Inspection on 03/01/08 for Silver Springs

This inspection was carried out on 3rd January 2008.

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

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 14/02/07

Silver Springs 16/11/05

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 WD18 0JY Lead Inspector Claire Farrier Unannounced Inspection 3 January 2008 2:30 rd Silver Springs DS0000019525.V351391.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 Silver Springs DS0000019525.V351391.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. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silver Springs Address 12 Rosslyn Road Watford Hertfordshire WD18 0JY 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.V351391.R01.S.doc Version 5.2 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. 14th February 2007 Date of last inspection Brief Description of the Service: Silver Springs is a care home providing personal care and accommodation for ten people who have a learning disability. Three of these may also have a physical disability. It is privately owned, and one of the proprietors is also the manager. The home is situated close to local shops and the main town centre of Watford is within walking distance. It is a two storey terraced house, providing ten single bedrooms for the residents. None of the bedrooms have en-suite facilities. The house provides a domestic environment and it is indistinguishable from the neighbouring houses. The Statement of Purpose, Service User Guide and previous CSCI inspection reports are available at the mangers office at Silver Springs (a copy of the Service Users Guide will be provided to prospective service users by the home) CSCI inspection reports are also available on the CSCI web site. Information on the fees charged was not available on this occasion. Silver Springs DS0000019525.V351391.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 2 stars. This means the people who use this service experience good quality outcomes. We spent one afternoon at Silver Springs, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We talked to as many of the people who live in the home as we were able to. We also talked to some of the staff. When we were in the home we looked at the home’s records and care plans, and we made a tour of the premises. The manager was away at the time of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 6 The staff are experienced and know the needs of each person well, but in one case the information on these needs is not recorded appropriately. During our visit we noticed that the cupboard where cleaning substances is stored was unlocked, and substances that included toilet cleaner were easily accessible. This could be a risk to the people who live in the home. The cupboard was locked as soon as it was noticed. 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. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 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.V351391.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient information on residents’ needs and access to appropriate services to enable their needs to be met. EVIDENCE: No one has moved into the home for several years. The home has a process for assessment before anyone moves into a home, and care plans are written with information and procedures drawn from these assessments. During this inspection the staff said that they have sufficient information and training to enable them to meet the residents’ needs. One person who had very high needs was admitted to hospital and then transferred to a nursing home. The manager carried out a full pre-admission assessment and concluded that they could not return to Silver Springs at that time. The person was anxious to return to Silver Springs. Several more pre-admission assessments have taken place and with the support of multi agency professionals they have returned to the home. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are fully involved in all decisions about their lives in the home. The care plans are person centred and provide the staff with appropriate information to enable them to meet people’s individual needs. EVIDENCE: We looked at the files of three people, which show what care is provided for them and how it is recorded. The care plans are written in a person centred format, which shows that people are involved in making decisions about their care and their lives in the home. Each person has a life story that they have written themselves or narrated to their key worker. This includes details of how each person makes decisions, and photographs of the things that they do. Those who are able to write their own care plans. One example was seen, where the person has written what they are doing and what their likes and wishes are. The staff who we spoke to said that the care plans provide them with good information on each person’s needs, so that they are able to provide Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 10 a good quality of care in the way that each person wishes. One person has recently returned to the home, with high physical needs, including a PEG feed. This person’s care plan has not been updated with details of the procedure for the PEG feed, and of their current needs. All the staff know this person well, and all have had training in the procedures. Information and guidelines on PEG feeds are in a separate file, but there is no reference to this in the care plan. Each person has risk assessments for some activities where a decision has been made concerning their safety. These provide guidance to staff in supporting the service users to take risks as part of an independent lifestyle. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported to live full and active lifestyles. EVIDENCE: The staff support and encourage the people who live in the home to develop and maintain their independence. Most people attend day centres during weekdays. The residents are full members of the community, and they use local amenities and facilities with support as necessary, including local shops, pubs, clubs, cinema, and public transport. They also access community health services such as GPs, dentists, opticians, chiropodists and so on. There is a varied programme of activities in the home. On the day of our visit two people went shopping with the activities organiser in the morning, and there was a music therapy activity in the afternoon. Some people told us about a recent trip to Disneyland in Paris, and others spoke about going out to eat. One Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 12 person was out visiting a friend during our visit. Everyone has families or friends who visit them or who they visit regularly. The menu is drawn up each week with the involvement of the people in the home, and there is a choice of meals each mealtime. The menu looked varied and suitable, including choices for the people who are vegetarian. We joined the residents for afternoon tea in the kitchen. Two people laid the tables and got cups out ready for the tea. It was a very cheerful and sociable occasion. The staff and residents talked about what they had been doing during the day, and one person started a sing-song that others happily joined in. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that they will receive a good quality of personal care and healthcare. EVIDENCE: The care plans contain good details of each person’s care needs. The healthcare records seen included references to hospital visits, and contact with GPs and other health professionals. During this inspection the occupational therapist visited to provide some information and training for the staff. There are clear details and procedures so that the staff can understand each person’s particular needs. Behaviour guidelines were seen for one person. One person is blind and diabetic, and the staff showed good understanding of the support that they need. One person has recently returned to the home, with high physical needs, including a PEG feed. All the staff know this person well, and all have had training in the procedures. Information and guidelines on PEG feeds are in a separate file, but there is no reference to this in the care plan (See Individual Needs and Choices). Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 14 The home has sound systems in place for the safe management of medication. Storage is secure and administration records checked were error-free, with no signature gaps found on the MAR (medication administration record) charts. The medication and records are checked every day to make sure that all the medication has been administered properly. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are encouraged and enabled to make their views and concerns known. Policies and procedures are in place to ensure that they are protected from abuse and neglect. EVIDENCE: The home has a satisfactory complaints procedure in place that is available to all residents and their relatives. No complaints have been recorded since the last inspection. The home has up to date policies concerning adult protection that follow the Hertfordshire inter-agency guidelines and a copy of the guidelines is kept in the office. All staff have had training in the prevention of abuse. Staff spoken with were aware of the general principles involved including the home’s whistle-blowing policy. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a safe and comfortable environment for the people who live there. EVIDENCE: The building is an ordinary terraced house, furnished and decorated in domestic styles that produce a homely, comfortable environment, which allows the people who live there to relax and feel very much at home. Everyone has their own room, which is arranged and decorated to reflect their particular interests and tastes. The lounge and kitchen are domestic in style and are comfortably furnished and well equipped. There is a rolling programme of refurbishment and redecoration. The home is generally well maintained, but in two bedrooms the curtains were hanging off the curtain rails. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 17 The home appeared to be clean and generally well maintained, and the staff follow appropriate procedures to maintain hygiene and prevent the risk of infection. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 18 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A stable staff team, who have the experience and training to understand and meet the residents needs, supports the people who live in the home. EVIDENCE: There has been no change in the numbers of staff employed in the home. On the day of this inspection there was a higher than usual number of staff in the home, as the occupational therapist visited to provide some information and training for the staff. The training records were not available on this occasion, as the manager was not in the home, but the staff spoken to said that the training and support provided for them is very good. There is a comprehensive training programme that covers all mandatory training in first aid, moving and handling, fire safety, food hygiene, etc, and training to meet special needs the residents have. Four support workers have a qualification at NVQ2 or above. We were not able to see any staff files on this occasion, as the manager was not in the home. During the last inspection we found that the home’s Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 19 recruitment policy and procedures were adhered to, so protecting service users. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 20 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): 27, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, and the management actively seeks the views of the residents and other involved people in order to ensure that a good quality of care is provided. EVIDENCE: The manager is one of the proprietors. She is a registered nurse and she works full time within the home. She was away from the home during this inspection, and the senior staff were competent and confident in meeting the needs of the people in the home appropriately during her absence. The home does not have a formal system of quality assurance. There are regular meetings for the people in the home, and everyone is encouraged to make their views known. Questionnaires are given to visitors to the home, Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 21 with a checklist including whether the visitor was made welcome and whether there were sufficient staff available. One example was seen, which gave a very positive response. It was reported that the manager monitors these forms in order to pick up any concerns or actions that are needed. However there is no process for auditing the responses and showing how they effect the development of the service. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. Health and safety records include regular checks of fire equipment and fire drills. The hot water temperatures are regulated, and the water temperature is tested each time someone has a bath. However there is no record of water temperatures to show that they are monitored to ensure that there is no risk to the people in the home. During our visit we noticed that the cupboard where cleaning substances is stored was unlocked, and substances that included toilet cleaner were easily accessible. This could be a risk to the people who live in the home. The cupboard was locked as soon as it was noticed. Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 3 4 X 5 X 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 YA6 Regulation 15(1) Requirement The manager must ensure that all care plans provide adequate and appropriate details of each person’s needs, so that the staff have the information that they need to be able to meet their needs. All substances that may be hazardous to health must be stored securely at all times. Timescale for action 03/03/08 2. YA42 13(4)(a) 03/02/08 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 YA39 Good Practice Recommendations It is recommended that the registered person should produce a report of the results of the consultation with residents and their families, that shows how they effect the development of the service. A record should be kept of the regular monitoring of water temperatures, to ensure that all water temperatures are maintained at a safe level. 2. YA42 Silver Springs DS0000019525.V351391.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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