Care Home: Springfield House

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What the care home does well Springfield House provides a generally good facility for the care of people with autism. People living in the home seem to be supported to a good standard and support is tailored to individual needs. There is a good range of activities available for individuals, and transport is provided so people can go out. Staff work in a manner to enable people living in the home to receive appropriate care, and make choices about their lives where this is possible. Staff are viewed positively by people living in the service and their representatives, and staff were observed by the inspector as being hard working and caring. What has improved since the last inspection? We concluded that satisfactory staffing is provided to people using the service. This enables them to have suitable opportunities to participate in activities and be members of the wider community. Medication procedures appear satisfactory, although there are still some minor areas for improvement. An area of damp which was raised as a concern at the last inspection has been treated, and the bedroom we were concerned about seems in a good state of repair. Fire doors were all shut and not wedged open on the day of the inspection. What the care home could do better: There are many positive features of this service. However there are also a number of areas of significant concern which require urgent attention. Subsequently we will be requiring the registered provider to send us an improvement plan outlining what actions will be taken regarding the significant number of statutory requirements which have been issued as a consequence of this inspection. In summary the requirements are that the registered provider must ensure: (1) Office and sleep in facilities are improved for staff. (2) Staff training is improved and records regarding this are improved. (3) An application to register the manager must be submitted. (4) Health and safety risk assessments must be completed, suitable control measures put in place, and documentation must be made available for inspection. (5) The commission must receive notifications required by law of any untoward incidents such as accidents. (6) Quality assurance systems must be improved. This must include evidence that someone designated by the registered provider visits on a monthly basis. Records of these visits must be available for inspection. (7) The system for maintaining, recording and checking monies and valuables belonging to people who use the service, must be improved. (8) Health and safety precautions, including fire precautions, must be improved. The commission will check appropriate action takes place to ensure the Care Homes Regulations are complied with. Key inspection report Care homes for adults (18-65 years) Name: Address: Springfield House, Perrancoombe Springfield House, Perrancoombe Perrancoombe Perranporth Cornwall TR6 0JA     The quality rating for this care home is:   one star adequate 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: Ian Wright     Date: 1 2 0 3 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 38 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Springfield House, Perrancoombe Springfield House, Perrancoombe Perrancoombe Perranporth Cornwall TR6 0JA 01872573538 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): mail@dcact.org Spectrum (Devon and Cornwall Autistic Community Trust) Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: One service user who will be 18 years old on 17/11/2007 may be admitted prior to his 18th birthday. This condition will cease thereafter. The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Springfield House is a care home providing accommodation and care for up to five adults with a learning disability. The registered provider is Spectrum, an organisation that provides specialist services for people with Autistic Spectrum disorders. Spectrum employs a manager and a team of staff to run the home on a day-to-day basis. Care Homes for Adults (18-65 years) Page 4 of 38 Over 65 0 5 Brief description of the care home External, on-call managers are available to provide specialist input, support and advice where necessary. The home is located in the village of Perrancombe on the outskirts of Perranporth, a seaside town with a variety of shops and a popular beach. There are shops within walking distance of the home. The home has a vehicle to provide transport for people using the service who need to access resources in the wider community. The home is a two-storey building. All the bedrooms have en suite bathroom facilities. There is an office on the ground floor. Most of the bedrooms are on the first floor, with one on the ground floor. Access arrangements could be made suitable for people using the service if they had physical disabilities. The home has a large lounge dining area with French doors leading off onto a paved patio area and extensive gardens. The upper part of the garden is securely fenced. The home has some parking space at the front of the building. There is a communal kitchen and ample storage space in the home. Laundry facilities are located in a separate area to the kitchen and dining facilities. The fees range from approximately £1506 to £5472 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the homes management or free of charge from the Care Quality Commission (i.e. from our website or a hard copy can be obtained via our customer services department. Care Homes for Adults (18-65 years) Page 5 of 38 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: one star adequate 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 key inspection took place in ten and a quarter hours in one day. All the key standards were inspected. The methodology used for this inspection was: (1) To case track three people using the service. This included inspecting their records, and where possible discussing their experiences of the service with them. (2) Discussing care practices with staff and management. (3) Inspecting records and the care environment. (4) Carrying