Inspection on 29/08/08 for Bigwig House

This inspection was carried out on 29th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 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 11/09/07

Bigwig House 27/06/06

Bigwig House 15/12/05

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 08/11/2008.

CARE HOME ADULTS 18-65 Bigwig House Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT Lead Inspector Lynda Kirtland Unannounced Inspection 29th August 2008 09:30 Bigwig House DS0000009102.V367619.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.V367619.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.V367619.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 Mr Terry David Morgan Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Bigwig House DS0000009102.V367619.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. Learning disability (Code LD) The maximum number of service users who can be accommodated is 3. Date of last inspection 11th September 2007 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. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection, which took place on 29 August 2008. 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 registered 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 people who use the service needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved talking with people who use the service 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 people who use the service 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 registered 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 staff working with them. This provides a useful, in-depth insight as to how people’s needs are being met in the home. At this inspection, all of the people who use the service were case tracked. What the service does well: Admission to the home is based on a detailed assessment so that people who use the service 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. Some people who use the service 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 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 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. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 6 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. People who use the service are encouraged to develop independent life skills and were observed to participate in household tasks and food preparation. People who use the service confirmed they were involved in the menu plans 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. People who use the service are consulted to choose the décor of their rooms and it is decorated to reflect their tastes. The home is in the main decorated and furnished to a good standard. 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 People who use the service in and out of the home. What has improved since the last inspection? The manager confirmed that all staff have attended induction medication training and will be booked to attend an external medication course run buy the University of Newcastle. This will provide staff with a greater understanding of medication issues in the home. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 7 The management team of Bigwig are now aware of when to alert the Department of Adult Social care of any safeguarding issues. In addition the registered manager is booked to attend the external multi agency safeguarding course within the next month. The registered manager has ensured that there is a safe process in the management of people’s monies and that the individual is involved in this process as per their abilities. However staff need to be aware of the location of the policy and procedure in respect of the management of people who use the service monies to refer to when needed. Terry Morgan has been approved as a registered manager at Bigwig House with the Commission. He states he has nearly completed his NVQ level 4 course and has attended relevant training to this post. Staff and People who use the service spoke positively about this management of the home. The registered manager and staff all stated that the minimum staffing levels have in the last two weeks increased from 2 to 3 per shift due to increased dependency needs. This is to be confirmed officially by headquarters. Staff felt this was a positive move and also stated that for all people who use the service to attend trips in the community that additional staff are employed on these occasions to ensure that sufficient staff are on duty to accompany people who use the service safely. The registered manager stated that formal supervision of staff has recently commenced and records are kept of this. An up to date overview of staff training has been formulated so that the management team can ensure that staff receive regular training to assist them in their work. The registered manager stated that the fire risk assessment has been reviewed to ensure that it meets current legislation, although no evidence of this was seen. However there was no clear evidence that fire training has occurred and this needs to occur. What they could do better: The presentation of the homes Statement Of Purpose and Service Users guide would benefit from review so that it is more meaningful to People who use the service. People recently admitted to the service must have a care plan so that staff are guided, informed and directed in how to provide consistent care for the individual. In addition other care plans must be updated so that they reflect current care needs. Spectrum management team have informed us that they are in the process of updating all risk assessments and these will be incorporated in the individuals Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 8 care plans. This will then guide, inform and direct staff in undertaking activities with individuals with greater clarity. It is recommended that when transcribing medication two staff members to prevent errors in handwriting medication instructions witness this. It is also recommended that when PRN medication is received a the home a accurate record of this is kept so that the MAR sheets tally with the medication that is kept in the medication cabinet as this was observed not to be the case. Less than the recommended 50 of care staff are qualified to NVQ level 2, although this situation should improve as staff are expressing a keenness to attend this training. The homes policy and procedure folder must be updated. Those seen in the home were dated 2000 or 2003. For example the medication policy was out of date and staff were unaware of its location or that of the policy in the management of peoples monies. All policies and procedures must be reviewed to ensure that they reflect current practices. As recommended at the previous inspection the registered manager should introduce a policy and procedure in the moving of laundry through the home to ensure that infection control measures are adhered too. In addition paper towels should be supplied and installed in the kitchen toilet areas to promote infection control. It is of concern that Spectrum management team have cancelled staff training for four months as this has meant that staff certificates are no longer valid and that staff skills are not kept up to date. We require that the registered provider write to us to explain the reason for the training cancelled and when it will be reinstated. Staff commented that they are frustrated that training has not been made available. The registered manager stated he would be commencing a quality assurance process. The findings of this audit and any actions the home are intending to take must be forwarded to the commission. The registered manager must ensure that when incidents occur that we are notified as per regulation 37 of the Care Standard Act as none have been received since Mr Morgan has been in post. In addition Mr Morgan must ensure that in future the AQAA is returned within time to avoid enforcement action. The inspector would like to thanks People who use the service, staff and the manager for their time and cooperation during this inspection process. