Inspection on 25/03/09 for Springfield House

This inspection was carried out on 25th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Springfield House 01/02/07

Springfield House 08/11/05

Springfield House 17/05/05

Springfield House 24/01/05

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 19/06/2009.

Key inspection report CARE HOME ADULTS 18-65 Springfield House, Perrancoombe Perrancoombe Perranporth Cornwall TR6 0JA Lead Inspector Peter Still Key Unannounced Inspection 25th March 2009 10:50 Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield House, Perrancoombe Address Perrancoombe Perranporth Cornwall TR6 0JA 01872 573538 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) mail@dcact.org Spectrum (Devon and Cornwall Autistic Community Trust) Manager post vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. 3. Learning disability (Code LD) The maximum number of service users who can be accommodated is 5. One service user who will be 18 years old on 17/11/2007 may be admitted prior to his 18th birthday. This condition will cease thereafter. 2nd October 2007 Date of last inspection Brief Description of the Service: Springfield House is a care home providing accommodation and care for up to five adults with a learning disability. The registered provider is Spectrum, an organisation that provides specialist services for people with Autistic Spectrum disorders. Spectrum employs a manager and a team of staff to run the home on a day-to-day basis. External, on-call managers are available to provide specialist input, support and advice where necessary. The home is located in the village of Perrancombe on the outskirts of Perranporth, a seaside town with a variety of shops and a popular beach. There are shops within walking distance of the home and the home has a vehicle to provide transport for people using the service who need to access resources in the wider community. The home is a two-storey building. All the bedrooms have en suite bathroom facilities. There is an office on the first floor. Most of the bedrooms are on the first floor, with one on the ground floor. Access arrangements could be made suitable for people using the service if they had physical disabilities. The home has a large lounge/ dining area with French doors leading off onto a paved patio area and extensive gardens. The upper part of the garden is securely fenced. The home has some parking space at the front of the building. There is a communal kitchen and ample storage space in the home. Laundry facilities are located in a separate area to the kitchen and dining facilities. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 5 The fees range from approximately £1477 to £5365 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the home’s management or the CSCI website. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Prior to the inspection, we surveyed people living at the home, staff and professionals involved. We also read information the Commission had received relating to the home since the last inspection. This included reports sent to us by the home about important things that had happened involving people who live at the home. We spent one day at Springfield House and spoke with people who live there and the staff who provide their support. One of the senior manager’s from Spectrum was present for most of the inspection and supported the process. We examined files relating to the care provided to individuals. We looked at the files of three people who use the service to track their experiences. We looked at the policy and processes to support their care. We also looked at other files relating to the way the home was being run including for example matters relating to fire precautions. What the service does well: What has improved since the last inspection? Personnel files were not available during the inspection since the acting manager and deputy were not working. However the Divisional Manager told us that Criminal Records Bureau checks were now being sought where a member of staff changed their role at the home. The personal cash containers for people living at the home were seen to kept locked away. Staff had received training in the protection of vulnerable adults. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 7 The service has a business plan. As a part of quality assurance process, monthly questionnaires were being sent out to people who live at the home so their points and ideas can be recorded and responded to. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 People using 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. People who consider living at the home have information to make an informed choice. A pre admission assessment provides the service with information to make a judgement about whether peoples needs can be met. A supportive and gradual admission process helps people to be sure the home is right for them. A written contract of terms and conditions protects the rights of people who live at the home. EVIDENCE: Each of the three care files we reviewed, held a copy of the homes statement of purpose and service user guide, providing clear information about the home using picture format when necessary. The files also contained a signed contract of residency. We found evidence of a comprehensive transition period for a person admitted, to ensure the person was comfortable with the arrangements. One file was inspected in detail concerning the information gathered by the home prior to agreement of admission. We found comprehensive Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 10 documentation and a thorough report produced by staff, detailing key points the service would need to know about, to make their admission judgement and to ensure appropriate care. We concluded that a sound approach was taken by the service in assessing the information provided. Information from external professionals and those important to the individual was also on file. We also read detailed documents following admission, which established that the home had not been made fully aware of the extent of some needs. We considered that the service had taken good steps, but that greater clarity of information was necessary so that they could have been more fully informed. