Inspection on 15/08/07 for 3 & 4 The Rise

This inspection was carried out on 15th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 & 4 The Rise 20/11/09

3 & 4 The Rise 24/07/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 3 & 4 The Rise Shipton Oliffe Cheltenham Glos GL54 4JQ Lead Inspector Mr Adam Parker Unannounced Inspection 15th August & 11 September 2007 09:45 th DS0000066767.V345368.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000066767.V345368.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000066767.V345368.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 3 & 4 The Rise Address Shipton Oliffe Cheltenham Glos GL54 4JQ 01242 820654 F/P 01242 820654 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.brandontrust.org The Brandon Trust Mr Michael Wayne Thomas Steed Care Home 6 Category(ies) of Learning disability (6), Physical disability (4) registration, with number of places DS0000066767.V345368.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th July 2006 Brief Description of the Service: 3 & 4 The Rise or The Rise is a detached house that is located in the village of Shipton Oliffe situated between Cheltenham and Northleach in Gloucestershire. The home is registered to provide care for up to six residents with learning disabilities. The home can be described as two chalet style houses that have been transformed into one building with adaptations and equipment provided to meet the needs of the residents. The providers are Brandon Trust and Advance Housing manages the property. The home and The Brandon trust are currently reviewing how best to provide information about the home to any prospective people who may use the service. The weekly charges by Brandon Trust are £202.21 to £436.66. DS0000066767.V345368.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in August and September 2007 and included visits to the home on 15th August and 11th September. Several records were examined including care plans, staff files, health and safety systems and quality assurance documentation. An (Annual Quality Assurance Assessment) AQAA was completed and provided for the inspection. Surveys were received from one person using the service and a General Practitioner (GP). The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? What they could do better: DS0000066767.V345368.R01.S.doc Version 5.2 Page 6 Recruitment although generally good must be made more robust in order to protect those using the service. Some attention should be given to some aspects of storing medication. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000066767.V345368.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000066767.V345368.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment of the person’s wishes and needs are undertaken before they move into the home. EVIDENCE: The information gathered for the person most recently admitted to the home was looked at. They were the only person to have been admitted in the last 12 months. The home had obtained a community care assessment from the funding authority and information from the previous home that the person lived at. This information was based on person centred planning and consisted of a person centred plan and an essential life plan. As well as making home staff aware of the person’s fears in ‘my nightmares’, positive areas were covered in ‘my gifts’. Full information relating to health issues had been forwarded from one home to another including the date of a forthcoming hospital appointment. DS0000066767.V345368.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information about how people who use the service may indicate decisions and preferences about their lives and the care and support they receive. Risks are identified and assessments completed to safeguard people using the service. EVIDENCE: People who live in the home have a ‘plan for life’ in addition to a personcentred care plan subject to monthly review. The information for one person included a copy of their care programme approach document that demonstrated how the home would work with community learning disability services to meet the persons mental health needs. Anther person had information on how they may indicate decisions and preferences based on non-verbal communication and actions. Risk assessments had been completed and these where detailed and individualised and had been reviewed on a six monthly basis. One person had DS0000066767.V345368.R01.S.doc Version 5.2 Page 10 a risk assessment for issues around safety on using the stairs and as a result control measures were in place. There was also a risk assessment in place for making hot drinks. Another person had a risk assessment for community safety for any risks encountered outside of the home. One person who completed a survey form indicated that they felt safe living in the home. DS0000066767.V345368.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home have the opportunity to take part in a number of social and recreational activities and keep in touch with family and friends. EVIDENCE: People using the service take part in a number of activities outside of the home. These include a day centre and a social club. One resident is often taken for drives. On the first day of the inspection visit one staff member was out of the home with one person. One person indicated on their survey form that they were sometimes taken shopping for food. Information is recorded on areas of interest, one person liked to attend football matches although this had not taken place since they had been in the home due to the close season. In its AQAA document the home sought to develop links for the people in the home “other than family and the traditional Learning difficulty networks.” DS0000066767.V345368.R01.S.doc Version 5.2 Page 12 There was written evidence that one person using the service had regular contact with family and friends through telephone calls and visits including visits out of the home, this was also confirmed on a survey form. A record is made of people’s daily routines noting how they spend their time and whether this is spent alone or in company. On the first day of the inspection visit people were taking breakfast in the dining room with appropriate support being given. The home has a menu that changes every week for four weeks. Staff compile the menu with an awareness of peoples individual preferences. One person had some dietary needs in respect of a health problem and these had been recorded. DS0000066767.V345368.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have their health and personal care needs met and there are generally good systems in place for the administration of their medication. EVIDENCE: A survey form received from a GP gave positive responses to questions on how the home managed people’s health care needs. One person receives regular input from a district nurse who attends to the treatment of their leg ulcers. There were records of people who use the service having contact with GPs, Chiropodists and other health care professionals. Plans were in place to meet both personal care and health care needs. And a daily record is made of care given. The weight of people using the service is monitored and recorded. Staff receive training in the safe administration of medication. As well as accredited training provided from outside of the home a series of checks are made on competency before a staff member administers medication to the people using the service. Regular checks are made on medication stock DS0000066767.V345368.R01.S.doc Version 5.2 Page 14 balances including a check at each shift change on the stocks of medication for the treatment of epilepsy. Monthly medication reviews are carried out by the GP who visits the home. Medication was stored securely although apart from items kept in the refrigerator there were no checks being carried out on storage temperatures that should be monitored in line with directions indicated on medication containers. Medication administration records were in good order although where any handwritten changes or entries are made these should be dated and signed by the person making the entry and checked for accuracy and signed by another member of staff. Medication administration plans were in place for medication prescribed on an ‘as required’ basis and in one case a plan was in place for staff to follow if the medication was ineffective. Each person using the service had detailed information recorded on the medication that they used. DS0000066767.V345368.