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 9 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.V367619.R01.S.doc Version 5.2 Page 10 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.V367619.R01.S.doc Version 5.2 Page 11 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, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of purpose reflects the service that Bigwig provides for People who use the service and their representatives’ information. The presentation of the Service Users guide would benefit form review so that it is in more meaningful formats to the People who use the service. People who use the service needs are assessed prior to their admission so that they can be confident it will meet their health, personal and social care needs. EVIDENCE: The home’s Statement Of Purpose and Service Users guide has been updated to reflect current management and staff changes in the team. The presentation of the Service Users guide document would benefit from review sop that it is more meaningful to People who use the service and their representatives. There has been one admission to Bigwig in the last couple of weeks. From documentation inspected there was evidence that a ‘person centred assessment’ had occurred prior to placement at Bigwig. In addition a transitional plan was formalised so that the individual visited the premises, met with other people resident and staff working a the home before admission. Previous placement assessments were on file. In discussion with the person Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 12 who uses the service he did not raise any concerns about the transition to Bigwig. It was evident that one person who use the service is 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. This included the total cost of their placement and a detailed breakdown of how their personal contributions towards the total cost is calculated. For two People who use the service this was missing and needs to be addressed. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 13 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. Peoples care plans address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds. All People who use the service must have a up to date care plan so that they accurately reflect the individuals 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: People who use the service, their family, advocate and relevant professionals are involved in the development of individual care plans and their subsequent reviews. The reviews record the person’s 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. Care plans have specific headings to address their health, personal and social care needs, including their individual and diverse needs. These are in written form. Personal Care plans provide People who use the service with specific goals to work towards, and inform and direct Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 14 staff in how to support the person 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. However it was noted that with the recent admission to the home no care plan was in place. In discussion with the registered manager he stated that due to the recent admission the individuals file was dated and did rely on information form his previous placement. Therefore staff were reliant on verbal accounts and old paperwork in how to provide care to this individual, in addition some of the ‘old’ paperwork was not being implemented i.e. token economy protocol. Therefore staff acknowledged that they did not have consistent or clear guidance in how to work with this individual. The registered manager agreed to address this immediately. The inspector noted, confirmed in discussion with the homes manager, plus a recent regulation 26 visit that one of the care plans were out of date, and did not reflect current care needs. The registered manager stated this has been addressed. However from inspection of monthly reports it was noted that the time of completing these varied i.e. for one individual there was a time delay from March 2008 with the next one completed in July 2008 and these documents were not signed. These reviews should occur as per the organisations policy as it shows clearly the progress a person has made, if needs have changed and what actions the home is intending to take to meet changing needs. However it was noted that PCP meetings are held approximately 6 monthly and the People who use the service and their representatives are involved in this process. 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 people who required it, to make decisions about what to do during the day. People who use the service 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. People who use the service can choose, and were observed to do so, the level of privacy they wish to enjoy in their private accommodation. Spectrum are reviewing their risk assessment process in the aim that they will be incorporated in the individuals care plans. The risk assessments will then be more detailed and relevant to the individual person. Current risk assessments for two People who use the service that are on file were seen to be reviewed. With the recent admission there was a reliance on risk assessments relating to his previous placement and therefore these must be reviewed to see if they remain appropriate to his current placement and any change in needs. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 15 Bigwig has a clear procedure in the management of individual’s monies with a clear line of accountability as to who holds the keys to the safe on the particular shift. A weekly audit of monies is undertaken plus a monthly audit occurs at Spectrum headquarters. People who use the service manage their own monies with support form staff. Records of monies deposited and withdrawn tallied with documentation and were in some cases signed by the individual. It is recommended to staff that when a person has received a gift voucher (as was seen) this is also recorded to promote the accountability of its whereabouts and when it was spent to protect the individual’s money and staff further promote staff accountability. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 16 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. People who use the service 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, People who use the service were engaged in a range of different individual activities and were able to comment on what activities they enjoy doing. Their individual needs and preferences are considered as part of the 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 Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 17 and choose what they will do each week with staff. A list of weekly activities the person has participated in can be sent to the families for their information. People who use the service were continuously in and out of the home during the inspection: walks, swimming at the beach, helping with food shop and Internet access 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 and attend work placements. People who use the service confirmed that they have regular contact with their families plus records of their contact with their families, including regular visits home, or visits from relatives to them at Bigwig were seen. Needs in relation to their developing personal relationships are considered as part of the ongoing assessment and care planning process, including specific risks. The registered manager is aware of the advocacy service to ensure that People who use the service have an independent voice. People who use the service do have regular contact with family members and the registered manager felt that they would raise any issues with them if and when they arose. People who use the service were preparing their breakfast during the inspection. Staff were heard to discuss with people who use the service what they would like for lunch and this was then prepared. The menu showed that People who use the service 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 People who use the service 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. The majority of staff has completed a basic food hygiene course. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 18 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. People who use the service 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 would benefit from further review to ensure that medication errors are prevented. Medication policies and procedures must be updated so that staff are aware of what is expected of them. Staff will be attending external medication training to ensure their knowledge in this area is increased. EVIDENCE: People who use the service 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. People who use the service 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. The home has low levels of medication to administer. From inspection of these records it was evident that staff are recording medications they receive, administer and dispose of. With Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 19 PRN medication (loose medication) the registered manager needs to ensure that the number of tablets in the medication cabinet corresponds to the MAR sheets, as a tablet count occurred and the records did not tally. He agreed to address this immediately. A member of staff is nominated each shift, which is recorded, to be responsible for the administration of medication and people who use the service monies. Staff stated this system works well and that they undertake a weekly audit of medication and monies. Staff were unable to locate an up to date medication or management of monies policy. However in the policy and procedure folder there were two medication policies that I found dated 2000 and 2003. Therefore not up to date and did not relate to the methods that the home practices. The medication policy and procedure needs to be updated to ensure that it reflects the homes practices accurately. It is recommended that when transcribing medication two staff members to prevent errors in handwriting medication instructions witness this. The registered manager confirmed that all staff have received induction medication training and all have applied for medication training via the university of Newcastle. First aid training is completed on staff’s induction period. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service 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. EVIDENCE: People who use the service were encouraged to speak to the inspector if they wished so that they could make their views known or raise any concerns. They were positive about the care they receive and did not raise any concerns. People who use the service 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. Spectrum 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. The registered manager stated that he would be attending the Multi agency safeguarding training. All staff have attended in house adult protection training as part of their induction. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 21 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 People who use the service with an ordinary, domestic setting so that they can develop their skills and independence in a non-institutional setting. It is safe and clean so that people who use the service and staff are protected from risks of cross-infection. EVIDENCE: The home looks like an ordinary, domestic dwelling. It is well decorated and comfortably furnished and people who use the service 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. As identified at the previous inspection the policy in respect of moving laundry through the home must be reviewed so that staff do not take it through the kitchen area. In addition paper towels should be supplied in the kitchen/toilet areas for staff to promote infection control. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 22 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 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 People who use the service 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. Access to staff training must be improved so that staff skills are kept up to date. 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: Two staff were on duty on arrival at the home with a third member of staff arriving later. Staff stated that there has been a recent increase in the minimum-staffing ratio of the home from two to three. This is due to dependency needs increasing. Staff felt more comfortable with the increase and felt that they would be able to provide more time with people who use the service. There concern was that if they are to take all people who use the service out on trips there would still be insufficient staff to accompany them as Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 23 per the individuals risk assessments, however they did state that extra staff have been employed at these times. The registered manager stated that the increase of minimum staffing has not yet been officially agreed but was confident this would occur. This then need s to be reflected in the homes Statement Of Purpose as minimum staffing levels currently state two staff are on duty. There have been 2 staff members on duty at night. We discussed with staff and manager that there is a large amount of paperwork relating to the persons care. As staff are being given more responsibility to complete care plans and monthly reviews they need administration time to complete this task which is currently lacking and has led to some documentation not being completed. 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 expressing a keenness to undertake this training. 