CARE HOME ADULTS 18-65
Spinney Hill Road 56 Spinney Hill Road Northampton Northants NN3 6DN Lead Inspector
Stephanie Vaughan Unannounced Inspection 20th February 2006 08:00 DS0000063583.V284176.R01.S.doc Version 5.1 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.V284176.R01.S.doc Version 5.1 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.V284176.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Spinney Hill Road Address 56 Spinney Hill Road Northampton Northants NN3 6DN 01604 642515 01604 642515 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) Compass Care Partnership Vacant Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places DS0000063583.V284176.R01.S.doc Version 5.1 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 ie Dual Disability. 16th May 2005 Date of last inspection Brief Description of the Service: Compass Care runs the home, which, is part of a group of other homes in the area. 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.Service Users 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 ensuite 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. DS0000063583.V284176.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Prior to this inspection a period of one hour was spent in preparation, which included a review of the service history, previous reports, including requirements and recommendations. No comment cards have been received from residents or their representatives since the last inspection. This second statutory inspection for the year, was conducted over a period of three and a half hours, during which the inspector made observations, spoke briefly to two residents; management and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of two residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. What the service does well:
Through discussion with management and staff the Commission is satisfied that the home has a satisfactory admission process. This enables staff to establish whether that the home is able to meet the needs of a prospective resident and that a new resident is able to integrate well with existing residents. Individual plans of care have recently been reviewed and contain detailed instruction to staff regarding the residents’ healthcare and behaviour management needs. Any restrictions placed on individuals are in their own best interests, based on reviews and supported by appropriate risk assessments Residents are supported to take appropriate risks; one example is that a resident has recently undertaken cycling proficiency training to enable him to have the supervised use of a cycle within the locality. Residents’ individual plans of care contained a weekly programme of activities, which indicated access to a range of facilities including work placements, social and educational opportunities. These activities take place in a variety of settings and evidence that residents are supported to integrate with the local community. In addition residents are supported to maximise their independence within the restrictions placed on them by their placing authority. One example noted was
DS0000063583.V284176.R01.S.doc Version 5.1 Page 6 the arrangements that had been made for a resident who wished to have greater independent access the local shops. Individual plans of care evidenced that residents have access to a range of health care professionals such as audiologists, dentists and podiatrists as well as medical specialists and the Community Learning Disability Team. The home is well maintained, in keeping with the local community and accessible to local amenities. Residents have appropriate fixtures and fittings, which promote their privacy and dignity. What has improved since the last inspection?
The home has produced a new Statement of Purpose to accommodate changes in the ownership of the home and subsequent management arrangements. In addition a new Service Users Guide has been produced to inform residents of the services and facilities available in the home. Following recommendations made at the last inspection the home have implemented a formal key worker system and the names of staff who fulfil these responsibilities are included within the individual plans of care Medication systems were reviewed and seen to be in good order. A spot check was conducted and found to correspond with the Medicine Administration Records. Following requirements made at the last inspection medication processes have been reviewed. The management now conduct regular medication audits to ensure compliance. The complaints policy is available to residents both within the revised Service Users Guide, and Statement of Purpose. A copy is also included within the individual plans of care. In addition the company are now developing pictorial complaints policies for residents and leaflets for their representatives. Since the last inspection staff have had some training in the Protection Of Vulnerable Adults and further training is planned for the near future. Following requirements made at the last inspection staff files now evidence improved recruitment processes, with evidence of appropriate references, povafirst checks having been received prior to the date of commencement of employment and appropriate Criminal Records Bureau Clearances. Following a recommendation made at the last inspection one resident has had a replacement bed, which is now able to accommodate his height. Two previous requirements were made regarding the fitting and use of window restrictors and these have now been addressed. DS0000063583.V284176.R01.S.doc Version 5.1 Page 7 The management have reduced the number of agency staff required by the development of a staff bank, in order that residents can be supported by staff who are known to them and have an understanding of their needs. Following a recent recruitment drive staffing levels have been increased. The home currently operates with two staff during the daytime, in addition to the presence of a recently appointed manager. Current staffing levels enable both residents to have continued 1: 1 supervision and support whilst away from the home. Staff files and staff spoken to confirmed access to appropriate statutory training and training pertaining to the needs of individual residents. One of the managers within the group has been identified to take responsibility for managing staff training through out the organisation and a full review of training needs has been conducted and used to develop a training programme for the current year. The organisation has recently appointed an appropriately qualified and experienced individual to the post of manager. Staff spoken to confirmed that this had had a positive effect on the stability of the home and outcomes for residents. The manager has submitted an application the Commission for Registration. Since his appointment the manager has commenced quality assurance activities, which include regular and frequent audits of medication and residents monies. In addition to regular residents meetings, residents’ satisfaction surveys have been implemented. The Commission continues to receive monthly reports from the responsible individual. What they could do better:
Individual plans of care have been recently reviewed, however, there is little evidence that the residents are involved in the care planning process. Individual plans of care have been reviewed regarding how residents’ personal care needs are to be met. However these should be further developed to provide greater detail, for example the arrangements for shaving. At present the individual plans of care contain no reference to Aging and Death and this should be developed within the plans, following consultation with residents and, or their representatives One resident has previously alleged that some staff had been buying residents presents to ‘curry favour’. This was discussed with the management who were unaware of any incidents such as this and agreed to take appropriate action DS0000063583.V284176.R01.S.doc Version 5.1 Page 8 One risk assessment associated with the transport of residents to outside activities by car must be reviewed to ensure residents have a safe level of supervision and staff are able to maintain appropriate control of the vehicle. 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.V284176.R01.S.doc Version 5.1 Page 9 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.V284176.R01.S.doc Version 5.1 Page 10 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, 4 & 6 The home has appropriate admission processes, which ensure that residents needs, and expectations can be met. EVIDENCE: The home has produced a new Statement of Purpose to accommodate changes in the ownership of the home and subsequent management arrangements. This document contains the required information as specified in the National Minimum Standards. In addition a new Service Users Guide has been produced to inform residents of the services and facilities available in the home. The home has had no new admissions since the last inspection, however one resident has been placed elsewhere, leaving one vacancy. Through discussion with management and staff the Commission is satisfied that the home has a satisfactory admission process, to establish whether that the home is able to meet the needs of a prospective resident. Staff confirmed that prospective residents had had the opportunity of visiting the home and staying for a week prior to deciding whether they wished to live there. Management are mindful of the need to ensure that a new residents is able to integrate well with existing residents DS0000063583.V284176.R01.S.doc Version 5.1 Page 11 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&9 Residents’ needs are met and they are supported to take appropriate risks. EVIDENCE: Both of the existing residents have an individual plan of care, which identified the residents’ individual needs. Healthcare and behaviour management plans contained detailed instruction to staff as to how to care for individual residents. Any restrictions placed on individuals are in their own best interests, based on assessments and supported by appropriate risk assessments Individual plans of care indicate that residents have access to designated key workers and recent review. However, there is little evidence that the residents are involved in the care planning process. Residents are supported to take appropriate risks; one example is that a resident has recently undertaken cycling proficiency training to enable him to have the supervised use of a cycle within the locality. DS0000063583.V284176.R01.S.doc Version 5.1 Page 12 DS0000063583.V284176.R01.S.doc Version 5.1 Page 13 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 & 18 Residents are enabled to maintain appropriate and fulfilling lifestyles in and outside the home EVIDENCE: Residents’ individual plans of care contained a weekly programme of activities, which indicated access to a range of facilities including work placements, social and educational facilities. These activities take place in a variety of settings and evidence that residents are supported to integrate with the local community. In addition residents are supported to maximise their independence within the restrictions placed on them by their placing authority. One example noted was the arrangements that had been made for a resident who wished to have greater independent access the local shops. Residents are assessed as to whether they are able to have a key to the front door and their involvement in personal house keeping tasks. DS0000063583.V284176.R01.S.doc Version 5.1 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 Personal and HealthCare support has been improved which promotes the continuity and consistency of care for residents. EVIDENCE: Residents appeared well presented and individual plans of care have been reviewed and now provide instruction to staff about how their personal care needs are to be met. However these should be further developed to provide greater detail, for example the arrangements for shaving. Following a recommendation made at the last inspection, the use of the bathroom facilities has been reviewed to ensure that residents have appropriate access to individual facilities. Following recommendations made at the last inspection the home have implemented a formal key worker system and the names of staff who fulfil these responsibilities are included within the individual plans of care Individual plans of care evidenced that residents have access to a range of health care professionals such as audiologists, dentists and podiatrists as well as medical specialists and the Community Learning Disability Team. DS0000063583.V284176.R01.S.doc Version 5.1 Page 15 Care plans evidenced that staff act on the guidance issued by health care specialists. Medication systems were reviewed and seen to be in good order. A spot check was conducted and found to correspond with the Medicine Administration Records. Following requirements made at the last inspection medication processes have been reviewed. The management now conduct regular medication audits to ensure compliance. At present the individual plans of care contain no reference to Aging and Death and this should be developed within the plans, following consultation with residents and, or their representatives. DS0000063583.V284176.R01.S.doc Version 5.1 