out a survey of the views of people using the service, staff and professionals who work with the service Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. Care Homes for Adults (18-65 years) Page 6 of 38 What the care home does well: What has improved since the last inspection? What they could do better: There are many positive features of this service. However there are also a number of areas of significant concern which require urgent attention. Subsequently we will be requiring the registered provider to send us an improvement plan outlining what actions will be taken regarding the significant number of statutory requirements which have been issued as a consequence of this inspection. In summary the requirements are that the registered provider must ensure: (1) Office and sleep in facilities are improved for staff. (2) Staff training is improved and records regarding this are improved. (3) An application to register the manager must be submitted. (4) Health and safety risk assessments must be completed, suitable control measures put in place, and documentation must be made available for inspection. (5) The commission must receive notifications required by law of any untoward incidents such as accidents. (6) Quality assurance systems must be improved. This must include evidence that someone designated by the registered provider visits on a monthly basis. Records of these visits must be available for inspection. (7) The system for maintaining, recording and checking monies and valuables belonging to people who use the service, must be improved. (8) Health and safety precautions, including fire precautions, must be improved. The commission will check appropriate action takes place to ensure the Care Homes Care Homes for Adults (18-65 years) Page 7 of 38 Regulations are complied with. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 38 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 9 of 38 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. Information provided to people who use the service (e.g. regarding services offered) is good. For example all people who use the service (and /or their representatives ) receive a statement of terms and conditions of residency or contract when they move in. This ensures people are aware of their rights and responsibilities. Pre admission assessment procedures are satisfactory and should ensure the registered persons check they can meet the persons needs before admission is arranged. Evidence: We inspected a copy of the homes statement of purpose and service user guide. These contain satisfactory information about the service. The registered provider has a satisfactory assessment procedure. For example prospective clients and their families visit the home before admission is arranged. Senior staff visit the person to meet them as part of the assessment process. The person concerned also visits the home. There has been no admissions to the service since the last inspection. We were able to inspect contracts / statements of terms and conditions of residency for people using the service. Information inspected was satisfactory. Care Homes for Adults (18-65 years) Page 10 of 38 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. Satisfactory care planning procedures are in place. There is satisfactory opportunity for people to participate in making choices and be involved in decision making. Staff enable people using the service to take an appropriate level of risk so they can pursue as independent a lifestyle as possible. These measures ensure the needs of people who use the service are met and they are given the opportunity to make choices how they lead their lives. Evidence: A care plan was contained in the file for each person we case tracked. Care plans are accessible to staff. There is a review process in operation, and people who use the service (and / or their representatives) are invited to review meetings when they occur. From discussion and observation, people who use the service are as much as possible involved in making decisions about their lives, and how the home is run. Where restrictions are in place, these are recorded. Restrictions in place appear appropriate Care Homes for Adults (18-65 years) Page 11 of 38 Evidence: considering peoples needs. Suitable risk taking seems to take place to enable people using the service to live as independently as possible. The home has its own transport, which enable people to participate in community activities. Suitable risk assessments are kept on file, and reviewed as necessary. From our postal survey staff said they either always or usually receive up to date information regarding people who use the service, and information sharing is usually satisfactory. The majority of relatives said they always have enough information about the service to make decisions, and also that the service always meets the needs of the person living in the home. Relatives said people living in the home either always or usually are able to live the life they choose, and the service either always or usually responds to peoples diverse needs (e.g. in regard to disability, gender, age, race and ethnicity,faith and sexual orientation). The inspector had no concerns regarding any of these issues. Care Homes for Adults (18-65 years) Page 12 of 38 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. The registered persons ensure people living in the home can live a lifestyle which meets their needs and wishes. Evidence: People using the service have the opportunity to pursue a range of activities such as going trampolining, social clubs, work placements, swimming and on a wide range of social trips. People also participate in helping with the house work, with the food shopping and other house hold activities. There is evidence from daily records that people participate in a suitable range of activities. People using the service said to us that they always had enough to do, and a wide range of activities were on offer which they enjoyed participating in. People have opportunity to visit friends and relatives and these people also visit the home. Our