CARE HOME ADULTS 18-65
Spinney Hill Road 56 Spinney Hill Road Northampton Northants NN3 6DN Lead Inspector
Stephanie Vaughan Unannounced Inspection 17th July 2006 02:00 DS0000063583.V304080.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 DS0000063583.V304080.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. DS0000063583.V304080.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Spinney Hill Road Address 56 Spinney Hill Road Northampton Northants NN3 6DN 01604 642515 01604 642515 spinneyhill@tracscare.co.uk suehullin@tracscare.co.uk Compass Care Partnership 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) Vacant Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places DS0000063583.V304080.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No person falling within the category of MD, Mental Disorder excluding Learning Disability or Dementia, may be admitted into the home unless that Person also falls within the category of LD, Learning Disability i.e. Dual Disability. 20th February 2006 Date of last inspection Brief Description of the Service: Spinney Hill Road is one of four homes in the areas owned by Compass Care. The home is registered to provide care for up to three people with a Learning Disability who additionally have a Mental Disorder. The house is on a road of similar houses in a residential area of Northampton. Residents are encouraged to be as independent as possible with staff support and supervision. The home is within walking distance of local community amenities, which include shops, pubs and a park. There is a bus service from the estate into town. Accommodation to service users is provided across two floors. All bedrooms are single occupancy, one is on the ground floor with en-suite facilities and two are on the first floor. The ground floor provides a sitting area, kitchen/dinner and conservatory. There is a garden area to the front and rear of the home. The current fees range from £1,800 to £2,300 per week with extra charges for one to one supervision, personal items and persistent wilful damage. DS0000063583.V304080.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One and a half hours was spent in preparation, which included a review of the conditions of registration, previous inspection reports with associated requirements and recommendations, the service history and other associated documentation. One Requirement and four Recommendations were made at the last inspection and in the main these have been addressed. Work is ongoing to develop the information on residents’ wishes regarding terminal care and death and the review of outstanding policies and procedures continues. The Commission have received no concerns or allegations about the service from external sources. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents, and upon their views of the service provided The Commission also has a national focus on Equality and Diversity for all within this current year and issues relating to this are included in the main body of the report. Two residents were ‘case tracked’ which involved following the care that residents receive through a review of their care plans, other associated documentation such as accident records, observations, and a limited tour of the premises was conducted, which involved a sample of the residents accommodation and communal areas. Three residents were spoken to and discussions held with three of the care staff. This unannounced inspection was conducted during the morning and lasted for four and a half hours, during which the Acting Manager was present and was highly cooperative throughout. What the service does well:
New residents are given the right information and opportunities to visit the home before deciding whether they would like to live there. Residents have contacts in place, which set out the charges and what is provided by the service. The management make sure that the service is able to offer the right care for residents and that the staff know how to look after them, this is written down in a care plan. The care plan shows that residents get the right help from doctors and specialists like psychologists and dentists. DS0000063583.V304080.R01.S.doc Version 5.2 Page 6 Staff make sure that residents are able to live with as much freedom as they are able and to remain safe. The individual plans of care tell staff how to support residents in the management of their behaviour and how to recognise when they need help. All residents have a Key Worker who knows the resident well and is able to give particular support with the things that they need. The residents have regular meetings and they are helped to make decisions such as the food to be put on the menu and to plan their activities. Residents can say what they think about the home and how things could be done better. Residents are able to have training to help them have more independence and continue to stay safe if there are risks involved Residents are able to lead interesting lives and are supported to go to college, get work, attend day centres and enjoy the local entertainment. Residents are able to stay in touch with their family and friends. Staff know about what the residents like and what they need to do in their daily routines. Residents said that they staff were nice to them and that they looked after them well. The management makes sure that the residents are treated fairly. Residents said that they liked the food and that there was enough of it. The staff make sure that residents have a healthy diet and the meals are served in the dining area, which is comfortable. The staff were making sure that the residents had the right things to keep the comfortable and safe during the hot weather. The manager makes sure that medication is given safely and that staff have the right training. The manager makes sure that residents know