Inspection on 27/05/08 for Spurfield House

This inspection was carried out on 27th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Spurfield House Main Road Exminster Exeter Devon EX6 8BU Lead Inspector Vivien Stephens Unannounced Inspection 27 and 28th May 2008 10:00 th Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 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 Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Spurfield House Address Main Road Exminster Exeter Devon EX6 8BU 01392 8322145 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) Spurfield.House@Guinness.org.uk Guinness Care and Support Ltd Mrs Primrose Bond Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Spurfield House DS0000071095.V365451.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. Mental disorder (Code MD) The maximum number of service users who can be accommodated is 12. 21st November 2007 Date of last inspection Brief Description of the Service: Spurfield House is a grade two listed building set in its own grounds in the heart of the village of Exminster and just five miles from Exeter City centre. It is a large detached building that has a long drive from the front entrance, on the main road through Exminster, leading to ample parking at the front of the building. Inside there is a large vestibule with the lounge and dining room to the right and a staircase leading to the upper floors. Further rooms and office space can be found on the left side of the ground floor. The home is registered to provide personal care for up to 12 adults who have enduring mental health problems. Spurfield House is owned and managed by Guinness Care and Support. Fees for the home currently range from £520 per week. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . A copy of the most recent Commission inspection report is displayed in the front entrance hall. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 5 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. Several weeks before this inspection took place we asked the home to complete an annual quality assurance assessment (AQAA) and the completed document provided us with useful information about how the home is run. It provided us with information about the number of staff employed, policies and procedures, dates of maintenance of equipment, and information about incidents and complaints. This inspection took place over 1½ days. During that time we talked to the manager, two members of staff, one relative who was visiting the home, and all of the people living in the home – some at length while other conversations were brief. We also sent survey forms to the people living in the home, to families and advocates, and to the staff team. We received 3 completed survey forms from people living in the home, 3 from staff and 2 from relatives or advocates and 5 from health and social care professionals. The responses we received have helped us to form the judgements we received. During the inspection we carried out a tour of the communal areas, and also looked at five bedrooms with the agreement of the people living there. We also looked at the records the home is required to keep. What the service does well: We heard many positive comments from people who live in the home, relatives and health and social care professionals about the home. People told us they are very happy living there. One relative told us “Residents are looked after well. The staff are always welcoming and happy to keep me updated with any information regarding the home or my brother. They are caring and approachable and nothing is too much trouble for them.” All of the people we met who live in the home told us how happy they are there. There are good admission procedures in place. The home carries out a careful assessment to make sure they are certain they will be able to provide the right level of support and care. People are given good opportunities to visit and get to know the home before any decision to move in is made. People told us about the way the staff support them to make choices about their daily lives. The health and social care professionals who completed a survey form before this inspection were generally very positive about the home Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 6 and the way people are supported by staff with their personal, emotional and healthcare needs, although some training needs were highlighted (see What they could do better). There are good procedures in place to make sure people are protected as far as possible from harm or abuse. People told us they felt able to speak out if they are concerned or worried about anything. They were confident about the home’s complaints procedures. In a tour of the home we found all areas were bright, comfortable and clean. The furnishings were generally satisfactory. Good recruitment, induction and basic training procedures have been followed. This means that’s people can feel confident that all new staff are suitable and have the basic skills to meet their needs. We heard many positive comments about the home’s manager and senior staff. We found the home was generally well managed and was running smoothly. People are encouraged to give their views on the day-to-day running of the home through regular residents’ meetings. What has improved since the last inspection? What they could do better: The care plans we looked at provided a good level of information for staff. There was enough information to help them support people with specific areas of need. We talked to people about how much involvement they have had in writing their own care plans and found that, while they have been fully consulted, the way the plans have been written prevent some people feeling as though the plans are their own. One person said she didn’t like some of the words used to describe her. Primrose Bond showed us a new style of care planning system they are thinking about using in the future. We talked to her about ways of helping people become more involved in writing their own plans. The plans could be written in a more accessible format for those people who may have difficulty with reading. The menus we looked at were balanced and provided good variety. However, some people may benefit from more individual support and guidance on how to eat healthily. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 7 While medicines were generally well managed there were a few areas that could be improved in order to provide additional safeguards and reduce the risk of errors. While the home was generally in good order, some areas have not been redecorated for some time. The home should draw up a realistic timetable for the maintenance, redecoration and renewal of the environment in order to make sure it is always kept in good order. Staffing levels are low. This means that they don’t have time to give people all of the individual support they need. In order to improve the level of activities, and guidance and support to achieve independent living skills, more staff are needed. We also heard from health and social care professionals that some staff would benefit from further training on specific topics, especially mental illness related topics. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Spurfield House DS0000071095.V365451.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 Spurfield House DS0000071095.V365451.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Quality in this outcome area is good People who may be thinking about moving in can be confident they will be helped to get to know the home and be certain the home can meet their needs before a decision to move in is made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new people have moved into Spurfield House since the last inspection. At the last inspection we heard that the local care management team have ‘block-bought’ the beds at the home, which means that the home only admits people who the care management team refer. We talked to Primrose Bond about how this may affect the way the home admits new people. She said that there is a very careful admission process with various stages in which they will carefully assess the potential new person to ensure they are suitable for Spurfield House and their needs will be met. There is also lots of discussion with the staff team before someone finally moves in. We heard that the home gathers as much information as possible through the initial referral. The manager usually visits the person to carry out a full Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 10 assessment. People then usually have a short visit to, and an overnight stay in the home before their admission. This is so that they can decide if they want to move into the home and the home can see if they will get on with others already living in the home. There is a three-month trial period during which people can change their mind about staying at the home. Spurfield House DS0000071095.V365451.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good Care plans provide a good level of information to staff to help them support people with specific areas of need, although people could be more involved in writing their own plans, and plans could be written in a more accessible format. Peoples’ choice is sought and acted upon whenever possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three care plan files during this inspection. We found the current care plan files contain a good range of relevant and important information. The plans have been regularly reviewed to ensure they are up-to-date. We talked to one person about their care plan to find out how much involvement they have had in the documents the home holds about them. We Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 12 found that, although people know that they can read their care plan files, (and some people told us they regularly do so), some of the documents are written in an official style and this may result in people not readily identifying themselves with the documents written about them. The person we talked to about her care plan confirmed that the factual information was correct. However, she told us she didn’t like some of the descriptions written about her. She felt they were other people’s judgements about her that she didn’t necessarily agree with. We talked to the manager, Primrose Bond, about how the home can work alongside people to help them draw up their own care plan and how they should take care to find a form of words that everyone feels comfortable with. She showed me a new document that is gradually being introduced called a WRAP plan. People complete this document themselves, with help from a member of staff if necessary. However, this plan isn’t currently being integrated into the main care plan files – we suggested they consider doing so. Primrose Bond also showed us an alternative style of care plan document they are considering using in future. We talked to her about the importance of involving people fully in their own care plans. We also talked about the importance of finding a style of care plan that is straightforward and easy to read, covers all important areas of need, and is indexed so that staff can quickly find important information. Primrose Bond said she would keep this in mind if and when they decide to change the care plans. Four staff that completed a survey form indicated that they are usually or always given up-to-date information about the needs of the people they support. We looked at the way people are involved in the daily routines in the home and how they are consulted and able to make decisions. A Residents’ Meeting is held every Monday. This meeting is minuted and we could see that people are consulted on many aspects of daily life at the home. People are able to choose what they do each day, within the limits of the homes’ budgets and staffing resources. People told us about their daily routines and that they get up/go to bed when they want, go out when they want, and they have a good choice of meals and are involved in drawing up the menus. There is a keyworker system. The staff offer guidance and support where necessary. We saw evidence to show that the home has sought guidance from relevant professionals on any areas where people may be at risk of harm. Documents in the care plan files provided good advice and guidance on how staff should support people in specific areas of risk. Spurfield House DS0000071095.V365451.