Care Home: 40 Spiders Island

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What the care home does well People benefit from a comprehensive admission process that ensures they are supported to settle in well. People have good access to healthcare professionals. People benefit from having a range of things that they like to do, both at the home and in the locality. People maintain good relationships with family and friends. People are encouraged to eat healthily. People benefit from a warm, comfortable, clean and well maintained environment. People decorate and furnish their bedrooms in their own style. People are supported to be involved in household tasks if they want to. Members of staff have developed good relationships with people who use the service and their families. Staff are committed to ensuring that people`s needs are met and monitored. Staffing levels mean that people are supported with their care needs when needed. People can choose the gender of staff who provide their intimate personal care. A robust recruitment process means that people are protected from anyone who is unsuitable to work with them. New staff members are inducted into their role and work with a more experienced member of staff. The home makes sure that everyone`s health and safety are protected. What has improved since the last inspection? An acting manager has been appointed. A registered manager from another home in the organisation is supporting the acting manager to develop the service and address the outstanding requirements. Efforts have been made to ensure that people`s care and support needs are captured in their care plans. Everyone has had their health needs assessed by healthcare professionals. Epilepsy management plans are being finalised. Immediate care charts are being fully completed. People`s risk of choking is better recorded. The daily reports now correspond to the directions in people`s care plans. Information packs are now available for people to take with them if they go to hospital. People are having assessments from the occupational therapist to see what equipment they may need. Staff vacancies have been filled so there is less reliance on agency staff. New staff have a good induction and are confident in their role. A new staff training programme now includes subjects that are relevant to the work that they do including learning and physical disability. Funding has been secured for more staff to do NVQs. Members of staff have attended team building sessions. The home`s development of a formal quality audit is in good progress. A local advocacy group were giving advice on how people could get involved in the audit. Questionnaires have been sent to different people and comments will be fed into the home`s development and budget plans. Fire drills and tests and checks of fire safety equipment and systems are being regularly carried out. A senior member of staff now has the delegated responsibility for fire safety. What the care home could do better: People`s files should be rationalised so that only current information is available. The different systems for recording should be rationalised so that recording is not duplicated. Confidential information about people must be recorded in their personal file, rather than in the staff handover book or anywhere else. Staff must have training in tissue viability so they can record more detail in people`s assessments for determining risk of developing pressure sores. The home must keep a record of all medicine that is received or returned to the pharmacy when not needed. The home must tell us about all medicine errors. The section of the medicine policy relating to errors should be put with the medicine administration record so that members of staff can immediately see what they have to do when errors occur. Guidance on administering medicine prescribed to be taken `when required` must include information about why it is given and intervals between doses. The home should explore the things that will be important to people in relation to their cultural background or faith. Consideration should be given to providing a gender working policy. So that members of staff know the boundaries of their work with people of a different gender, and in particular those areas where staff members have to take into consideration people`s best interests or act in an emergency. The sensory area in the sitting room should be made more accessible by moving objects that stop people using it when they want to. There must be suitable storage for different items currently stored in the sitting room and a toilet which cannot be used. So that equipment does not restrict people`s use of rooms and toilets. The home must consult with the Fire and Rescue Authority to make sure that they comply with safe storage of oxygen cylinders. So that everyone is protected from any unnecessary risks. After consultation with the Fire and Rescue Authority about the safe storage of oxygen, the home`s fire risk assessment must be reviewed and updated. Key inspection report Care homes for adults (18-65 years) Name: Address: 40 Spiders Island Grimstead Road Whaddon Salisbury Wiltshire SP5 3BG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Sally Walker     Date: 2 0 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: 40 Spiders Island Grimstead Road Whaddon Salisbury Wiltshire SP5 3BG 01722710072 01722710072 alderbury@scope.org.uk www.scope.org.uk SCOPE care home 5 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who may be accomodated is 5 The registered person may provide the following category of service: Care Home only Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Physical Disability (Code PD) Date of last inspection Brief description of the care home 40 Spiders Island is a residential care home registered to care for five adults with a physical disability. The home is situated in Whaddon, a small village near Salisbury. The home is managed by SCOPE. Mr Paul Glover has recently been appointed as the acting manager. 