how and are able to complain and deals with situations as they arise. The manager also makes sure that the staff have the right skills and checks to make sure that they will not harm residents. The manager has made arrangements for improvements to the home while the residents are on holiday this will include a new kitchen, improvements to the heating and replacement carpets. Residents are able to have their own things in their rooms and are able to choose some furniture and fittings. The rooms also have privacy locks and staff make sure that residents have as much privacy as they need. . DS0000063583.V304080.R01.S.doc Version 5.2 Page 7 The manager had the right training and experience to be in charge of the home and intends to become registered with the Commission. The manager makes sure that he does the right checks to make sure that the home is safe and meets the needs of the residents. What has improved since the last inspection? 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. DS0000063583.V304080.R01.S.doc Version 5.2 Page 8 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 DS0000063583.V304080.R01.S.doc Version 5.2 Page 9 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): 1,2, 4 & 5 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. Appropriate admission processes are in place, which ensure that the home is able to meet the needs and expectations of residents EVIDENCE: There have been no new admissions to the home since the last inspection. However one resident has transferred to the home from another within the group. The resident confirmed that he had had the opportunity to visit the home, meet the other residents, staff and view the facilities before making a decision as to whether he would like to move there. There was also evidence that the appropriate information such as the Service Users Guide had been supplied to the resident and their representatives. The resident confirmed that the transfer had been managed well and that his quality of life had improved as he had moved to a more spacious environment and a location, which offered access to better facilities. All of the residents selected for case-tracking purposes had appropriate contracts in place, which had been signed by the acting Manager, however these had not been signed by the resident or their representative. This was discussed with acting Manager who has agreed to rectify this omission. DS0000063583.V304080.R01.S.doc Version 5.2 Page 10 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 & 9 The quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to the service. Individual needs and choices are generally managed well however the current style of documentation is not accessible to all residents. EVIDENCE: Each of the residents selected for case tracking purposes had an individual plan developed from regular assessments of need; these take into account the assessments conducted by the funding authorities. Following a previous recommendation the plans of care set out detailed instruction to staff about the personal and health care needs of the individual and how these needs are to be met. Individual pans of care evidenced that residents have access to appropriate specialist support and identifies where any restrictions are required. These are in the best interests of the individual and to be supported by appropriate risk assessments. The plans contain detailed information regarding the residents’ behaviours, which included triggers, warning signs and appropriate interventions.
DS0000063583.V304080.R01.S.doc Version 5.2 Page 11 Each resident has an allocated Key Worker and plans of care are reviewed on a regular basis and following consultation with the individual resident. However there was little evidence within the plans of care to demonstrate the level of the residents’ involvement or to show that the resident or their representative knew and agreed with what had been written. In addition the plans would benefit from being further developed into a more user-friendly format to enable greater access for residents with communication difficulties Residents are supported to make decisions and confirmed that they attended regular meetings to discuss communal issues such as the food and activities. During the inspection staff were seen to support residents with decisions regarding their daily routine and activities. Individual plans of care evidenced that residents had some access to advocacy services, however this should be further developed, particularly for residents who have no family to act on their behalf especially in respect of signing contacts and reviewing the content of the individual plans of care. Residents are supported to take risks within their daily lives and these are supported by appropriate risk assessments and specific training for example one resident is now allowed supervised use of the kitchen, which has been agreed following Basic Food Hygiene training. DS0000063583.V304080.R01.S.doc Version 5.2 Page 12 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, 16 & 17 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Residents are able to maintain an individualised lifestyle that meets their needs and expectations EVIDENCE: Residents spoken to confirmed that they had opportunities to pursue employment, education and training activities. All were able to discuss the arrangements that were currently being made on their behalf to comply with their wishes about their individual interests. Residents are supported to integrate with the local community. Residents confirmed that they had independent or supported access to the local shops; access to the local swimming pool as well as other leisure facilities such as the cinema, local pubs and restaurants. Residents also have access to social functions with other residents from homes within the local group.
