Care Home: Spurfield House

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What the care home does well People told us they enjoyed living at Spurfield House and praised the manager and staff team for the support they provided. Comments from people living in the home included "This home keeps us safe, well fed and occupied. I have had some very happy days here". The staff team were enthusiastic and positive and told us how much they enjoy working in the home. They talked about the training and support provided and felt the home was well managed. The home has followed good admission procedures. People have been given plenty of opportunities to visit and get to know the home before any decision to move in permanently has been made. They have taken care to find out as much as possible about the person, and to make certain they have the skills and facilities to give the person the support they need. Two health professionals who were visiting the home on the day of this inspection praised the way the staff team have supported people to help them work towards greater independence. They told us that the staff team have been very keen to listen to advice and guidance and have demonstrated good practice. One person has recently moved from the home into more independent accommodation and we heard how the home has continued to support this person to ensure the move is successful. We heard many examples of how people were able to make choices and take risks in all aspects of their lives. The staff team offered guidance and enabled people to minimise risks where possible, but did not restrict people in any way. There were good procedures in place to make sure people were protected from abuse. All staff have received training on the protection of vulnerable adults. What has improved since the last inspection? Work has been carried out on the care plans to make the information easier to read. A new care planning document has been introduced that has been written following close consultation with each person. The document has been drawn up in the words of the person, and signed by them to agree the content. The plans gave some useful and important information to the staff team about the person, their goals, and how they wanted the staff team to support them to reach those goals. The level of activities, education and work opportunities for people have increased. While there is still room for further improvement, we saw much more evidence of people leading interesting and fulfilling lives than we saw at our last inspection. The new staff team have introduced a number of new regular activities and interests for people. We saw and heard evidence of people going out more, gaining greater confidence, and developing new skills. There was a happy and lively atmosphere throughout the home. The home has recently employed a new cook and they have been working to improve the quality of the food offered with an emphasis on healthy eating. The staff team talked about how they have offered guidance and support to people about their dietand level of exercise. Since the last inspection a number of new permanent staff have been employed. We heard how the new staff have demonstrated a positive atmosphere and the atmosphere was happier and more positive. In addition to the new cook they have also employed a cleaner - her appointment has improved the level of cleanliness of the home and made the home a safer and more pleasant place to live. What the care home could do better: Medications procedures have improved, but more still needs to be done to make the systems safe. Safe storage must be provided for any controlled drugs that may be prescribed in the future. All gaps in medication records must be followed up promptly and advice from a pharmacist or health professional sought quickly if a mistake or omission has been made. The home should consider strategies they could follow to help people move towards greater control over their medications, and where possible to enable more people to self medicate. A new refrigerator has been purchased for medicines that need to be kept cool. The temperature must be checked regularly to make sure medicines are stored at the right temperature. While the home generally appears comfortable, bright and homely there were some areas that could be improved. We were assured that quotes have been obtained to redecorate the outside of the house and some of the communal areas inside. They hope that the quotes will be approved and the work will be carried out in the near future. The front gardens are attractive with large lawns and mature trees and shrubs. However, at the back of the house there were unsightly patches of weeds and worn garden furniture in an area that people regularly sit, and an area that is used for barbeque`s. This area needs to be tidied and made more attractive. Inside the home we saw some bedrooms that could be made more attractive and comfortable and to help people demonstrate a sense of pride in the home. These included attention to bedroom curtains, bed heads, and bed linen. Good recruitment procedures have been followed to make sure that new staff are entirely suitable, although we recommended that the home always obtains at least two written references in addition to any verbal references. This is to provide evidence to confirm the references are genuine and from a reliable source. Due to the recent changes in the staff team many of the new staff do not hold a relevant qualifification. We heard that two new staff are about to start on a training course, but the home should continue to increase the level of training and qualifications to ensure the home meets the recommended level of at least 50% of staff with a relevant qualification. Training on relevant health and care topics should also be increased. We asked the home to seek advice on safe laundry facilities to prevent the risk of cross contamination. The home told us they were actively seeking alternative storage arrangements for clean laundry to address this. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Spurfield House Main Road Exminster Exeter Devon EX6 8BU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivien Stephens     Date: 1 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Spurfield House Main Road Exminster Exeter Devon EX6 8BU 013928322145 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) : Spurfield.House@Guinness.org.uk Guinness Care and Support Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 12 The maximum number of service users who can be accommodated is 12. 