CARE HOME ADULTS 18-65
Spout House Support Services Spout House Bay Horse Lancaster Lancashire LA2 9DE Lead Inspector
Mrs Joy Howson-Booth Unannounced Inspection 20th October 2005 2.00 Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 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 Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 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. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Spout House Support Services Address Spout House Bay Horse Lancaster Lancashire LA2 9DE 01524 792261 01524 792261 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) Mrs Pamela Joyce Broxup Miss Joanne Helen Swindlehurst Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th March 2005 Brief Description of the Service: Spout House is a small residential care home registered to accommodate up to five people of either sex who have a learning disability and associated needs. The home’s aim is to provide a domestic environment, which consolidates existing skills and abilities and endeavours to develop the lifestyles and potential of each of its residents. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which meant that the registered manager, the residents and staff did not know it would be taking place until the inspector arrived. The inspection was carried out over 3 hours and included talking with the assistant manager, residents in the home at the time and a member of staff on duty. The registered manager later came on duty and was available to provide some further information and to discuss the inspection. In addition to this, a range of other documents held by the home was examined. The home was toured and found to provide a clean, tidy and homely environment for the residents to use. Comment cards were left at the home for the residents, relatives and other professionals to send it but none were returned to the inspector. What the service does well: What has improved since the last inspection?
The management team now have clearer individual responsibilities which they feel has resulted in more focussed working and a happier staff team. The office is much better organised, with systems in place to ensure information is accessible but secure.
Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 6 The recruitment procedures for the home are much more organised, although advice was provided over one Criminal Record Bureau disclosure form received. The member of staff spoken said they felt very well supported by the management team and other colleagues and commented that there is always someone senior on duty to provide advice and guidance. 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. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 There are good arrangements in place to make sure a full assessment would take place so that the needs of the prospective resident can be identified and the home can take an informed judgement as to whether these can be met within this care setting. EVIDENCE: As ascertained during previous inspections, there is a comprehensive referral and assessment procedure undertaken prior to any decision being made regarding admission. This involves information from funding agency/Social Worker, home visit, half day and overnight stays and a further multi-disciplinary review meeting (involving all parties) takes place to look at all the information gained. At this meeting the prospective resident’s needs, abilities, specialist input, etc., will be identified and a decision taken as to whether the placement will go ahead, or identify what, if any, further actions are needed. There have been no new admissions to the home since the last inspection and the assistant manager confirmed that these assessment procedures remain in place. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards from this section were assessed during this inspection EVIDENCE: Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Arrangements and planning to provide good nutritional food are good and the residents are provided with good food to ensure healthy living. EVIDENCE: Records of menus and also individual meals eaten were seen and found to be well maintained. The meals provided were discussed with the assistant manager who confirmed that the breakfast and lunchtime meals are generally planned on a day-to-day basis and residents are given a range of options. For the main (evening) meal of the day, each resident has a set day when they choose what they would like to make for themselves and the other residents and staff to eat. For one of the remaining days, the staff on duty decide what to eat and on the other day a roast dinner of some kind is provided. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 11 Dietary preferences are maintained, with one resident currently wishing to diet. Another resident is considering whether they would like to take part in trying out specialist diet under the monitoring of their consultant and GP. The residents spoken with all said they enjoyed the meals at the home and had plenty to eat. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 12 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): 20 There are safe systems in place to ensure that medication is kept secure and administered appropriately to residents by staff trained to do so. EVIDENCE: The assistant manager confirmed that the requirements and recommendations made by the Pharmacist Inspector in the last inspection report have been met in full. Records examined evidenced that a record is now kept on all medications brought into the home and leaving the home. Any medications for disposal (i.e. dropped tablets) are recorded separately and signed for as part of the returned to pharmacy records. Medications are brought to the home in a monitored dosage system. These are kept secure in a locked cabinet. There are no controlled drugs in the home. The assistant manager is to organise a controlled drugs book which will then be in place should it be needed in the future. A selection of medication administration records were examined and found to be accurately maintained.
Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 13 The assistant manager confirmed that only staff who have undertaken the safe handling of medication training give out medications to the residents. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 14 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): No standards from this section were assessed during this inspection EVIDENCE: Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 15 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 and 30 Spout House is generally a safe place for people to live in although some improvements are still required. EVIDENCE: Discussions with the registered manager clarified that the programme for redecoration and refurbishment work has had to be put on hold as some major repairs to the roof have to be carried out. It is anticipated that once these repairs have been completed, the redecoration and refurbishment work will take place. The registered manager stated that residents are to be involved in choosing colour schemes, new curtains and carpets and a new settee is to be purchased. The dining room table is to be refurbished in the next couple of weeks. A tour of the home found that it was clean and tidy with no offensive odours. The redecoration and refurbishment work needs to be carried out as quickly as possible to ensure that the home continues to provide a comfortable home for the residents accommodated.
Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 16 The registered manager was advised that the shower area requires some attention as it was not clean. The shower tray is also discoloured. The registered manager is to address this. In addition, discussions are underway regarding a total refurbishment of the bathroom facilities in the home. Work has been completed on the kitchen and the conservatory and both these provide a positive environment for the residents to use. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 17 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 and 36 Residents are cared for by a professional, supportive, trained and committed team of staff. The homes recruitment procedures are thorough and ensure the vulnerable residents are protected from abuse. Staff are well supported by the management team. EVIDENCE: The staffing rota was examined and the assistant manager confirmed that there are at least 3-4 staff on during the day at differing times and sometimes 5 staff, dependent on residents individual activities. One resident currently has 2-1 funding. Residents spoken with said that they were happy with the care provided by the staff. The staff and the residents appeared to get on well together and this generates a good atmosphere in the home. Apart from a relatively new employee, all the remaining staff have worked at the home for well over 12 months, some of the senior staff having worked at Spout House for several years. Two staff files were examined and found to be very well organised and containing all the required information. Advice was provided over Criminal Records Bureau disclosure forms held.
Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 18 There is a formal recruitment procedure in place, which includes obtaining all the required checks and staff having a formal interview. The registered manager has also put in place a “return to work” interview, which is held on return to work, dependent on the length of time off, pattern of sickness or nature of the incapacity. The home’s induction programme was seen and advice given that the form which outlines what the new member of staff needs to know on the first day, within two weeks, first month, etc., may benefit from being split further. In addition to this, the new member of staff should sign each section (once completed) to indicate they understand the induction given. The assistant manager confirmed they are intending to review the induction procedure and would look at the advice provided at this inspection. Staff training was discussed with the assistant manager and with the staff on duty who confirmed that a range of training has been provided. Staff file also contain copies of certificates for training completed. The assistant manager confirmed that training accessed since the last inspection includes – the continuation of the National Vocational Qualification training at both Levels II and III; Skills for Care (previously TOPSS) induction training, Developing Teams course; Access to Management course; Counselling Skills for Working with Hurt and Anger; Promoting independence Level III; Assertiveness course; Vulnerable Adults Abuse Protection level I; and Counselling Skills for Working with People who Self Harm. In addition to these courses, mandatory training in food hygiene, first aid and moving and handling have also been attended. It has already been confirmed that staff who are to administer medication attend a safe handling of medication course before taking on this responsibility. Supervision records were examined. As well as this, the member of staff spoken with confirmed that regular formal supervision is held between them. The member of staff spoken with also confirmed that they feel well supported by the management team and their colleagues and additional support and guidance is always on hand from a senior member of staff, if needed. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 19 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 Experienced and qualified management staff run the home which results in the residents living in a well managed environment. EVIDENCE: The registered manager has achieved a range of qualifications, including National Vocational Qualification in Management Level IV and the Registered Managers Award. Other training includes Recruitment and Selection; Health and Safety in the Workplace; Time Management; and Conducting an Appraisal course. Since her appointment as registered manager, the home has improved, particularly in relation to better organisation of the administrative side. The main office in the home has benefited from the office systems put in place and paperwork is kept accessible but secure. There is an obviously good working relationship between the registered manager and the assistant manager, who feels that now there are much Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 20 clearer management responsibilities the home is better managed and the staff and residents are happier. Staff spoken with felt they are well supported by the registered manager and the senior management team and feel the home is well managed. Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Spout House Support Services Score X X 3 x Standard No 37 38 39 40 41 42 43 Score 3 X X X X X X DS0000010040.V259792.R01.S.doc Version 5.0 Page 22 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 YA30 Regulation 23(2)(d) Requirement The shower area and shower head must be thoroughly cleaned Timescale for action 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA24 YA34 YA20 YA35 Good Practice Recommendations Once the roof has been repaired, the programme for redecoration and refurbishment should commence as soon as possible The registered manager should follow the Department of Health guidance when Criminal Record Bureau forms are returned The assistant manager is to organise a controlled drugs register in readiness should this be needed in the future The induction training should be further split and each section should be signed by the member of staff and the instructor when understood Spout House Support Services DS0000010040.V259792.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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