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 People using 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. Care needs of people using the service are recorded in care plans. These are reviewed to help individuals improve their lives and make decisions with the support of staff. Ongoing consultation with people who live at Springfield House ensures people are involved in all aspects of their life. Appropriate risk assessment procedures ensure risks are considered, and as necessary minimised. Subsequently people can enjoy a fulfilled life. People can be assured that confidential information is maintained appropriately. EVIDENCE: We examined three care files, and found each had comprehensive documentation relating to assessment of needs. Care plans included micro care plans, which provided detail to help staff to be aware of key points. A full review was conducted six monthly and the Person Centred Plans had been Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 12 reviewed monthly. These reports were detailed, and provided valuable information about progress towards targets and objectives. Files reviewed contained an ‘Introduction to Service User’, including sections regarding people’s backgrounds and regarding what areas the person needs support in. One individual had been helped to write the A bit about me section, which demonstrated how people are involved in their care planning. Significant detail was seen on files and showed excellent examples of work undertaken by staff to record, and document key issues, to help individuals improve their lives. Care files showed good evidence of input from healthcare professionals. To support care plans, staff use a daily record book for each person and we examined three of these, which were completed and provided a good level of detail. This subsequently made it easy for the reader to understand how the day or night had been for the individual. Each person has two key workers to help ensure good communication between the staff team. There was also a note of other staff an individual prefers to go to, so that it is very likely that each person living at the home can always have at least one person they feel comfortable with. During the day we observed staff as they interacted with individuals. We could see that staff were confident and relaxed as they supported people. People using the service responded well to staff. They showed they were content and happy with staff supporting them. We found people were well supported in making decisions about their lives and what they wished to do. There is a daily log for each person. There is a structured activity programme, and it is discussed daily what is going to happen. The process was considered to be good when agreed arrangements were undertaken. We found some concerns when people had not been able to do the things they wanted to, and the evidence for this is noted later in this inspection report. We spoke particularly with three people who live at the home. They told us that they like the staff that support them and that staff talk to them about things. This is important and helps them to make choices. Detailed risk assessments were seen on the files we examined and they had been reviewed recently. Care files were comprehensive and contained necessary information. It may be helpful to review the file system since files appeared overloaded and some documents were duplicated or not current, which may lead to confusion. An archiving system may be of help. Confidential files were seen to be kept locked away and staff were appropriate in the way they discussed confidential matters. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: Standards inspected 11-17 inspected. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for personal development and activity are seen of crucial importance to people living at the home and an extensive and changing programme was provided. However this is impaired at times of staff shortage. People were provided with a healthy diet, with individual needs understood and catered for. The home has the benefit of a homely kitchen to meet the needs of people at the home. EVIDENCE: We reviewed care plans and found that people were treated as individuals and supported to do the things they wish to. People living at the home enjoy spending a lot of time out from the home and engaging in an extensive programme of activities, which are discussed and agreed with them. A weekly programme was recorded within care files for each person. One person we spoke with said they enjoy walking and another said they could do the things Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 14 they wish to do. We reviewed the daily logbooks for three people and from the information we found, it appeared that agreed activity programmes were being undertaken. We also noted that one person had changed their mind about an activity, when it was offered. We spoke with four members of staff about people’s activities, and also considered responses from surveys we sent out. The feedback we received was different to the impression we had formed from the other evidence available. It appeared that individuals were undertaking an agreed programme of activity. However the consensus from staff was that whilst staff work hard to ensure agreed activities take place, there are occasions when it does not. Staff felt this could have a negative impact on people since activities had been agreed with individuals, and some had been unhappy at missing an activity. We were given an example of a person who was not always able to attend a weekly work