Inspection on 09/05/05 for Silver Springs

This inspection was carried out on 9th May 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 1 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 16/11/05

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 9 May 2005 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 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 Stationary 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 I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Silver Springs Address 12 Rosslyn Road Watford Hertfordshire WD1 7EY 01923 227852 01923 227852 Telephone number Fax number Email 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 Mrs Devi Sedani Care Home 10 Category(ies) of LD LD Learning Disability - 10 registration, with number PD PD Physical Disability - 3 of places Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 30.12.04 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 I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted by two regulation inspection officers, during the day on the 9th May 2005. We looked at records, discussed the service with service users and staff, did a tour of the home and made general unobtrusive observations throughout the inspection. We found that most of the National Minimum Standards had been met. One requirement was made: for the recording onto the Medication Administration Record, of a pre-medication (to be administered prior to a dental appointment and meanwhile kept in the medicine cupboard). Two recommendations were made one was for staff to revisit the knock and wait policy and procedure and one was made for the balances to be brought forward on Medication Administration Records. What the service does well: What has improved since the last inspection? Since the last inspection took place, the home has worked on putting a range of risk assessments in place, and guidance to minimalise risks. The home has worked with the local authority on providing a person centred approach to care planning and to provide evidence of the involvement of the Service Users in the putting together of their individual care plans. A toilet, which had been out of order, has been repaired. Staff files now contain all required documents. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 6 The needs and wishes of Service Users is recorded on the care plans. Staff have attended a session on better communication to support service users with an improved and respectful approach. A record is in place of formal supervision. The home has user friendly booklets titled ‘My Health’ where a health record is maintained for each individual and provides current consistent information to hand. Radiators have been covered and quality assurance has been formerly carried out. Various courses had been provided for staff including: Managing Aggression in Workplace, Food Hygiene, and Medication Training. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 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 standard(s) 1,2,3,4 and 5, Prospective Service Users are provided with information and opportunities to make an informed choice as to whether the home appears to be right for them and will meet their needs. EVIDENCE: The home has a Statement of Purpose and Service User guide which provides the information required by the National Minimum Standards; these have been updated to contain the address of the Commission for Social Care Inspection and including the change of the first line of the address to Mercury House. Service Users ‘test drive’ the home prior to moving in and a full assessment of their need is undertaken, records of this seen on file. Both parties sign a copy of agreement with one copy being issued to the Service User and maintained on his/her file. The contracts are with the Local Authorities of the Service User’s borough of origin. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 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 standard(s) 10. 6, 7, 8, 9 and Service Users are involved in drawing up the care plan, their views are being obtained and acted on. Service users are supported to take risks and make decisions. Information, personal to Service Users is securely stored and staff training is provided to ensure confidentiality. EVIDENCE: The local authority has worked with the home over the past year to develop the person centred approach to care planning, which includes the full involvement of the Service User. Records show that Service Users have made decisions about how they will plan their care regarding personal, health and social needs; the inspectors saw three care plans and these included risk assessments regarding risk taking activities. The service is well supported by a community nurse, GP surgery and physiotherapist and dietician. The Service Users meetings had been minuted and these were seen and they contained evidence of decision-making including decisions about how the home is run. The records were securely stored and staff spoken to were clear about the importance of confidentiality. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 10 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 standard(s) 11, 12,13,14,15,16 and 17. Opportunities for personal development are provided in and out of the home. Activities are age, peer and culturally appropriate and many of these are organised to take place in the local community. Relationships with family and friends are supported. There was one point raised regarding rights and respect. A healthy diet is encouraged and provided. EVIDENCE: The three care plans seen provided evidence that opportunities for personal development are structured in as part of the daily activity for each individual; these included structured and leisure opportunities and were observed to be age, peer, and culturally appropriate. Various activities, especially leisure were, according to the records, being experienced in the local community. There were records of family and friends relationships that had been appropriately recorded. A support worker was observed to enter a room without knocking and this was raised with her and with one of the proprietors and a formal recommendation is made in this report for the policy and procedure to be revisited. The records showed that the dietician provides monthly input and the menu seen recorded a varied and nutritious diet. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 11 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 standard(s) 18, 19, 20 and 21. Personal support is provided appropriately and physical and emotional needs are met (although see standard 16). Medication is generally well managed, however there were some shortfalls in the management of this. The wishes of service users, when they will approach the final stages of their life, have been considered. EVIDENCE: The care plans provide guidance to staff when providing personal support to ensure it is according to the Service Users need and preference. Physical and emotional needs were also documented on the three care plans and records looked at by the inspectors and these appeared to be met. None of the current Service Users were able to manage their own medication. A premedication obtained for a forthcoming dental appointment had not yet been entered on the Medication Administration Record, it was found by us stored securely in the medication cupboard; a requirement was made that this be entered on to the Medication Administration Record. There were 10 paracetamol tablets in stock that appeared to be over the amount that there should have been; a recommendation was made that balances be brought forward so that there is ease of reconciliation in the future. Service Users wishes in the event of illness, ageing and death are recorded on the care plan and there is a policy and procedure in place regarding this. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 12 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 standard(s) 22 and 23 Service User’s views are responded to and the opportunity to air views is provided. Service users are offered protection from abuse, neglect and selfharm. EVIDENCE: One of the Service Users told us about his Service User meetings and how they help to change things in the home so that things are the way he wants them to be. Staff told us that they ask Service Users what they would like if a decision needs to be made and that they support Service Users to document their views at Service User meetings and also support them to make a choice about outings and holidays. Policies and procedures are in place regarding protection of vulnerable adults and both staff and service users attend training in abuse awareness. Staff training files showed that the support staff and seniors had attended abuse awareness training. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 13 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 standard(s) 24,25,27,28 and 30. The home has large adequately furnished rooms and Service Users rooms have been personalised. The home was clean and hygienic at the time of the inspection; although the laundry needed some attention. EVIDENCE: The house was observed by us to be adequately furnished and providing sufficient comfortable seating for relaxation. We observed that there are 2 showers, 2 baths and 4 toilets in this home. Service user occupancy is for up to 10. One shower and toilet on the ground floor had been refurbished. The toilets and bathrooms are private with locks on the doors. The home was seen to be clean and hygienic although the laundry wallpaper was peeling. A recommendation was made for this to receive attention. A conservatory extension has been added fairly recently, and this provides a bright airy room that is used as an alternative room for leisure and for activities. The garden provides a safe enclosed space with a large lawn, vegetable beds and flowerbeds. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34,35 and 36. Staff understand their own roles and responsibilities and those of others in the team. Staff receive training to achieve competence to meet Service Users needs both individually and jointly (but see standard 16). Recruitment practices have been tightened to meet standards designed to protect service users. Staff are supported and supervised formally and informally. EVIDENCE: Staff spoken to on the day inspection, were aware of their job descriptions and roles and responsibilities. Minimum staffing levels appeared from records and discussion with staff to be generally maintained to meet the service users needs. On the day of the inspection 3 staff were on duty. All new staff complete LDAF training. There is a programme of in-house training and staff access training from other providers e.g. Oakland’s college. The proprietor and a member of staff stated that two staff are in the process of enrolling for NVQ Level 2 and the manager is in the process of enrolling for the Managers Award through NVQ. The rota provided evidence that there are usually 3 members of staff on duty at times of peak needs. During the day when the service users are using day services this is reduced to 2 staff. Waking night staff and a sleep in staff are employed to meet the needs of the service users during the night; in addition to the evidence seen in the rota; the staff on duty and one of the Service Users also verified this. Staff meetings are held Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 15 monthly and the minutes of the last staff meeting and the agenda for the next meeting were seen. Three staff files were inspected; the staff files contained the documents required by the National Minimum Standards, and for the protection of Service Users. The record for staff supervision was seen. Staff confirmed that they did receive regular monthly formal supervision. Individual supervision records are kept. A training record is also maintained for each staff member and three of these were seen. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39.42 and 43. The home is generally well run and service users were benefiting from the ethos, leadership and management of the home. Service Users views were being obtained and responded to. There was an issue in Standard 16 that the inspectors were concerned about and this has been dealt with there. The health, safety and welfare of Service Users is protected. The inspectors were satisfied that the management of the service is conducted with a satisfactory level of competence and accountability. EVIDENCE: Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 17 From records examined and discussions with staff and Service Users we gained evidence 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. There were exceptions we observed, and these have been dealt with in Standards 16, 20 and 30 (concerning an observation we made regarding a member of staff not knocking before entering a Service Users room, improvements in the management of medication and attention needed to the décor of the laundry room). We saw minutes of Service Users and staff meetings evidencing that these are held regularly to support Service Users and staff to air their views and be involved in influencing developments in the home. In the past year, detailed environmental and individual risk assessments have been developed. All staff are receiving mandatory training, Fire safety, health and safety, food hygiene and First Aid. The water temperature of the water was at 41 degrees Centigrade on testing at this inspection and records show regular in house testing. 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. Silver Springs I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 18 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 3 x 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 2 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 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 3 I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 19 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 YA20 Regulation 12(2) Requirement Records must be kept of all medicines received. (Refers to a pre-medication to be administered prior to a dentist visit). This was securely stored but had not been entered on to the Medication Administration Record. Timescale for action Immediate 09.05.05 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 YA16 YA20 Good Practice Recommendations Staff should evidence that they have revisited the knock and wait policy and procedure and then ensure they put this into practice. Bring balances forward on the Medication Adminstration Record for ease of reconciliation. (The inspectors found it difficult to reconcile the amount of paracetamol in stock and it appeared that there was more in stock than the records indicated). If the balance is brought forward each month the task of reconciliation will be made easier to audit. Some decoration in the laundry needs attention. (The wallcovering is peeling in some areas). I52 s19525 Silver Springs Un v226407 090505 stage 4.doc Version 1.30 Page 20 3. YA30 Silver Springs Commission for Social Care Inspection 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. 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