40 Spiders Island is a purpose built bungalow. Each person has a single bedroom. There is a spacious lounge with dining area and an adjoining kitchen. Bathing facilities consist of an assisted bath and shower. A range of specialised equipment is provided in relation to individual need. Staffing levels are maintained at generally four members of staff during the day. At night one member of staff undertakes a waking night and another provides sleeping in provision. An on call management system is also available. Care Homes for Adults (18-65 years) Page 4 of 35 5 Over 65 0 Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on 20th January 2010 between 9.45am and 6.15pm. Mr Paul Glover, acting manager was present for part of the inspection. Mrs Carrie Irvine, registered manager at another home run by Scope, was supporting Mr Glover to develop the service and was also present for part of the inspection. The last key inspection was on 15th July 2009 when the home was given a Poor quality rating. The home has had five different managers in the last three years. Mr Glover was appointed in October 2009 as the previous manager who did not register with us, resigned. Since July 2009 we have met with managers from the organisation and been given assurances that the homes improvement plan is being addressed. Mr Glover is also managing another home run by Scope in Salisbury. Care Homes for Adults (18-65 years) Page 6 of 35 As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? An acting manager has been appointed. A registered manager from another home in the organisation is supporting the acting manager to develop the service and address the outstanding requirements. Efforts have been made to ensure that peoples care and support needs are captured in their care plans. Everyone has had their health needs assessed by healthcare professionals. Epilepsy management plans are being finalised. Immediate care charts are being fully completed. Peoples risk of choking is better recorded. The daily reports now correspond to the directions in peoples care plans. Information packs are now available for people to take with them if they go to hospital. People are having assessments from the occupational therapist to see what equipment they may need. Staff vacancies have been filled so there is less reliance on agency staff. New staff have a good induction and are confident in their role. A new staff training programme now includes subjects that are relevant to the work that they do including learning and physical disability. Funding has been secured for more staff to do NVQs. Members of staff have attended team building sessions. The homes development of a formal quality audit is in good progress. A local advocacy group were giving advice on how people could get involved in the audit. Questionnaires Care Homes for Adults (18-65 years) Page 8 of 35 have been sent to different people and comments will be fed into the homes development and budget plans. Fire drills and tests and checks of fire safety equipment and systems are being regularly carried out. A senior member of staff now has the delegated responsibility for fire safety. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 9 of 35 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although no one has recently moved in to the service, the home has a transition plan to make sure that new people settle in to living at the home. Evidence: No one had recently moved in to the home. At the last inspection we found that people experienced good quality outcomes in this area. We spoke with one person who told us that moving in had been a very positive experience for them. Two people returned the surveys we sent them. They both said that they had been asked if they wanted to move into the home. One person said they had enough information about the home so they could decide if it was the right place for them. Mrs Irvine told us that Scope was in the process of drafting a corporate template for the statement of purpose and service users guide. This could then be adapted by each service to include specific details of what the home provided. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having their care and support plans more regularly reviewed. Care plans are more detailed about what people need. Members of staff use peoples preferred methods of communication. Evidence: Much effort had been made to review and revise peoples care and support plans. This meant that there was sufficient information available about peoples care and support needs and any risks to their safety, as we required at the last inspection. We also made a recommendation at the last two inspections that the detailed morning routine format should be applied to other areas so that staff had clear and specific information. This recommendation had been met. However the files contained lots of information that was not easily accessed. Some information was duplicated in different files and books. There was some personal information about people in the staff handover book. There was also information about some peoples assessments and use of equipment in the shift plan book. The Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: occupational therapist had carried out assessments with everyone. Risk management was included in the care plans. There was good detail about how risks were reduced or eliminated and reviewed. In a survey form a social care professional in answer to the question about what they thought the home could do better, told us Due to lack of support from management and external agencies the home has had to catch up with assessments and care plans. Recording was poor but, with support from the CTPLD this has shown improvement. Also liaise with external agencies as and when the need arises. They told us the home was good at maintaining privacy and dignity with service users. Mrs Irvine told us that she was introducing a care planning format that she had brought from her care home. This would be gradually introduced with keyworkers. She also told us that the new care plan format will include a life story and communication section for people. One person showed us their care plan that they kept in their bedroom. They