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: Mental disorder (Code MD) Date of last inspection Brief description of the care home Spurfield House is a grade two listed building set in its own grounds in the heart of the village of Exminster and just five miles from Exeter City centre. It is a large detached building that has a long drive from the front entrance, on the main road through Exminster, leading to ample parking at the front of the building. Inside there is a large vestibule with the lounge and dining room to the right and a staircase leading to the upper floors. Further rooms and office space can be found on the left side of the ground floor. The home is registered to provide personal care for up to 12 adults who have enduring Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home mental health problems. Spurfield House is owned and managed by Guinness Care and Support. Fees levels have been determined by the local authority who have a block contact with the home. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . A copy of the most recent Commission inspection report is displayed in the front entrance hall. 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: Several weeks before this inspection took place we asked the home to complete and Annual Quality Assurance Assessment (AQAA). They completed it and returned it when we asked for it. The document gave us some useful information about how the home is run. We also sent some survey forms to the home and asked them to distribute to a random selection of people living in the home, staff, and health and social care professionals. We received 4 replies from people living in the home, 7 from staff, and 3 from health and social care professionals. Their responses helped us to form the judgements we have reached in this report. The inspection took place over two half days. During that time we talked to the manager, three members of staff, three people who live in the home, one person who Care Homes for Adults (18-65 years) Page 6 of 35 previously lived in the home, and two visiting professionals. During the inspection we carried out a tour of the home and we looked at some of the records the home is required to keep, including assessment and care plan files, staff recruitment, supervision and training records and staff rotas, medication storage and administration, and records of cash held on behalf of people. What the care home does well: What has improved since the last inspection? Work has been carried out on the care plans to make the information easier to read. A new care planning document has been introduced that has been written following close consultation with each person. The document has been drawn up in the words of the person, and signed by them to agree the content. The plans gave some useful and important information to the staff team about the person, their goals, and how they wanted the staff team to support them to reach those goals. The level of activities, education and work opportunities for people have increased. While there is still room for further improvement, we saw much more evidence of people leading interesting and fulfilling lives than we saw at our last inspection. The new staff team have introduced a number of new regular activities and interests for people. We saw and heard evidence of people going out more, gaining greater confidence, and developing new skills. There was a happy and lively atmosphere throughout the home. The home has recently employed a new cook and they have been working to improve the quality of the food offered with an emphasis on healthy eating. The staff team talked about how they have offered guidance and support to people about their diet Care Homes for Adults (18-65 years) Page 8 of 35 and level of exercise. Since the last inspection a number of new permanent staff have been employed. We heard how the new staff have demonstrated a positive atmosphere and the atmosphere was happier and more positive. In addition to the new cook they have also employed a cleaner - her appointment has improved the level of cleanliness of the home and made the home a safer and more pleasant place to live. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 9 of 35 following this report, you can contact them using the details set out 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 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. People who are thinking about moving into the home can be confident they will be given plenty of information and opportunities to get to know the home and their needs will be fully assessed before any decision to move in permanently is made. Evidence: Since the last inspection one person has moved into the home and one person was in the process of moving in at the time of this inspection. We heard about the careful admission procedure involving a number of visits to the home to help the people get to know the home and decide if it is the the right place for them. One person was visiting the home on the day of this inspection. The person was able to use the vacant bedroom they would have if they moved in permanently as a place to go if they wanted a quiet place to sit during the day. We looked at the assessment documents the home has used to gather information about each person before they moved in permanently. These provided detailed and useful information. In addition the home had obtained information from the persons Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: care manager and other people involved in each persons care. We also heard how the manager had consulted with the other people living in the home to find out if they felt each potential new owner would fit in. In this way everyone was involved in getting to know the potential new residents and making them feel welcomed. The home gives people who are thinking about moving in a copy of their updated statement of purpose and service user guide. Care Homes for Adults (18-65 years) Page 13 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 can be confident that the home will work alongside them to draw up and agree a plan of the support they will need so that they can look forward to a more independent life. People are encouraged to take risks and make choices to help them take control of their own lives. Evidence: We looked at three care plan files and talked to the manager and some of the staff to find out the systems that were in place to inform the staff about the support and guidance each person needed. We also talked to three people who live in the home, and one person who recently moved out, to find out if they felt the staff gave them the support they wanted and needed. Since the last inspection the home has made further