DS0000063583.V304080.R01.S.doc Version 5.2 Page 13 Residents conformed that they are supported to maintain contact with family and friends. Individual plans of care contained good detail about the residents’ needs and preferences regarding their personal daily routines. Residents are risk assessed regarding the use of keys either to the front door or their personal accommodation. Staff were seen to relate well to residents and to refer to them using their preferred form of address. In addition staff are supportive of the residents rights to privacy. At present there are no formal policies relating to Equality and Diversity for residents, however residents have access to a Charter of Rights and this is intrinsic to the philosophy of the home and the person centred care provided. Residents confirmed satisfaction with the food provided, being involved in the menu planning and the individual plans of care contained good detail about the individual’s preferences. A weekly menu was reviewed which appeared to offer three meals a day and a varied diet. However there appeared to be little evidence of fresh salad and vegetables. Fresh fruit was available in the conservatory and through discussion with a member of staff it was established that the residents were ‘put off’ by having salad and vegetables on the menu however these were provided with each meal. The lunchtime service was viewed and seen to comprise a good quantity and variety of home made sandwiches with salad; residents had been involved in discussions about the choice for lunch during the morning. Cold drinks were also available. The meal was served in the kitchen diner, which provided a pleasant environment and a relaxed atmosphere. DS0000063583.V304080.R01.S.doc Version 5.2 Page 14 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 & 21 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Personal and healthcare support is managed well and meets with the resident’s needs and expectations EVIDENCE: Residents appeared well presented and were dressed appropriately for the extreme hot weather. Individual plans of care contained detailed instruction to staff about the individual’s personal and health care support, including specific detail about shaving and oral healthcare. The detail also included individual preferences for care being provided by persons of the same gender. Residents spoken to confirmed that the staff supported them appropriately and there was evidence that routines were flexible within the constraints of residents programmes of activities. Residents have access to appropriate healthcare specialists and annual health checks. Residents are risk assessed to determine whether they are able to manage their own medication. Where this is not possible residents sign a consent form for this to be managed by staff. Each resident had a photograph and
DS0000063583.V304080.R01.S.doc Version 5.2 Page 15 medication profile which corresponded to the medication administration record. A spot check was conducted and the medication was found to correspond with the administration records. Storage of medication was within an approved container and the stocks were at an appropriate level. Following a recommendation made at the last inspection the management are now reviewing the residents wishes regarding their views about terminal care and death and these are being incorporated into the individual plan of care. DS0000063583.V304080.R01.S.doc Version 5.2 Page 16 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 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Concerns, complaints and protection are managed well and residents are protected from abuse. EVIDENCE: The Commission for Social Care Inspection have received no concerns, complaints or allegations about this service since the last inspection. Residents spoken to confirmed that they knew how to complain should they wish to do so and that they would have confidence that their concerns would be handled appropriately. Each of the individual plans of care contains a complaints procedure and all residents have access to the Service Users Guide. One of the residents stated that there were some minor tensions between himself and another resident associated with the use of the television and the bathroom facilities. This was discussed with the Acting Manager who was already aware of the issues and was taking the appropriate action. Residents confirmed that they were happy living at Spinney Hill Road and that they were treated well by the staff. The staff have access to appropriate training such as Induction and Safeguarding Adults as well as appropriate Criminal Records Bureau Clearances. Residents are supported to manage their finances, the service holds small amounts of money in a secure facility and a spot check was conducted which evidenced appropriate records, receipts, individual storage and accurate balances.