also had another file which was kept in the office and had more personal information about their care and support needs. Peoples preferences about who provided their intimate personal care were recorded in their care plans. One lady told us she did not mind if one of the male staff supported her with personal care. There was no gender working policy. Mr Glover and Mrs Irvine told us that staff members were clear about the boundaries and what support they could give. One staff member was using one persons preferred method of communication when asking them what kind of drink they wanted. They also used the method so that the person could give permission for us to look at their communication book. Another member of staff told us how people who did not have speech made their needs known. They described different vocalisations, facial expressions and gestures that people used and how some people would indicate pain by touch. They told us that people sometimes expressed themselves by refusing to eat or drink in different circumstances. The staff member told us that much of the information was gained through talking with families and through recognising patterns of behaviour. Mr Glover told us that he was implementing the communication passports with each person. He said this would give more specific details of each persons expression of need and decision making. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from going to local day services where they meet their friends. People go to a range of different facilities in the locality. People maintain good relationships with family and friends. People are encouraged to eat healthily. Evidence: Everyone attended the day service, run by the organisation for different sessions during the week. Some of the sessions included: painting, cooking, computing and exercise classes. One person told us they met their friends at the day service and liked to chat with them there. They also said they had hydrotherapy and physiotherapy at the day service. People had a communication book which they took with them when they went to their day service or for visits with family. One member of staff was writing with one person in their book. This book contained information about what the person had done each Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: day, what they had eaten and information about their general wellbeing. The member of staff told us that there was very little information from the day service in the books. A member of staff told us that the staff member who co-ordinated the activities had left. Mr Glover told us that he was considering other staff who would take on the responsibility so that activities could be further developed. People had one to one time with staff to do different activities, for example, having their nails painted or going to the garden centre for a coffee or meal. One person told us they were currently watching television, but they liked to go shopping, go out for a coffee or to the local pub and social club. They said they liked to cook cakes and were doing cooking at their day service. People liked to listen to music and play games. There were raised beds and a greenhouse in the garden where people grew vegetables during the summer. Some people had gone to the Horse of the Year show in London. They had also gone to restaurants in the New Forest. In answer to our survey both people who responded told us that they usually made decisions about what they wanted to do each day and at the weekend. Parents were involved with some of the fund raising activities. Money raised went to different projects, for example, sensory equipment and planned installation of a conservatory. A member of staff was employed for four hours a day to drive the homes accessible vehicle. Staff told us that this person was currently on sick leave and this had caused difficulties as few staff members were able to drive the vehicle. Later, a member of staff from the other home came to drive the vehicle so that people could go to the day service. Mr Glover told us that the home had two vehicles, one of which was new and he was waiting for equipment to be fitted so that wheelchair users could travel safely in the vehicle. Risk assessments were in place for going out in the vehicles. Some people used the local taxi service to go into Salisbury. People had regular contact with family and friends and often went to stay with family for the weekend. One person told us that their friends at the day service visited them at the home. There was very little information in care plans about peoples cultural backgrounds or faith needs, save what they could not eat, how to dress and who could provide their personal care. We asked staff members about whether peoples cultures, religions and festivals had been researched; they told us that they relied on family to guide them. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: Staff told us that people were beginning to look at planning holidays. One person told us they preferred to go on day trips. Some people had planned to go on holiday with their parents. A corner of the sitting room had been designated as a relaxation area with some sensory equipment. One staff member told us that a curtain would be fitted so that people could have some privacy when using the equipment. The area was not readily accessible to people as members of staff would have to move some of the chairs so that people could use the area. We thought people would benefit from the area being set out so it would look more inviting. There was a large screen television in the sitting room which was visible from all parts of the room. There were bowls of fruit in the sitting room for people to help themselves to. There was a bowl of strawberries in the fridge for peoples evening meal. We also saw treats and snacks in the kitchen. A staff member showed us the chocolate bars that people often liked to eat in the evenings when they relaxed in front of the television. The fridge and cupboards were well stocked. There was a four week menu that staff used as a guide for what to cook. Staff members told us that people chose what they wanted to eat and changes were marked on the menus. One person told us they liked to have scampi and although it was not on the menu, they said they had it as often as they liked. People were having baked salmon for their evening meal with rice pudding to follow. Staff told us that people had their main meal in the evening. People had a cooked lunch when they went to day service. The day service menu was available so that people did not have the same thing twice. Staff members told us that people often chose to have a takeaway. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from recent reviews of their healthcare needs with different professionals. Outcomes are recorded in peoples updated care plans. Systems for managing peoples medicine are generally safe. Evidence: Efforts had been made to ensure that the care plans had been reviewed and revised to reflect peoples current care and support needs. Action had been taken to address the requirement we made that care charts must be fully completed and show that a person has had sufficient fluid intake and has been supported to change their position at identified intervals. One person had a care plan for monitoring their sleeping pattern following consultation with a healthcare professional. Turn charts were being fully recorded. There were photographs provided by the physiotherapist showing how to use equipment and which positions to use when turning people when they were in bed. At the last inspection we made a requirement that care plans, daily reports and turning charts must correspond and identify the support the person required and the actual support given. This requirement had now been met. Some people had fluid charts if they were at risk of dehydration. The charts were being well recorded, with details of what they should achieve each day and a total of what they had taken. Mrs Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: Irvine told us that Wiltshires Quality team are going to provide a Nutritional assessment tool which will be used to re-assess all customers and the care plans/risk assessments amended accordingly. Action had been taken to address the requirement we made that epilepsy management plans must be in place for those people who have epilepsy. The team coordinator told us that those people who were living with epilepsy had had a review by the community nurse so that an epilepsy profile could be produced. The co-ordinator told us about the delay in the nurse sending the profiles to people. People had pressure relieving equipment in place and some people had turn charts to record when their position was changed when they were in bed. The risk assessments were not detailed enough to show what factors had been taken into consideration when assessing the risk of pressure damage. The care plans stated that the district nurse must be alerted when red marks were noted. We said that this could be too late, as damage may already have occurred. Staff had not received training in tissue viability. Action had been taken to address the requirement we made that potential risks such as choking must be identified and addressed within the risk assessment process. We said that measures to minimise the risk must be put in place, be fully documented and reviewed. This requirement had now been met. The team co-ordinator told us that one of the senior staff was sourcing male and female body maps as the one currently in use were male only. The maps showed the location of any marks or wounds that people may have sustained. Care plans identified clear guidance for supporting anyone who was fed artificially with a PEG (percutaneous endoscopic gastrostomy). Staff members told us that people had very good support from their GPs and the district nurses. The district nurses notes were kept in the bedrooms of those people needing treatments. Staff members told us that people generally went to appointments at the GP surgeries, but increasingly as people were getting older; their GPs would visit them at home. The home had developed an information pack for people to take with them if they were admitted to hospital. There was good information about peoples medical condition and contact details. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: Keyworkers supported people to attend regular appointments with specialist healthcare care professionals. One staff member told us they had received training in medicines at the local college. They also told us that this was regularly updated. People had a locked medicine cabinet in their bedrooms. The medicine administration records were kept in a central medicine cabinet. Some medicines, stored in the inner locked cupboard could not be accounted for in the medicine administration record. One of these medicines had fewer tablets than written on the medicine administration record. There was another packet of very strong pain relieving tablets that was no longer needed. There was no record of unwanted or unused medicines that were returned to the pharmacist. We saw that there had been two occasions where tablets had been found on the floor on the same day. Although the home had checked with peoples GPs, having established who they belonged to, the home had not informed us of the medicine errors under Regulation 37. The data sheets supplied with each medicine were kept so that staff members would have the information about each persons medicine and anything to look out for. Action had been taken to address the requirement we made that guidance for any medicines to be taken as required must be in the persons care plan. We said that guidance must state what triggers an administration and at what intervals the medicine should be given. There was good information about when medicines were prescribed to be taken only when required; including the correct time between doses and why they were taking it. There was also good detail about telling the person that their medicine was administered via their artificial feed tube. Care plans showed detailed guidance about administering medicines rectally for seizure management. Peoples GPs had confirmed in writing which over the counter medicines people could take with their prescribed medicines. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place for anyone to make complaints about the service. Members of staff are confident in reporting any allegations or observations of abuse to the local safeguarding process. Evidence: Action had been taken to address the good practice recommendation we made that a more user friendly complaint procedure be considered so that people were more involved. Mrs Irvine told us that the home were updating their complaints procedure to make it more accessible to people. The home was also going to adapt the local policy which was in large print so that people who use this service could access it more easily. Advice had been sought from a local advocacy service for ways in which people could access it better. In response to our survey about making complaints and who to talk with, both people said they knew who to talk to. One person said they did not know how to make a complaint. The complaints log showed details of any investigations of complaints, action taken and responses to complainants. There had been no recent complaints. Staff members were confident in reporting any allegations or observations of abuse to management or directly to the local safeguarding procedure. One member of staff told Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: us they had received training in safeguarding vulnerable people and the local reporting procedure from the local authority. People could keep small amounts of cash in the homes safe. Only senior staff had access to the safe. Records and receipts were kept of all transactions. The monies were checked at each shift handover. The team co-ordinator told us that if people have a meal out, part of it is refunded as people have already paid for a meal as part of the fees. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a warm, comfortable, clean and well maintained environment. Evidence: One of the people who use the service gave us a tour of the building and showed us their bedroom. All the accommodation was single bedrooms on one level. Some bedrooms had patio doors to the outside. People had decorated and personalised their bedrooms with their own furniture and different things to reflect their personality. All the radiators were guarded to ensure no one was scalded. One person used oxygen which was kept in their wardrobe. The spare cylinder was also kept in their wardrobe rather than in a secured storage. Action had been taken to address the good practice recommendation we made that the hoists stored in a separate toilet be moved so that the toilet could be used. However the hoists had been moved to the sitting room and the toilet was still being used to store continence pads and other equipment so the toilet was not used. The rail on which the night staff hung ironed clothing was stored in one of the bathrooms. Staff told us that the home did not have any storage space for equipment and aids. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: There was a bathroom and a shower room with toilet. People had their own named hoist slings which were stored in the bathroom. One of the staff told us that they were waiting for a new shower chair to be purchased as the other one had become worn and difficult to keep clean. There was a patio area to the side of the building which people used in the summer. The rest of the garden was on a slope. A staff member told us of the plans to build a conservatory extension which would provide more communal space for people. Since the inspection Mrs Irvine has told us that there are no plans to build a conservatory although this is on a service user wish list for considertion in the future, should funds be available. The kitchen was wheelchair accessible. The exits and entrances were level access. All the light switches were at waist height for easy access. Action had been taken to address the good practice recommendation we made at the last two inspections that specialised programmes such as physiotherapy should be regularly reviewed and changes documented. The occupational therapist was at the home on the day we visited. They were assessing everyone for equipment that they might need to make their lives more comfortable, both in moving around and when they were in bed. There were call alarms in all the bedrooms and toilets and bathrooms. Staff told us that people would not be able to use the call alarm themselves and staff used them to call for assistance when needed. Staff told us that night staff made different checks on people during the night depending on need. The home contracted for the removal of clinical waste. There was a separate laundry room which was well organised and clean. Some people were supported with doing their own laundry. One staff member told us how one person with a visual impairment and hearing difficulties recognised the smell of different cleaning and washing materials when they were involved with laundry and other household tasks. In response to our survey about whether the home was fresh and clean, both people answered always. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having staff members to support them when they need, but not always when they want one to one activities. A robust recruitment process means that people are protected from anyone who is unsuitable to work with them. Much effort has been made to ensure that staff are trained in subjects related to peoples care and support needs. Evidence: There was a shift leader and three members of staff working during the morning. The staffing rota was compiled according to the support people needed when they were at home. One staff member told us that there was a minimum of two staff working during the day when people were at home. At night there was one waking night staff and a member of staff sleeping in. In a survey form one member of staff told us in answer to the question about what they thought the home could do better, Get enough staff for more one to one activities to vary the residents lifestyle. Another member of staff told us Provide better level of staff for all shifts. I enjoy my work at Spiders Island. Its a safe, secure, happy home to work in. Each member of staff had a delegated area of responsibility, for example, planning the rota and the arrangements for medicines. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: Mr Glover told us there was less use of agency staff now that staff vacancies had been filled. In response to our surveys both people told us that members of staff always treated them well. One person said that members of staff usually listened and acted on what they said. The other person said members of staff always listened and acted on what they said. One of the newer members of staff told us they had received a six month induction into the work. They said this was their first job in care. They said they had initially shadowed a more experienced member of staff and a record was kept of when they had achieved the different parts of their induction. Another member of staff showed us the homes newly produced induction pack which was being completed by the latest staff member to be appointed. All the documents and information required by regulation had been obtained before staff members commenced duties. No one started work unless checks on their suitability to work with vulnerable people had been carried out with ISAfirst (the Independent Safeguarding Authority). Action had been taken to address the good practice recommendation we made at the last two inspections that training should be offered with regard to peoples physical disabilities. We also said that staff should receive training in learning disability, communication, eating and drinking, tissue viability and catheter care. Two staff members told us that they had undertaken a lot of training recently. One member of staff told us of the benefits they found from the recent communication training. They told us they had also undertaken recent training in moving and handling, giving medication if anyone has a seizure, food hygiene, safeguarding vulnerable people and infection control. They said they were about to start NVQ Level 2 in care. Another staff member told us that they had received training in managing artificial feeding via a PEG (percutaneous endoscopic gastrostomy) and were awaiting the certificate. They showed us the list of training posted on the kitchen door. Mrs Irvine told us that managers had received training in the Mental Capacity Act 2005 and the deprivation of liberty safeguarding standards. She said that the training was available to staff on line. One staff member told us they held NVQ Level 3 and hoped to do Level 4. Mr Glover told us he was in the process of trying to access funding for three staff members to undertake NVQ Level 4 in care. Action had been taken to address the good practice recommendation we made that timescales for refresher training should be specific rather than when needed. Mr Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: Glover told us he had applied to Skills for Care to provide further staff training. There was a training plan for the next three months. A training matrix had been developed which showed each individual staff members record of training undertaken and when updates were needed. There had been team building sessions for the staff group. Staff had received training in epilepsy, medicines, complaints, use of oxygen and suction. The following week training was planned in epilepsy, moving and handling, health and safety, writing and recording and infection control. Other planned training was for dignity in care, nutrition and further team building. There were male and female staff to support people. There was information about people choosing the gender of the staff member when providing intimate personal care. There was no written policy on gender working for the protection of staff and the people who use the service. Staff told us that they had regular supervision every four to six weeks. There was a list of planned supervisions on the office notice board. The manager supervised the senior team, who then had a group of staff members who they supervised. Records were kept of supervisions and both parties contributed to the agenda. Regular staff meetings were held with minutes kept. In a survey form one member of staff told us Due to absence of a manager, Team co-ordinators have been providing more than adequate support for my progress within the home. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mr Glover is succeeding in improving the quality of care and supporting staff, with support from another manager in the organisation. He knows the areas in which the home still needs some development. He will need to consider how time spent at the other home impacts on his priorities at this home. Evidence: In the last three years the home has had five different managers. This has meant that there has been no clear leadership for members of staff. We judged the outcomes for people who use the service to be poor at the last inspection. Mrs Irvine told us that the managers post had been advertised. Mr Glover had been appointed as acting manager in October 2009. He told us his previous work had been with younger people with learning disabilities in an educational setting. He said he did not have the Leadership and Management Award but had previous management experience. Mrs Irvine told us that Mr Glover was being inducted into the role. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: The previous manager had sent us their improvement plan following the last inspection. Mr Glover told us about his priorities for developing the service; working on addressing the requirements from the last inspection and developing and supporting the staff team. Mr Glover had met with peoples families and the local community team for people with learning disabilities to introduce himself and discuss any issues. Mr Glover said that he currently spent two days at this home as his priority at present, was addressing issues at the other home, for the other three days of the week. Mrs Irvine was supporting him to achieve these aims. There were two team co-ordinators who ran the home in Mr Glovers absence. They had worked at the home for some time and had different delegated areas of responsibility. In a survey form one member of staff told us in answer to the question about what they felt the home could to better, told us Employ a manager that is able to manage as one unit and not have to manage two units as since this has been in place I feel that the unit is being neglected by management although no fault of their own. I do not believe this is working for service users or staff. An administrator was employed for two days a week. Managers of other homes in the organisation carry out the unannounced monthly visits required by regulation. The requirement we made at the last two inspections that a formal quality assurance system must be developed and implemented was in good progress. We also recommended at the last two inspections that people should be more involved in the quality audit. A quality assurance audit had been set up. Questionnaires had been sent to people, their relatives and others involved with peoples care. A local advocacy group had been approached to give advice on different ways of involving people in the audit to make their views known. The organisation was undertaking a national staff survey, using an external company. Mrs Irvine said that once the questionnaires had been collated, an action plan would be produced. This would then be monitored regularly and fed into the homes annual development plan and budget. Risk assessments had been carried out on the environment and different tasks that staff members were involved in. Mr Glover told us that he had recently been on a course for health and safety. Action had been taken to address the requirement we made that fire safety Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: procedures must be kept up to date and be specifically related to the service. We also recommended at the last inspection that if any staff needed more training in fire safety, the additional training and an assessment of their competence should be stated. Staff members told us that they had recently undertaken training in fire safety from an external provider. The team co-ordinator had been given the delegated responsibility for making sure necessary checks, drills and maintenance of fire equipment were carried out. We said that the fire risk assessment must be updated following discussion with the Fire and Rescue Authority about the oxygen storage as reported upon in the Environment section of this report. Staff had also trained in infection control, first aid, moving and handling and food hygiene. Care Homes for Adults (18-65 years) Page 30 of 35 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 35 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, Care Homes 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 19 13 Peoples risk of developing pressure damage must be assessed and any risk management strategies set out in their care plan. So that people do not develop pressure sores. 31/03/2010 2 19 13 Staff must receive training in tissue viability. So that peoples risk of developing pressure damage can be assessed and care plans set up to show how any risk is managed and monitored. 01/04/2010 3 20 13 We must be informed of any 31/03/2010 medicine errors. As required by Regulation 37. 4 20 13 Guidance on administering medicine prescribed to be taken when required must include information about 31/03/2010 Care Homes for Adults (18-65 years) Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 why it is given and intervals between doses. So that people are given the right medication when they need it. 5 20 13 Records must be kept of all medication received into the home and returned to the supplying pharmacist. To reduce the risk of people being given the wrong medicine. 6 29 23 The home must consult with the Fire and Rescue Authority to make sure that they comply with safe storage of oxygen cylinders. So that everyone is protected from any unnecessary risks. 7 29 23 There must be suitable storage for different items currently stored in the sitting room and a toilet which cannot be used. So that equipment does not restrict peoples use of rooms and toilets. 8 42 23 After discussion with the Fire 31/03/2010 and Rescue Authority about the safe storage of oxygen, the homes fire risk 31/03/2010 31/03/2010 31/03/2010 Care Homes for Adults (18-65 years) Page 33 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 assessment must be reviewed and updated. So everyones fire safety is taken into account and protected. 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 1 6 Peoples files and other documents must be rationalised. So that only current relevant information is available and more easily accessed. Consideration should be given to peoples cultural and faith needs and observations, in consultation with their family. The sensory area in the sitting room should be made more accessible so that people can use it when they want to and not wait for staff to move chairs and other objects. Size of marks should be recorded on body maps. The part of the medicine policy referring to what action to take if a medication error occurs should be placed with the medicine administration record. This is so that staff members know that they must tell us when this occurs. Hand written entries in the medicine records should be witnessed, signed and dated by two staff. Consideration should be given to providing a gender working policy. So that staff know the boundaries of their work with people of a different gender, and in particular those areas where staff members have to take into consideration peoples best interests or act in an emergency. Consideration should be given to staffing levels so that there are more opportunities for people to have one to one activities. 2 3 13 14 4 5 19 19 6 7 20 31 8 33 Care Homes for Adults (18-65 years) Page 34 of 35 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. Copyright © (2009) Care Quality Commission (CQC). 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