improvements to the care plans. They had developed a new document that explained, in the persons own words, what their goals were, and the support they needed from the home to help them reach Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: those goals. The manager explained how they had consulted with each person about the wording and information in the plans, and we saw evidence of changes to the wording where a person had requested it. The plans gave good information about peoples care needs and were easy to read. People have signed the plans to show they agree with the content. We talked to two Care and Support Workers employed by the Health Authority who have been visiting the home recently. They described how they have worked with the staff team to help them provide the right level of support to help people work towards greater independence. They praised the attitude of the staff team and told us Primrose is an excellent manager and explained how she had lead her staff team by demonstrating examples of good practice. They explained how they had been working with the staff to help them walk alongside people to help them regain their independence. The staff we talked to and those who completed a survey form before this inspection confirmed that they have been given plenty of information and support and they felt they had good access to care plans and information about each persons needs. We saw handover notes and communication systems to show that staff are kept up to date. One member of staff who completed a survey form before this inspection told us Spurfield has got the balance right for the needs of the residents, with the integration into the community and with the view of leaving and living independently. We heard that the home has recently started working towards introducing a key worker system. They have split the staff into 2 teams, and each team will be allocated half of the residents group. They hope that, in the future, they may be able to allocate an individual key worker for each person living in the home. We looked at how the home helps people work towards moving on and becoming more independent. One person who had recently moved from the home into supported accommodation came back to visit friends at Spurfield House. The manager, Primrose Bond, explained that they continue offering support even when people have left as they feel this approach is likely to result in the move being successful. The home told us that they help people to take control of their lives through weekly residents meetings, one to one discussions, and through organised activities both in the home and outside the home. We saw evidence of how the home supported people to take risks and lead their lives as they wished by offering advice and guidance. People we talked to confirmed they were never prevented from doing anything they Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: wanted to do, and the staff were never bossy or controlling. Advice and guidance has also been sought from other professionals in specific areas of risk. Care Homes for Adults (18-65 years) Page 16 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. The level of activities, education, work and social opportunities have increased in the last year and people now lead interesting and fulfilling lives. The home provides a healthy and nutritious range of meals to suit all dietary needs. People have been fully involved in menu planning and encouraged to develop cooking skills as part of the goal towards independence. Evidence: Since the last inspection one member of staff who was off sick has returned to work, and some new permanent members of staff have been recruited. At the time of this inspection they had a full complement of staff, and this has enabled them to look at how they could increase the opportunities for fulfilling activities and employment opportunities for each person. The staff we talked to were positive and enthusiastic Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: and talked about how they had worked with the people living in the home to introduce many new regular activities. People told us about some of the work and education opportunities they have had. One person has attended Exeter College regularly, while another person worked as a cook in another care home. This person had undertaken first aid and food hygiene training. One person had trained as a painter and decorator and the home planned to make use of these skills in the near future. Around the home we saw paintings displayed that had been created in the regular arts and crafts sessions. We also heard about a weekly knitting group that some of the women living in the home had organised. Some of the women also enjoyed a regular pampering group during which they had a range of beauty treatments. The home has a karaoke machine and we heard about the fun people have had during karaoke evenings in the home. On the day of this inspection some people went out for the day either to Exeter or to Teignmouth. The home is on a bus route and many people had bus passes. Some people regularly attended groups or social events in Exeter, including football and bingo. We also heard about theatre trips, coffee mornings and jumble sales. The home has a vehicle to take people out. They often organised group outings, particularly at weekends. The home has not organised holidays for people for many years, but the manager told us they have started to make enquiries about the possibility of arranging holidays for people this year. Some people also talked about how they make use of the village facilities. They regularly enjoy trips to the local cafe and pub. Some attended church services regularly. We also heard about how people kept in touch with their families and friends. Some regularly went to visit friends and families while others kept in touch by telephone. In the last year the home has worked towards offering people a more healthy and nutritious diet. They have recently appointed a cook who will be looking at making further improvements to the range of meals offered. At the time of this inspection the menus were based on a four weekly rota that provided a good variety of meals. We talked to one member of staff who took a keen interest in healthy lifestyles and she told us how the home had given people advice and support on adopting a healthy lifestyle. More healthy foods had been gradually introduced including fresh fruit, and Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: sugar and salt levels have been reduced where possible. One person who completed a survey form before this inspection told us the food is good