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place that safeguard people from possible harm or abuse and allow for complaints and concerns to be raised on their behalf. EVIDENCE: The home has a policy and procedure for dealing with allegations of abuse to residents. This includes referring the issue to other agencies. In addition the home has a whistleblowing policy setting out guidelines for staff who may need to report any issues of concern. All staff in the home have received training from the provider in protecting vulnerable adults except for the registered manager and one other member of staff although training has been arranged. The home has a complaints procedure included in the statement of purpose and available in the home. The registered manager described how only one person using the service would be able to express any dissatisfaction although staff knew behaviour that would indicate unhappiness in other people. One person who completed a survey form indicated that they knew who to tell if they were unhappy. DS0000066767.V345368.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people to live in a safe and comfortable environment that is well maintained. EVIDENCE: The environment both inside and outside of the home was looked at. The home was well maintained with a good standard of decoration, clean and fresh smelling. Individual rooms had adaptations for the needs of the people living in the home such as mirrors at an appropriate height. Communal areas also included such adaptations as raised chairs and sofas. There is a multi sensory room that is used by two people in the home. Outside the home blends in with the local community, consisting of two homes joined into one. Adaptations have been made to enable wheelchair users to access the home from the front and to gain access to most of the garden at the rear where there is a specially DS0000066767.V345368.R01.S.doc Version 5.2 Page 17 adapted swing for one person. The garden is maintained by a visiting gardener. The laundry was clean with an impermeable floor covering and washable wall surfaces. On the day of the inspection visit liquid hand wash was missing although it was reported that this is normally available for staff use. One person who completed a survey form indicated that they liked their room and liked Shipton Oliffe. DS0000066767.V345368.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures need some improvement to ensure that people are being safeguarded from possible harm. Staff have access to a training programme that will equip them to meet the specific needs of people using the service. EVIDENCE: Staff working in the home have received training in a number of areas such as Person centred planning, encouraging choice, dealing with incidents and benefits. Some training has been provided that relates to the specific needs of the people using the service. These include Makaton and pressure area care. Over half the staff in the home have an NVQ at level 2 with some achieving a level 3.Training for each member of staff is recorded in a training profile which also provides a record of when training updates are due. Training is planned and monitored through supervision sessions. The information obtained for the most recent member of staff recruited to the home was looked at. The correct information and documentation had been obtained for the staff member prior to employment including written DS0000066767.V345368.R01.S.doc Version 5.2 Page 19 references and Criminal Records Bureau (CRB) checks. However information relating to the reasons for leaving past employment in a care setting had not been fully documented. The application form gives a space for the applicant to give this information although written verification must also be obtained. The registered manager stated that although he could start staff working at the home with a check against the Protection of Vulnerable Adults (PoVA) register before a CRB check had been returned he would not do this due to the nature of the service where staff would have to work unsupervised in a number of situations. DS0000066767.V345368.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed with a robust quality assurance system in place and staff trained in safe working practices. EVIDENCE: The registered manager has a wealth of experience in working with people with a learning disability and has qualifications in both care and management. He is currently undertaking a diploma in management studies and has attended recent training in the Mental Capacity Act, fire safety and health and safety. The home has a quality assurance system that uses the ‘Brandon Trust Quality Standards’. This is comprehensive and initially involves a self-assessment of DS0000066767.V345368.R01.S.doc Version 5.2 Page 21 the service. Following this an action plan is drawn up, the assessment and plan is checked by another manager and progress is monitored. In addition a representative of the registered provider carries out inspections under regulation 26 of the Care Homes Regulations 2001. Reports are produced which have been forwarded to the Commission as well as a copy kept at the home. The home has plans for introducing stakeholder surveys to gain further views on how it is delivering the service in the interests of the people using the service. Staff in the home have carried out training in safe working practices in the areas of fire safety, moving and handling, first aid and food hygiene. No recent training has been carried out by staff in infection control and this should be considered given the needs of the people using the service. The central heating system has been serviced and the electrical systems and appliances in the home have been checked. Cleaning materials are stored securely and there is a risk assessment in place regarding this. However a small number of items had been placed in an unlocked cupboard, this was pointed out to the staff and remedied during the inspection. Temperatures from hot water outlets are checked and recorded and any temperatures over 43°C are highlighted and investigated. Temperature control valves are in place. The home has a set of environmental risk assessments subject to monthly review. A Legionella risk assessment has been carried out although the home was awaiting a check in relation to Legionella monitoring. Window restrictors are fitted where the need indicates this. DS0000066767.V345368.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X DS0000066767.V345368.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19(1)(b) Schedule 2 Paragraph 4. Requirement Before a person starts work in the home a check must be made if paragraph 4 of Schedule 2 applies and if so this information must be obtained to ensure that people who use the service are protected through robust recruitment procedures. Timescale for action 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA20 Good Practice Recommendations The temperature in the medication storage cupboard should be monitored and recorded to check that residents’ medication is being kept at the correct temperature. Where any handwritten changes or entries are made these should be dated and signed by the person making the entry and checked for accuracy and signed by another member of staff. Checks should be made to ensure that the laundry has hand-washing facilities at all times. Checks should be made to ensure that cleaning materials are stored in a locked cupboard. DS0000066767.V345368.R01.S.doc Version 5.2 Page 24 3 4 YA30 YA42 5 YA42 Staff should receive Infection control training. 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