 5 6 YA36 YA42 Bigwig House 7 YA39 The findings of the quality assurance audit and any actions the home are intending to take must be forwarded to the commission. Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Bigwig House DS0000009102.V345115.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
