Care Home: The Spinnies

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Spinnies Linby Lane Linby Nottinghamshire NG15 8AF two star good service The quality rating for this care home is: 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: David Litchfield Date: 1 7 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: The Spinnies Linby Lane Linby Nottinghamshire NG15 8AF 01159631844 01159631844 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Creative Care (East Midlands) Limited Name of registered manager (if applicable) Naomi Reynolds Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: The registered provider may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD of the following age range 16 to 25 The maximum number of service users who can be accommodated is 4. Date of last inspection A bit about the care home The Spinnies is a residential home that supports four young adults who have a learning disability. The home is an older residential building based in large grounds, and located in the small village of Linby, around 10 miles north of Nottingham. The service has been registered with us since April 2008. Before that time, it had been registered as a childrens service. At the time of the inspection fees range from £2357 to £2510 per week. 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 How we did our inspection: This is what the inspector did when they were at the care home We visited the home in October 2008 and we met the manager, staff and people who use the service. We asked the manager and staff about what they do for people. We ask them how they learnt how to do this. We looked at people’s records. We wanted to see if people agree with the information about them. We wanted to see if people are happy with their service. We also looked at staff files to see if they are safe to work with people. We looked at other paperwork, like any complaints people have made. We found it difficult to speak to some people who use the service so we spoke to some family members as well. What the care home does well People get good information about the service. It is written in a way that helps people understand it. People who use the service can give their opinions and are listened to. People are helped to stay in contact with family and friends. What has got better from the last inspection What the care home could do better People’s plans about their care do not show where the information comes from. The manager needed to make some changes around how it manages people’s medication. They have done that now There should be more information about how they prepare for situations like a fire. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact David Litchfield CSCI Nottingham Edgeley House Tottle Road Riverside Business Park Nottingham NG2 1RT If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 are provided with the information they require, and the service ensures it can meet their needs. Evidence: At the time of the inspection, nobody new had moved into the service since it was first registered in April 2008. All the people living there originally moved when the service was registered as a Childrens service. Each has an assessment from their social worker which is a document that describes the support they need. The manager told us about what she would do if someone new was thinking about moving in. She said there would be no rush, and that people would be given the time to make a decision. She said they could visit for short periods first and that she would have to consider the needs of the other people living in the home before anyone else could move in. The manager showed us the information pack they have produced to tell people about the service. This describes all the information we expect to find such as details about the home, and how people can make their opinions known. We saw that this has been updated recently and it is kept in the hallway for anyone to see. There is also a guide for people who currently use the service or for anyone thinking of using it. We saw that people had a copy of this in their bedroom to read whenever they want. We looked at this and it has been designed for people with a learning disability, in easy to read text and with symbols to help people understand it better. It has lots of information including how to make complaints, how they respond to Evidence: bullying, and how they keep peoples information safe. It shows how to get in contact with us. It was not dated but the manager told us it was about to be updated soon to include more information on their policies and in particular about how they will apply a new law called the Mental Capacity Act which relates to how to support people who have difficulties making choices in their lives. The manager told us how the service can meet the special needs people may have. We saw that one person needed particular support around communication. The manager showed us that there had been special training provided to staff, and links had been made with a charity to help them provide the right support for the person. 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 . Peoples care is planned and they are supported to make choices in their daily lives along with playing an active role in the life of the household. Evidence: We saw that each person who uses the service has a file showing the plans made about their care. Each plan has lots of information about the person and show the individual differences each person has. This includes how to support them in areas such as their personal care and communication, as well health care needs, background history and the things they like. There are also plans about how staff can help people manage their behaviour, and how they should respond if the persons behaviour is difficult for the staff. We saw that one person has agreed to a reward system where they have a special trip out when they are successful at managing their own behaviour. A family member told us that the service tries to consider every need. The plans also have information about how the home manages the risks people face in their daily lives. We saw there are two different forms used for this. The older ones do not give as much detail. The manager and staff told us that the newer forms are much better for understanding how to support people. The manager said she will be putting all the information about risks on the new forms. We saw that peoples plans show staff how to support them with making choices. We observed staff supporting people with to choose their food and drink and decide about what they wanted to do during the day. Staff told us about how they could help people with choices, for example we were told Evidence: that they would offer two choices of clothing to one person who found too much choice difficult. A staff member told us that despite people having complex communication needs, that all have ways to communicate. A family member told us that the service has encouraged their family member to says what he wants or doesnt and gives him control over his life. They said this has really helped his independence. The manager told us that they involve people in the life of the household and the plans give some information about this. People are encouraged to help with the housework and laundry, and we observed people using the service help clear up after lunch with support from staff. One service user told us I make my bed. We also saw that they were part of the food