Inspection on 06/11/08 for 3 Cherry Tree Close

This inspection was carried out on 6th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Cherry Tree Close 12/11/07

3 Cherry Tree Close 29/09/06

3 Cherry Tree Close 06/01/06

3 Cherry Tree Close 08/02/05

3 Cherry Tree Close 07/04/04

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 16/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 3 Cherry Tree Close 3 Cherry Tree Close Nailsworth Stroud Gloucestershire GL6 0DX     The quality rating for this care home is:   one star adequate 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: Malcolm Kippax     Date: 0 6 1 1 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. the things that people have said are important to them: They reflect 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 34 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 3 Cherry Tree Close 3 Cherry Tree Close Nailsworth Stroud Gloucestershire GL6 0DX 01453835023 Telephone number: Fax number: Email address: Provider web address: jo@ggh.org.uk Name of registered provider(s): Name of registered manager (if applicable) Mr Jeffrey Michael Bird Type of registration: Number of places registered: Gloucestershire Group Homes care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 2 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home 3 Cherry Tree Close is one of a number of homes that are run by Gloucestershire Group Homes. This organisation specialises in the care of people with Aspergers Syndrome. 3 Cherry Tree Close is in a residential area of Nailsworth, and is close to the towns facilities. The home is located in a cul de sac and the style of the property is in keeping with the neighbouring houses. The two people who live at the home have their own bedrooms on the first floor. On the ground floor there are a lounge and a kitchen with a dining area. There is a garden at the rear of the property. The people who live at 3 Cherry Tree Close receive support from a permanent staff team. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 2 Brief description of the care home Gloucestershire Group Homes also employ relief staff who are available to support people at the home when the need arises. Information about the home is available in a Statement of Purpose. Copies of inspection reports are available from Gloucestershire Group Homes and are also available through the website www.csci.org.uk Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us some information about what has happened during the last year, and about their plans for the future. We looked at all the information that we have received about the home since the last key inspection, which took place on 12th November 2007. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 6th November 2008. We sent out surveys to the home, so that these could be given to the people who live there, to staff, and to other people who know the service. When we visited the home we were told that none of the surveys had been completed. Care Homes for Adults (18-65 years) Page 6 of 34 During our visit to the home we met the two people who live there. One staff member was present for most of the inspection. While at the home we also met with another staff member, and with the registered manager. We looked at some records and went around the home. During the afternoon of the visit we also went to the Gloucestershire Group Homes office in order to look at the recruitment record for a new member of staff. The fees at the time of the inspection ranged from 650 - 1373 pounds per week. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the care home does well: What has improved since the last inspection? What they could do better: A number of the matters that were identified as being in need of attention at the last inspection remain outstanding. Overall, there are shortcomings in the organisations response, which means that people cannot be confident that the service is being appropriately monitored and developed in their best interests. We have confirmed at several previous inspections that there is a need for visits to be made to the home each month by a representative of the organisation, in accordance with Regulation 26 of the Care Homes Regulations 2001. Under this regulation, a report of each visit must be completed, and a copy of the report kept in the home and available for inspection. This is not happening. Non compliance with this regulation is an offence. These monthly visits are important, because it is one way in which the organisation is required to monitor standards, for example by looking at the outcomes for people and whether the organisations policies and procedures are being implemented. We found that the organisations own policy on staff supervision was not being complied with. We have recommended that the contact that the registered manager has with the home is reviewed. We saw from the minutes that the manager had not attended the staff meetings that had been held during the last year. We thought that it would be Care Homes for Adults (18-65 years) Page 8 of 34 important for the registered manager to attend these meetings, as a means of keeping directly in touch with the staff team and being part of the discussions about matters that affect the people who live at the home. The organisation also needs to look at its approach to quality assurance and improvement. We reported at the last inspection that a formal system of quality assurance was not in place, and confirmed that this needed to receive attention. A system still needs to be established for evaluating the quality of services provided at the home. The system must include consultation with the people who live at the home, and their representatives, so that their views can be taken into account in the homes development plans. More needs to be done to ensure that risks to people are well assessed and recorded. This is to ensure that there is good information about the hazards and the safety measures that need to be in place, and that people at the home are better protected from harm as a result. 