postal survey said that relatives said the home always helps people using Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: the service to keep in touch with them, and always or usually keeps them up to date regarding important issues. People using the service, who we spoke to, said to us that they could remain in contact with relatives and friends through regular visits and via letter, telephone and email. There is a web cam facility which one person uses to communicate with friends and relatives. Routines in the home seem appropriate according to individual needs. There was a relaxed and friendly atmosphere in the home throughout the time of the inspection. The home has a menu with a suitable range of meals available. Records also show people appear to have a varied and nutritious diet. The people using the service, who we spoke to all said they enjoyed the food, and there was always enough to eat and drink. Care Homes for Adults (18-65 years) Page 14 of 38 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. Personal and health care needs of people living in the home are satisfactorily promoted and met. The management of medication is satisfactory so people using the service and their representatives can be assured medication is managed appropriately. Evidence: We observed people using the service receiving suitable care and support from staff. Support was carried out in a professional, but relaxed and friendly manner. Documentation regarding how care tasks are completed is satisfactorily documented in care plans. People living in the home appear to have their personal hygiene needs met. All people using the service looked well cared for on the day of the inspection. Staff working in the home, who responded to our survey said the staff team worked well together to ensure the needs of people using the service are met, that care is individualised and individual choices are encouraged. The manager said people living in the service have suitable access to health care professionals such as GPs, dentists, district nurses, chiropodists, opticians etc. Records of this support is well documented. Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: We inspected the medication system. The medication policy seems satisfactory. Medication is stored appropriately in a medication cupboard. Although there was not excessive amounts of stock, there was over supply of one type of prescribed medication. Staff need to monitor this carefully to ensure excessive amounts of medication are not ordered from the National Health Service. Other medication is administered via a monitored dosage system supplied by a local pharmacist. Administration records are generally well kept, although we did note one dosage of medication which was not signed for, although it did appear to be administered. The manager said some staff have recently received training regarding the handling of medication, although certificates had not yet been sent to the home by the training provider. Other staff had received training previously regarding this matter and there were records of this training on their files. Administration and recording of medication is satisfactory. Care Homes for Adults (18-65 years) Page 16 of 38 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. The registered persons have satisfactory complaints and adult safeguarding procedures. This should help to ensure any concerns, complaints and safeguarding allegations are investigated appropriately. Evidence: Copies of the complaints and adult safeguarding procedures were inspected and are satisfactory. The registered provider said there had been no complaints about this service, and the commission has also not received any complaints about the service according to our records. Staff who we spoke to, and who answered our survey said they could speak to the manager or another member of senior staff if they had any concerns. In our survey all relatives said they knew how to make a complaint about the service if they needed to. All relatives said the care service always or usually responded appropriately if they, or their relative using the service, had raised any concerns. The registered providers adult safeguarding procedure is satisfactory. Care staff said they would inform the manager if they suspected any abuse had occurred, but all the people we spoke to said they had not witnessed any bad practice or abusive behaviour. The people using the service, who we were able to speak to, all said staff looked after them well, and they had no concerns about staff practices. Staff training regarding safeguarding is delivered to care staff as part of their induction. Care Homes for Adults (18-65 years) Page 17 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Springfield House provides a generally suitable facility for the people living there. However the registered provider must improve sleep in and office facilities for staff members. It is also recommended that the registered provider review the number of people accommodated at the home. Improving facilities will ensure the registered provider meets their legal obligations in regard to staff facilities provided, and there is satisfactory space for the number of people accommodated at the home. Evidence: The building was inspected. The home is registered for five people, and five people are currently accommodated. The house has a large lounge /dining area. There is a reasonably sized kitchen. Staff said the down stairs of the home is due to be re carpeted shortly. The decorations in the home are generally satisfactory, although staff said these were in the process of being up graded. Each person has their own bedroom. Many of the bedrooms have en suite toilets which also include a wash hand basin. Peoples bedrooms are decorated to individual tastes, but all were clean and well presented. The damp area highlighted in the previous report has been addressed. There is a communal bathroom which has suitable fixtures and fittings. One down Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: stairs room is used for a calming area for example if people have challenging