Inspection on 12/05/05 for Springbank

This inspection was carried out on 12th May 2005.

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

Springbank 13/07/06

Springbank 02/11/05

Springbank 19/01/05

Springbank 15/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Springbank 1 Charlton Lane Brentry Bristol BS10 6SG Lead Inspector Helen Taylor Unannounced 12 May 2005 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 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 Stationary 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. Springbank Version 1.10 Page 3 SERVICE INFORMATION Name of service Springbank Address 1 Charlton Lane Brentry Bristol BS10 6SG 0117 9505220 0117 9505450 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Shaw Health Care Specialist Services Ltd To be appointed PC Care Home 11 Category(ies) of LD Learning Disability (11) registration, with number of places Springbank Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate residents aged 40 years and over. Date of last inspection 19 January 2005 (Announced) Brief Description of the Service: Springbank is a residential care home registered with the Commission for Social Care Inspection to provide accommodation and personal care for 11 service users aged 40 years and over who have a learning difficulty. The home is an adapted bungalow, and accommodation is arranged over two floors.The first floor of the property contains the staff room, office and a bathroom and toilet facility. Service users individual accommodation and communal lounge are situated on the ground floor. To the outside of the property there is a large private garden, and in close proximity are local shops and amenities. The home is owned and operated by Shaw Healthcare and the acting manager is Mrs Kay Williams. An application for the position of registered manager will shortly be processed by the CSCI in respect of Mrs Williams. Springbank Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection as part of the annual inspection programme. The purpose of the visit was to review any requirements and recommendations made during the last inspection, and to examine the standard of care provided. Evidence was gathered from a review of records held, consultation with the manager, staff and residents, and through observation. What the service does well: What has improved since the last inspection? What they could do better: Re-decoration is some areas would make the home more attractive. Staff need to make sure that unpleasant smells are dealt with quickly. People who have some physical difficulties would benefit from a walk in bath with hydrotherapy. Springbank Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springbank Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Springbank Version 1.10 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 standard(s) 1,2,3,4,5. There was adequate information available to enable residents, and/or their relatives to make an informed decision about moving to the home. EVIDENCE: The statement of purpose and resident guide provide detailed inforamtionabout the services offered by the home. Each resident has a copy of the guide in his or her own room. Although the residents have lived in the home for many years, the admission procedure and information provided has been reviewed to reflect current legislative changes. The care files contained individual care plans focusing on residents’ individual assessed needs and choices. It was evident from observation that the home was meeting the needs of the residents accommodated. Springbank Version 1.10 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 standard(s) 6,7,8,9,10. Continual improvement in the care files and associated records enables the home to provide consistent sensitive support based on the residents needs. The manager and staff team make strenuous efforts to involve the residents in this process, promoting more choice in their daily routines. EVIDENCE: A review of the care plans provided evidence of a commitment to encouraging residents to lead active and independent lifestyles. Developments in the recording process in relation to the monthly care plan review, provided a focus on changes to the plan and ensured staff provided consistent care meeting the changing needs of the residents. Through observation and discussion it was evident the staff team had developed a good understanding of the communication needs of the residents, and were able to meet those needs. The Inspector had contact with six residents who indicated they were happy in the home, and demonstrated a degree of confidence when communicating with the staff team. The atmosphere was happy and relaxed. Springbank Version 1.10 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 standard(s) 11,12,13,14,15,16,17. The residents are encouraged and supported to participate in activities of their choice. Competent staff promote and foster interest in new ventures both in the home and in the community. EVIDENCE: Discussion with the manager and staff team, and a review of care file information, indicated that the residents take part in various activities both in the home and in the community. The manager explained that an annual holiday is planned for each resident. Through the development of positive relationships the key team provide detailed information about the residents likes and dislikes and the holiday venue and accommodation are booked to meet individual need. Three residents attend local centres to develop life skills, woodwork skills and take part in social activities. The residents are supported to maintain family relationships through the provision of transport and an escort. Springbank Version 1.10 Page 11 In addition to the above the home has a visiting aroma therapist, musician and an Indian head masseur. Trips to the seaside, cinema, local walks and shopping are planned by staff for those residents who wish to participate. The Inspector had the opportunity to have lunch with the residents, who indicated they were happy with the food provided. Through observation it was evident that a choice was available, and adequate sensitive support was provided during the mealtime. The residents ate their meals in the room of their choice, for example, the dining room, conservatory, lounge or small kitchen area. The meal was tasty and nutritious. One staff member has recently taken on the role of activities organiser, to ensure all residents have the opportunity to participate in organised events. This extra support means that quality time can be spent with those residents who remain in the home. The residents moved confidently around the home and indicated through verbal and non-verbal communication that their needs were being met, and they were able to assist in the day-to-day functioning of the home. This is good practice. Springbank Version 1.10 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 standard(s) 18,19,21. The personal and healthcare needs of the residents are monitored effectively and action is taken promptly when concerns arise, so that residents can be confident their needs will be met. EVIDENCE: The administration of medication was not reviewed on this occasion, however robust policies and procedures are in place at the home. A review of one residents care file provided evidence that the home had made strenuous efforts to consult health professionals to ensure medication is reviewed regularly, and guidance and support is provided in relation to the mental health needs of the resident. Information reviewed demonstrated the home operates from a multi-disciplinary approach. This is consistent with good practice. All interventions in relation to health are recorded in detail in an appropriate format. Notifications sent to the CSCI under Reg.37 of the Care Home Regulations provide further evidence that