Inspection on 16/04/07 for The Springs Community

This inspection was carried out on 16th April 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Thorndene

Insight - Eastchurch

Southfields

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Dovedale Court

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

CARE HOME ADULTS 18-65 The Springs Community Coast Drive St Mary`s Bay Romney Marsh Kent TN29 0HN Lead Inspector Lois Tozer Key Unannounced Inspection 16 April 2007 09:10 The Springs Community DS0000067971.V328191.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 The Springs Community DS0000067971.V328191.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. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Springs Community Address Coast Drive St Mary`s Bay Romney Marsh Kent TN29 0HN 01797 363550 01797 361040 autism@thespringscommunity.co.uk www.cygnethealth.co.uk www.thespringscommunity.co.uk Cygnet Healthcare Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Elizabeth Scanlan Care Home 29 Category(ies) of Learning disability (28), Mental disorder, registration, with number excluding learning disability or dementia (1) of places The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Adults with a Learning Disability shall be between the ages of 16 and 65 years of age. Residential Care for people with mental health difficulties is restricted to one (1) resident whose date of birth is 05/05/1958. Registered bedrooms comprise of the following components-Hollands House-twelve (12) Fernleys Annexe-five (5) Monteith Villas-four (4) Winifred House-four (4) Coastways- two (2) The Willows- two (2). Date of last inspection Brief Description of the Service: The Springs Community provides accommodation, personal care, and developmental support for people who have been diagnosed with Autistic Spectrum disorders including Asperger’s Syndrome. The Home holds one variation to the above catagory. Ownership of the home changed in May 2006, and it is now owned by Cygnet Healthcare Ltd. It continues to be managed by Mrs Elizabeth Scanlan, and the core body of the staff team remain as they did under previous ownership. The main residential site is situated on Coast Drive, in St Mary’s Bay. Accommodation is provided in small clusters, and one home is situated in the local community, away from the site. Every individual has a full en-suite facility for their exclusive use. Staff are provided with a full induction programme which focuses on people who have autistic spectrum conditions. The numbers of staff are provided in direct relation to the assessed needs and interests of the service users. There is a wide variety of facilities including a classroom with computer systems, and two squash courts, outdoor tennis courts, covered, heated, swimming pool, relaxation room, ‘training’ kitchen, residents smoking room, library, bicycles and tricycles, and multiple lounge areas. A community gym is used with professional tutors. Qualified tutors visit the home for a variety of individual lessons including foreign languages, computer skills, and special needs. Qualified therapists such as masseurs and reflexology are available inhouse. Previous inspection reports are available from the home, as they are no longer available on the CSCI website since the change of ownership (and therefore the service number) took place. The weekly fee for this service starts at £351.91 rising to £2008.51. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit took place on 16 April 2007 between 09.10 and 5.00pm. The manager, Mrs Elizabeth Scanlan, service users and staff assisted with the process. As the home is large, and there are a lot of people to speak to, two inspectors carried out this visit. The ownership of the home has, from July 2006, passed to Cygnet Healthcare Ltd. The management and staffing of the home has not changed. The Responsible Individual is available to the manager in a supporting capacity and visits at least once a month. Twenty-four people live at the home, many gave face-to-face feedback and eight sent in responses to our survey. Nine relatives of service users sent feedback and comments. Eleven care manager / professionals views were sought, and three responded. Organised and spontaneous activities were taking place throughout the visit, and observations formed part of the evidence collected. The manager and a service user gave a tour of the main parts of Holland’s House and Winifred House. The inspection process consisted of information collected before and during the visit to the home. Other information seen included assessment and care plans, medication records, duty rota and employment paperwork. What the service does well: The home has a friendly, homely atmosphere. Service users are involved in many decision-making processes. People are involved in running their home People are getting out and about into the community a lot. There are lots of opportunities to meet new people and to have fun. The home is spacious and that allows people to dip in and out of activities and engagement without feeling pressured. Relationships (personal and with families) are supported, and people know that they can seek help from staff to see their friends. People go to clubs and social events regularly. Personal interests are encouraged. Residents plan holidays or special day trips to places that they really want to go to. Several people are involved in preparing meals. Everyone has access to the training kitchen. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 6 Service users know how to use the complaints procedure and feel sure that they will be listened to. The quality assurance process is well known, and service users know that their input will help with development and changes. Some comments from service users said, - ‘(CSCI) questionnaires should be more like the ones The Springs send, where there are numbers to indicate how much you like something (sliding scale). The manager gives me lovely support for my creative writing’. ‘I like it here, coz my stuff is safe, and I have a key to my room’. ‘Its OK, the staff are nice’. Everyone reported that they could choose what to do for their daily activities and free time. Some comments from relatives and care managers were, - ‘Peoples needs are always taken into account and they are supported in their choices. Staff are well trained, and understanding of clients needs related to Asperger’s and the autistic spectrum’. ‘Superb service in all respects & our son thoroughly enjoys all of the activities on offer’. ‘Care staff show patience and understanding… giving him a safe social life outside the home, without their