behaviour. The home has a pleasant garden which people living in the home can use without staff accompanying them. There is an area which can be used for barbeques in the summer. The home was clean, warm and light enough on the day of the inspection. The kitchen was clean. Laundry facilities are satisfactory. The outside of the building and the gardens were maintained to a satisfactory standard. We received a significant number of concerns about the appropriateness of the building. Some people said there were too many people accommodated in the home. People said due to peoples behaviours, which at times can be challenging, the home could sometimes seem cramped. This is particularly the case as a high number of staff are required to be on duty at any one time. The home has a designated office. This is partially partitioned. The office working area has limited natural light. The other part of the room is used as a sleeping area at night. During the day, one of the people using the service uses the area to eat, and also watch TV. This can compromise confidentiality, for example if staff are on the telephone, they need to have meetings or talk about issues concerning the people using the service. The facility is not satisfactory, but it is difficult to ascertain how it could be improved without a major rethink about the number of people accommodated and / or extension to the building. We raised this matter as a concern when we inspected the service in 2009. We received a high number of comments regarding sleep in arrangements. Currently two members of staff need to sleep in, and one person completes a waking night shift. One member of staff sleeps in the office, and the second person sleeps in the calming room. If and when the calming room has to be used during the night, it is necessary for the person who is sleeping in to vacate the room. This is clearly not a satisfactory arrangement, as the person cannot sleep in and remain off duty elsewhere in the building, while this room is required. This can make it difficult for them to go back to sleep if the disturbance is for a significant period of time. This problem is exacerbated if they have to work a full shift the following day and leave staff feeling very tired. We also received comments regarding the lack of staff facilities in the calming room. Due to the behaviours of people using the service, when the room is required, it needs to be sparsely furnished, as all furniture has to be removed when the room is required Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: for therapeutic reasons. This results in staff sleeping on a mattress on the floor. The room only has vinyl floor covering, and no heater. Subsequently the room can be very cold and uncomfortable for the person sleeping in. The window cannot be opened so the room can be too hot in the summer. The registered provider needs to seriously consider whether the facilities provided meet the regulations under the Health and Safety at Work Act (e.g.1974). The facilities clearly do not meet the current regulations under the Care Standards Act 2000. The current sleep in facilities must be improved to provide satisfactory accommodation for staff. We previously raised concerns about this matter when we inspected in 2009. It is now essential suitable action takes place to ensure staff have satisfactory accommodation when they are sleeping in, and can have a comfortable and undisturbed when they are off duty. In regard to the concerns raised it is advisable that the registered provider reviews the use of the building and its current facilities. However, although we do understand the concerns that staff have expressed, the building is registered to provide care and accommodation for five people under the Care Standards Act 2000. It also would not be appropriate to forcibly move one of the people living in the home to improve facilities. There are plans for one person to move from the house in the summer /autumn of this year. The registered provider will also need to re register the service by October 2010. When these two events occur we request the registered provider to reconsider the current number of people the service is registered for. We request that the registered provider write to us to outline their plans for the service in order to address these issues. In the short term staff should at least be provided with a heater / fan in the calming room for when they are off duty and sleeping in. If the registered provider wishes to continue to provide accommodation for five people, in the longer term, they may be able to extend the building to provide additional sleep in accommodation and/or communal space. We request this response by 1st June 2010. Care Homes for Adults (18-65 years) Page 20 of 38 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. Staffing levels appear satisfactorily to meet the needs of people currently accommodated at the home. Recruitment checks are to a good standard. Improvement is required regarding staff training. First aid training and training updates regarding the management of challenging /aggressive behaviour needs to be prioritised for some staff. This will ensure staff are trained to legal standards. Evidence: On the day of the inspection there were satisfactory numbers of staff on duty. There were seven staff on duty during the day (i.e. within the core time of 08:00-16:00). There were four people on duty in the evening (16:00-22:00). Two staff sleep in (i.e. they are off duty and asleep, although they can and should be woken if there is a need). One person completes a waking night duty (i.e. is awake from 22:00 to 08:00-when they then go off duty). Concerns were raised, when we last inspected in March 2009, that there was sometimes not enough staff for people to carry out activities. The managers present at the inspection said staff were now not as often moved to other homes to complete shifts. Staff responding to our survey said there was sometimes or usually enough staff. Records demonstrated that people living in the home seem to live full lives and participate in a range of activities. Where