the health care needs of the residents are being met. The manager explained a monthly meeting is held with the Community Learning Disability Team to share ideas and review care provision in the home. Springbank Version 1.10 Page 13 There was evidence that staff members receive training in health related issues for example sessions included epilepsy and autism. This is good practice. The staff members demonstrated throughout the inspection process a sensitive, committed and enthusiastic approach to their role within the home. The residents were clearly comfortable and confident that their needs would be met. Springbank Version 1.10 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 standard(s) 22,23. The manager has developed an open door policy; this enables the residents to feel safe and confident their views will be listened to and action taken to meet their needs. EVIDENCE: Policies and procedures are in place to safeguard the residents from any form of abuse. The manager is presently investigating pictorial information, which summarises the contents of the complaints procedure, to ensure accessibility for all the residents. Protection of Vulnerable Adults training is being provided through the local council and the CLDT for all staff members. A list of training dates was displayed on the office wall. The manager provided evidence that a training matrix for all staff ensures the organisation can monitor and review which staff have attended training sessions, and when up-dates are required. This is consistent with good practice. One staff member spoken with demonstrated a good understanding of their role in relation to the protection of the residents, and was clear about reporting any concerns in relation to bad practice. Springbank Version 1.10 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 standard(s) 24,25,26,27,28,29,30. The residents live in a safe, homely, comfortable environment, where improvements have been made to the kitchen and dining area. EVIDENCE: Recent improvements to the environment have included the following: • Re-location of the laundry facility to improve ventilation and obtain appropriate gas certificate • Installation of new kitchen work surfaces and cabinets • New flooring laid in the kitchen/dining room, and in one residents room • Purchase of a new dishwasher • Action taken to minimise odour in a residents room The home has a rolling programme of re-decoration and replacement of some of the furnishings and furniture. A maintenance person is employed by the organisation to attend the home two days per week to carry out minor repairs. The Inspector had the opportunity to speak with the maintenance person who confirmed part of his role was to fault find and organise any external contractors to carry out major repairs. Springbank Version 1.10 Page 16 The maintenance person was able to provide evidence of training in health and safety, infection control, and fire training. Although the maintenance person is employed by the organisation to carry out repairs at three homes, the manager at Springbank provides support guidance and formal supervision. Although action has been taken to minimise odours in the home, further action is required in this area, to ensure a pleasant, homely environment is maintained for the residents. The residents’ bedrooms are personalised and reflect their personality, and personal choice. Suitable adaptations and equipment are available to meet their individual needs. Springbank Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36. The residents’ benefit from a stable, competent, trained staff team who are supported by a committed management team ensuring consistency in the care delivered. EVIDENCE: The organisation operates a corporate robust recruitment procedure, and the personnel department ensure all appropriate employment information is collated prior to the start date. This information was not reviewed on this occasion. A comprehensive induction-training programme is also in place. The induction programme incorporates the Learning Disability Award Framework and leads to progression on the NVQ in Care programme. Further training in specific areas for example: Positive Response Training is organised on a rolling programme. Information about planned training was displayed on the office wall. Training, supervision and staffing levels in the home are monitored by the organisation on a monthly basis. The manager has recently reviewed the role of the team leaders and delegated increased responsibility in line with the job description. Each team leader supervises a team of support workers, and a review of records provided Springbank Version 1.10 Page 18 evidence that sessions have been held on a regular basis. The recording format prompts the team leader to review the following areas: • Policies and procedures • Training and development • Personal development • Care plan review • Key work support The manager supervises the team leaders and monitors the support provided by them to the staff team. A review of the records indicated a good standard of guidance provided on a regular basis. This had been a requirement from the previous inspection, and compliance has been achieved. The staff present conveyed to the Inspector a warm, caring approach to the residents, and demonstrated a good understanding of the individual communication methods used. Springbank Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42,43. An improvement in support provided to staff ensures the health and welfare of the residents is promoted, and they benefit from a competent management structure. EVIDENCE: Mrs Kay Williams is the manager of the home and will complete an application to begin the registration process with the Commission for Social Care Inspection. The manager is progressing through the NVQ level 4 and registered manager award, with an expected completion date of December 2005. There was evidence of good systems of communication between staff including daily handovers, staff meetings, regular supervision and informal support. A recent review of the team leader responsibilities had improved the management structure and provided clear lines of accountability. Springbank Version 1.10 Page 20 The style of management was open, supportive and inclusive. The residents were confident and entered the office at will, indicating to the inspector their ownership of the home and facilities. This was consistent with good practice. There are robust systems in place to ensure the health and safety of all residents’ and staff members living and working in the home. A monthly health and safety audit is completed and sent to the head office. The fire safety records examined indicated that all relevant tests, checks and fire drills with staff and residents had taken place at appropriate intervals. A valid certificate of insurance and registration certificate were displayed in the entrance hallway. All records reviewed were up to date and in order. The commission receives copies of monthly monitoring visits carried out by the provider. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 Springbank Score 3 3 Standard No 22 23 Version 1.10 Score 3 3 Page 21 3 4 5 3 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 4 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 4 Standard No 31 32 33 34 35 36 Score 4 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 2 3 3 Springbank Version 1.10 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 24 24 Good Practice Recommendations Take action to eliminate unpleasant smells in the home. Continue with refurbishment programme including installation of improved bathing faciltiy, and replacement of worn furniture. Springbank Version 1.10 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 Springbank Version 1.10 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!