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. Care Homes for Adults (18-65 years) Page 9 of 34 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 10 of 34 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. Standard 2 was not looked at on this occasion. Nobody had moved into 3 Cherry Tree Close since the last inspection. This standard was met when it was assessed at the last inspection. Gloucestershire Group Homes had a policy and procedure in place for admissions to the home. Evidence: We reported at the last inspection that there was an admissions policy in place. The admissions process included obtaining an assessment from the placing authority, an assessment undertaken by Gloucestershire Group Homes, and visits to the home. Care Homes for Adults (18-65 years) Page 11 of 34 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 needs are reflected in their individual plans and they are supported with making decisions. People can take risks as part of an independent lifestyle, although further information is needed about the safeguards that are in place. Evidence: The people who lived at the home had individual files that contained information about their needs and personal support. The files included personal profiles and guidelines for support, which had been reviewed during 2008. Peoples needs and aspirations were discussed at annual review meetings. We saw records of reviews that had taken place in May 2008 and in July 2008. The people at the home had talked about new things that they would like to do, and places that they would like to go to. We read that one person was pleased with changes that had been made to their weekly timetable. Peoples individual plans were being reviewed in conjunction with the Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: meetings. There were restrictions in place about what the people who lived at the home could do. These related to one persons diet, and to another persons alcohol consumption. We had reported at the last inspection that the rationale for these restrictions needed to be provided in greater depth in peoples individual plans. When we looked at peoples records again, we saw that further information about these areas had been recorded during the last year. Each person had a general risk policy on their file. These outlined the hazards and support needed in areas such as the administration of medication, diet and personal care. The documents had been reviewed in May 2008 and June 2008. It was reported in one persons risk policy that their finances were looked after by staff. However in their personal profile it stated that they administered their own finances. The guidance needed to be reviewed, to ensure that it was clear from the records what type and level of support the person actually required. A staff member told us what support they provided people with and we looked at examples of the records that were being maintained. Receipts were being kept for expenditure, although these were not numbered and cross referenced to the records of expenditure. We had recommended at the last inspection that this happens, and we has also recommended that the financial records are regularly audited. We saw records of risk assessments that had been undertaken for specific activities and behaviours. We had found at the last inspection that one person was spending time by themselves in the home, although there had been no risk assessment for this. We looked at the records for this person and saw that a risk assessment had been undertaken in June 2008. It identified the hazards, and some safety measures that were in place. Details of timescales and frequency were not specified. We thought that this information was important to include as part of the overall safeguards, and to show that the arrangement was primarily there to help the person to develop their independence. A staff member said that the persons placing authority was aware of the arrangement. Care Homes for Adults (18-65 years) Page 13 of 34 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 participate in a range of activities that reflect their interests and abilities. They receive support which helps them to maintain relationships and to be part of the local community. People are offered a healthy diet and have meals that they enjoy. Evidence: The two people who lived at 3 Cherry Tree Close were busy with their morning routines when we arrived at the home. One person was keen to talk to us about their hobbies and interests, which included model aircraft, train sets and naval history. They showed us a model railway that they were building with support in a spare room. They were enthusiastic about this on going project and we thought that it was very good that the home had been able to provide the space for it. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: People showed us their bedrooms, which were very different and highlighted peoples individual preferences and how they liked to spend their time. One person particularly liked to watch television in their room and we were told that people were paying to receive satellite broadcasts. People went out during the morning and returned later in the day. One person had attended the organisations day centre, which they walked to by themselves. The other person went out shopping with support and did some jobs outside the home. They visited a garden centre, which we were told they went to regularly and was where they could have one of their favourite meals for lunch. There were timetables on peoples personal files, which showed their different activities during the week. One person undertook work at the day centre that had been arranged though a local employer. They also followed their own choice of activities at the home. The other person had a mix of regular, planned activities, and others that were arranged on the day. The home was well placed for people to get to a range of local facilities, either by walking or using the house vehicle, which was shared with another home that was run by the same organisation. People used the local shops regularly, either to buy things for the home, or for their own interest. One person particularly liked to visit craft and charity shops. One person talked about their contact with neighbours and said that they shared an interest in cats. They had kept in touch with a former neighbour who had recently moved. There was information in peoples files about their backgrounds and relationships. One person told us that they had recently visited a family member, which was something they did regularly. We saw people spending time in different parts of the home and being involved in the domestic work. People were expected to contribute to the day to day tasks, such as helping with the recycling, taking the rubbish out, and cleaning the rooms. A staff member reminded one person about the need to clear away their breakfast dishes before leaving the home during the morning. There was a domestic type kitchen, which people could use with support from staff. People went out for lunch but returned home for the evening meal. People were involved in the menu planning, and a record of food prepared was kept for each Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: person. On the day we visited, one person had chosen what they wanted for the tea. This was a very individual meal, which reflected the persons fondness for particular types of food. We were told that the person did not have this meal every day. There was a written agreement in place about the meals that they would have throughout the week, to help ensure that they had a healthy and balanced diet. We saw that people at the home were being encouraged to eat fresh fruit and vegetables, and to include these in their diet on a regular basis. Care Homes for Adults (18-65 years) Page 16 of 34 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. Peoples personal and health care needs are met. Improvements are being made in the administration of medication, so that people are better protected. Evidence: There was guidance in peoples individual files about the way in which they wished to be supported. The support covered a range of areas and tasks, such as supervision with bathing, reminding people to clean teeth, and advice about managing money. We also saw a Guide to Working at Cherry Tree Close, which included a summary of peoples daily routines and the support that they would need at different times of day. This looked like useful information for relief staff who may be less familiar with the people who lived at the home. During our visit, staff members talked to people in a respectful way, and responded positively to issues that arose. Peoples privacy was being respected; we heard a staff member knock on a bedroom door and ask if they could come in. There were records on peoples files about their contact with GPs and other healthcare Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: professionals. Monthly health check forms were being completed with each person. These gave a summary of appointments and the health related matters that had arisen during the month. People had visited the dentist in October 2008. Their weight was being recorded each month, and we saw records of well man checks and medication reviews. We had recommended at the last inspection that health action plans are introduced for the people who lived at the home. A staff member told us that this had not happened. One persons epilepsy was being monitored through the use of charts, on which staff recorded any epileptic activity. There was some information on the persons individual file about their epilepsy history, but a staff member said that there was no formal epilepsy profile or management plan. We thought that this would be useful in providing an overview of the persons epilepsy, its management, and the outside professionals who were involved. There was information on peoples individual files about the medication that they were prescribed. We looked at the arrangements being made for its storage and administration. At the last inspection we had made three requirements and two recommendations about how peoples medication was being managed. One of the requirements had concerned the need to have a system in place for monitoring stock levels of medication. We saw that stock levels were now being recorded regularly on an appropriate form. We talked to a staff member about the second requirement, which was to ensure that medication was dispensed directly to the person and the record signed for each item of medication. The staff member confirmed that the practice of putting medication into containers to give to people later, had stopped. We saw that medication was being recorded on each occasion that it was administered. The third requirement had concerned the need to label certain medication with the date of opening, and to dispose of it appropriately when no longer needed. We saw that records were being kept for the