Care Home: 18 Spindlebury

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What the care home does well 18 Spindlebury is a small comfortable bungalow conveniently located on the edge of Cullompton in Devon. It is also close to a larger unit for adults with more complex needs, owned by the same organisation, where clinical specialsts in head injury rehabilitation are based. This means that on-going clinical input for people is easily accessed. The routines at the home are flexible but offer structure for people. Rehabilitation is person centred and staffing support is appreciated and valued by people living at the unit. What the care home could do better: We have made one statutory requirement as a result of this visit. The service must develop and introduce a system in order to prevent hand transcribing errors on people`s medication administration records. This is to ensure that people always receive medication that they are prescribed. Random inspection report Care homes for adults (18-65 years) Name: Address: 18 Spindlebury 18 Spindlebury Padbrook Cullompton Devon EX15 1SY three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Judith McGregor-Harper Date: 1 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: 18 Spindlebury 18 Spindlebury Padbrook Cullompton Devon EX15 1SY 0188433530 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Brain Injury Rehabilitation Trust Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 2 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: Date of last inspection Brief description of the care home 2 Spindlebury provides rehabilitation care and support for two people with an acquired brain injury. The home is part of the Brain Injury Trust and works closely with the professionals within the Trust. The professionals based at The Woodmill Brain Injury Unit carry out all rehabilitation and therapeutic assessments/programmes for the service users living at the home in conjunction with the carers and House Leader working at Spindlebury. The home is a bungalow situated in a modern housing estate in Cullompton. Minor adaptations have been made to the house to meet the current service users physical Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home needs. The home is within walking distance to the local amenities, including public transport. The emphasis in the home is to support people become more independent, in and out of the home, to seek employment and training opportunities, and maintain regular contact with relatives and friends. The weekly cost is approximately 1300 pounds per week. Additional charges are made for toiletries, sweets, clothes and shoes. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: This was an unannounced routine inspection. We reviewed the one requirement made at the last key inspection in 2007 and we focused the remainder of our inspection on records in relation to assessment and admission, on-going and changing care needs, risk assessment of the individual, medication management, staff recruitment, the homes environment, management and health and safety measures. Choice of home. At the inspection we met a person who had recently moved into the home. We talked about the process of moving in and this person confirmed that they had been consulted about moving in and that they felt they had made an informed choice about moving in. Prior to the inspection we sent surveys to anyone living at the home. We received a survey reply from one person who also said that they had been consulted about moving in at the time of their move into 18 Spindlebury. Their survey return also told us that they had received information about the service to assist them in deciding whether to move in. We looked at care and assessment records for one person in detail. We saw that records of need were detailed and kept under regular review to reflect changing needs or levels of risk management. People living at the service told us either in person or by survey that they are satisfied with the care and support they receive at the home. Individual needs and choices. We inspected care records for one person and found they were person centred and reflected current health care support needs. People living at the service told us by survey or in conversation that the service routine is structured but there is flexibility in order to support peoples individual daily programmes. This is a reablement service and people are supported to make choices and participate in setting personal goals. The service operates a risk management approach to goal setting and we saw that this was assessed in a written plan. Regular multi-disciplinary team meetings take responsibility for the management of this risk. We saw that personal records were stored in a manner that protected confidentiality. Lifestyle. One person was away from the house on holiday with family members. We were also informed by someone living at the home that they appreciated the location of the home as it provided a quiet setting within close walking distance to the town centre and its amenities. Care Homes for Adults (18-65 years) Page 4 of 10 We received two surveys from staff who work at the home prior to the inspection. One survey told us that a vehicle for the service would improve community access for people at the service as public transport is not always accessible or convenient. People confirmed to us that meals reflect personal choices. We saw that the service has taken appropriate steps to monitor food intake for one person at risk from missing regular meals and to develop ways in order to persuade people to eat in order to maintain their health. Personal and health care support. Written records demonstrated that peoples health care needs were being monitored. One staff survey return expressed an opinion that the clinical team based at The Woodmill unit have not provided the support that people living at 18 Spindlebury need, notably in a period of transfer between the two homes. We looked at how medicines were stored and administered. We saw that medicines were stored securely and that a good system for ordering medicines was followed. We inspected medicines administration records for the current month. On the whole recording of medicines was good. However, there was one hand written alteration to a prescribed medicine during the month. The alteration made led to an ambiguity of how much medicine to administer. The hand written entry was not countersigned, which would have reduced the likelihood of an ambiguous entry being tolerated. We were informed that at times agency staff are on duty and they will not have the background knowledge of peoples recent medicines. We require that in order to prevent errors in the administration of prescribed medicines that there must be a system introduced to monitor the accuracy of hand transcribed entries on medicines administration records. Concerns, complaints and protections. The service has received no complaints in the last year and we have received no complaints directly. Environment. The three bedroomed bungalow was clean and fresh. Fixtures and fittings were in a good state of repair. Peoples private spaces were personalised. Staffing. There is a small staff team for this two person care home. We saw that staffing was flexible and that staff cover within the 24 hour period had been reviewed to reflect changes in supervision and support people need. People living at the home told us in person or by survey that staff treat them well and listen to what they have to say. Surveys from 2 staff told us that training provided was relevant to their staffing role and met peoples needs. However, neither staff survey return told us that their induction covered everything they needed to know very well. One person said their induction Care Homes for Adults (18-65 years) Page 5 of 10 covered this mostly, the other person said it did this not at all. They told us that they felt their induction threw them in at the deep end, despite the induction being a 6 month programme. Nevertheless, they did tell us that their induction got much better as time went on. We suggest the registered manager reflect upon how inductions could be changed to meet staffs individual training needs. We looked at staff recruitment files and we saw that processes were robust in order to prevent applicants unsuited to working with vulnerable people gaining employment at the service. Conduct and management of the home. People who live at the service were happy with the support they receive. Staff surveys told us that the manager is approachable and supportive. At the last inspection in 2007 a requirement was made in relation to risk assessing the potential of heat transfer injuries from unguarded radiators. We received email confirmation that this requirement had been met by the service as written risk assessments have been completed and there is a plan to change a radiator in the bathroom to a wall mounted towel rail. We saw how accidents were recorded and we saw that there is a system in place to audit accidents for trends or patterns. We did not see any accidents or incidents in the recent accident records that would be reportable to us under our notifiable events regulation 37 reporting requirement. We spent two hours at the home on a site visit and reviewed other records outside of this time. 18 Spindlebury continues to provide excellent outcomes for people living there. What the care home does well: What they could do better: We have made one statutory requirement as a result of this visit. The service must develop and introduce a system in order to prevent hand transcribing errors on peoples medication administration records. This is to ensure that people always receive medication that they are prescribed. Care Homes for Adults (18-65 years) Page 6 of 10 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 set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The service must develop and introduce a system in order to prevent hand transcribing errors on peoples medication administration records. This is to ensure that people always receive medication that they are prescribed. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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