and very healthy. Menus have been discussed during the weekly residents meetings. Several people told us how they enjoy cooking their own meals and talked about their cooking skills. People have also been involved in meal planning by helping out with the weekly food shopping. The home keeps a record of the meals actually eaten by people. The manager explained how they offer advice and suitable alternatives to people who do not eat the main meals on offer. Care Homes for Adults (18-65 years) Page 19 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 well supported by staff in all of their personal, emotional and health care needs. While improvements have been made in the last year in the storage and administration of medicines, further action is needed to ensure people receive the correct medicines, and to help people work towards holding and managing their own medications safely. Evidence: We looked at three care plan files and talked to Primrose Bond, three members of staff and three people living in the home to find out how people were supported with personal and health care needs. Most people were entirely able to look after their own personal hygiene tasks, although care plans gave guidance to staff on how to offer advice and support where needed. There was a good balance of male and female staff so that there should always be a member of staff of the same sex on duty if support was needed with personal care. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: In the last year there have been regular pampering evenings for the women who live in the home. Some of the women we talked to enjoyed wearing fashionable clothing, and having their nails painted and their hair coloured or styled. The home has sought advice and guidance from health and social care professionals for people with specific health problems. While no training courses have been provided to staff on specific illnesses, we were shown a range of information in the home that staff have been encouraged to read on such topics as diabetes, schizophrenia and epilepsy. The manager told us that they have been concentrating on getting new staff through induction and health and safety related topics but would offer training on health topics as soon as courses become available. We heard how the home has maintained good relationships with the local health professionals and have consulted with GPs where necessary. Comments from health professionals who completed a survey form included - (in response to What does the home do well?) Try to give as normal life as possible within the significant restraint of their budget. Communicates well with other agencies. Supports residents when they are in hospital. Welcomes staff from other agencies. Very good communication with the GP surgery. Staff and residents respond well to our visits and I am not currently aware of any major concerns. In the last year people have had their medications reviewed by their GP or a health specialist where requested by the home. We looked at the way the home stores and administers medications. They use monthly monitored dosage packs supplied by a local pharmacy. At the last inspection we found that some aspects of medicine storage and administration were unsatisfactory and during this inspection we looked at the actions they had taken to address the requirements we made. They had updated their policy on the safe administration of medicines. At the time of this inspection no controlled drugs were held in the home. They did not have suitable storage in the home if controlled drugs are prescribed in the future. We advised the home to seek advice on suitable storage facilities from their pharmacist. Since the last inspection a refrigerator has been provided for medicines that must be kept cool. Temperatures have not been checked regularly - this is recommended to ensure the medicines are kept at the correct temperature and therefore remain effective. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: While some staff had received training on the safe administration of medicines at the time of the last inspection many of these have since left. New staff have not yet received accredited training on this topic. At the last inspection we found unexplained gaps in the medicine administration records. At this inspection the number of gaps were less, and a senior member of staff showed us how he had checked the medicine administration charts on a weekly basis and had checked to make sure the medication had actually been taken (this was recorded on the back of the administration records. We were concerned that the weekly checks did not provide adequate safeguards for people who may have missed vital medications. We advised that action must be taken promptly as soon as the next member of staff notices a gap in the medicine administration charts. All staff who administer medicines must be fully aware of the risks to people if a medicine is missed and what actions they must take. The home have introduced a system for checking the balances of stocks held at the end of each month. This system demonstrated good practice. The home has continued to help some people hold and manage their own medicines. This demonstrated good practice. However, for other people the home continues to hold and administer medicines. We looked at the care plans and talked to the manager and staff about strategies for helping people work towards holding and managing their own medicines. No strategies had been identified - this is recommended. Care Homes for Adults (18-65 years) Page 22 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. People can be confident that they can raise concerns or complaints and know they will be listened to and acted upon. Staff understand the principles of supporting people and know what to do if they have any concerns about poor practice or abuse. Evidence: Since the last inspection no new complaints have been received by the Commission about the home. The home told us they had received two complaints in the last year but these related to a complaint that was received at the time of the last inspection. The matter was investigated by senior Guinness Trust staff and took several months to investigate but has now been satisfactorily concluded. The home told us in their annual quality assurance assessment We try and listen to any and every issue, however trivial in its nature and advise or react on it to relevant people concerned - to ensure safety for the service user. Having an Open Door Policy ensure the approachability for anyone to come and discuss any issue at any time and know they will be kept well informed. Service users/staff as