placement, for example the day before the inspection. This was due to staff shortage. We were told, The activity is important and he should not have to miss out on it. It was also said that whilst a scheduled activity may be missed, it was unlikely people would not have gone out at all. We were told that at times of staff shortage, one person may have to cancel their activity so that remaining staff can ensure other people can go out. Another member of staff said: Activity for service users has to change due to staff shortage. At weekends if we have sufficient staff to provide activities, and another home does not have minimum staffing, then we do have to go to another unit at times. This means service users will not always get their activities. This situation was considered to be poor. Whilst people can enjoy going out with other people from the home, there were four vehicles provided to ensure people can spend time away from the home with ease, individually. Local community facilities were taken advantage of and some people enjoy the beach. Due to the needs of people on the day of inspection eight staff were available, including a member of the organisations bank staff. During the day people spent time out with staff, engaged in a variety of individual activities and they commented that they had enjoyed their day. During the evening meal people were seen to be relaxed and happy, enjoying communication with staff. Care files showed that contact with families was encouraged and there was good communication with staff at the home. One person talked about family visits, which were clearly important. People undertake some responsibility with daily tasks in the home. They are supported by staff, and bedroom areas were personalised, clean and tidy. People living at the home have a balanced diet and there was a recent visit from a dietician, supporting people living at the home and providing staff with Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 15 information and guidance. The dietary needs of people were recorded within care plans. Fresh fruit was available in the kitchen for people to choose as they wished. People with help from staff, do their own shopping for food. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18-20 inspected. People using the service experience generally good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can be assured that staff provided support in the way people wish. Due to challenges facing staff, which results from conflict between people living in the home; there is at times a negative impact for other people living at the home. However the service is managing these challenges. There must be a review of the medication administration process to ensure people are protected. EVIDENCE: It was evident from care files examined that the staff team, supported by external professionals, work hard to ensure people receive personal support in the way they wish. We found that care records showed significant and detailed input. Both staff and people who live at the home supported our positive view about the way care was provided. Staff showed enthusiasm and commitment for the people they care for. Feedback from individuals was positive. People using the service responded openly to staff. We did not observe any behaviour to show individuals had concern or that they were withdrawn in the presence Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 17 of staff. Staff did not show any institutional approaches and it was apparent that care and support was based on individual needs, with gentle guidance from staff. During the time of the inspection it was clear that emotional needs were being well met. However in talking to staff and from reading care records, it was clear that our positive observations would not always be evident. We read extensive records, which showed that there were ongoing challenges to the service, which had an adverse impact on the lives of people who live at the home. We looked at the records involved in some depth and could see that progress had been made, and that senior managers had been taking good and necessary steps, which included input from external healthcare professionals. We note Springfield House provides a highly specialist service for people who challenge conventional services. We reviewed the medication system for the home and found that points from the last inspection had been responded to. For example, a new and locked metal medication cabinet had been installed. However, when we checked at random medication for two people, we found errors. One type of medication for one person had been discontinued and should have been returned to the local pharmacy. A member of staff supporting our inspection, could not find a record of when the medication had been discontinued. The signature record for another person was correct for the day of inspection, but there was a failure to record the medication being administered for the previous day. The Divisional Manager for the organisation was present during this medication check and agreed the failures had occurred. We were told that all staff who administer medication are trained. The acting manager of the home also undertakes medication audits. Two members of staff spoken with said they were trained, and one talked of the excellent training they had received. We discussed the possible reasons for the mistakes. The current system continues to involve a number of staff and our view is that this presents a risk of mistakes. For example there could be a key designated person on each shift. The Divisional Manager agreed there should be a review of the medication policy and procedures. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using 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. People who live at the home can be assured that staff will listen to their concerns and will take appropriate action. People are protected from abuse by staff who understand policies and procedures, and who receive training in the protection of vulnerable adults. EVIDENCE: The home has policies and procedures in place, which enable staff and those important to people who live at the home, to know what to do and who to talk to if there is a concern. Policies include No Secrets, which makes it clear that where there is any concern, it must be reported, and they must follow a procedure to protect people who live at the home. The homes Annual Quality Assurance Assessment was reviewed and gave evidence of policies and the systems in place. This includes a monthly questionnaire sent out to people who live at the home. People living in the home are also reminded about who to speak to if they have a concern. Three people spoken with said they get on well with staff and had no current concerns. Three concerns had been recorded for the last twelve months and had been resolved in a timely manner. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 19 We spoke with two staff, who said they had training in the protection of vulnerable adults, including ‘Whistle Blowing’. The staff said they were clear about the steps to take if they became aware of an allegation of abuse. We considered one complaint, which had been notified to the Commission, and examined the documentation relating to it. We could see that the home took a number of appropriate steps and that the matter had been resolved satisfactorily. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment, which was comfortable though not fully adequate for the people who use the service, or the staff who provide their care. Bedrooms promote the independence of people living at the home and the facilities provide them with privacy to meet their needs. The home was fresh, clean and hygienic except for areas where damp was evident. EVIDENCE: We found Springfield House to be homely and providing an ordinary domestic setting. The decoration of the home was seen to be good and an annual maintenance programme was said to be in place. The home was clean and tidy. Bedrooms are personalised and people have a routine to help ensure bedrooms are kept as they wish them to be. The property presents a number of difficulties, which remain a concern or cause some difficulty. For example, there is a restriction on the number of cars, which can be parked at the home and staff have to park away from the Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 21 home. Though the property is adequate in terms of size for the number of people living at the home, the significant number of staff working at the home presents difficulties, in terms of facilities, which the provider was aware of. A planning application was seen to extend the home and if achieved, this may improve the situation. The home has two rooms for staff to sleep at night and neither were proper designated rooms for staff. One room was attached to the office and had a partial wall separating the areas. This room was also being used for one person to take their meals, and was also used as a second lounge, with the bed for staff needing to be made up each night. This facility was not considered adequate. It was also noticed that this room had a tall shelving unit full of videos, which was not attached to the wall and may have been a hazard. The Divisional Manager, who was present understood the risk and said it would be made safe on the day. It was also noticed that a step leading from the office had a small section of missing carpet, leaving a gripper for the carpet in place, and presenting a tripping hazard. The Divisional Manager said this would be responded to. The second room for staff to sleep in at night was inspected. This was also used as the Restrictive Strategy Area for people to use, if they needed to be away from other people for periods of time. We considered that this room was unsuitable, both for people who live at the home and for staff to sleep in. We found evidence of damp in the room. Windows had been restricted so that there was no ventilation. Staff would need to make up a bed each night and use a mattress on the floor, which was considered unsatisfactory. We spoke with members of staff about the two rooms they use to sleep at night. Whilst they were not fully happy, they did not see it as a significant issue. One member of staff said they had got used to it and the night rota was well organised so that they did not have to spend consecutive nights sleeping in at the home. They could also use the main lounge of the home if they wished. We were concerned to see documentation about damp in the bedroom of one person. The problem had been longstanding, without a proper resolution. We looked at the bedroom and found a damp area on a wall next to where the individual chooses to sleep. We found that special paint had been applied, which had failed to solve the problem. It appears that there is a fundamental problem with the building, evident in this room and it may need significant work to resolve it. We were told that further action was to be taken. This will need to be undertaken soon. During our tour of the building we found a wedge under a door, which said ‘Fire door keep shut’. This was dangerous and the Divisional Manager immediately removed it. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured their needs are met by a staff group that demonstrate commitment, and know how to provide support in the way people wish. Whilst the staff team were seen to be highly effective during the inspection, monitoring of staffing levels is necessary to ensure an effective service can be delivered. Staff reported that they have sufficient training to meet individual and joint needs of people who live at the home. However we were not able to view recruitment and training records due to the absence of the manager. Arrangements for these records to be made available for inspection need to be improved; for example if the manager is not on duty. Management will need to continue to develop a supervision structure for all staff to receive at least six recorded supervisions a year so that staff are well supported. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 23 EVIDENCE: We spoke with five staff and found them to be highly motivated and enthusiastic about their work. During the day we observed staff fully involved in their specific responsibilities and providing constant support to people living at the home. Staff demonstrated an awareness of people’s needs so that small points were immediately addressed and there was a relaxed atmosphere. Staff were seen to be confident and experienced with positive responses from the individuals they were caring for. There was much coming and going during the day as people were supported with their lives and planned activity. We considered that staffing levels were good on the day of inspection. Three people spoken with talked positively about staff that care for them, and one person said they knew who to talk to if they had a particular need. Staff talked about needing to go to other homes if there was a staff shortage. One member of staff said they could say no. We asked if there would be pressure to go and were told that there had already been three calls requesting staff on the day of this inspection and staff had not left Springfield House. We considered that there may inevitably be some pressure, and that staff may struggle with their role and responsibility at Springfield House with the need to help out at other homes. We spoke with the Divisional Manager about staffing levels, and occasions about staff shortages. We were told that the organisation is aware of the issues and that they had already increased minimum staff from five to six, and have the desire to increase further to a minimum of seven, which would resolve the difficulty. They also plan to increase the organisation’s own bank staffing team. It was noted that staffing was adjusted based on the needs of people and that the home had eight staff on the day of this inspection as a consequence. We talked to one member of staff about staffing rotas and were told that they had been improved recently, but that there were still small adjustments, which could be made to make things better still. This showed that the providers had understood the issues and had worked to address them. The further adjustments would relate to specific daily needs of individuals, and not about overall staffing levels. Staff spoken with talked about their training, which they said was good and gave them the necessary skills for the job. One member of staff said they had received very good training concerning medication and were looking forward to further external training regarding this. We also found evidence of this training noted within the Annual Quality Assurance Assessment completed by the home. Another member of staff said they were receiving refresher medication training the day after this inspection. One member of staff said they had completed the National Vocational Training at level two. They had received training concerning autism, which included training concerning people who can be a challenge to a service. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 24 We were not able to see evidence of staff supervision notes, staff recruitment or staff training, since these were locked away. The acting manager and deputy, who are the key holders, were not at the home during the inspection. It is important that the organisation considers how such records can be made available for inspection, which maintaining confidentiality. We spoke with staff about supervision and found that the frequency of supervision had not been adequate. The deputy was now responding to this and it is understood a plan would be put in place to ensure compliance. One member of staff said they had not received supervision for a few months. Another member of staff said they had not had supervision since that started at the home, some four months previously. Staff did not have copies supervision notes. We reviewed well-recorded notes of a recent staff meeting, which demonstrated that staff could raise matters important to them. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards inspected: 37, 39, 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are cared for by a staff team that promote a positive life for each individual. The lack of a registered manager may have contributed where there are failings at the home. People living at the home are supported to make their views known to improve their lives. Consideration of the way the registered provider self-monitors the development of the home will improve confidence in the way the home is run. People living at the home can be assured that staff undertake detailed documentation to ensure their best interests and that the policies and procedures of the home support this. The health and safety of people will be protected by a review of the way checks and risk assessments are undertaken and that outcomes result in safe measures being taken. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 26 EVIDENCE: We found evidence that the home was largely well run, with experienced staff who work well as a team. Staff provide capable support to people so that they could tell us that their experience of the home was good. The leadership and management of the home has been problematic since the last inspection. We believe this has contributed to the lack of resolution of some of the concerns identified within this report. There has not been a manager registered with the commission for some time. We were told in early December 2007 that the then manager was not managing the home for a few weeks because she was helping out at another home. An acting Manager was provided, and an application made for another person to be registered. However this person gained another position, and the home currently has another acting manager. We have been told the current manager has completed his application to be registered with the commission, but needs to get his Criminal Records Bureau application processed. The Commission has not been formally approached to do this, so there could be a period of several months before the registered manager’s application is submitted and subsequently approved, even if the CRB application was posted today. This situation is not satisfactory. We are concerned regarding the period where there has been a lack of registered manager. We are concerned regarding Spectrum’s failure to respond within a timely manner to ensure an application for the manager has been submitted. We are concerned Spectrum has failed to keep us abreast of the management changes. The home has a quality assurance process. We saw monthly questionnaires, which are given to people at the home and who are supported where necessary with their responses. Goals are set for individual people living in the home with their input. The Annual Quality Assurance Assessment document had been completed for our inspection and returned to the Commission to support our process. We noticed that the document sent, possibly in error, to the Commission contained some areas, which had been crossed out but were still clear in relation to their detail. Some points provided greater clarity about concerns we had also found. One example related to a need for a re-structure of activity plans to support the needs of an individual, resulting in plans for others needing to change. We found evidence that the home maintains good and extensive records within care plans to ensure the best interests of people who live at the home are safeguarded. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 27 We found that testing of portable electrical appliances had been undertaken to maintain safety. Records we reviewed concerning safety checks showed these checks had been undertaken appropriately. Monitoring of freezer temperatures were being undertaken and documentation was in the kitchen. We saw that some doors at the home were designated as fire doors and yet they were kept locked to protect people living at the home (e.g. from absconding). All staff held a key to the doors. One member of staff showed the key and was clear about how to open the doors. We have since discussed this matter with the manager of the home. The manager said a risk assessment is in place. We have advised Spectrum to contact the fire authority to discuss the matter fully. It may be worthwhile for the provider to ask the fire officer to revisit the home to look at the issue. It is essential there is satisfactory means of escape in an emergency situation. We do understand this has to be balanced with the need to keep people safe (e.g. if some people living in the home have a tendency to abscond from the home). This also needs however to be balanced with preventing people being deprived of their liberty and the principles of the Mental Capacity Act. The registered provider has to come up with a workable solution to address what may appear conflicting priorities. The commission is happy to discuss this matter further with the registered provider, should further approaches be made to us. Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 3 28 3 29 N/A 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 N/A 35 N/A 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 2 3 3 3 2 3 Version 5.2 Page 29 Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc 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 YA11 YA12 YA14 Regulation 18(a) Requirement There must be sufficient staffing at all times to ensure agreed activity programmes can be undertaken. This will ensure people who use the service are supported by a satisfactory number of staff so they can enjoy lifestyles of their choice. The policy and procedures for the administration of medication must be reviewed to ensure medication is administered, recorded and disposed of to ensure the well being of people. This will help ensure people who use the service can have confidence their medication is managed safely. Work must be undertaken to ensure a damp area of an individual’s bedrooms is repaired. This will help ensure people who use the service have good quality accommodation. The registered provider must DS0000062591.V374886.R01.S.doc Timescale for action 31/05/09 2. YA20 13(2) 30/04/09 3. YA25 YA26 23(2)(b) 31/08/09 4. YA37 7, 8, 9 01/06/09 Page 30 Springfield House, Perrancoombe Version 5.2 submit an application for there to be a registered manager at the home. This will help ensure people who use the service know that the manager of the home is legally accountable for its operation. Wedges must not be used to 30/04/09 hold open a fire door. There must be a review, of the risk assessment of fire precautions, in relation to locked fire doors. People must be kept safe, where possible people should not be deprived of their liberty, and people must be able to get out of the building in an emergency. The fire brigade should be involved in this discussion. This will help ensure people are kept safe, and any restrictions on their liberty are minimised. 5. YA42 23(4)(a) 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. Refer to Standard YA37 Good Practice Recommendations It may be helpful to consider an archiving system to ensure the current file system is easy to use and does not lead to possible confusion. A clear index may also be of value. There should be consideration of the environmental arrangements for staff sleeping at the home so that they are satisfactory for staff that undertake this work. Staff should receive regular one to one supervision 2. YA24 3. YA36 Springfield House, Perrancoombe DS0000062591.V374886.R01.S.doc Version 5.2 Page 31 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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