Inspection on 15/05/07 for Spinney (The)

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Spinney (The) 04/09/06

Spinney (The) 08/03/06

Spinney (The) 28/07/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Queen Elizabeth House

Spring Lane Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Spinney (The) 21 Forest View Chingford London E4 7AU Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 15th May 2007 10:00 X10015.doc Version 1.40 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 Spinney (The) DS0000061978.V339017.R02.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 Older People. 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. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Spinney (The) Address 21 Forest View Chingford London E4 7AU 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) 020 8524 2200 020 8529 1346 Care Base (Chingford) Ltd Michele Jacqueline Cunnington Care Home 48 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0) Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of beds 48 to be used flexibly between the following categories: OP (not falling within any other category) both genders DE 55 both genders DE(E) both genders 4th September 2006 Date of last inspection Brief Description of the Service: The Spinney is a purpose built care home run by Care Base (Chingford) Ltd. The home is situated in the north Chingford area of the London Borough of Waltham Forest and overlooks a golf course. The home is close to the Station Road shopping area, and within easy reach of Chingford rail and bus stations. The home can accommodate up to 48 people in either single or double bedrooms. There are 37 single bedrooms with en suite facilities, several of which also have a shower, 1 single room without en suite facilities which is located next door to a toilet, and 5 double rooms with en suite facilities. Accommodation is over three floors and each floor has a lounge and dining area. There is a very well maintained rear garden with seating areas for residents, and there is limited car parking to the front. The home prides itself on providing a caring, dignified, and homely service, including promoting active lifestyles for its residents. They welcome and encourage close involvement from relatives. Comments made by residents and relatives at inspections help to conclude that this is a very well run home that consistently meets the expectations of residents and their families. At the time of this inspection the fees ranged from £650 - £850. per week. A copy of the statement of purpose and service user guide can be obtained by application to the manager. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on Tuesday, 15th May, 2007 between 08.45 hours and 16.30 hours. A tour of the home was undertaken, and the inspector was able to talk to many of the residents, staff who were on duty, visiting relatives, a visiting health professional and the registered manager. A pre-inspection questionnaire had also been returned to the Commission and evidence from this has been used to inform this inspection. 12 residents’ files were case tracked, together with the viewing of staff rotas, training schedules, activity programmes, medication administration, residents’ finance records, maintenance records, accidents records, fire safety records, menus, complaints and staff recruitment processes and files. A tour of the premises, including the laundry and the kitchen, was undertaken and all of the rooms were clean with no offensive odours present anywhere within the home. The garden was well maintained with seating areas for residents. At the end of the inspection the inspector was able to provide feedback to both the registered manager and a senior carer. The people living at the home were asked how they wished to be referred to in this report, and without hesitation they said ‘residents’. The inspector would wish to thank the residents of The Spinney and the staff who work there for a really enjoyable inspection. What the service does well: The highest priority for the management and staff team at The Spinney is to give the residents the best lives that they can possible give. Throughout the inspection it was very apparent that the staff go to any lengths to comply with the wishes of the residents and nothing is too much trouble. Whilst waiting for the manager to arrive, the inspector was able to spend time talking to residents who were sitting in the dining room having breakfast, and also spent time with the head cook in the kitchen. There was a really calm, but happy atmosphere with lots of laughing and joking between staff and residents. Throughout the inspection all staff were seen to treat residents with kindness and respect, and it was very apparent that meeting the needs of residents is of the highest priority for all of the staff. Residents are encouraged to participate in community life and there are many visits to external venues such as restaurants, pubs, theatres and shops. One Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 6 gentleman still visits a bowls club of which he has been a member for many years. One resident said “wonderful home, staff are kind and courteous, food always looks and tastes fantastic and I wouldn’t change anything.” Another said “I visited a couple of homes but this is the best.” Another relative had moved his mother from another home because he was not satisfied with care she was receiving, and said “since she has been at The Spinney she has put on weight and looks so much better, she is my mum again.” Activities are varied and involve all of the residents at various times, and some of the residents living with dementia were engaged in making pot pourri bags, and they seemed to be really enjoying smelling the bags once they had made them. Each Sunday afternoon there is an ‘open bar with nibbles and music’ for residents and relatives. Quiz evenings are held on a regular basis and many of the staff and their relatives give of their time to organise and help with these evenings. The activity co-ordinator ensures that a wide