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. The registered manager has an overall training plan for the home. Spectrum headquarters have not supplied staff training for four months due to the need to staff spectrum homes sufficiently. This has meant that staff training is out of date and staff have commented that they are frustrated that training has not been available. We have requested that the registered provider writes to the Commission to explain the situation regarding staff training. Staff commented that whilst there is the communication course available they feel more training in the use of Makaton is needed. The registered manager stated that supervision has just re commenced and records of individual one-to-one supervision of care staff showed it occurred in August 2008. The registered manager is aware that all staff should receive a minimum of six supervision sessions per year. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 24 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): 37,39,40, 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is mainly well managed for the benefit of People who use the service There are formal and informal systems in place to ensure that People who use the service views are accounted for in the day-to-day running and ongoing development of the home. There are systems in place to protect people who use the service and staff from avoidable harm and injury. Policies and procedures must be up dated so that staff are aware of what is expected of them. In addition staff training must be resumed to ensure that staff skills are kept up to date. EVIDENCE: Mr Morgan was approved as registered manager of Bigwig in April 2008 but has been in post as manager of the home since November 2007. Mr Morgan has to complete his NVQ4 but has completed first aid, food hygiene, medication, health and safety, infection control and is a trainer for the Positive Behaviour Management course. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 25 Staff spoke positively regarding Mr Morgan’s support and felt that he was approachable if they had any concerns or ideas for improving the service. People who use the service gestured a ‘thumbs up’ when asked about Mr Morgan’s support. The registered manager is aware that he needs to complete an annual quality assurance and commented that he is developing questionnaires to send to People who use the service representatives. The findings of this audit and any actions the home are intending to take must be forwarded to the commission. The registered manager did send in late his AQAA. Monthly regulation 26 visits occur to oversee the quality of the service, the last one occurring 1/8/08 where practices regarding the auditing of care plans, and for risk assessments to be reviewed were some issues raised. In addition the Spectrum compliance officer who undertook the regulation 26 visit noted, as did we that the registered manager has not been notifying the commission of incidents under regulation 37 (last one received October 2007) and yet incidents have occurred. These must be reported to the Commission. Records are stored confidentially. The registered manager must ensure that policies and procedures are kept up to date and reflect current practices that Spectrum expects of staff. Policies and procedures that were seen were dated 2000 or 2003 and did not relate to what practices the home currently provide. Spectrum headquarters have not supplied staff training for four months due to the need to staff spectrum homes sufficiently. This has meant that staff training is out of date and staff have commented that they are frustrated that training has not been available. We have requested that the registered provider writes to the Commission to explain the situation regarding staff training 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. The registered manager stated that Spectrums fire officer has reviewed the fire risk assessment to ensure that it meets current legislation but no evidence of this was seen has reviewed the fire risk assessment. The registered manager said that fire training occurs at the same time as the monthly evacuation drills but no evidence of who was present at fire training was documented. Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 26 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 1 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 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 1 2 1 X Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 27 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 YA35 YA42 Regulation 18(1) (c)(i)(ii) Requirement Timescale for action The Responsible Individual 30/09/08 must write to the Commission to inform them why training for staff has been cancelled and when it is to resume. This is to ensure that staff are kept up to date with their knowledge and skills. The homes policies and procedures must be kept up to date to ensure that their inform, direct and guide staff so that staff are adhering to safe current work practices at all times. In addition staff must be aware of the location of the policies and procedures documentation. The registered manager must notify the commission of all incidents in the home as per regulation 37 of the Care Standard Act 30/11/08 2 YA42 17(2) 3 YA42 17(2) 26 30/08/08 Bigwig House DS0000009102.V367619.R01.S.doc Version 5.2 Page 28 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 YA1 YA5 Good Practice Recommendations The presentation of the Statement Of Purpose and Service Users guide should be reviewed so that it is presented in a more meaningful format to People who use the service. All People who use the service should have a copy of their statement of terms and conditions, which includes the details of their fees so that People who use the service are of what contributions they are to make to the placement. All People who use the service should have a up to date care plan to direct, inform and guide staff on how to provide consistent care to individuals so that they reflect current care needs Work on reviewing risk assessments should continue, as they need to be more detailed and relevant to the individual person. It is recommended that when transcribing medication two staff members to prevent errors in handwriting medication instructions witness this. In addition the registered manager should ensure that all medication received in the home is accounted for and that a tablet counts cross references with the medication records. This will prevent medication errors. The registered manager should ensure that at least 50 of the staff team are qualified to at least NVQ level 2. The homes manager should produce a written policy in how soiled laundry is to be transported through the home to promote infection control. Administration time must be incorporated in the staffing rota for managers, and care staff to enable them to undertake the administrative duties of their work The findings of the quality assurance audit and any actions the home are intending to take must be forwarded to the commission. DS0000009102.V367619.R01.S.doc Version 5.2 Page 29 3 YA6 4 YA9 5 YA20 6. 7. YA32 YA30 8 9. YA31 YA39 Bigwig House Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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