possible moving staff from the unit to assist Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: other homes should be avoided, if this is to the detriment of people living at Springfield and the service funded by their sponsoring local authority. However it is recognised that such action is necessary in emergencies. Relatives responding to our postal survey said staff always or usually have enough skills and knowledge to meet the needs of people living in the home. Narrative comments said staff treat people well, provide lots of activities and are committed and caring. Staff members regarded the team as friendly and hardworking, although some people said management should be firmer regarding some members of the team who had high levels of sickness and absenteeism. The inspector certainly felt very impressed by the hardworking staff members observed, and that staff seemed very caring and person centred regarding the people living in the home. Even when staff expressed concerns about aspects of the service, this was done in a thoughtful and balanced way. Staff appeared to be knowledgeable about the people they worked with, and demonstrated that they carried out their duties with great skill. These views were matched by what the people using the service said to us. Personnel records were inspected for the staff on duty for the day of the inspection. These were satisfactory.Staff employed had two references, a Protection of Vulnerable Adults First check (POVA First) , a Criminal Records Bureau check (CRB) , a completed application form and evidence of identification. It would be helpful if a scanned copy of the POVA First check is stored with other personnel records on the Spectrum records system. This will help us validate this check has been completed before the member of staff has commenced employment. We inspected training records for the same sample group of staff. By law staff require the following training: * Regular fire training in accordance with the requirements of the fire authority. *There must always be at least one first aider on duty (at appointed person level) *All staff must have manual handling training and should have regular updates of this (e.g. annually) *All staff must have basic training in infection control. * Staff who handle food receive food hygiene training. * All staff must have an induction and there needs to be a record of this. * Awareness training regarding the needs of people accommodated. For example it is essential that staff have theoretical and practical training regarding dealing with challenging behaviour and aggression. The delivery of training is generally satisfactory. The registered provider offers staff a comprehensive staff induction which covers the majority of the elements required by law. Staff subsequently attend follow up training which covers the areas in more Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: detail. However, some of the staff files inspected show that some of the staff still need to attend training for example in first aid, food handling, and infection control training. In house induction records were, in some cases, also incomplete. Records regarding staff attending training regarding dealing with challenging behaviour and aggression were not complete. This training meets recognised national standards and appears appropriate to help staff to manage people using the service with their challenging behaviour. However some staff did not appear to have received an annual update regarding this training. For example several people last appeared to have received either the basic training or an update in the training in the autumn /winter of 2008. One person, who had commenced employment in October 2008 did not appear to have received the training over and above the half day introductory training during their induction. The apparent gaps in training may be a result of inaccurate record keeping. The organisation has a computerised personnel record keeping system. However, we have found this is not always reliable. Managers within the homes have generally developed a paper based system to compensate for the gaps in effectiveness of the computerised system. By using the two systems we can generally create a more comprehensive picture of training that staff have received. However, this is still not totally accurate. For example a member of staff confirmed to us what training they had received, but this did not match with our audit of the organisations systems. It would be wise for the organisation to improve the accuracy of its computerised systems, and therefore avoid duplication of information by staff in the home having to keep a secondary system. We have however given a statutory requirement regarding improving the training provision, although we hope that the shortfall is a result of the need to improve record keeping rather than primarily the need to improve training delivery. The registered provider also has a system of competencies. This involves a senior and/or more experienced member of staff observing a new member of staffs practice, before they are given the opportunity to do the task alone. (For example the administration of medication). This is a good system, but the records for some members of staff were incomplete, and this aspect of staff training needs to be addressed. There is opportunities for staff to obtain a National Vocational Qualification in care. When staff have received an NVQ 2 there is the opportunity to obtain an NVQ 3 in care if this is deemed by management as appropriate. Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: Staff interviews and the postal survey we completed showed that staff were generally positive about induction and training. Relatives also responded to the postal survey that they thought staff were either usually or always knowledgeable and skilled regarding working with people using the service. Care Homes for Adults (18-65 years) Page 24 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are required to most aspects of this area of the report i.e. in regard to management arrangements, the quality assurance system, the management of monies belonging to people using the service, policies and procedures and health and safety. Improvements to these areas will ensure the service is managed more effectively. Evidence: The registered provider is Spectrum, a registered charity supporting people with autism / aspergers syndrome. A manager is also in post, but has not been registered with CQC or the previous regulator; the Commission for Social Care Inspection. People answering our survey were positive about the organisation. For example people said the organisation had a positive attitude to working with people with autism and strongly encouraged staff to work in a person centred manner. We also found this evident, from staff practise, through out the inspection. Some comments were received from staff regarding the need of the manager to Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: improve organisation and support in the home, although the manager was generally viewed as approachable, friendly and a nice person. We are concerned that at the time of the inspection the Commission had not received an application for the manager to be registered with the Care Quality Commission. At the time of the last inspection, in March 2009 we were awaiting the application, and it is of significant concern that the registered provider has been carrying on the home illegally (i.e. without a registered manager) for such a significant period of time. We understand there have been a number of mitigating circumstances such as the Criminal Records Bureau check getting lost in the mail, and this process then having to be repeated. However, it is essential that the registered provider monitors the situation of its services not having applications submitted for its managers to be registered with CQC much more carefully. This will ensure the registered provider is working within the legal framework of the Care Standards Act 2000 more effectively. The inspector met both the manager of the home and the deputy of the home. The deputy has only worked at the home for a short period of time. Both seemed pleasant and approachable, and the staff we spoke to spoke positively about them. We are also concerned that we have not received a completed Annual Quality Assurance Assessment (AQAA) (an annual dataset, and self assessment required by CQC). Although our records show this was sent to the registered provider on 6/1/2010, for return by 3/2/2010 this was not received. The manager said the document had not been received by him, so we have reset the deadline for return to 6/4/2010. There is also a problem with the receipt of notifications required by the commission. These involve the reporting of accidents and other incidents which is required by law. According to our records we have not received any notifications under regulation 37 of the Care Homes Regulations 2001. The manager however has a file of incidents which should have been notified to us. These either have not been forwarded to the registered providers office, the registered provider has not forwarded them to CQC or the CQC office has not forwarded the information on to the inspector. It is essential that notifications which we require the provider to notify us of, our sent to CQC. There are also incomplete records of visits required by the registered provider to the home. We did view one report of a visit which occurred in the last month, but other records of visits to check the quality of the service, and to check regulatory matters are being addressed, were not available for inspection. It is essential these visits are carried out on a monthly basis, and the reports of the visits are maintained in the care Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: home. Otherwise the registered provider generally has a good approach to quality assurance. This includes the manager of the home completing a monthly report of the home to the registered provider, regular surveys of people using the service and other stakeholders and the completion of an annual development plan. However the registered provider needs to develop a written policy regarding quality assurance, and ensure this is contained within the service policy file. The implementation of the organisations approach to quality assurance, at this home, does need to be improved. For example: (1) The monthly reports from the manager to the registered provider should be made available for inspection (We were only presented with one report). (2) We were not presented with copies of surveys from stakeholders completed in the last year. We were shown some surveys which were contained in one persons file, but surveys for stakeholders with regard to other people were not presented to us. (3) An annual development plan was available for 2008, this had only been reviewed in 2009, but not re completed. Staff raised concerns regarding the frequency of staff meetings at the home. Staff said there had not been a meeting for several months, and they believed it was important the staff team got together to discuss a number of issues affecting people using the service, and the staff group. The agenda on the notice board showed the meeting had been cancelled twice since the beginning of the year. The staff members who raised concerns all recognised that it was logistically difficult to arrange cover for the meeting. Cover requires several staff to come to the home from another unit, and these people all needed to be familiar with the needs of the due to the complexity of their needs. The commission would recommend that such meetings do occur at least quarterly, even if the staff group has to meet in two groups separately rather than one large group. Some of the issues on the agenda may also be able to be resolved in other ways for example via email to team members or messages in the communication book. In the previous report in March 2009 concerns were raised to us about the frequency of staff supervision. This matter has again been raised to us via staff interviews and surveys. Staff raised concerns about the support they received. Responses from our postal survey ranged from