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 Residents are able to access the Complaints Procedure and their concerns are addressed. Residents are protected from abuse. EVIDENCE: The Commission for Social Care Inspection have received no recent complaints about this service, however the complaints policy is available to residents both within the revised Service Users Guide, and Statement of Purpose. A copy is also included within the individual plans of care. In addition the company are now developing pictorial complaints policies for residents and leaflets for their representatives. Residents are protected from abuse by the homes policies and procedures. Since the last inspection staff have had some training in the Protection Of Vulnerable Adults and further training is planned for the near future. Following requirements made at the last inspection staff files now evidence appropriate recruitment practices which include evidence of a povafirst check having been obtained prior to commencing employment, the required Criminal Records Bureau Clearances and appropriate references. One resident has previously alleged that some staff had been buying residents presents to ‘curry favour’. This was discussed with the management who were unaware of any incidents such as this and agreed to take appropriate action. DS0000063583.V284176.R01.S.doc Version 5.1 Page 17 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 & 30 The home provides a safe environment that is appropriate for residents preferred lifestyles and needs. EVIDENCE: The home is well maintained, in keeping with the local community and accessible to local amenities. Residents have appropriate fixtures and fittings, which promote their privacy and dignity. Following a recommendation made at the last inspection one resident has had a replacement bed, which is now able to accommodate his height. Two previous requirements were made regarding the fitting and use of window restrictors and these have now been addressed. The home is clean and hygienic throughout. DS0000063583.V284176.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 & 36, Staffing levels and training are adequate to meet the needs of the existing residents and improvements have been made to the recruitment process. EVIDENCE: The management have reduced the number of agency staff required by the development of a staff bank, in order that residents can be supported by staff who are known to them and have an understanding of their needs. Following a recent recruitment drive staffing levels have been increased. The home currently operates with two staff during the daytime, in addition to the presence of a recently appointed manager. Current staffing levels enable both residents to have continued 1: 1 supervision and support whilst away from the home. Risk assessments are in place for there to be only one waking night staff on duty and this has been agreed with the placing authorities. The organisation provides access to a floating support member of staff throughout the night. A selection of staff files evidenced improved recruitment processes, with evidence of appropriate references, povafirst checks and references having been received prior to the date of commencement of employment and appropriate Criminal Records Bureau Clearances. DS0000063583.V284176.R01.S.doc Version 5.1 Page 19 Staff files and staff spoken to confirmed access to appropriate statutory training and training pertaining to the needs of individual residents. One of the managers within the group has been identified to take responsibility for managing staff training through out the organisation and a full review of training needs has been conducted and used to develop a training programme for the current year. Staff files evidenced regular formal staff supervision. DS0000063583.V284176.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Residents are now able to benefit from the stability of a permanent and experienced manager. The management of risk is generally good however further improvement is required to ensure the safety of residents and others. EVIDENCE: The organisation has recently appointed an appropriately qualified and experienced individual to the post of manager. Staff spoken to confirmed that this had had a positive effect on the stability of the home and outcomes for residents. The manager has submitted an application the Commission for Registration. Since his appointment the manager has commenced quality assurance activities, which include regular and frequent audits of medication and residents monies. In addition to regular residents meetings, residents’ satisfaction surveys have been implemented. The Commission continues to receive monthly reports from the responsible individual. Health and safety is managed well, window restrictors have now been installed and are in use, following requirements made at the last inspection.
DS0000063583.V284176.R01.S.doc Version 5.1 Page 21 Residents have appropriate risk assessments in place, which are generally detailed and cover most eventualities. However one risk assessment associated with the transport of residents to outside activities by car must be reviewed to ensure residents continue to have the required level of supervision and staff are able to maintain appropriate control of the vehicle. DS0000063583.V284176.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 2 X DS0000063583.V284176.R01.S.doc Version 5.1 Page 23 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 YA42 Regulation 13 (4) Requirement The risk assessment associated with the transportation of residents by car must be reviewed to ensure that residents have the required level of supervision and that staff are able to maintain appropriate control of the vehicle. Timescale for action 01/03/06 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 YA21 Good Practice Recommendations Residents and/or their representatives should be involved in the development and review of their personal individual plans of care and the plans should evidence this Individual plans of care should be further reviewed to include detailed instruction to staff regarding the personal care needs of residents. E.g. shaving. Information regarding Aging and Death should be recorded within the Individual Plans of Care, following consultation with residents and, or their representatives. Practice, policies and procedures should be reviewed to
DS0000063583.V284176.R01.S.doc Version 5.1 Page 24 4 YA23 ensure that staff have appropriate guidance on the giving of gifts to residents. DS0000063583.V284176.R01.S.doc Version 5.1 Page 25 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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