range of activities and outings are available to all of the residents. It was also apparent that any opportunity for a celebration is taken, and this was confirmed in discussions with residents and relatives. Care planning is very person centred and these are regularly reviewed with the individual resident and relatives. There are close working relationships with the GP, district nurses, chiropodist and other health and social care professionals where necessary. The management and the staff are very aware of the importance of equality and diversity issues, and this was demonstrated, in particular by the way they meet the needs of a person who is a non-English speaker. A senior carer speaks the person’s language and is often on hand to assist with the care of this resident. A prompt list has been drawn up with words in both English and the language in question, and work is now in hand to develop some of the signage in both languages for the benefit of this resident. All of the residents and relatives spoken to said that the food is excellent, and a new resident told the inspector that “I had smoked mackerel the other evening for tea, and it was lovely. The cook is wonderful, because nothing is ever too much trouble and if I don’t like something she will always find an alternative for me.” The cook was also very aware of the special dietary needs of some of the residents, and showed a good understanding of the need of appropriate foods, such as finger foods, for some residents living with dementia. At the time of this inspection none of the residents were having food supplements such as ensure, again because of the use of good quality foods, whole milk and cream in drinks, puddings and sauces where appropriate and necessary. The statement of purpose states that pets are welcome, and the home also has its’ own pet cat called ‘Ginger’, and it was very apparent from talking to some of the residents that Ginger is a much loved pet. One gentleman insisted that the inspector be introduced to Ginger and he took great pleasure in doing this. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 7 Staff training is given a high profile and staff confirmed that training courses are always available. More than 50 of the staff team has achieved NVQ level 2 or 3. 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. The summary of this inspection report can be made available in other formats on request. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 5 (Standard 6 does not apply to this service) People who use the 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 and their families are given every help and assistance in making the life changing decisions required for entering residential care. Opportunities are given to visit the home prior to making a decision, but some information could be given in formats that can be more easily understood by prospective residents who may have dementia. Qualified staff undertake comprehensive assessments and individuals are supported and encouraged to be involved in this process. EVIDENCE: The statement of purpose and service user guide are comprehensive and considers the different styles of accommodation, support, philosophies and services available to meet the needs of the residents. However, the service user guide and some other information such as the complaints procedure and Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 10 menus could be produced in a more user friendly format for those residents living with dementia. This was discussed with the manager during the inspection and the inspector is confident that such materials will be produced. For one resident who is a non-English speaker, every effort has been made to ensure that communication with her is effective and that she understands the service and facilities available within the home. From viewing residents’ files it was apparent that all new residents receive a full comprehensive needs assessment before admission, and qualified staff carry this out. For residents who are supported by a local authority, the manager insists on receiving a copy of the assessment and care plan before admission. It was evident that the assessment process focuses on achieving positive outcomes for people. This includes ensuring that ethnicity and diversity needs of the individual can be met, in all areas such as religion, culture, social, sexual, disability. Prospective residents are invited to spend time at the home and a member of staff is allocated to that person to give them special attention during the visit, and make them feel welcome and comfortable. This was confirmed in discussions with several residents and relatives. All residents receive a contract that gives clear information about fees and extra charges, and this is reviewed and updated as necessary. Where any resident wants this explained then staff are on hand to do this. This was evidenced from viewing the files of some of the residents. However, the organisation must ensure that such contracts/statement of terms and conditions are in accordance with the guidance given by the Commission, following the report produced by the Office of Fair Training in 2005 on contracts and fee information in care homes. This was discussed with the manager who will clarify this with Care Base Ltd, so that any necessary amendments can be made. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of residents are set out in an individual care plan, which is regularly reviewed to ensure that these needs are fully met. Residents can be sure that they are protected by the home’s policies and procedures for dealing with medication. At all times residents are treated with respect, and their right to privacy being upheld, and they can also be sure that at the end of their life they will be treated with care and sensitivity. EVIDENCE: The inspector case tracked 12 residents, 4 on each floor, and was satisfied that their current health and personal care needs are being met. It was evident that health care professionals such as the GP and/or district nurses are involved and there is a very good working relationship with health and social care professionals. This was supported in discussions with a visiting reflexologist who said “this is an excellent home, and if I had to go into a home Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 12 I would come in here, in fact my mum is living here. Staff are wonderful and there is always something going on.” From viewing the files and from observation and discussions with residents, relatives and staff it was apparent that care is very person centred. One resident told the inspector “whenever I need to see a doctor I do”, another resident said “of course I can see the doctor or the optician when I need to.” The outside of each file indicates whether or not a resident has an allergy, care plans were very comprehensive and work is currently being undertaken to change the style of the care plans. From observation on all of the units, the inspector was satisfied that staff demonstrated an awareness and understanding of the needs of the individual residents. Personal support was flexible and consistent so that the changing needs of people were met. The care plans were reviewed monthly, or more frequently if necessary, and showed evidence of an awareness of equality and diversity issues with religion, ethnicity, disability, cultural and social needs being recorded. The question of sexuality was discussed with the manager and the senior carer, and they demonstrated an awareness of these needs and would ensure that these were included in the care plans. It was evident that residents living with dementia are enabled to maintain their independence with support and assistance from the care support staff, and the care plans for these residents were detailed around personal care, communication needs and behavioural needs. For example, one care plan stated ‘needs guidance on dressing as unaware of the order in which to put on her clothes, be patient and only give assistance when necessary. This will help to maintain independence.’ Many of the staff working with residents living with dementia had received adequate and appropriate training, and this was evident in their care practices. One resident said on another unit said “the staff are lovely, they know just how to bath me and help me.” Residents are enabled and encouraged to remain as independent as is possible, and staff were observed encouraging and assisting residents in a kind and caring manner. One resident whose en suite facilities include a shower said “it is great having my own shower as I can be even more independent.” Care plans for some residents indicated the need to maintain mobility and dexterity, so encouragement be given to attend ‘extend’ classes which were held at the home. Risk assessments were in place for residents who were prone to falls. One resident, whose risk assessment indicated that he could fall out of bed, has been provided with a new wider bed which can be lowered, and this seems to have improved the situation. The manager is also considering the use of pressure mats and other forms of techniaids to enable discreet monitoring of Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 13 some residents who are prone to wander at night. Moving and handling risk assessments were in place for residents who needed assistance through the use of hoists. Comprehensive care plans were in place for a resident with diabetes. Where residents food and fluid intake is being monitored, charts were in place and being completed at the time, and not retrospectively. Although services such as a chiropodist and dentist will visit the home, wherever possible residents are encouraged to make such visits in the community, and from discussions with some of the residents it was obvious that they preferred this. Continence problems are handled in a very sensitive way and the continence advisor is involved wherever necessary. It was obvious that systems and procedures for dealing with continence problems are successful as there were no unpleasant odours anywhere in the home, and residents were being reminded and encouraged in a very discreet and sensitive manner. Nutritional screening is undertaken on admission and on a regular basis. Weights are recorded monthly or more frequently where necessary, and any cause for concern is addressed immediately with the appropriate health professionals. The home has a very efficient medication policy, procedure and practice guidance, and a medication administration round was observed during the inspection. This was done in accordance with the home’s policy and the medication administration records (MAR) were inspected and found generally to be in good order. There were controlled drugs in the home and the records for these were inspected and found to be in good order. A resident, who is self medicating, has had the necessary risk assessment undertaken, and this is in line with the homes medication policy. Regular audits are undertaken, and all staff involved in the administration of medication have had the necessary training. Some minor adjustments such as recording the actual number of tables, or amount of liquid, given with PRN medication where 1 or 2 was indicated, and two signatures on hand written entries, were discussed at the time of the inspection, and the inspector is confident that such adjustments will be made. The insulin for one diabetic resident is delivered by staff using a pentex and this is being stored appropriately in accordance with the product licence. With regard to end of life issues, the management team is further developing these in line with the recent Department of Health guidance. However, residents who are dying are treated with sensitivity and respect and their wishes are complied with. Relatives are very involved and arrangements are made for their support, as well as those of the staff members and other residents. A lounge on the ground floor which is now available residents and visitors to meet privately, can be made available for a ‘wake’ and the home will provide the refreshments. A letter sent to the home by a relative said “we are Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 14 writing to express our gratitude for the wonderful care received from The Spinney throughout my mother’s life. The staff were kind, loving and caring. When she became extremely fragile and needed constant attention it was given with great compassion. How sad she was unable to survive to the age of 100 years this year (2006). Nevertheless there is great consolation she died peacefully, without paid and with people she knew and in her normal surroundings.” Another relative wrote and said “just a note to say thank you and your staff for looking after my mum all these years. Also the kind and sensitive help given to my family on the day of her funeral. We much appreciate the support you are now giving to my father.” Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents at The Spinney find the lifestyle they experience suits their expectations and preferences and are sure that their social, cultural, religious and recreational interests and needs are met. Contact with family, friends and the wider community is positively encouraged and all residents are helped to exercise choice and control over their lives. Food is of a high standard and residents can be sure of being served an appealing, wholesome and balanced diet in congenial surroundings. This means that residents at the home benefit from the quality care provided. EVIDENCE: From discussions with residents and visiting relatives it was very evident that residents at the home are very involved in activities of daily living. This was also evidenced from records viewed, photographs and from talking to care staff and the activity co-ordinator. It was evident from talking to many of the staff that they really enjoyed working at The Spinney, and one said “I always enjoy coming to work, never think I can’t face it.” Although the home is on three Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 16 levels, it was apparent that residents can, and do, move between the floors and use the different communal areas. The inspector was pleased to see that the residents living with dementia were engaged in various activities of interaction either with staff, each other or doing things such as colouring and making pot pourri bags. One resident was very proud of a picture which she had coloured and took great pleasure in showing the inspector. It was also evident from talking to some of the residents and viewing documentation that residents living with dementia are always included in celebrations and outings. On this unit there was a sense of calm and well-being. Music reflecting the cultural origins of a person who enjoys dancing is provided and other residents join in. Whilst there is some evidence, such as old film star photographs and name/pictorial indicators on bedroom doors, more could be done around the environment to make this unit more amenable to residents living with dementia. Improvements, for example, could be through the use of ‘touch and feel’ materials, pictures/photographs which are more meaningful to the residents than those currently displayed in the corridors/communal areas, pictorial menus and the further development of life histories. It would seem that any opportunity for a celebration is taken with the involvement of the residents, and they all enjoyed festivities at Halloween, Christmas, Easter and St. Patrick’s day. On St.George’s day a local pub invited some of the residents for lunch, and they enjoyed boiled beef and carrots and sticky toffee pudding. One resident said “there is always something going on, and I can join in if I want, but if I don’t want to then that is okay.” A relative said “we always leave here laughing and the residents always seem so happy.” There are often themed evenings such as a Cockney evening where residents enjoy traditional foods such as sausage & mash, and there are Chinese evenings. Residents spoken to said they really enjoyed the food, one said “the meals are always wonderful, and if I don’t like something they will always get me something that I like.” One resident said “wonderful home, staff are kind and courteous, food always looks and tastes fantastic and I wouldn’t change anything.” The dietary needs of residents are viewed as a very important aspect of the care at this home, and menus are varied and nutritional. The cook was very aware of the varied dietary needs of some of the residents, including those with diabetes, those who are vegetarian and a person who has particular cultural needs. Generally fresh vegetables are used, and fresh fruit is always available and is offered to all residents on a daily basis. Residents are involved in the planning of menus and the cultural and dietary needs of residents are being met. The cook has now achieved the NVQ level 3 (chef) qualification, and other catering staff have achieved the NVQ level 2 in catering. It was evident throughout the inspection that drinks and snacks were available for Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 17 residents and visitors alike. Before lunch residents can have a sherry or other such aperitif if they wish. One resident was still enjoying her sherry after lunch when she was talking to the inspector. Four main meals each day are served and these are: Breakfast from 8a.m (this is flexible depending upon the wishes of the residents Lunch from 12,30 p.m. Tea from 5p.m. Supper from 8p.m. (milky drinks, sandwiches and cakes) Because of the importance of maintaining fluid intake, drinks were available at all times. Lunch was observed being served on Maple unit, and it was apparent that any resident who needed support was given this in a discreet and sensitive way to both the individual and having regard to the feelings of other residents. Residents are encouraged to go shopping for personal items such as toiletries and clothes, and often go to the local shops. Arrangements are also made for them to visit the large shopping mall at Lakeside. Residents are helped to write their own greetings cards for relatives, and also to