well as community teams, care co-ordinators, families and relatives are aware of whom to voice concern to if they have an issue. The people who completed a survey form before this inspection, and those we spoke to during this inspection told us they knew how to make a complaint. The staff told us Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: they knew what to do if someone had a concern about the home. Advocacy meetings are held in the home every month organised by the organisation known as MIND. All staff have received training on the protection of vulnerable people. At the time of this inspection we heard that each person handled their own income, savings and financial affairs. However, four people had asked the home to look after small amounts of cash to help them budget for day to day items such as cigarettes and toiletries. The cash was held in individual locked cash tins and good records had been kept to show the amounts taken out and balances held. Each transaction had been signed by the member of staff and the person to confirm the balances. Care Homes for Adults (18-65 years) Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in comfortable and homely surroundings, although some areas would benefit from redecoration, maintenance and improvement to make the home more attractive and safe. Evidence: During our visit we toured the home and looked in three bedrooms, some of the communal bathrooms and toilets, the lounge, dining room, kitchen, smoking room, laundry and gardens. The gardens are large and laid mainly to lawns with trees and shrubs. While some people liked to sit outside at the front of the house where the gardens were pleasant we saw some people sitting at the back of the house where it was more sheltered. This area was also used at times for barbecues. There were patches of weeds where flower beds had been left untended and the garden furniture was shabby. We talked to the manager about the possibility of making this area more attractive. The exterior paintwork was showing signs of wear and many areas of paintwork were peeling and looked shabby. The manager told us and estimate for repainting the building had been obtained and had been submitted to the Guinness trust for approval. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: She hoped the work would be carried out in the near future. While the general appearance of the home was comfortable and homely there were a few areas that had not been decorated for several years and would benefit from attention to make the home brighter. Primrose Bond told us that an estimate has been obtained for decoration of some of the communal areas including the hall, staircase and corridors. She hoped the once the estimates have been approved the work will be carried out in the near future. The smoking room ceiling had large cobwebs hanging from it and needed cleaning or decorating. While some of the bedrooms appeared attractive and comfortable, in one room the curtains were too short and appeared shabby and unattractive. We talked to the manager who assured us they would find a more suitable pair of curtains. we also noted that one bed did not have a headboard and others did not have valances covering the bed bases. The overall appearance of these bedrooms was a lack of care and homeliness. We talked to Primrose Bond and a senior member of staff about ways the home could support people to make their bedrooms more attractive and comfortable. We also discussed the possibility of providing more furniture for storage where necessary. All bedroom doors have locks and people have the key to their rooms. The home has recently employed a cleaner who has shown dedication in her work and works alongside the people living in the home to keep all areas clean, fresh and hygienic. One member of staff told us Cleanliness has improved since the last inspection since the employment of a cleaner. Internal decoration is still needed but awaiting quote to be sanctioned. We looked at the laundry arrangements. The laundry room is very small with two washing machines and two tumble driers. There is no sink. Clean laundry was stored in this room and was stacked next to the washing machines. we were concerned about infection control measures and the risk of cross contamination. We asked the home to seek advice from the health Protection Agency and/or the Environmental Health Service. On the second day of this inspection we heard that they had identified an area to move the clean laundry to as long as it did not pose any other safety risks. They were in the process of seeking advice. Care Homes for Adults (18-65 years) Page 26 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. The staff team have been carefully recruited, and have the skills, training and management support to help them make a positive difference to peoples lives. Evidence: At the time of this inspection there were six full time care staff, four part time care staff, a cleaner and a cook employed by the home. On the day of this inspection there was a manager, two care staff, a cook and a claener on duty during the day. The staff rota showed that at night there is normally one waking and one sleeping-in member of staff on duty. At the last inspection we found that there were insufficient staff employed to meet the needs of the people living in the home. Since the last inspection there have been a number of staff changes. Some staff who were employed by a health trust have been re-deployed while some have left for various personal reasons. The employment of a cook and a cleaner has freed up staff time to do other work with people. We heard a number of comments about the positive attitude of the new staff employed and the happy atmosphere within the home since their employment. The staff we Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: talked to were enthusiastic and had introduced many improvements to the home. We heard how all staff have worked closely together as a team. We looked at the recruitment files of four staff employed since the last inspection. We found that the home had followed good practice by obtaining two satisfactory references and a Protection of Vulnerable Adults (usually known as POVA 1st) check before the new staff were employed. In most instances they also obtained a full Criminal Records Bureau check before staff began work. For two people the home had experienced difficulties and delays in obtaining one of the references and therefore had obtained a verbal reference while attempting to obtain a written reference. The verbal references were well documented, and in one instance the referee had signed the statement to