Inspection on 16/11/05 for Silver Springs

This inspection was carried out on 16th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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

Silver Springs 03/01/08

Silver Springs 14/02/07

Silver Springs 09/05/05

Silver Springs 30/12/04

Silver Springs 23/07/04

Silver Springs 24/03/04

Silver Springs 22/08/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Silver Springs 12 Rosslyn Road Watford Hertfordshire WD1 7EY Lead Inspector Hazel Wynn Unannounced Inspection 16th November 2005 10:00 Silver Springs DS0000019525.V267215.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 Silver Springs DS0000019525.V267215.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. Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Silver Springs Address 12 Rosslyn Road Watford Hertfordshire WD1 7EY 01923 227 852 01923 227 852 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) Mrs Devi Sedani Mr K.P. Sedani Mrs Devi Sedani Care Home 10 Category(ies) of Learning disability (10), Physical disability (3) registration, with number of places Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home is registered for 10 people with a learning disability or physical disability (when associated with a learning disability). Residents with physical disability (when associated with a learning disability) shall not exceed 3 at any one time within a total of 10 residents. 9th May 2005 Date of last inspection Brief Description of the Service: Silver Springs is a residential home in Watford providing residential accommodation for 10 adults with learning disabilities. The home is a large house in a residential street in keeping with the property around it. The home is easy walking distance from all the amenities of the town centre and there is a large supermarket is just round the corner. The home is in a multi racial area and this is reflected in the service user and staff groups and gives the home a particular personality and place in the local community. The home itself is large and spacious, has parking at the front and a pleasant enclosed garden at the back, a large conservatory has now been added to the back of the property which enlarges the communal space, and is a good flexible space, which can be two smaller areas or opened up to provide a large party room. Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken, during the afternoon and early evening of 18th November 2005. We looked at records, gained feedback from service users and staff, did a tour of some of the areas of the home and made general unobtrusive observations throughout the inspection. We found that most of the National Minimum Standards had been met. Requirements have been made regarding medication. A member of the staff team was being shadowed for training as a senior staff member over an extended period. General outcomes for service users appeared good. What the service does well: What has improved since the last inspection? What they could do better: All medication must be dated on opening. An externally applied medication cannot be applied as prescribed due to restrictions in treatment at the day centre (as stated by the registered manager) this must be reviewed with the GP for advice as it was not being administered as prescribed. The registered Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 6 manager should consider re-assessing staff competence in the handling of medication, as this is the 2nd inspection of this year where there have been issues with medication. Two requirements and a recommendation have been made in respect of the administration of medication. 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. Silver Springs DS0000019525.V267215.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 Silver Springs DS0000019525.V267215.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): 2 Service Users individual aspirations and needs are assessed. EVIDENCE: A sample of service users’ care plans were produced for this inspection and these contained full assessment of all needs and aspirations. The assessment is carried out in conjunction with a multi-agency team. Silver Springs DS0000019525.V267215.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, 7 and 9 Service users can be assured that their assessed and changing needs and personal goals are reflected in the care plan. Assistance is given where necessary to support service users to make decisions. Service users are supported, within a risk management framework, to take risks as part of an independent lifestyle. EVIDENCE: Service users told the inspector about the things they liked to do and how and when they did them or were going to do them. They were looking forward to some planned Christmas events. Service users plan holidays and leisure pursuits with their keyworker making decisions on what they would like; this is evidenced in the care plan progress notes (a sample of which were scrutinised at this inspection). Risk assessments were in place to provide guidance to staff in supporting the service users to take risks as part of an independent lifestyle (a sample of these were on the files scrutinised). Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 10 Service users meetings are held monthly and recorded, the last recorded meeting was on the 15th November 2005 (the day before this inspection. Silver Springs DS0000019525.V267215.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, 15 and 17. Service users take part in age, peer and culturally appropriate activities and engage in leisure pursuits. The service users are part of their local community. Service users have appropriate personal and family relationships. A healthy diet is provided and enjoyed by the service users. EVIDENCE: The service users discussed Christmas event plans with the inspector and were looking forward to these events. The progress notes scrutinised showed a track of leisure events enjoyed by individuals. A local minister visits the service users frequently and had last visited on 26th October 2005. The progress notes show that the service users individually, and sometimes in small groups, frequent the resources of the local community. Family members and friends are appropriately involved and there are no restrictions on visits. None of the service users are currently involved in a sexual relationship but there is a policy in place to support such. Good nutrition is provided and staff seeking the advice of the dietician who makes monthly visits; the dietician’s last visit had taken place the day before Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 12 this inspection. The menu looked varied and suitable and service users were observed to enjoy a meal during this inspection visit. A service user helped himself to a snack of chocolate biscuits during this visit and then took some around to share with other service users. Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 13 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): 18, 19, 20 and 21 Personal support is provided in accordance with individual preference and according to assessed needs. Physical and emotional needs are met. It would not be appropriate for the service users in this home to manage their own medication. Although previous requirements were met new discrepancies have arisen in the management of medication. Ageing, illness and death of a service user would be handled with respect and in accordance with the wishes of the service user and their advocates. EVIDENCE: Guidance is clearly written to support staff to provide personal support in accordance with the service users assessed needs and preference (observed recorded on the care plans scrutinised). Progress notes provided evidence that health and emotional needs are met; regular reviews are held and other professionals are involved in monitoring and providing input in addition to care the staff team. The current service users are not able to retain and administer their own medication; this is noted on the care plans and from observation the inspector is in agreement that the service users do not yet have the capacity to manage this aspect of their care even with support. In checking the medication Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 14 administration records the inspector noted that not all medication was dated on opening and a requirement was made in this respect. An externally applied medication was not being applied as prescribed due to restrictions in treatment at the day centre; this was discussed with the proprietor/manager who explained the difficulties. The Inspector explained that this must be reviewed with the GP and advice obtained; as it must be administered as prescribed. A requirement was made that medication must be administered as prescribed. A recommendation was made that difficulties in the administration of medication be drawn to the GPs attention for review and advice/re-prescribing (if the GP considers the latter to be appropriate). The registered manager should consider re-assessing staff competence in the handling of medication, as this is the 2nd inspection of this year where there have been issues with medication. Two requirements and a recommendation have been made in respect of the administration of medication. Policies and procedures are in place regarding ageing, illness and death and service users wishes are noted on their care plans (samples were seen at this inspection). Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 15 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): 22 & 23 Service users or their advocates on their behalf feel that their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. EVIDENCE: The complaints book was scrutinised at this inspection and there had been no complaints recorded since the last inspection. A policy and procedure is in place for the handling of complaints and past complaints have been handled appropriately in accordance with the company’s policy and procedure. Abuse awareness training is provided to staff and the Hertfordshire County Council joint agency guidelines for the protection of vulnerable adults are highlighted as a reference in the home. Abuse awareness training was last updated in October of this year and a managing aggression workshop had also been attended by some of the staff in February 2005. Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 16 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): 24 and 30 The environment is adequately homely, comfortable and is a safe environment. The home is maintained in a clean and hygienic condition. EVIDENCE: This inspection included a tour of some areas of the home including the lounge, the activities room, the laundry, office, hallways, stairs, one of the bathrooms and a bedroom; they were seen to be reasonably comfortable and maintained in a clean and hygienic condition. Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 17 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): 32, 34 and 35. The care staff are provided with training and work through a competence induction programme leading on to NVQ qualification. Trained staff are meeting the service users individual and joint needs appropriately. The homes recruitment policy and procedures are adhered to thereby protecting service users. EVIDENCE: The training plan for the year was seen and certificates for training were provided at this inspection; some staff had attended person centred planning training and dates were planned on the training planner for the remainder of the staff. One member of the staff team has achieved level 2 NVQ and 2 other care staff are enrolled. The manager holds an SRN/RMNH and the deputy is SRN/RNM qualified. At least one staff member held a BTEC Advanced certificate in medication training (certificate seen at this inspection). One staff member has been promoted to the position of senior carer and is working through an extended training programme to gain competence at this level. The progress notes scrutinised suggested that the staff understood the service users needs and were able to record appropriately the developments made. Staff were observed supporting service users in a competent and appropriate manner. Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 37, 38, 39 and 42. The home is generally well run and the service users appear to be benefiting from the ethos, leadership and management approach of the home. Service users can be confident that their views and the views of their advocates underpin all self-monitoring, review and development of the home. The health, safety and welfare of service users is promoted and protected (although see comments in standard 20). EVIDENCE: The records scrutinised at this inspection indicated that the home is generally well run (requirements have been made regarding medication and although previous requirements in respect of medication were met, discrepancies in other areas of medication were found during this inspection and requirements made in respect of Standard YA20 under the appropriate section of this report). Plenty of appropriate events had been planned for the Christmas festivities and rotas had been well planned to cover needs adequately and this demonstrated Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 19 that the home did have a healthy ethos and that the management and leadership approach was satisfactory. The registered manager does respond to requirements and recommendations in an appropriate and timely manner and a quality monitoring system was being utilised. From records examined and discussions with staff and service users it was evidenced that the home is generally well run and that the ethos, leadership and management of the home is benefiting the service users and staff team. During the last inspection it was noted that detailed environmental and individual risk assessments had recently been developed. All staff are receiving mandatory training, Fire safety, health and safety, food hygiene and First Aid as well as additional training. One staff member has achieved level 2 NVQ and two staff are enrolled. Some of the care team have other qualifications appropriate to this field of care. The fire alarms are tested regularly and records are maintained. Fire points and emergency lighting checks were being conducted monthly and recorded and fire drills are planned in at regular intervals. Fire fighting and prevention equipment is checked and serviced. A quality monitoring system was being utilised. The health, safety and welfare of service users and staff are promoted and protected as evidenced under the appropriate sections of this report. Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Silver Springs Score 3 3 1 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X 3 X DS0000019525.V267215.R01.S.doc Version 5.0 Page 21 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. 2. Standard YA20 YA20 Regulation 13(2) 13(2) Requirement Timescale for action 16/11/05 All medication must be dated on opening. The GPs instructions for the 16/11/05 administration of medication must be adhered to. Any change to administration must be authorised by the GP and any altered instructions clearly stated on the Medication Administration Record. 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 Discuss the difficulties with applying external medication while the service user is at day care and request the GP to advise and prescribe according to his advice; then adhere to his reviewed prescribing as will then appear on the reviewed Medication Administration Record. Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Silver Springs DS0000019525.V267215.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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