shop for gifts. Visits are undertaken to the theatre and further a field to the coast depending on the wishes of the residents. Recently residents have visited Paradise Wildlife Park. If residents want to help with dusting, washing or drying crockery then they are encouraged to do so. Each resident has a detailed activity record, and there is a monthly programme for group activities, and also individual activities on a daily basis. The activity co-ordinator makes a point of visiting as many residents daily to let them know what is going on for that day, and also spends time talking to those residents who do not want to join in. This does ensure that no resident will feel isolated. At other times it would seem that all staff are engaged in activities. For example the cook does cooking sessions, and many of the residents living with dementia enjoy these as they like to make rock cakes which they can remember making when they were younger. Each Sunday afternoon there is an open bar with nibbles and music for residents and relatives, and one relative said “it is always a lovely atmosphere, and the staff always work so hard.” Staff and their relatives organise and assist with quiz evenings, and the home is preparing for the summer fete. If residents wish then they can have massages and currently about six residents purchase this service from a visiting reflexologist. Some of the staff are also now doing ‘makeovers for the residents who really seem to enjoy this, and as one said “it makes me look glamorous.” Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 18 Residents are encouraged to participate in community activities, and one resident still goes to his bowls club once a week. Some have taxicards and all are members of dial-a-ride. Some residents still like to use the local buses and have their ‘freedom passes’. Religious services are held at the home, and if residents wish they are enabled to go to their preferred place of worship. It was evident from touring the home, and visiting some residents in their rooms, that bedrooms are very personalised. A hairdresser does visit the home, and work is soon to be undertaken to provide a dedicated hairdressing salon. However, if residents want to go to an external hairdresser then this is arranged. It was very apparent that the service is very person centred, routines, activities and plans are resident focused, regularly reviewed and can be quickly changed to meet a resident’s changing needs, choices and wishes. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and concerns are listened to, taken seriously and acted upon and all residents are protected from abuse through staff training, the ethos and practices within the home. All residents can, therefore, feel safe and protected. EVIDENCE: In discussions with residents and relatives it was clear that they felt that they could express concerns or make a complaint to the manager and her staff if it was necessary. They knew of the complaints procedure and some had an understanding of the role of the Commission. All complaints and concerns are addressed promptly, taken seriously and acted upon. Outcomes are used to influence the direction of the service in a very positive manner. Information on making a complaint is on display in the home, and staff spoken to were also aware of the need to take any complaint seriously. The complaints log was viewed, and there had been one formal complaint regarding the laundering of clothes. This complaint had been investigated by the manager, and the complainant had been responded to in a satisfactory manner. Issues had also been addressed with the laundress and no other incidents have been recorded. Residents and relatives are able to record any concerns in a book that is kept in the reception area, and this is viewed on a regular basis by the Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 20 management. Residents and relatives spoken to confirmed that any concerns are dealt with by the manager and staff immediately so that nothing becomes a major concern or complaint. There is an open culture within the home and residents spoken to said that they felt safe at all times. They said that they could speak to the manager and the staff about anything. All staff have very recently undertaken training in safeguarding adults and the necessary procedures. Staff spoken to demonstrated a good understanding of safeguarding adults and the whistle blowing policy. The manager was clear when an incident needed to be referred to the local authority as part of the local safeguarding procedures. Staff spoken to had a clear understanding of what restraint is, and alternatives to its use in any form are always looked for. The use of bed rails is not promoted within this service, and alternatives are always used. For instance one resident in danger of falling from his bed was given a new wider bed that could be lowered so that he was nearer to the floor if he should fall. Since the purchase of the new bed there have been no further incidents. Some residents told the inspector that they are included in the electoral register and are encouraged and enabled to participate in civic affairs if they wish. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26. People who use the service experience excellent 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, well-maintained environment, which is clean and hygienic and they are able to have their own possessions around them. People who use the services are encouraged to see the home as their own. There is a selection of communal areas inside the home that means that people have a choice of place to sit quietly, meet with family or be actively engaged with other residents. The rear garden offers a secure and pleasant place to sit, EVIDENCE: During a tour of the home, and when visiting individual residents in their rooms, it was evident that residents are encouraged to personalise their bedrooms. All of the bedrooms, other than one single, have en suite toilet and handbasin, and several also have a shower. Residents occupying the shared bedrooms have made a positive choice to share. One new resident is having Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 22 her bedroom redecorated in accordance with her own choice, and in discussions with her she told the inspector that she was looking forward to moving into her new bedroom which leads onto the garden. All of the bedrooms promote high levels of privacy and locks are in place for those residents who wish to have their own keys. Residents can have a private telephone line in their bedrooms, and many of the residents have chosen to have this facility. Throughout the home decorations and furnishings are to a high standard, and there is an ongoing programme of redecoration. The home was very clean and well maintained, and there were no offensive odours. One relative told the inspector “when you come into the home it always smells nice, it doesn’t smell like an old people’s home.” There is a proactive infection control policy and work to ensure that any infections are minimised. The home is designed to provide small group living where residents can enjoy maximum independence in a discrete, non-institutional environment. Residents are free to move between the three floors, and some take advantage of this so that they can have meals or relax with friends whose bedrooms are on a separate level. The environment is fully able to meet changing needs of the residents, along with their cultural and specialist care needs. Having discussed some signage and décor additions to Maple unit, the inspector is confident that these improvements will be made. The home is fully accessible throughout to residents with disabilities. To aid access to the front of the home, the organisation has joined with some other property owners in the private road, and the roadway has been re-laid with tarmac. The kitchen was inspected and food was being stored appropriately and was labelled. Fridge/freezer temperatures were recorded on a daily basis. The kitchen was clean and well maintained. The laundry area has been re-sited and is now larger than previously. Adequate equipment was in place and the machines and dryers were in good working order. The old laundry area is being separated into a hairdressing salon and a wet room. Staff have been given a staff room, and there is now a new seniors office on the top floor. A lounge on the ground floor has been made into a family room, where residents can meet with relatives quietly, or for functions such as birthday parties or family occasions. The Oak lounge has been completely refurbished, and there is now a small kitchenette in the corner of the dining area where residents are encouraged to make their own drinks, and help with food preparation and washing up. The lounge/dining area on Maple unit has also been redecorated. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 23 Residents spoken to confirmed that there is always plenty of hot water and the temperature in the home can be adjusted on request. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the 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’ needs are met by the numbers and skill mix of staff and residents can feel that they are in safe hands at all times. Staff are trained and competent and residents are supported and protected by the home’s recruitment policy and practices. EVIDENCE: From viewing staff files, training records, talking to residents, relatives and staff, it was apparent that the majority of staff at The Spinney were skilled and competent to carry out their jobs. Whilst ongoing training is available, staff do sometimes have to wait sometime for a suitable course. Induction training is undertaken for new staff and this is a six week course. Consideration should be given to the possible allocation of a mentor for each new member of staff, as this would help with the induction process. The induction books and programmes are currently being reviewed which may be opportune to introduce a mentoring scheme. This was discussed with the senior carer who agreed to take this up with the manager. Staff have recently completed refresher training in safeguarding adults, health and safety, moving and handling, food hygiene, first aid and fire safety. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 25 More than 50 of the care staff are trained to either NVQ level 2 or 3 and both internal and external trainers are used for the various courses identified as being required by staff. The cook has recently achieved the NVQ level 3 (chef) and the remainder of the catering staff have achieved NVQ level 2 in catering. There is good team working in the home and this was confirmed in discussions with staff. Residents and relatives spoken to also confirmed that staff always seem to be working co-operatively with each other. The files of new staff were inspected and all were found to be in good order with the necessary references being received and verified, application forms and any gaps in employment had been discussed with the individual and recorded, the individual’s identification had been verified and the appropriate criminal records bureau (CRB) disclosures had been obtained. However, discussions took place with the manager around the retention of the actual CRB’s. The inspector confirmed that under the Data Protection Act such disclosures should only be kept for the length of time required to make a decision. Guidance from the Commission is that disclosures should be kept until the next inspection and then destroyed. The organisation may wish to record the name, date and disclosure number on the individual staff record. Agency staff are sometimes used, and the management must ensure that they are fully informed of the needs of the residents. One resident told the inspector that “sometimes agency staff are not very good, as they do not always know the problems and I have to tell them.” However, the manager ensures that there is always sufficient staff on duty to meet the needs of the residents, and this was evidenced from the staff rota and also from talking to residents and