care he would suffer social exclusion’. ‘Staff have shown exceptional skill in knowing his needs and difficulties’. ‘Never been happier, the manager is meticulous in her managing and caring skills’. ‘Provides a high level of staff to service user ratio’. ‘‘Do definitely support faith and sexual orientation’. ‘We have visited our son at various times of the day and have always felt the support and care to be of the highest standard’. What has improved since the last inspection? What they could do better: Medication training and management has improved to a degree, but there are still some serious administration problems. This has been a continually difficult area for the home to do well. The manager is quite willing to explore this, and is dedicated to the rapid improvement in this area. People who have experienced crisis have used the local Mental Health service. Feedback from this service said that the home was not prepared when dealing with critical situations. There is conflicting information, but the bottom line is that the home should have a contingency plan to deal with future admissions for assessment under the Mental Health Act. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 7 Feedback from relatives, care managers and staff was in the main very positive. Some suggestions for improvement were, - ‘We feel our son and others might benefit from a sheltered workshop facility where residents could earn some money’. ‘Years ago Springs produced a ¼ newsletter which was helpful’. 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. The Springs Community DS0000067971.V328191.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 The Springs Community DS0000067971.V328191.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prior to moving in, service users benefit from a full assessment of needs, aspirations and goals and have a detailed contract. EVIDENCE: A holistic pre-admission assessment is conducted that takes into account all aspects of the person’s life and wishes for the future. Family, psychiatrists, key workers and anyone else the individual wishes to be involved contribute in the assessment. Feedback from a relative and a care manager said that preadmission process was extensive, so that all parties felt confident that needs would be met. The terms and conditions are stated clearly in the contract, and efforts to help people understand these are in place. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 10 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. This judgement has been made using available evidence including a visit to this service. Service users changing needs are assessed, enabling opportunities to make real decisions within a carefully monitored risk assessment process. EVIDENCE: The individual plans are written, wherever possible, in consultation with the service user. The majority of service users can read, therefore text is appropriate. Where communication methods are needed, they are applied. They detail support and goal plans and explore known risks, giving clear guidance as what action should be taken to reduce the risk. Every service user has a regular review, and either them or their advocates offer suggestions for change. Discussion with service users showed that they were very aware of the content and any restriction (and the reasons for this) that may be placed on their individual freedom to make decisions. Meaningful decision-making was observed in action. Staff used skilled approaches to include and involve people in activities that could lead to their feeling more empowered. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 11 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, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users choose occupations and the daily routines that interest them. Leisure time can be spent in the way the individual chooses. People enjoy their meals. EVIDENCE: Activities within and outside of the home are planned around individual’s interests and own goals. Everyone gets to go out to the community many times a week to do shopping or other things they enjoy. Some people have paid employment within the home, doing chores in the communal areas they are especially good at. Key workers are trying to support people to find real work opportunities away from the home, and college placements provide work experience. Some people have a great deal of freedom to come and go from the Springs site, and understand the importance of responsible timekeeping. Personal space is respected. Although everyone is encouraged to participate in their chosen activities, staff are available to do activities within the home as The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 12 interest occurs. Understanding and the development of relationships are encouraged, and many people have made significant personal improvements living within this community. A dedicated chef who designs the menus (from the service user feedback through meetings) provides the majority of main meals. All service users make their own breakfast (either independently or with support) and often have opportunity to make their own tea in the training kitchen. They can also be supported to make individual main meals. The main kitchen has restricted access for service users. The foodstuffs used in the training kitchen are kept in the main kitchen. Staff had to obtain the ingredients on service user behalf, so a potential level of independence and choice is being lost in this activity. However, those preparing their own main meal go out to shop for the ingredients as part of the activity. Better ways of showing people what the main meal will be was discussed. This would help people make an earlier, and more informed choice. The service users of The Willows are, with staff support, fully self catering. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. Service users personal and healthcare support needs are documented and known to staff. Medication policies are not being followed, putting service users at risk. EVIDENCE: Feedback from service users said they are supported with respect and dignity in personal care. The guidance for staff on how to support people is clear, and has been written from consultation with the service user. Accessing healthcare is very well supported, however the home has encountered serious problems supporting people who are presenting with mental health problems. Records show that action to prevent problem behaviours escalating had been put in place. In depth consultation with psychiatry had provided clear management guidance, and records show this had been followed. Further development of a contingency plan and policy for admission under the Mental Health Act needs to take place. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 14 Some aspects of medication management have improved, such as a clean and tidy storage area. Only currently used medication is held in the home. Two people have been assessed and are, with support, self medicating. Other people may be able to take, with support, a role in managing their own medication, but so far, this has not been fully assessed. In discussion, the manager sees that this is an achievable possibility. Administration records are clear, but these are showing some serious errors. A service user appeared to have missed important medication on several occasions, and the policy for dealing with this had not been followed. There was no way of telling if the medication had been given, but forgot to be signed, or had been omitted altogether. Other records showed that medication was missing. Staff had not completed the records to say what had happened to the medication, and there were no records to say what action had been taken to deal with these and other issues, such as refusal of medication. Problems have repeatedly occurred in this area and the safety and welfare of service users must be improved. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to speak up and staff have training to recognise and respond to abusive practice. EVIDENCE: The majority of service users know how to use the complaints procedure. It is clearly displayed in each unit and in discussion with service users, the route for complaints was understood. People who have limited communication skills have their indicators of distress noted in the individual plan. Through adult (and child) protection training, staff become familiar with such signs and report or deal with any problems as they arise. Parents and visitors also act in an advocating capacity. There are clear policies and procedures to keep service users money safe. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 16 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, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, hygienic, safe, has some excellent facilities and although large, very homely. EVIDENCE: There are five separate buildings that make up the entire complex. A system of renewal and replacement is continually in place. During the visit, the office area was undergoing a major refurbishment, but this did not affect the well being of service users. A full re-decoration of the main building, Hollands House, has commenced. A new heating system has been installed to the main building, with cool touch radiators. Service users have had a big say in how the home looks, and a democratic process, through residents meetings and the quality assurance process ensures that the new furniture and décor is what the majority vote for. Individual rooms are decorated and furnished exactly how the person wishes. There is a huge amount of communal space and leisure facilities within the home and grounds, which all service users are able to enjoy. Locked doors are minimal, and only used to protect safety or dignity. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 17 The home is clean and hygienic throughout, and a team of domestic staff support residents keep the place looking good. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 18 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 excellent. This judgement has been made using available evidence including a visit to this service. Service users know that staff who support them have had the correct employment checks and in-depth induction with ongoing training. EVIDENCE: After a full interview, reference and police check, staff are given an in-depth skills for care induction. The manager makes sure that all staff complete their workbooks and provides learning time within the shift. Evidence that work has been marked and development supported is clearly available. Staff are able to use this for their ongoing development, and are required to continue onto NVQ training. Additional service user specific training is also provided in the induction process, and this provides service users with a team of people who understand their needs better. Service users assessed needs promote further training. An example is that recent research showed Cognitive Behaviour Therapy (CBT) to be successful for people on the Autistic Spectrum. CBT methods training is being provided for all staff in late April 2007. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager consults with service users to run the home safety and in their best interests. EVIDENCE: The manager has considerable knowledge, skill and qualifications. She keeps up to date on current research, employing it to the working practices of the home. The quality assurance process used involves all stakeholders; service users, relatives, staff, other interested persons. Development of the service has been based on their feedback. Records and discussion with service users confirm this is a real and happening process. A service user critically compared CSCI questionnaire to The Springs own questionnaire, stating how The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 20 the homes’ own was easier to use. Service users gave many instances of where suggestions had been put into action by the home. The health and welfare of service users is well managed, but a recent hospital admission has shown a policy shortfall, which the manager has agreed to deal with. All servicing of appliances is up to date and staff have a broad range of health and safety skills, providing a first aid trained staff on duty at all times. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 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 3 25 X 26 X 27 X 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 X 4 X 4 X X 3 X The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement To ensure the safety of service users, review the procedures of administration and management of medication. Timescale for action 01/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA19 Good Practice Recommendations Develop a policy and procedure that will enable staff to support service users if admission to hospital under the Mental Health Act is to take place. Form a contingency as what action should take place in conflicting situations where challenging behaviour is not deemed to be caused by mental ill-health. The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Springs Community DS0000067971.V328191.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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