DS0000063583.V304080.R01.S.doc Version 5.2 Page 17 DS0000063583.V304080.R01.S.doc Version 5.2 Page 18 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, 26, 27 & 30 The quality in this outcome area is adequate, this judgement has been made using available evidence including a visit to the service. The standard of the environment is adequate for the needs and expectations of the residents. EVIDENCE: The premises are suitable for the stated purpose and in keeping with the local community. The premises complies with the space requirements of the National Minimum Standards and provides residents with individual private accommodation and three communal areas with access to front and rear gardens. The general standard of the environment is adequate and clean, however would benefit from some improvements to the décor furnishings and fittings. Through discussion with the Acting Manager it was established that there are improvements planned for the next month, whist the residents are on holiday and these include improvements to the water and heating system refitting of the kitchen and replacement carpet to the hall stairs and landing. Resident’s rooms are fitted with privacy locks and evidenced personalisation.
DS0000063583.V304080.R01.S.doc Version 5.2 Page 19 Residents confirmed that they have been able to make choices regarding the furnishing of their rooms. The premises were clean and hygienic throughout. DS0000063583.V304080.R01.S.doc Version 5.2 Page 20 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 & 35 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Staffing, recruitment and training are managed well to ensure that residents are in safe hands at all times EVIDENCE: Staff files indicated that staff have thorough induction training and access to the General Social Care Council Code of Professional Conduct. Staff spoken to confirmed that they had commenced National Vocational Qualification training in Care. Through discussion with the Acting Manager it was established that the service has achieved the recommended level of 50 . Staff files also indicated that appropriate recruitment procedures were in place with staff having submitted application forms, records of interviews are maintained, appropriate references and Criminal Records Bureau Clearances are obtained prior to the commencement of employment. Staff confirmed access to appropriate Induction Training, and other mandatory training such as Fire Safety, Basic Food Hygiene, Safe Administration of Medication, Movement and Handling, Safeguarding Adults and First Aid. DS0000063583.V304080.R01.S.doc Version 5.2 Page 21 Staff also have access to training pertinent to the needs of the residents for example the management of challenging behaviours and up to eight hours per month for private study. DS0000063583.V304080.R01.S.doc Version 5.2 Page 22 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, 39 & 42 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. The Conduct and Management of the home is good which ensures that residents are cared for in a safe environment. EVIDENCE: The Acting Manger is appropriately qualified and experienced to manage the service and has sought Registration with the Commission for Social Care Inspection, however continues to wait for the enhanced Criminal Records Bureau Clearance necessary to continue with the application. This has recently been followed up and the clearance is anticipated within the next few weeks. The Certificate of Registration is displayed and is accurate to the current needs of the residents. Quality Assurance Systems are in place and these involve regular residents meetings, internal audits of individual plans of care, medication systems and residents money. However these would benefit from being formalised within
DS0000063583.V304080.R01.S.doc Version 5.2 Page 23 the organisation in order that benchmarking and good practice can be identified. Systems would benefit from further development in suitable formats to enable residents to comment individually on a regular basis as to their views about the quality of service provided. The organisation continues to review corporate policies and procedures for the services within the group. A significant number of these have yet to be done, despite the change of ownership having been completed over a year ago. It is recognised that this is beyond the scope of the individual service managers and this has been addressed in separate correspondence with the Responsible Individual and the Commission for Social Care Inspection are currently awaiting a response. Following a requirement at the previous inspection risk assessments have been reviewed regarding the required level of supervision for the safe transportation of residents by car. Safe working practices are managed well. Staff have access to appropriate mandatory training, appropriate risk assessments are in place for the environment and residents individual needs. No hazards were identified and appropriate safety equipment is available. Accidents and incidents are appropriately recorded and reported. DS0000063583.V304080.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 3 X 3 X DS0000063583.V304080.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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. 3. Refer to Standard YA6 YA6 YA7 Good Practice Recommendations Individual plans of care should evidence the residents or their representative’s involvement. Individual plans of care should be further developed in formats suitable to the communication needs of residents. Residents who do not have family members to represent them should have greater access to advocacy services DS0000063583.V304080.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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