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): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate The level of activities and social opportunities is beginning to improve, but more could be done to help each person achieve a fulfilling and interesting lifestyle. Menus are nutritious and varied but people would benefit from more individual support and guidance on how to eat healthily. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff we talked to told us they have tried to increase the level of activities provided by the home in recent months. In the hallway there were two notice boards, one giving information about the staff on duty, the daily menu, and some of the things planned for the day. The second notice board gave information about the planned activities for the coming week. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 14 During this inspection some of the people living in the home were out and about, either at regular planned activities, or had taken themselves off into Exeter or out for a walk. Some people went to the Springboard Centre in Exeter; others were involved with the Westbank League of Friends. One person talked about the local church she is very involved with. We also heard that the local Community Teams come into the home each week to provide a range of activities or to take people out. When we arrived on the second day of this inspection one person had baked some cakes and cooked a meal. Other people also talked to us about some of the things they enjoyed doing. Some of the activities that the home’s staff regularly organise include bingo, swing ball, card games, story telling, cooking, gardening, and beauty treatment. These usually take place between 2.30pm and 4 pm. While we could see that the level of activities has increased in recent months we also heard that not everyone joins in with these. One parent told us that his son does very little each day. For some people, staffing levels were one of the main barriers to helping them find meaningful activities. Some people clearly needed more support to help them things they are interested in and want to do but we heard that staffing levels were too low to enable staff to spend enough time with individuals. Some of the comments we received from relatives, care managers and health professionals about the level of activities included – “All my daughter does is watch telly.” “The staff are superb but the residents need more to stimulate them.” “My clients need more 1 to 1 contact with the staff and there needs to be more activities offered. For instance, my clients need to learn how to cook and could be more involved with this.” One member of staff who completed a survey form told us “I believe we should be able to engage with the service users more consistently to provide more stimulus. I believe the situation regarding meals; particularly nutritionally is piecemeal at best and chaotic at worst.” The home does not provide holidays each year for people. We were told that that one person goes on holidays with their family, and another person organises their own holidays and goes away on their own. For other people in the home day trips are provided from time to time. One major barrier to people going on holiday is lack of available money. Most people in the home smoke and therefore have little cash left to pay for a holiday. Some people are working towards moving out of the home and living in more independent accommodation. We saw that people were receiving help and support to reach this goal. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 15 We talked to the mother of one person who was visiting at the time of this inspection. We also heard from the parent of another person. We were satisfied that the home welcomes families and friends at any time. Some people go out with their families or go to visit them. The home encourages them to keep in touch. Bedrooms are fitted with locks and people have their own keys. Staff do not enter unless they have the person’s permission – we saw evidence of this during our inspection. We looked at the menus and talked to people about the meals provided. The menus were varied and included a balanced range of choices. The main meal of the day is normally in the evenings with a lighter meal midday. On the first day of this inspection we sat with the people at lunchtime and shared a meal. The meal on offer was a very tasty and attractively presented salad. We received some comments that the home doesn’t do enough to promote a healthy diet, or to help people who have weight problems. We heard that some people regularly eat unhealthy snacks and this affects their appetite when meals are offered. We talked to Primrose Bond about how the staff encourage people to eat healthily. We heard that the home struggles with balancing individual choice against encouraging healthy eating. We suggested they look at how they use the care planning process to help people work towards goals, and how they agree ways in which they can help people reach those goals. Spurfield House DS0000071095.V365451.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate People are well supported by staff in all of their personal, emotional and healthcare needs. Some aspects of medicine administration and storage are poor and may place people at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three care plan files and talked to Primrose Bond, staff and people living in the home about the way people are supported. Most people do not need help with washing, dressing or bathing, although some need guidance and support from staff to ensure they look neat and tidy. A few people need help with bathing. The manager and staff team work closely to ensure that staff rotas allow people to receive support with personal care from a member of staff of the same sex. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 17 We spoke to most of the people living in the home during this inspection, and they were all very full of praise for the staff team, especially Primrose Bond. They talked about the way the staff have helped and supported them both with physical care needs, and especially with emotional support. We heard several examples of how people have been helped to overcome significant problems in their lives and to become happier and more self-confident. The home has sought guidance from health and social care professionals on specific health problems. The care plans contained letters and evidence of contact with these professionals on how to support people with their specific health problems. On the first day of this inspection one person had a bad back and an appointment with the GP was arranged and treatment prescribed. Some people are at risk of self-harm and the home has been working with a clinical psychologist to find strategies to help people overcome this problem. Health and social care professionals who completed a survey form before this inspection made a number of relevant and helpful comments, including – “Training in relation to rights and dignity would benefit some care staff who are institutionalised in their practice.” “Excellent care. Very caring. Aware of client’s illness and needs. Respects client autonomy.” “Need more training within supporting people with mental health issues towards their recovery.” “Due to the lack of training offered to the staff they cannot be expected to help people recover and also lead fulfilling lives in the way that they might choose.” We were pleased to find that the home is working with some people to help them retain and administer their own medicines. This was an important part of helping people work towards independent living. The home uses a monitored dosage system of medicine administration. We talked to a senior member of staff who has responsibility for ordering, checking in new medications, and returning unwanted medicines. Medicines are kept in a locked cupboard in a room next to the managers’ office. When this room is not in use staff have been instructed to keep this room locked. We heard that most people go to this room when they are due to take their medicines, rather than the staff take medicines to people. If a person doesn’t go to collect their medicines the staff then goes to find them and takes their medicines to them. We felt that this method of giving out medicines may be considered to be institutional, although it may also be the safest and most suitable method for this home. We asked the home to review this with everyone to find out if this is what everyone prefers. If people are happy with this method, and if it is decided this method is the safest, it should be written into the home’s own individualised medication policy. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 18 If medicines are taken out of the office to be administered they are placed in a pill pot with the person’s name on a strip of paper. We recommended that, for additional safety, a lid should be placed on the pot. There is a checklist that is used to double check that everyone has received their medicines at the correct time. This is used in addition to the medicines administration record (MAR chart). This demonstrated good practice and additional security. While the medicine administration records were generally well completed, we noted one gap and asked the member of staff what should happen if they see a gap. He said they should contact the previous member of staff who was responsible for administering the medicines and check if they had actually been given. If there was any doubt they must contact the GP or pharmacist for advice. We asked if this was written into the homes’ medicine administration policy but he wasn’t sure. In the case of this particular gap there was no record to show that this policy had been followed, or that any check had been made to ensure the person had received their medicines correctly. The home has recorded each time creams and lotions have been administered – this is good practice. However, the creams had not been dated to show when they had been opened or when they should be discarded. We found there were no specific instructions on how, why or where creams and lotions should be administered, and there was no system in place to monitor the effectiveness of the creams. This is recommended. At the time of this inspection no controlled medicines or medicines that needed refrigeration were held in the home. The home did not have a secure cupboard for controlled drugs, or a secure refrigerator. We were told that if they have medicines that require refrigeration these would be held in the refrigerator in the kitchen. We advised that suitable storage should be provided in case such medicines are prescribed in the future. The records showed the amounts of medicines received into the home each month. However, there was no ‘brought forward’ amounts recorded. We heard that there have been incidents in the past with incorrect medicines being administered, medicines lost/unaccounted for, and some problems with security of the medication room and cupboard. We advised that a robust accounting system should be introduced to ensure that the overall amounts held at the end of each month are checked, and then added to the new amounts received at the beginning of each month. In this way it should be easier to check if the correct level of stocks are held, particularly for ‘as required’ (PRN) medicines, liquid medicines, creams and lotions, and those medicines not supplied in a monthly blister pack. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 19 All staff that have responsibility for administering medicines have attended short courses on medicine administration. However, Primrose Bond was unsure if this training met the standards laid down by the nationally recognised training organisation known as Skills for Care. We advised that all staff that are responsible for administering medicines should receive training to this standard, and their competency should be checked. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good People feel confident they are safeguarded by staff that know what to do to protect people from harm. Complaints are dealt with appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home told us they have received three complaints since the last inspection. Two of these complaints have been investigated by the home and we could see the records and check that the outcomes were satisfactory. The third complaint was being investigated by Guinness Care and Support Ltd at the time of this inspection. We were satisfied that the organisation were taking the matter seriously and investigating thoroughly. In the annual quality assurance assessment completed by the home before this inspection they told us that people have been reminded about the home’s complaints procedure, and they have checked to make sure everyone understands who they should contact if they have a complaint. The people we talked to who live in the home told us they felt confident that if they had any concerns or complaints they could talk to a member of staff or to Primrose Bond and they felt confident they would be listened to and the matter would be dealt with satisfactorily. One person who completed a survey form Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 21 before this inspection told us that if they are unhappy “We can speak to the staff that offer help regularly”. All staff have received training on the protection of vulnerable adults. This training is usually provided very soon after a new member of staff begins. Primrose Bond told us that the topic of abuse is discussed in staff meetings and in supervision. The staff we talked to confirm they had received training on abuse, and understood the procedures they should follow if they suspected abuse might have occurred. Some people have chosen to ask the home to hold cash/bank account details on their behalf. We checked the records of cash held and found that balances were correct, receipts held where appropriate, and all records were clear and correctly signed. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate The home is comfortable and clean and the furnishings are generally satisfactory, although some areas would benefit from some redecoration and a regular programme of maintenance and renewal. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at all of the communal areas, the gardens, and five bedrooms. We found the garden was generally tidy, with large lawned areas and many large mature trees. At the back of the house the staff have started to dig a vegetable patch, although this hadn’t been finished and was beginning to get overgrown. A small area had been planted with bedding plants by staff and some residents. We found that most areas were reasonably decorated, and appeared comfortable and homely. There were some areas where paintwork was Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 23 chipped and worn, but the overall appearance of the home was bright. Pictures and ornaments gave the home a personalised touch. However, one parent said they felt the home looked shabby and desperately needed some attention. They also described their son’s room as ‘a tip’ and said they felt the home should give their son more help to keep the room tidy. All areas of the home appeared clean and free from unpleasant odours. We looked in five bedrooms. People told us they liked their rooms. They are responsible for looking after their own rooms, although staff will provide help and support if necessary. Some of the rooms were large, neat and attractive, while some rooms were untidier according to the lifestyle of each person. Most people are responsible for doing their own laundry, although staff will help where necessary. The laundry facilities were found to be satisfactory. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. There are insufficient staff to meet the needs of the people living at Spurfield House. Good recruitment, induction and basic training procedures have been followed to ensure staff are suitable and people are in safe hands. However, staff would benefit from further specialised training relevant to the health needs of the people living at Spurfield House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing levels remain unchanged since the last inspection. There are usually either two or three staff on duty (including the manager) during the day, and at night there is one waking and one sleeping in staff. The home does not employ ancillary staff and therefore the staff have to carry out all tasks in the home including cooking, cleaning, gardening, and decoration as well as caring for the people living in the home. The staff we talked to told us that, while they are able to carry out most of the routine tasks it is difficult to find time to provide activities, and almost Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 25 impossible to provide the one-to-one time needed to help people move towards independence or achieve personal goals. They also find it is very difficult to find time to do such tasks as gardening or decoration. One member of staff told us that due to staffing problems the home sometimes struggles to achieve a good balance of staff in terms of gender ratios. However, Primrose Bond told us that she would often work longer hours to ensure people have personal care from a member of staff of the same sex. In addition to low staffing levels the home is facing the possibility that a number of the longer serving staff employed by the health authority may leave due to changes in their employment contracts. This may cause significant disruption for the people living in the home. We looked at the recruitment files of four members of staff. We found that the home had taken up references, criminal records and protection of vulnerable adults checks before new staff were confirmed in post. All new staff have received thorough induction training. We also saw certificates of training given to all staff. We found that staff have received training on all health and safety required topics. They have also received training on such subjects as equality and diversity, support, time and recovery, and training is planned for the near future on self-harm. Comments from health and social care professionals indicated that some staff would benefit from training on topics specific to the health needs of the people living at Spurfield House. Comments included – “Training in relation to rights and dignity would benefit some care staff who are institutionalised in their practice.” “Unfortunately the staff generally have had very little training in respect to mental health issues/risk which negatively impacts on residents’ recovery. Many of them are clearly doing their best and have a positive attitude but their employers do not give them sufficient training!” Four staff have obtained a nationally recognised qualification known as NVQ level 3 and one staff is currently in the process of obtaining this qualification. . I person has a City and Guilds qualification. Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good The home is well managed. People’s views are sought, listened to and acted upon as far as possible in order to continuously improve the services they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager, Primrose Bond, has had many years experience of managing care homes. She has experience in business management as well as care, and holds a nationally recognised qualification known as NVQ level 4 in care and management. The staff and people we talked to praised the manager for her skills in ensuring the best possible care for people living in the home. Primrose Bond told us she has an ‘open door’ style of management and Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 27 that she is always willing to talk to people at any time if they come to her with a problem. We heard many positive comments about Primrose Bond and the deputy manager. These included – “The manager is excellent – as is her senior staff member” “The manager is excellent and very supportive of external colleagues, internal colleagues and residents in the home.” “Primrose Bond and new girl (her 2nd in charge) are excellent and so are all of the staff.” “Yes as a direct result of effective and caring management. Mrs Bond is a credit to the home.” No specific management hours are allocated to the home. The manager is part of the care staff rota. This means that she doesn’t have specific time allocated to carry out management tasks People’s views are sought in a variety of ways. A Resident’s Meeting is held every week. Minutes of these meetings have been kept. The home also has a formal quality assurance system including questionnaires sent out to everyone living and involved in the home. A representative of Guinness Care and Support visits the home at least once a month to ensure the home is running smoothly. The AQAA submitted before this inspection took place shows that equipment has been maintained and serviced regularly. It also shows that the home has policies and procedures in place on all aspects of the management, care and services in the home. All staff have received training and regular updates on all health and safety related topics. We looked at the fire logbook and found that regular checks, servicing and fire drills and training have been carried out as required. Most radiators in the home have been covered to minimise the risk of people burning themselves if they should fall against them. Windows above ground floor level have been restricted to minimise the risk of people falling out. Spurfield House DS0000071095.V365451.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 x 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 2 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 3 x x 3 x Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA12 Regulation Requirement Timescale for action 01/10/08 2 YA20 16(2)(m)(n) You must consult with people about their social interests, and the activities they would like to participate in. You must improve the level of access people have to appropriate and meaningful activities, within and outside the home. 13(2) You must ensure that all aspects of medicine storage and administration are safe. You must provide a policy on the storage and administration of medicines that specifically relates to the practices that have been agreed for Spurfield House and all staff must fully understand the contents of the policy. All staff responsible for administering medicines must receive training to an accredited standard; their competency must be checked. You must provide secure storage for controlled drugs and medicines that require refrigeration. All gaps in the medicine administration records should DS0000071095.V365451.R01.S.doc 01/10/08 Spurfield House Version 5.2 Page 30 3 YA32 18(1)(a) 4 YA35 18(1)(c)(i) be investigated as soon as they are noted, the homes’ procedures should be followed, and a record made of the actions taken. There must be a robust accounting procedure to ensure that balances of medicines are checked regularly and amounts of stocks held are brought forward each month. You must ensure that there are sufficient staff on duty at all times to meet the needs of people living at the home. (Previous timescale 31/12/07) You must ensure that staff receive suitable training to ensure they can meet the needs of people living in the home. (Previous timescale 31/12/07) 01/10/08 01/10/08 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 YA9 Good Practice Recommendations You should encourage and enable people to fully involved in the writing of their care plans, wherever possible writing the care plans in their own words, or with words that they agree with. The plans should be easily accessible to staff and to the individuals concerned. You should look at ways of helping people work towards achieving a balanced and healthy diet. If medicines are placed in a pill pot and taken to people a lid should be placed on the pot for added security. Creams and lotions should be dated when opened in order to show when they should be discarded. You should ensure that the people living at the home do so in a well maintained environment, that is well decorated and is suitably furnished. 2 3 YA19 YA20 4 YA24 Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Spurfield House DS0000071095.V365451.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!