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Inspection on 27/08/08 for Spectrum Support Services

Also see our care home review for Spectrum Support Services for more information

This inspection was carried out on 27th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents live in a comfortable and homely environment that merges well with other domestic housing in the vicinity. The home is maintained to a good standard of cleanliness and decor. Residents are encouraged to develop skills and independence, and make use of the local community and facilities. Staff work hard to motivate residents in participating in the daily routines of the house. Residents are supported to maintain contact with family and friends including visits home and are provided with an annual holiday by the service. Staff tell us they feel supported and have access to a good range of training to develop their skills, knowledge and awareness of this specialist area. The service liaises well with families and other agencies, and is proactive in seeking interventions where changes in need are presenting support issues. The service is responsive and flexible to changing needs of residents.

What has improved since the last inspection?

The AQAA tells us that over the last 12 months the service has updated its brochure to better reflect diversity and equal opportunities, improved residents involvement in the development of their support plan, and worked with them to better understand and deal with the consequences of their decision making. Residents have been encouraged to take up new activities and these have been brought into the home or accessed externally dependent on resident wishes,where motivated to residents are encouraged to express their own aspirations. A notice board has been introduced to alert residents to activity opportunities. One resident has been enabled to write own daily records and review although their motivation for this has discontinued. All staff have attended POVA training and the complaints procedure has been reviewed. Remedial works in the lounge and dining areas have been completed, a new internal lobby door has been installed to aid privacy and security, planning for a new kitchen is underway.

What the care home could do better:

The Home maintains a good level of service to residents, has a history of compliance and sustained performance. The manager and staff demonstrate insight into areas of practice where they perceive further improvements can be made. The site visits highlighted some areas for suggested improvements to enhance the current practice, three of these are recommended and are: That the home provides clarity within staff guidance to ensure expected staff responses are made clear, and that frequencies of reviewing and updating of support plan and risk information is reviewed. That where residents are responsible for collecting their own prescription clear timescales are provided to staff within guidelines as to how long staff should wait before intervening in collections and thereby assuring a supply of medication is available. That the frequency of formal recorded staff supervisions are increased to at least six times per year.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Spectrum Support Services 8 Southwater Road St Leonards-On-Sea East Sussex TN37 6JS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michele Etherton     Date: 0 1 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Spectrum Support Services 8 Southwater Road St Leonards-On-Sea East Sussex TN37 6JS 01424 447318 Telephone number: Fax number: Email address: Provider web address: spectrum-support-services-ltd@st-leonards-onsea.fsbusiness. Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Spectrum Support Services Limited Ms Nicola Jane Booth care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of residents to be accommodated is three (3) younger adults with learning difficulties within the Autistic Spectrum. 3 Over 65 0 Date of last inspection Brief description of the care home Spectrum Support Services 8 Southwater Road is registered for three younger adults with learning disability within the Autistic Spectrum specialising in persons diagnosed with Asperger?s. The building is a terraced three storey Victorian house. It is situation in St Leonard?s on sea and is a short distance from local amenities, shops and railway station. The house has a kitchen, lounge and dining area on the ground floor, bedrooms, bathroom, toilet and office on the upper floors. It has a small terraced garden to the rear of the property. Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. A key unannounced inspection of this service has been undertaken. This has taken account of information we have received from and about the service since the last inspection, including an Annual Quality Assurance assessment (AQAA) form completed to a reasonable standard by the manager. This provides us with information about the service activities in the last 12 months and future planning. The inspection included an unannounced site visit to the service on 27/8/08, during which all key standards have been assessed. The visit included a tour of the premises. Care Homes for Adults (18-65 years) Page 5 of 26 We consulted with staff on duty, and both current residents, the views of staff and residents have been influential in compiling this report. We have examined a range of information that includes support plans, risk assessments, complaints information, medication administration records, daily records, and a staff communication log. Some information that we needed to examine in respect of staff was not accessible at this visit and a further announced visit to the service has been made on 1/9/08. During this visit we met with the manager and another staff member on duty and examined records relating to staff recruitment, training and supervision in particular. What the care home does well: What has improved since the last inspection? What they could do better: The Home maintains a good level of service to residents, has a history of compliance and sustained performance. The manager and staff demonstrate insight into areas of practice where they perceive further improvements can be made. The site visits highlighted some areas for suggested improvements to enhance the current practice, three of these are recommended and are: That the home provides clarity within staff guidance to ensure expected staff responses are made clear, and that frequencies of reviewing and updating of support plan and risk information is reviewed. That where residents are responsible for collecting their own prescription clear timescales are provided to staff within guidelines as to how long staff should wait before intervening in collections and thereby assuring a supply of medication is available. That the frequency of formal recorded staff supervisions are increased to at least six times per year. Care Homes for Adults (18-65 years) Page 7 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that the service will undertake an assessment of their needs prior to admission to ensure these can be supported appropriately. Evidence: Prospective residents to the home receive a comprehensive assessment of their needs prior to admission to ensure these can be met. Opportunities for visiting the home and short stays are also available, admission can be phased and tailored to a pace that the prospective resident is comfortable with. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff understand residents care and support needs and try to involve them in how they would wish this to be delivered, improvements to the frequency of updating information on support needs and risks is needed. The Home actively encourages the independence and skills development of residents within a responsible risk taking strategy Evidence: Staff demonstrate a good understanding of individual residents needs and the support they require, this is reflected in comprehensive support plan, risk assessment and guideline information available to staff for reference. Some guidelines viewed would benefit from improved clarity, where statements made are not sufficiently detailed to inform staff how to respond and also the frequency of their updating needs review and Care Homes for Adults (18-65 years) Page 11 of 26 this is a recommendation. Residents are encouraged to be involved in their support plans, guidelines and risk assessments but this is by choice. Residents confirmed they made day to day decisions often involving some element of risk. Staff actively encourage development of skills and independence and have worked with residents to raise their awareness that decisions they make may have consequences with which they have to live Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lead the life they wish, making good use of the community facilities in which they live. Staff encourage independence skills development and active participation in the running of the home. Contact with friends and relatives is supported. Residents are involved as much as they want to be in menu development food purchase and preparation Evidence: Residents are consulted about what they would like to do with their time and are provided with information about events and activities they can attend in the community, they are encouraged to make use of community facilities, some activities Care Homes for Adults (18-65 years) Page 13 of 26 they have expressed an interest in are provided for them within the home. Residents are supported and encouraged to maintain contact with their relatives and friends, they are supported to make visits and have short breaks at home with their families who are made welcome at the home, and with whom staff enjoy good and positive communication. The home promotes independence and individual decision making within individual day to day routines. residents are involved in discussions about annual holidays and are provided with a weeks holiday every year. Residents are consulted and listened to about their menu choices, special diets are catered for and residents are encouraged to take an active role in shopping and cooking for the household. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal emotional and health care needs of residents are appropriately supported Evidence: Staff provide prompting and supervision to enable residents to undertake their own personal care routines and these are well documented. Residents are encouraged to access routine health care and hospital appointments with staff support where necessary. Refusals to treatment by residents are documented and discussed with other relevant stakeholders. Staff maintain good liaison with other agencies and health professionals. Medication records examined indicated satisfactory recording and appropriate use of medication codes by staff, We asked staff about medication arrangements within the home, they told us that only trained staff administer and that all staff have received medication training. Only one resident is prescribed medication and takes an active Care Homes for Adults (18-65 years) Page 15 of 26 role in their medication regime, this includes responsibility for collection and filling of repeat prescriptions, guidance to staff regarding this arrangement is in need of update to ensure a clear timescale is given for when staff will intervene if there is a delay in the resident fulfilling this responsibility and this is a recommendation Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has an open culture that encourages residents to express their views and concerns and for these to be acted upon. Residents are generally protected by practice and procedures in place to safeguard them. Evidence: The home has systems in place to record and investigate complaints, none have been received in the last 12 months. Staff have received training in the protection of vulnerable adults and their awareness and the systems in place should safeguard residents from harm or abuse, a recent incident involving two service users was referred to the police and the social workers from the funding authorities this was not proceeded with to adult protection status and new guidance for staff has been developed to minimize future such occurrences, the home is also advised to make the local adult safeguarding staff aware of such incidents in future. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, clean and homely environment that is well maintained. The premises are appropriate to the needs and lifestyle of the current residents and they are encouraged to take an active role in the day to day running of the home. Evidence: The premises are located in a residential area close to shops and public transport. The home is in keeping with surrounding properties and appropriate for the needs of the current residents. The premises are not accessible to those would be residents who may have mobility issues or cannot manage stairs. A tour of the premises included all communal spaces and an example of a resident bedroom, we found the home offers a clean and comfortable environment for residents to live in. Measures are in place to ensure that maintenance of the property is maintained and a programme of upgrading is in place. Furnishings and fittings are of good quality. Residents are actively consulted about changes in the decor of the house and their views taken account of. Care Homes for Adults (18-65 years) Page 18 of 26 The home undertakes appropriate servicing and maintenance of fire alarm and fire fighting equipment and ensures monthly checks and tests of this equipment is carried out. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and have an understanding and awareness of the specialist needs of the residents in their care. A robust recruitment system is in place to ensure that the fitness of staff is fully assessed. Staff feel supported and that the manager is approachable but the frequency of their formal supervision sessions needs improving. Evidence: The staff team is well established providing continuity for residents. Staff are well trained, the service expects staff to be trained to NVQ level 3 as a minimum, all staff have achieved or are completing this. A sample of staff files provided evidence that a robust recruitment procedure is in place with all necessary vetting and checks undertaken to ensure staff fitness for their role. Individual training profiles are in place although the current format for recording does not work well, the manager discussed a need to review this and the training matrix to make them more effective, it was suggested that the profiles might be best placed Care Homes for Adults (18-65 years) Page 20 of 26 within staff files in future to improve their usefulness as a reference and recording tool and the manager has agreed to consider this. Staff files examined provided evidence of induction; the manager was reminded of the need to review the present induction format against the updated common induction standards introduced by Skills for Care for use with new staff. Staff we spoke with during our visits to the service confirmed access to a range of specialist training and also that mandatory training is being updated. Whilst at present staff undertake no personal care or moving and handling and therefore have minimal training needs in these areas and which are presently catered for adequately within health and safety training, the manager is aware that this arrangement would need to be reviewed in the event of needs changing requiring increased staff involvement. Staff told us the manager is avaialble at any time and that arrangements for formal supervision are in place, support staff who are also shareholders receive supervision from the responsible individual, the manager receives external supervision and other care staff who are not shareholders receive their supervision from the manager, a review of supervision records indicates that supervision is conducted thoroughly but frequencies of have drifted. It is recommended that the provider seeks to ensure that formal supervision frequencies are maintained for all staff . Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to be well managed in the best interests of the residents. Evidence: The home continues to be well managed with continuity in management and staffing. The provider and management team have a clear understanding of the kind of resident they would wish to support in the service; although not a home for life the service accepts that some residents may be at the home for a long time before they move on. It is acknowledged that progress and change for some residents whilst at a pace suited to them can leave staff feeling frustrated and De-skilled, and as a consequence the manager undertakes to motivate staff and direct their energies so as to overcome any concerns they may have. There is a commitment to the development of staff to Care Homes for Adults (18-65 years) Page 22 of 26 ensure they have the right skills to support and engage with residents. The home provides opportunities for residents to express their views independently and analysis of their feedback may influence the ways in which the service works with the individuals concerned. The home is aware of the need to develop quality assurance further and has acquired a quality audit format, this is being adapted to better reflect the service and this will be undertaken annually,the service advises this is to be implemented shortly. The home are already able to provide detailed analysis of residents feedback and this should be included with overall quality assurance findings in an annual published report. The Home has told us within AQAA information that all health and safety checks and servicing have been undertaken and a sample of these have been verified at the site visit. A minimal number of accidents have been recorded for residents and these have been dealt with appropriately. The AQAA tells us that the home maintains a full range of policies and procedures , the lack of a policy in respect of admission to hospital under section has been discussed during the site visit, although small the home has agreed that such an event could occur at the home and that it would be useful to develop guidance for staff in this area and are urged to do so. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 14 6 Some guideline information available to staff would benefit from improved clarity to ensure staff are fully informed of their expected response. The frequency of updating support plans and risk information should also be reviewed. Guidance to staff in respect of a residents responsibility to collect and fill a repeat prescription for their self should include clear timescales within which this should be undertaken before staff intervene, this should ensure no opportunity for medication to run out That staff have access to formal recorded supervision a minimum of six times per year in addition to regular contact they may have on day to day practice, supervision should also include an observational element 15 20 16 36 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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