disposal of medication. There were creams that had not been labelled to show when they had been opened. This was brought to the staff members attention. We had recommended at the last inspection that permission to use homely remedies is obtained from the pharmacist or doctor. We saw that the pharmacist had signed a list of homely remedies that could be given to the people who live at the home. We had also recommended that two people should countersign any handwritten entries on the medication records. We saw examples of where this was being done, although it was not happening consistently. Care Homes for Adults (18-65 years) Page 18 of 34 Care Homes for Adults (18-65 years) Page 19 of 34 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 express their views and are listened to by staff. Staff members receive training and guidance, which helps to protect people at the home from harm. Evidence: The organisation had produced a procedure by which people could make a formal complaint. It was reported in the homes AQAA that no complaints had been received since the last inspection. People who lived at the home had the opportunity to express their views, and to raise any concerns more informally, during the annual review meeting process. During our visit, the people who lived at the home were open in talking about the home and expressing their views. Staff members listened to issues that were raised, such as when a person became concerned that they did not have a particular item that they wanted for their model making. A staff member helped to reassure the person and gave the person the time that they needed to explain the problem. We were told in the AQAA that there had been no safeguarding referrals had been made during the last 12 months, and their had been no incidents which had involved restraint. Staff said that they were aware of the action that they should take if they had a Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: concern about somebodys well being. They were aware of the local procedure for following up allegations of abuse, and had received training in abuse awareness. We were told in the AQAA that there were plans to provide staff with updated POVA training in the next 12 months. Care Homes for Adults (18-65 years) Page 21 of 34 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 accommodation is meeting peoples needs and is kept clean and tidy. Evidence: 3 Cherry Tree Close looked like an ordinary domestic house and did not stand out as being a care home. It fitted in well with the neighbouring properties. There was a garden at the rear of the property. Each person had their own bedroom. As reported under the Lifestyle section, one person also had the use of a second room for their model railway set. People had the choice of using a bathroom or a shower room on the first floor, which were both close to their bedrooms. The communal rooms included a lounge and a kitchen with a dining area, which looked sufficient space for the two people who lived at the home. An area under the stairs in the lounge was screened off to provide some additional storage space. We reported at the last inspection that this must be kept free of flammable materials. This requirement was being complied with. A staff member said that there were plans to create some additional storage space in the kitchen, as part of the refurbishment of the room. The accommodation looked clean and tidy at the time of our visit. Care Homes for Adults (18-65 years) Page 22 of 34 Care Homes for Adults (18-65 years) Page 23 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who they know well and they are familiar with. However, there are shortcomings in the staffing arrangements, which reduces the benefits for people at the home and limits the opportunities for staff development. People at the home are better protected as a result of improvements that have been made in the procedure for recruiting staff. Evidence: There were four permanent staff members in the staff team, who between them had several years experience of working with the people who lived at the home. It was reported in the AQAA that the four staff members had achieved a National Vocational Qualification (NVQ) in care at level two, or above. The organisation had recruited bank staff who could provide cover, if one of the permanent staff was not available. We reported on the staffing arrangements at the last inspection. Staff members worked a 24 hour shift, which included a sleep in. They usually worked alone apart from when they had an end of shift handover. We had recommended at the last inspection that a lone working policy and procedure is put in place. We spoke to a staff member about this and they were not aware of a new policy and procedure having Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: been introduced. Staff recruitment files were kept in the organisations office, which was a few minutes drive from the home. At the last inspection we had looked at the files for two bank staff, and had identified a number of issues that were in need of attention in order to ensure that the people being supported were protected by a robust recruitment procedure. We were told that no new permanent staff had been appointed to the homes staff team since the last inspection. The organisation had recruited a new relief staff member, who had worked some shifts at 3 Cherry Tree Close. We looked at the recruitment file for this person and saw that the appropriate checks had been completed. Their file included written references and copies of documents, as proof of the persons identity. A Criminal Records Bureau disclosure had been obtained, and the persons name checked against