satisfactory support being received Regularly to Never. However the majority of people responding said they Often received satisfactory Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: levels of support. The inspector does recognise that it must be a difficult task to manage this home. The deputy of the home has only been in post for a short period of time so the current management team is just developing to work together in a cohesive manner. Added to this is the size of the staff team (approximately 20 people) and the complexity of the needs of the people using the service, who can also have needs which can be very challenging. It is important the management group now has time to develop so management systems can improve. The report rates this service as adequate overall. This is purely due to this section of the report being rated as adequate. Further work to develop standards in this area will result in the home being rated as good as long as other standards are maintained. Some people we interviewed said they did not have one to one meetings with a manager at the home as frequently as they thought they should do. This caused them to feel they were not receiving appropriate levels of support. It is a concern this is still an issue, as the matter was raised at the last inspection and it still does not appear to have been resolved. Staff said the management group in the home were trying to implement a supervision system. The home now has a new deputy, and it is planned that the deputy formally supervises half the staff group, and the manager the other half. This will still be a huge task due to the size of the team, and the demands placed on management and team members. We also recognise the current staff facilities are inadequate so people cannot have a confidential private meeting in the rooms provided. However, one to one supervision should be recognised as a core management task, and it is important managers are trained to provide and deliver this duty on a regular basis. Personal monies are managed by staff on behalf of people using the service. Money is held in a filing cabinet, in cash tins. The cash tins are locked and the keys are kept separately. However the filing cabinet is not locked. Staff said the office is always locked if staff are not present. However we are aware that part of the room is used by one person to have their meals and watch TV. It is important security of monies is improved and they are kept in a lockable cupboard or safe. The deputy manager assured the inspector this matter would be rectified as soon as possible. There is a record of expenditure of the monies belonging to people using the service. However there appeared to be some minor discrepancies between what was recorded in records of peoples monies and cash held in peoples cash tins. This is particularly of concern as the records had just been audited by staff in the organisations office, and it was not clear if the reasons for the discrepancies had been picked up, and what action would take place to resolve them. Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: Management need to ensure systems are improved to avoid such discrepancies occurring-for example staff should regularly check cash held against totals in records, and ensure records are kept up to date. There should also be a clearer system of recording when money is taken out of peoples tins, for what purpose, and by whom. It was clear in one case, money was taken out, but there was no date, no record why, and no record who had taken the money out or when it would be returned. The system therefore needs to be improved in this, and the other homes managed by the organisation. The organisation has a range of policies and procedures. These are contained in a policy file although some policies such as the organisations Safeguarding policy are not contained in the file. The majority of policies were written in 2003 and there is no record that these have been reviewed on an annual basis. We understand that the organisation is in the process of reviewing and updating all of its policies. This should be done as soon as possible and new policies issued to each home in a comprehensive policy file or via an intranet electronic system. The registered provider has a health and safety policy. This is satisfactory. A fire risk assessment is in place. We raised concerns about checks taking place on the fire prevention system. The form which is being completed on a weekly basis only seems to primarily cover checks on fire exits and fire blankets. There appears to be some checks completed on fire lighting (e.g. 23/3/10). There was also a record regarding when fire evacuations had occurred. No other records were available for inspection. One of the organisations managers said that unit managers are required to check the fire system on a weekly basis, and email the return to the organisations office. However, these records were not made available to us for inspection. It is essential that fire call points (of the fire alarm), fire lighting, fire doors, fire extinguishers etc. are checked according to frequencies and to other requirements of the fire authority. Clear records must be made available for inspection. There was a record of external contractors visits to test the fire system and fire extinguishers. However we raised a concern regarding recommendations made in the report by one of the contractors as it was not clear whether these had been actioned (i.e. report by Fire Crest 2/9/2009). We were not presented with a record that health and safety risk assessments have been completed or any action taken to minimise any highlighted risks. This should include a risk assessment regarding the prevention of legionella. Records also need to be kept regarding a testing routine for this. Suitable records regarding accidents and Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: incidents are kept. Portable electrical appliances have been tested and appear satisfactory. The electrical hardwire circuit was tested on 27/11/2008. However the contractor deemed the circuit to be unsatisfactory. Some work