Inspection on 15/12/05 for Bigwig House

This inspection was carried out on 15th December 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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 01/06/05

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 Unannounced Inspection 15th December 2005 09:30 Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 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.V273409.R01.S.doc Version 5.0 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.V273409.R01.S.doc Version 5.0 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 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 Miss Ruth Jayne Colley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st June 2005 Brief Description of the Service: Bigwig House is a detached house in the village of Holywell Bay. The home is registered to provide accommodation and care for up to three service users with a learning disability. The registered provider is Spectrum, an organisation which provides specialist services for people who have autistic spectrum conditions. The aim is to provide service users with a homely environment in a community setting and enable them to enjoy ordinary valued living. Senior managers from the organisation are available to provide consultation and advice when required. 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 good car parking for staff and visitors. The home has three vehicles. The current residents do not need any specialist equipment or adaptations for physical disability. There are two steps at the main entrance, a long flight of steps from the back door down to the garden, and a flight of stairs internally. The home is not suitable for a person with a physical disability. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned unannounced inspection. The aim was to review compliance with the requirements set in the last inspection report, dated 1 June 2005 and to focus on key standards in the care planning, lifestyle, environment and staffing areas. The last inspection report covered the key standards in other areas. Some standards, for example care plans, have been included in both inspections. The inspector was on the premises for over seven hours and spent time with staff and residents, examined documents and records and toured the premises. The inspection report takes account of material submitted in relation to the requirements from the last inspection and the records of monthly management visits submitted to the commission. The inspector is grateful for their kind assistance of the staff and residents in completing the inspection. What the service does well: What has improved since the last inspection? The service users guide now includes some views of residents and their families. Spectrum has revised and issued the policy and procedure for the safe handling of medication as part of a general review of policies and procedures. Staff have undertaken food hygiene training and first aid training. Staff are undertaking training in the safe handling of medicines very soon. The floor to the shower room has been replaced and some double-glazing units, which had become misted up, have been replaced. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 6 Spectrum is now consistently sending the commission copies of monthly management reports as required by regulation 26. The registered manager has obtained copies of the adult protection procedures from two of the commissioning authorities. 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 DS0000009102.V273409.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 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 the following standard(s): These standards were not inspected in detail. They were included in the last inspection report. EVIDENCE: The service users guide now includes a summary of the views of residents and their families as obtained from quality assurance survey. This was required in the last inspection report. No new residents have been admitted since the last report. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 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 the following standard(s): 6 and 9 Service users have detailed individual written care plans which inform and direct staff in meeting their assessed needs. The care plans include detailed risk assessments which set out the interventions required to support residents in the activities of daily life. EVIDENCE: The records for resident were case tracked in detail. The care plan is set out in a care plan summary document, a risk assessment and safe working practice document, a plan of current goals identified from individual personal planning meetings, and a number of risk assessments and protocols covering specific activities and needs. The plan covers all aspects of personal and social support, and healthcare needs and informs and directs support workers in detail about the support needs of the resident. Staff report that the care plan and associated records are extremely useful working documents. There are records of monthly profiles and six monthly individual planning meetings with the resident and involving his family. Staff record a daily diary and maintain a number of records for specific areas. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 10 Risk assessments with detailed directions and information for support workers support the resident’s safe participation in a range of activities in the home and in the community. The risk assessment and safe working practice document directs staff in minimizing the risks and hazards which can result from the resident’s complex needs. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14, 15, 16 and 17 Service users have opportunities for personal development and take part in a range of appropriate educational, social and leisure activities, but this can be limited when staffing is at a minimum level. Service users are supported to make choices about their meals, eat a healthy diet and enjoy their mealtimes. EVIDENCE: There are written weekly activity plans for each resident. Each resident has an individual plan which identifies their needs and current goals in relation to social, communication and independent living skills. Two residents attend Truro College, one for two sessions weekly, one for three or four sessions. One to one and two to one staffing supports all attendances at activities outside the home, in line with written risk assessments. One resident has chosen not to pursue any educational activities. The records show regular shopping expeditions in local towns. One of the residents assists with the house shopping at Tesco. Most activities are individual preferences – for example one resident likes going for walks and drives, another prefers to visit the local public house. Two residents use the local library and one uses the DVD and computer games library. One resident Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 12 enjoys attending the local Gateway club. All three residents enjoy bowling. Staff report good relations with neighbours. The residents and staff were all looking forward to the annual Spectrum Christmas party at the Watering Hole in Perranporth on the evening of the day of the inspection. The home has three vehicles and spending time with residents outside the home is a recognised part of the staff duties. One resident prefers to participate in a fairly limited range of activities and outings, and is reluctant to do more. The manager and staff are supporting him sensitively to expand his activities. Records showed that there were occasions, when the home had a minimum staffing level of two, for example at weekends, and individual activities and outings were not possible. A member of staff reported that this happened less often now. The home provides television, video, DVD and music. Residents have their own entertainment equipment. For two residents this is modified suitably to meet their risk assessment. Two residents have computers. The residents had a holiday at Colvennor, the Spectrum holiday home this year while maintenance was carried out on the home. Records show that residents are supported to maintain contacts with their families. Arrangements for contact are set out in individual care plans. Staff reported that families are welcomed when visiting the home and their involvement in care planning is encouraged. The residents have keys to their rooms, although two leave them in the doors. Residents can access the patio area and garden. Times for getting up are related to activities and attendance at college and each resident has his own preferred times for going to bed. Staff were observed to interact in and adult and facilitative manner with residents during the inspection. Residents assist with housekeeping tasks. Their involvement in running the home is included in care plans and risk assessments. There is a cleaning plan in the kitchen and daily diaries detail the tasks carried out. The home retains a recorded menu and records of food consumed. The records show a varied and nutritious diet. The menu includes individual choices and meals enjoyed by all three residents, for example a roast dinner on Sunday. Individual likes and dislikes are recorded. Residents had a sandwich lunch on the day of the inspection at times to fit in with their individual activities. One resident told the inspector that he was able to choose meals and enjoy his preferences, for example a hot curry, and the food provided was ‘good’. He reported that there more meals prepared from fresh ingredients, rather than frozen food and meals, were served now. A support worker stated that there were good cooks in the team. None of the residents is assessed as having particular nutritional needs; staff monitor the food intake of one resident. The manager and staff encourage a healthy diet and residents are weighed regularly. The refrigerator and freezers were well stocked. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 13 Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 20 The arrangements for the safe handling medicines do not fully protect service users, but this is being addressed. A revised policy and procedure has been issued and staff are due to complete training very soon. EVIDENCE: A new Spectrum policy and procedure on the safe handling of medicines that complies with the standard has been issued to homes. Bigwig is now using the Boots monitored dosage system. Medicines are stored in a small lockable steel cabinet in the office. The key to this cabinet was in a small key cabinet which had been left with the key in it. Staff reported that this was not the usual practice and the key cabinet was normally locked. The medicine administration records show that medicines are checked on receipt. No resident has been assessed as safe to manage their own medication. The intention is for all administrations to be signed and witnessed. The signatures of the staff administering the medicine are consistently complete; second signatures are sometimes missing. Good practice guidelines do not normally require a second signature unless a controlled drug is administered. No controlled drugs were in use. There is a specimen staff signatures list and information about the medicines in use. The dosage for one drug had been amended on the medicine administration record following instructions from the GP. Such amendments should be signed and dated and referenced to the Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 15 entry in the resident’s records. Staff do not currently have up to date training in the safe handling of medicines; they were due to receive this training in the week following the inspection. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 16 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 the following standard(s): These standards were included in the last inspection report. EVIDENCE: The registered manager has obtained copies of the adult protection procedures for two of the three commissioning authorities; one authority has not responded to requests. The revised Spectrum adult protection procedure, a requirement from the last inspection report, is awaiting final approval. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 17 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 the following standard(s): The service users live in a comfortable and well-maintained home which provides a safe and suitable environment and meets their needs. EVIDENCE: Bigwig House is a spacious three-bedroom house on two levels in a coastal setting in Holywell Bay. This provides a comfortable and homely environment. There are two steps to the main entrance on the upper floor, and a long flight of steps from the rear door to the garden. Internally there is a flight of stairs between the two levels. The bedrooms and bathrooms are on the lower level and the shared accommodation on the upper level. The home would not be suitable for a person with mobility problems or a wheelchair user. The premises were airy, clean and well presented. Furnishings and fittings were of good quality and domestic in style. The home continues to provide the same area of accommodation as at April 2002. Since the last inspection some double glazing units that had become misted have been replaced. The shower room floor has also been refitted. The premises are generally well maintained and in good decorative order. There were no obvious health and safety risks on the day of the inspection. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 18 Residents have their own rooms. These rooms have furniture and fittings which reflect the residents’ lifestyles and interests. Residents have chosen the colour schemes for their rooms. A resident expressed his satisfaction with his room and was happy with how it met his needs. On the lower floor there is a shower room with toilet, and a bathroom with toilet. On the upper floor there is a toilet. There is a recurrent problem with loose toilet seats, which the provider continues to address. The bathroom, shower room and toilet have suitable locks which staff can override from outside. The upper floor has a hall leading to the lounge, dining room/sitting room and kitchen. The garden has a paved area close to the house and a large lawn. The garage is used for the laundry equipment and storage. Staff sleep in on call in the dining room using a sofa bed. The premises were clean and hygienic with no untoward odours. The bath, toilets, basins and shower were all clean and hygienic. The refrigerator was well ordered and no out of date food was evident. The washing machine is an industrial standard. The home uses a ‘biorinse’ additive for incontinent laundry. There are antiseptic hand washes in bathrooms and the kitchen, and a locked cabinet for hazardous substances. Staff prompt and support service users in personal care rather than provide direct intimate care. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 36 Staffing is generally adequate and effective to support residents in meeting their assessed needs, but there are occasions when a minimum staffing level restricts the ability to provide individual activities and outings. EVIDENCE: The registered manager reported that the establishment figure for the home’s staffing has been increased to 8.5 full time equivalents. The organisation is recruiting to the additional post. There were three staff on duty during the morning of the inspection and four staff during the afternoon to provide required cover for residents’ individual activities. Additional staff were also scheduled for the attendance at the Spectrum Christmas party during the evening. There is a written staff roster which details the minimum level of staffing as two, but with regular additional staffing to cover individual care needs, activities and outings. One support worker sleeps in on call with a 24 hour on-call support. There is no evidence that this arrangement is currently unsatisfactory, but Spectrum needs to monitor the night staffing in relation to the potentially changing needs of residents. Spectrum has an in-house bank staff system. From time to time, staff are moved temporarily from one home to another to cover shifts when an absence has caused a problem with minimum staffing. Consequently, there are occasions when three staff at Bigwig are reduced to two at short notice and planned activities have to be cancelled. There are also occasions when individual activities and outings for residents are not possible because only the minimum safe staffing level of two Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 20 is rostered. There are currently no staff under the age of 18. There is a mix of male and female support workers with a good proportion of males reflecting the all male resident group. Standard 35 was not inspected in full. Spectrum has developed a comprehensive training plan to meet the training needs of their workforce and to comply with the national minimum standards. The commission will be reviewing the implementation of this plan in future inspections. There has been good progress at Bigwig in training staff in food hygiene. Training in the safe handling of medicines was planned for the week after this inspection. The registered manager reported that a course in health and safety had been cancelled, but staff would re-apply. Three staff have completed first aid training and other staff would undertake this in due course. The last inspection report included a requirement for training in these areas. As action is now being taken, this requirement has not been re-notified. Staff reported that they felt well-supported and supervised, and made positive comments about the qualities of the registered manager. They stated that they received regular formal supervision with the registered manager and there are regular team meetings. The most recent minutes for these meetings were dated 9 December 2005. It was not possible to access confidential staff records during the inspection because the registered manager who has access was not on duty. However, staff reported that a record is completed and signed. Spectrum does not currently carry out annual appraisals, but is considering the introduction of a system for this. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were included in the last inspection report. EVIDENCE: Spectrum is now consistently sending the commission copies of monthly management reports as required by regulation 26. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 3 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 2 X X 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bigwig House Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000009102.V273409.R01.S.doc Version 5.0 Page 23 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 YA23 Regulation 13 Requirement 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. (Renotified as previous timescale not met. This document is expected in early 2006) The registered provider must review current levels of staffing in relation to meeting the assessed needs of service users and for effective uninterrupted work with individuals. Timescale for action 31/03/06 2 YA33 18 31/03/06 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 YA20 YA20 Good Practice Recommendations Amendments to the medicine administration record should be signed and dated and appropriately referenced. The key to the medicines cupboard should be stored securely or in the possession of a member of staff. DS0000009102.V273409.R01.S.doc Version 5.0 Page 24 Bigwig House 3 YA36 The registered provider should introduce a formal system of staff appraisal. Bigwig House DS0000009102.V273409.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection St Austell Office 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. 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