the Protection of Vulnerable Adults (POVA) list before they had started working at 3 Cherry Tree Close. Staff training records were kept at the home. Staff members confirmed that mandatory training was being provided in subjects such as first aid, medication, fire safety and food hygiene. They had also received training in aspergers syndrome and autism. Some subjects were being covered at an annual staff team training event. When we looked at training at the last inspection we had recommended that staff should be aware of the Mental Capacity Act and the implications for the people they supported. We had also recommended that staff have access to refresher training in the management of challenging behaviour. A staff member said that they had not received this training and there were no details on the staff training records. There was no record of staff having received training about diversity and disability awareness. After the visit to the home we spoke to a manager from the organisation. We asked about a training plan for the year ahead. We were told that a written plan had not been produced, and that the training needs of staff were discussed on an individual basis. There was a Staff Guidance Manual, which included a copy of the homes induction policy and procedure. This was dated September 2003 and did not refer to the common induction standards that now apply. There was also a policy on staff supervision, which stated that supervision would be held on a monthly basis for a period of one hour. Staff members told us that they received supervision less frequently that this, and said that they had met with a senior support worker two or three times during the last year. Care Homes for Adults (18-65 years) Page 25 of 34 Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Action needs to be taken to ensure that people can be confident that the home is being appropriately monitored, and the organisation is meeting its statutory responsibilities. Evidence: Mr Bird is the registered manager for three of the organisations homes. He has a Diploma in Social Work, Certificate in Management Studies and is a Bachelor of Philosophy in Autism Studies. As the registered manager, Mr Bird has responsibility for the running of the home, although day to day management tasks, such as supervision, were being delegated to a senior support worker. Staff said that Mr Bird was available on the telephone, or at the organisations office. When we arrived at the home for the visit, the staff member present contacted Mr Bird and informed him of the inspection. He later arrived at the home and left to accompany somebody on a trip outside the home. It was agreed that we could speak to Mr Bird later on the telephone if there were matters that we wanted to follow up after the visit. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: We saw from the minutes that Mr Bird had not attended the staff meetings that had been held during the last year. We thought that it would be important for the registered manager to attend these meetings, as a means of keeping directly in touch with the staff team and being part of the discussions about matters that affect the people who live at the home. We were told by a staff member that Mr Bird visited the home occasionally, the frequency being less than once a month. We reported at the last inspection that a formal system of quality assurance was not in place, and confirmed that this needed to receive attention. After the visit to the home we spoke to a manager from the organisation. We asked about the existence of an annual development or improvement plan for the year ahead. We were told that a written plan had not been produced, and that developments were discussed on an ongoing basis. A system still needs to be established for evaluating the quality of services provided at the home. The system must include consultation with the people who live at the home, and their representatives, so that their views can be taken into account in the homes development plans. We have also confirmed at several previous inspections the need for visits to be made to the home each month, in accordance with Regulation 26 of the Care Homes Regulations 2001. Under this regulation, a report of each visit needs to be completed, and a copy of the report kept in the home and available for inspection. These visits are important because they are a way in which the provider monitors standards, for example by looking at the outcomes for people and whether the organisations policies and procedures are being implemented. When we looked at the records on 6th November 2008, we saw that there were reports of two visits that had taken place since the last inspection. The reports were dated 12 December 2007 and 10 October 2008. There must be reports to show that the visits have taken place monthly and on an unannounced basis. It was acknowledged in the AQAA that the regulation 26 visits was one area that could be done better. Overall there was a lack of detail in the AQAA about the improvements that would be made in the coming year. Since visiting the home we have received further information from the organisation about the action that is being taken in response to inspection requirements and the shortcomings that have been identifed. When we went around the home we saw examples of how health and safety was being maintained. There was guidance about food storage and we saw that processed foods in the fridge had been labelled with the date they had been opened. The portable electric appliances had stickers to confirm that they had been safety tested in July 2008. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: We had reported at the last inspection that water temperatures over 43 degrees C needed to be investigated. We discussed this again with a staff member during our visit on 6th November 2008. We were told that a contractor had visited and a new valve had recently been fitted. The staff member said that this had produced more consistent temperature levels. We were told that the levels were being monitored and that the system could be adjusted if needed. The staff member spoke to did not feel that this was an area of risk for people, although it had not been reviewed through the formal risk assessment process. We saw examples of risk assessments that had been completed in connection with peoples activities and support. We had reported at the last inspection that a fire risk assessment was being put in place and that this must be completed. When we visited on 6th November 2008, we saw a document titled fire risk assessment, which was dated 23rd May 2008. The document consisted of a list of questions and answers about fire, but did not show what the overall outcome of the assessment was, and whether the current safety measures were adequate. There was no review date and the name of the person completing the form had not been recorded. Guidance about carrying out fire safety risk assessments in residential care premises can be obtained from the website: http:/www.communities.gov.uk/publications/fire/firesafetyrisk5 Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 20 13(2) Any creams or liquids used 30/11/2007 must be labelled with the date of opening and disposed of appropriately. Monthly, unannounced visits 31/03/2008 to the home must be undertaken in accordance with Regulation 26 of the Care Homes Regulations 2001. This is to ensure that Gloucestershire Group Homes meets its statutory responsibilities, and the people who live at 3 Cherry Tree Close can be confident that the standard of care and the conduct of the home are being appropriately monitored and reported on. 2 39 26 Care Homes for Adults (18-65 years) Page 30 of 34 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 36 18 Staff members must receive appropriate supervision. In order to show compliance with the regulation, a programme of supervision must be put into practice, which is in accordance with the homes policy and procedure. This is to ensure that the people who live at the home benefit from staff who are well supported and whose performance is monitored on a regular basis. 15/12/2008 2 39 24 A system for evaluating the 31/01/2009 quality of services provided at the home must be established and maintained. The system must provide for consultation with the people who live at the home, and with their representatives. This is to ensure that Gloucestershire Group Homes is making the Care Homes for Adults (18-65 years) Page 31 of 34 improvements that are needed, and that the views of the people who live at the home and of their representatives are being taken into account and acted on. 3 42 13 A risk assessment in respect 31/12/2008 of hot water temperatures must be undertaken and appropriate action must be taken, as indicated by the findings. This is to ensure that any hazards are identified and the people who live at the home protected from harm. 4 42 13 A fire risk assessment must 31/12/2008 be completed with appropriate details, including the outcome, the date on which it will be reviewed, and the name of the person who has undertaken the assessment. This is to ensure that the findings of the assessment, and the safety measures in place, are clearly identified kept under review. 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 7 Financial records should be regularly audited. The person doing this should sign and date the records. Receipts should be clearly numbered and cross-referenced with the record. That more details are recorded about the arrangements, for 2 9 Care Homes for Adults (18-65 years) Page 32 of 34 example the timescales and frequency, which are being made for a person to spend time by themselves in the home. This is so that people are better safeguarded and it will show that the arrangement is primarily there to help the person to develop their independence. 3 19 That an epilepsy profile and management plan are completed with the involvement of an appropriate health care professional. This would be useful in providing an overview of the persons epilepsy, its management, and the outside professionals who were involved. Health action plans should be introduced for people living at the home. Two people should countersign handwritten entries on medication records. A lone working policy and procedure should be put in place. That the homes policy and procedure about induction is reviewed to ensure that it reflects the current standards that are expected. That a training plan is produced which sets out the intentions for training and how this is to be prioritised and provided. Initially, a training needs assessment for the staff team should be undertaken, to ensure that the training provided is matched to statutory requirements and peoples individual needs. Staff should have access to refresher training in the management of challenging behaviour. That the day to day management arrangements are reviewed to ensure that the registered manager is in a good position to disharge his responsibilities fully, and to monitor the day to day affairs of the home, for example through his attendance at staff meetings. 4 5 6 7 19 20 32 35 8 35 9 10 35 37 Care Homes for Adults (18-65 years) Page 33 of 34 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 © (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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