relatives. It was also evidenced from the many varied activities which take place at the home where often additional staff members are required. Residents spoke very highly of the staff and one resident said “they are amazing, nothing is ever too much trouble for any of them. I don’t know how they do what they do.” One relative said “the staff are wonderful, and I have booked my place here when the time comes.” It was apparent that residents knew the names of the different members of staff and were able to communicate with them freely and easily. Staff were observed to demonstrate a thorough understanding of the needs of the individual residents, and were seen to deliver highly effective person centred care. A fairly new member of staff confirmed that she had received induction, and all staff spoken to confirmed that they had had supervision and attended staff meetings. This was also confirmed in documentation viewed. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person who is qualified and able to discharge her responsibilities fully manages the home. Residents can be sure that the home is run in their best interests, that their financial interests are safeguarded, that staff are appropriately supervised and that their health, safety and welfare will be promoted and protected. EVIDENCE: The manager has now been registered by the Commission, and is very experienced and highly competent to run the home and meet its’ stated aims and objectives. The manager was able to demonstrate a sound knowledge of Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 27 the organisation’s strategic and financial planning systems and how the business plan for the home ‘fits’ with these. The manager was able to describe a clear vision for the home based on the organisation’s values. A clear sense of direction is communicated to her staff, and she was able to demonstrate continuous improvement with regard to the service. Support is given by the organisation through a dedicated line manager. The organisation undertakes the customer satisfaction surveys for all of the homes in its’ group, and an annual quality assurance report is published. The organisation also publishes a newsletter, and this is personalised to each home with contribution being made by residents, relatives and staff who wish to. Regular meetings take place at the home with residents and relatives, and the outcome of such meetings is used to influence the service. In discussions with the manager it was apparent that she gives priority to equality and diversity issues, and she demonstrated an awareness of the varying strands that this involves. The manager ensures that staff deliver in this important area through training and supervision. The policies and procedures are effective, and there are efficient systems to ensure effective safeguarding and management of residents’ money. No money is kept as expenditure for each resident is made from the home’s petty cash and any expenditure is reclaimed through the provision of an invoice, supported by receipts. Records in this connection are maintained on the computer and these were viewed by the inspection. Where residents wish, they are supported to manage their own finances. The manager has a diploma in dementia care, and is well placed to ensure that a high quality of care is given to residents living with dementia. In essence The Spinney is the home of the residents and everybody working at the home must ensure a quality of life for the residents, that residents are treated as individuals, offers them choice and gives respect and understanding. This was certainly evidenced in the very person centred care being delivered at the home for all of the residents. Amendments to the care plans are made with the involvement of the resident, and with relatives if necessary. The working practices in the home are safe and all within a risk management framework. Accidents are to a minimum but accurate records are maintained and the necessary Regulation 37 notifications are sent to the Commission. Where necessary advice is sought from health and safety professionals. A range of safety and maintenance records and certificates were inspected and these included, insurance, fire safety and fire alarm testing, electrical and gas safety certificates, water, equipment maintenance including the hoists, Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 28 wheelchairs and lift. The programme for the redecoration and refurbishment of the home was also inspected. All were found to be in good order. Regulation 26 monthly visits are being undertaken and a copy of each month’s report was available at the home for inspection. Guidance from the Commission is that it is not necessary for these reports to be sent to the Commission unless specifically requested, but that a copy must be available in the home for inspection. The manager was aware of the recently introduced Mental Capacity Act 2005 and she is discussing training needs with the organisation. The further development of preferred place of care and end of life plans were discussed with the manager she will be progressing this in line with the guidance from the Department of Health. There is a strong ethos of being open and transparent in all areas of running the home, and the management team is person centred in their approach and leads and supports a strong staff team who have been recruited and trained to a good standard. Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 4 X 3 X 4 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 3 X 3 Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP30 Regulation 18 Requirement The registered persons must ensure that all staff undertake training in the implementation of the Mental Capacity Act 2005 to ensure that all residents are deemed to have capacity to make decisions unless it can be proven otherwise. Timescale for action 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Spinney (The) DS0000061978.V339017.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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