confirm it was correct. While this provided good evidence to show the home had received good evidence of the staff members suitability we talked to the manager about current good practice guidance that advises that employers should obtain written references in order to verify that the references are from the correct person, particularly where references are from a previous employer or a professional. (It is good practice to follow up written references with a verbal reference where possible). We heard that people living in the home have participated in the recruitment of new staff by having a nominated person on the interview panel. This demonstrated good practice. All new staff have received induction training at the start of their employment following topics laid down by the national training agency known as Skills for Care. The home has drawn up a matrix of all health and safety related topics. We were able to see the dates the training had been completed and where courses had been requested for new staff employed in the last year. We also heard about additional courses that some of the staff have attended in the last year. These have included breakaway techniques, conflict resolution, deprivation of liberty, person centred planning. All staff will be attending training in the near future on an introduction to mental health. This course will also cover mental capacity. Two staff hold a nationally recognised qualification known as NVQ level 3. Two new staff have just enrolled on an NVQ training course. While the level of staff employed by the home who held a relevant qualification was below the recommended level of at least 50 we were satisfied that the recent turnover of staff was the reason for this, and that the home is now working towards increasing the level of training and qualifications for all staff. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Since the last inspection a senior member of staff has returned from sick leave. This has improved the level of support and supervision for all staff. We heard that there are now regular staff supervision sessions, staff meetings and daily handover sessions. We talked to two members of staff recruited since the last inspection and they told us the level of support and supervision they received was very good, and they felt they was always someone they could approach for help or guidance. They said the atmosphere within the staff team was positive and happy and people enjoyed working at Spurfield House. Care Homes for Adults (18-65 years) Page 29 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. The home is well managed. People are consulted and involved in the daily management and routines in the home, and there are systems in place to review and improve the quality of the services provided. Evidence: The registered manager, Primrose Bond, has had many years of experience managing care homes. She has experience in business management as well as care, and she holds a nationally recognised qualification known as NVQ level 4 in care and management. We heard many people praising the commitment and attitude of the manager. One member of staff told us The manager is very approachable and helpful, cheerful, consistent and positive, while still professional and firm. Her team seem to be caring, efficient and work well together. Another staff member told us Great improvement since the last inspection. Better relationship with Care Managers and staff morale has improved. Introduction of younger members of staff has helped. The home is much more recovery focused in Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: talking to people about the next step. Care plans have been re-written and improved. One health professional told us Staffing shortfall is being masked by the manager working ridiculous hours. We talked to Primrose Bond about the number of hours she works. She agreed she does work longer hours than she is employed for. However, she remained positive and talked about the improvements in the staff team in the last year. We heard examples of how the people living in the home have been consulted and involved in the daily management of the home. A Residents Meeting is held every week and these meetings have been minuted. We saw evidence of how the staff talked to everyone in the home on a daily basis. People have been consulted on areas including menus, staffing, and activities. A representative from the Guinness Trust visits the home every month to ensure the home is running smoothly. We saw evidence to show that all staff have received training and updates on all health and safety related topics. The home has a range of policies and procedures in place including all relevant areas of health and safety. Staff told us that fire equipment is tested regularly. The home told us in their AQAA that all equipment has been tested and serviced regularly. The home has notified us of any serious accidents or incidents that have occurred. Care Homes for Adults (18-65 years) Page 31 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 32 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 20 13 All staff responsible for administering medicines must receive training to an accredited standard on the safe administration of medicines. You must provide secure storage for any controlled drugs held in the home. Any gaps in the medicine administration records must be investigated as soon as they are noted and prompt action must be taken in line with the homes policies and procedures. This is to ensure that care workers are competent to administer medicines safely and are fully aware of the risks people may face if they do not receive the correct medications at the correct times, and the actions they must take to minimise those risks. 28/08/2009 Care Homes for Adults (18-65 years) Page 33 of 35 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 19 The home should ensure that all staff, especially those recently recruited, receive good training on health topics relevant to their work, for example, epilepsy, diabetes, schizophrenia. The temperature of the medicines refrigerator should be checked regularly to make sure medicines are stored at the correct temperature. The home should consider methods of helping each person work towards holding and managing their own medications safely. New staff should not be employed until at least two satisfactory written references are obtained. The home should continue to work towards achieving at least 50 of the staff group to hold a relevant qualification. 2 20 3 20 4 5 34 35 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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