required was deemed as urgent. It was not clear whether remedial work had been completed after this test. There is an oil heating system. There is no record the system has been serviced in the last year. An up to date certificate of insurance is displayed. Care Homes for Adults (18-65 years) Page 30 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 37 7, 8, 9 The registered provider must 01/06/2009 submit an application for there to be a registered manager at the home. This will help ensure people who use the service know that the manager of the home is legally accountable for its operation. Care Homes for Adults (18-65 years) Page 31 of 38 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 24 23 The registered provider must ensure there are appropriate office and sleep in facilities for staff members. This will ensure staff have satisfactory facilities to work confidentially, and to sleep in, when they are not on duty. 01/11/2010 2 35 18 Staff need to receive 01/06/2010 training as outlined in the body of the report. Staff training regarding first aid and the management of challenging /aggressive behaviour needs to be prioritised. Improvements may also be required regarding the record keeping of training provided to staff. This will ensure all staff have appropriate knowledge and skills, in accordance with the law and to meet the needs Care Homes for Adults (18-65 years) Page 32 of 38 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 of the people accommodated in the home. 3 37 7 An application to register the 01/05/2010 manager of the home must be submitted (Previous timescale of 01/06/2009 not met. Second Notification) This will ensure the registered provider is carrying on the home according to the requirements of the Care Standards Act 2000, and associated regulations. The registered provider must ensure notifications regarding accidents and untoward incidents are notified to the commission without delay. This will help ensure the commission is made aware of any incidents, and subsequent action taken by the registered provider so we can be assured people using the service are safeguarded. 5 37 26 The registered provider must ensure a designated person visits the service on a monthly basis, and prepares a report regarding the visit. A copy of the 01/04/2010 01/04/2010 4 37 37 Care Homes for Adults (18-65 years) Page 33 of 38 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 report must be made available for inspection. This will provide the commission with more assurance the registered provider is monitoring the quality of the service. 6 39 24 The registered provider must ensure there is a quality assurance procedure and a satisfactory quality assurance system is implemented. This will provide people who use the service, and other stakeholders, with more assurance there is a process of checking compliance with the Care Homes Regulations, and a process of continuous improvement for the service. 7 41 13 The registered provider 01/05/2010 must ensure there is a satisfactory system for the safekeeping of monies and valuables belonging to people who use the service. This needs to ensure satisfactory systems are in place to ensure monies and valuables kept are checked and balances of monies kept are correct. 01/05/2010 Care Homes for Adults (18-65 years) Page 34 of 38 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 This will provide more assurance that the property looked after, on behalf of people using the service, is looked after with greater care. 8 42 12 Ensure there is a 01/05/2010 satisfactory system of health and safety risk assessment regarding matters required by regulation. Risk assessments, and plans outlining any measures to reduce any risks identified, must be available for inspection. This will help to ensure staff, visitors and people who use the service are protected from any risks which could result in accident or injury. 9 43 12 The registered provider 01/05/2010 must improve health and safety precautions in the home. This must include: (a) Ensuring checks on the fire system take place according to the frequencies recommended by the fire authority. Records must be maintained and made available for inspection. (b) Clarify whether actions recommended by the service engineer have been Care Homes for Adults (18-65 years) Page 35 of 38 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 implemented to ensure the fire system is safe and complies with current regulations. Records should be maintained to verify suitable action has taken place. (c) Ensure there is an appropriate system of health and safety risk assessment. This needs to include an action plan outlining how any identified risks are minimised. These records must be made available for inspection. (d) Ensure any remedial action takes place to ensure the buildings electrical circuit is deemed safe. The system needs to be retested, and documentation obtained to demonstrate appropriate action has taken place (e) The heating system needs to be serviced on an annual basis, and there needs to be evidence it is deemed as safe. Suitable records must be made available for inspection regarding these matters These measures will ensure people who use the service and staff live and work in a safe environment. Care Homes for Adults (18-65 years) Page 36 of 38 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 24 Review the number of people accommodated at the home. Provide the commission, by 1/6/2010 with a copy of the written plan regarding any action to be taken to improve facilities in the future. The registered provider should ensure there are regular staff meetings in the home. The registered provider should ensure staff members receive one to one supervision on a regular basis (for example at least six times a year) The registered provider should ensure policies and procedures are reviewed and updated where this is appropriate 2 3 38 38 4 40 Care Homes for Adults (18-65 years) Page 37 of 38 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). 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. 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