shopping, and on the day of the visit they went to the supermarket for the weekly shop. The manager told us that she plans to start a rota to encourage people to be as involved as possible in tasks around the home. We saw that the manager makes sure staff read the information and sign to show they have done this. We also saw that all peoples plans about their care had been recently updated. However, the manager did not have records showing how they had done this or who had been involved in the process of writing the plans. We saw diaries showing that meetings had been held with peoples social workers, and the manager had taken some personal notes from the meeting about what she needed to do. A family member also told us about having regular meetings to discuss the persons support and current situation, and that the manager attended these. However, the manager did not have any of the formal records from these meetings as she said she was still waiting for them from the social workers. The service supports people whose level of disability means they need to be actively supported to make sure their personal wishes are reflected throughout their plans. The manager showed us a new document they are now starting to use for planning peoples care. We saw that it has headings like what is important for the person. The manager said that it will be used together with all the other information to help staff focus focus more on what each person really wants from their support. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People receive a service that gives them choices and opportunities around their life style, and they are supported to maintain relationships with people important to them. Evidence: We saw that peoples plans about their care describe the types of activities they like. We also saw records showing that they had been doing these planned activities, like horse riding, swimming, reflexology and others. A family member told us that they have plenty of activities during the day. We heard from staff that activities are adapted to peoples wishes, for example we were told they stopped bowling as they didnt seem to like it. Another family member told us that they like the way the home encourages the people to try new things. We saw that the people using the service had recently been on a holiday away. We saw photos of them taking part in activities on this holiday, and there were other photos around the house showing the range of different things they are involved in. Peoples plans showed how they maintain relationships with people important to them like family members. Family members told us that they are invited to join in some activities such as swimming. They said the manager always stays in touch, for example ringing when their family member is unwell. We observed this happening on the day of the visit. Family told us they are always made to feel welcome and can visit anytime. Another family member told us that they have joined the household for a meal. We also heard about that people go out with their family, with one family Evidence: member telling us about the emotional support staff give the person after coming back home again. The manager told us that the people make use of the local facilities like the farm shop, and neighbours know them and say hello when they pass. There is a vehicle for visiting places outside the village, but we were told that one person also enjoys using the tram and so they sometimes use that for going into town. We saw that the people using the service go out into the community, and on the day of the visit they went out in the morning and brought lunch home. We saw that they had chosen what they wanted. One person had said what he was going to buy before leaving the house, and he had that item on his return. We observed people eating their lunch. Staff ate alongside them and there was a friendly, unhurried atmosphere. Family told us that they like the way they all sit down and have a meal together and that the meals seem nice. We saw a four-week menu and staff told us how they offer an alternative if people dont like the planned meal. The service keeps a record of what people eat to help understand better what they like and to monitor their health. 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 . The health and personal care that people receive is based on their individual needs, and they are treated with respect and dignity. Evidence: On our visit we saw people who use the service being supported by staff in a respectful way. Family told us that staff are very kind and very attentive to details. We also heard that the home is caring and dedicated and concerned about peoples welfare. Staff told us that the care is different for each person, and that the organisation focuses on everyone as an individual. A staff member said they would never work in a place that didnt deliver a high standard of care. Peoples plans about their care show how they are to be supported around personal hygiene and we saw that this is done with respect for peoples dignity and with people being supported in private. The plans also show the health support people need. We observed the manager and staff gently supporting a person who was feeling unwell, and we saw how they kept important people like family informed about the situation as well as making sure staff coming on shift were fully aware. We saw that records are kept about any contact people have with health professionals, along with any changes to their care afterwards. We saw that there are systems for supporting people with their medication. We saw certificates showing that the staff are trained in handling peoples medication and that records are kept of when they have given them out. One medication is on a special list of controlled drugs and we saw that this is administered correctly. All medication is stored safely. However, the service has not been fully recording the quantity of all the medication Evidence: kept at a given time. We asked the manager about this and she told us that they had only been recording medication received but not how much is held. She has now implemented a system for recording all medication they administer and we have seen the recording sheets used for this. Some peoples have medication that they only take occasionally. On the day of the inspection, some peoples plans did not show when people needed these while others were clearer. We asked the manager about this and she has now changed the plans to show staff how to tell when someone needs their medication and how to give it to them. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are able to express their concerns, have access to an effective complaints procedure and they are protected from abuse. Evidence: The manager showed us a book where they record any complaints received by the service. We saw that there is an up-to-date policy in place to show people how to complain which is provided to family and people who use the service. It is provided in different formats to help people understand it better. We saw that there have been four complaints in total coming from different people, and it showed what actions the manager had taken to resolve the concerns. We saw the manager had taken each one seriously no matter what it was about and reacted appropriately, including a minor complaint from a person using the service. This complaint had been made verbally but we also saw that people who use the service have access to an easy to use complaint form should they want it. We asked the manager about what she does to keep people safe from the risk of abuse or neglect. We saw that staff have been given training in this area and that they have easy access to the local authority policy around this. We spoke to staff about their knowledge around this area and they showed they understand about how to recognise the signs and indications people might show. They told us that they would not just look for physical signs but also observe their behaviour to help tell if something is wrong. The manager also showed us a new system that that they are developing to help them assess each individuals risk of abuse. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: People live in a large building with sizable gardens. It is well maintained, and we saw records kept of the maintenance work undertaken. On the day of our visit, we saw a damaged window being replaced. We saw that it is clean and tidy and family told us that it has a homely feel and that it has plenty of space. We saw that there are plenty of bathrooms and toilets for the people who live there and the staff. The property is rented. The manager told us that they have needed to negotiate the redecoration of some of the communal parts of the house, but that there has been no issues with decorating peoples bedrooms or most areas of the house. The manager told us how the home has been adapted to the needs of one individual who is registered blind. The furniture is kept to specific areas and any changes are made slowly and thought through. The carpets are kept light with textures to help the person understand their location. Staff told us that instead of having an office, a decision was made to use the available room as a relaxation and sensory room instead. Records are appropriately stored in various cupboards around the communal spaces. These are locked to maintain confidentiality, and blend in so that the house remains homely. We looked at each persons bedroom, and saw that they are individualised to peoples tastes. The manager showed us some items of furniture that are to be replaced, and we saw the new furniture. The manager said that these items must be changed over slowly to help people adjust to the changes. In one persons records we saw he had Evidence: made a request for particular furniture, and we found that item in his room. We saw that the laundry facilities are in a suitable location and appropriate for controlling any risk of infection, and that there is protective equipment such as gloves and aprons for staff to use to protect themselves and others. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are care for by well-trained and supported staff. Evidence: We looked closely at four staff records to see how they were recruited. We saw that all the necessary checks had been made before they started. We spoke to staff who verified this was the case and they told us that they were closely supervised at the start. The manager told us about this induction and said that new staff were always extra to the standard team to begin with until they knew more about their job. We saw that new staff have their own personal plan drawn up about the support they need to develop in their work. We saw that the plan is overseen by a mentor who records the staff members progress and makes notes. The plan covers things like their role, note writing, accidents and other areas. Staff receive further training around things like health and safety, infection control and assessing risks. Some staff had received training the day of our visit on how to support people with the things that make them different from others. We asked staff about this and we were told that they are encouraged to make sure people are treated as individuals and keep people in control of their own lives. Staff are also given training around how to communicate with the people who use the service and we saw that each member of staff had been given a video to help them remember what they had learnt. Some staff had been specially trained to support one individual who had particular needs in this area. Staff have been given training around supporting people when their behaviour is difficult for staff to cope with. Some members of staff have qualified as trainers, and we heard how they teach everyone including senior managers. Evidence: Staff told us they feel really supported and are asked opinions about things. They told us that they are given time alone with senior staff to talk through their work and we saw records from these. Team meetings are held every few months to discuss any issues and we saw records from these. We also observed that when there is a changeover of staff during the day, there is a brief meeting to make sure everyone is aware what has been happening. 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 . People receive a well-managed service. Evidence: The manager was in post before the service was first registered with us in April this year. She told us about how the service had changed from being a childrens service to one for adults and how this had happened smoothly. The manager told us how this had required a change to some of the policies. We looked at the policies available and saw that new policies were being put in place at the time of the inspection that cover all the necessary areas. The manager showed us how the company director visits the home to see if things are working correctly and we also saw that the manager had made steps to improve and change things when necessary. However, there was not a complete record of all the actions taken to resolve any of the issues noted. The manager told us she will record all the changes made following the visits in the future. We also how the manager meets formally with one person who is able to do this, and asks for feedback about the service and about any changes they want. We saw that the manager then does what she says she will do. However, there were no other formal systems for getting feedback from people using the service or from people important to them. We did see thank you cards from family members, thanking the manager and staff for the work they do. Family members told us that the manager is very good and welcoming. We saw that the manager has systems in place for ensuring peoples safety, such as Evidence: testing the fire alarms. However there were limited records showing what they had done to ensure people can evacuate the building safely in the event of a fire. Are there any outstanding requirements from the last inspection? Yes  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 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 Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Peoples plans should show how they and people important to them are involved in planning their care. This would help ensure peoples expectations are kept at the centre of their support. Systems should be developed to gather more feedback from people who use the service and people important to them. This would help ensure the continual development of the service to better meet peoples needs and expectations. Complete records should be kept of fire drills and other activities to keep people safe should there be a fire. 2 39 3 42 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk 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 © (2008) 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. 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