Inspection on 15/02/06 for Cathedral View

This inspection was carried out on 15th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cathedral View 22/12/06

Cathedral View 04/10/05

Cathedral View 23/03/05

Cathedral View 02/12/03

Cathedral View 18/11/02

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

CARE HOME ADULTS 18-65 Cathedral View Archdeacon Street Gloucester GL1 2QX Lead Inspector Kath Houson Unannounced Inspection 15th February 2006 09:15 Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 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 Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 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. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cathedral View Address Archdeacon Street Gloucester GL1 2QX 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) 01452 303248 01452 505073 debbie.ewers@gloucestershire.gov.uk Gloucestershire County Council Mrs Deborah Ewers Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9), Physical disability (1) of places Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2005 Brief Description of the Service: Cathedral View is a nine-bed unit, which provides planned and emergency respite care for adults with learning disability. The facility is owned and operated by Gloucestershire Social Services and would accept referrals countywide. The premises are situated close to Gloucester Cathedral and are within walking distance of the docks and town centre. The accommodation has equipment and adaptations to meet the needs of service users with mobility difficulties and can accommodate one wheelchair user at a time. The premises consist of single well-furnished rooms on both upper and ground floors and residents have the use of a lift. There is also a separate quiet lounge, landscaped gardens to the rear of the building, a dinning hall and recreation area. There is a well-maintained and organised laundry room. There is plenty of quiet space within various parts of the building for residents to have time alone or with visitors. The home maintains and encourages residents to continue to participate and attend day centres as part of their normal daily routine. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place in February 2006. The registered manager was available for part of the inspection. Assistance was given from the deputy manager who was able to assist and provide all relevant documentation on request. Twenty-five of the core and non core standards were assessed and included an examination of documentation; three residents records were case tracked, a short and informal discussion was conducted with guests and staff team, a tour of the environment and a short succinct feedback was given to conclude the inspection visit. The inspector would like to express her thanks to the service users, staff and manager and health professionals for their time and assistance during the inspection. What the service does well: What has improved since the last inspection? What they could do better: 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. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 6 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 Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Guests would benefit from adequate preparation in regards to individual needs prior to staying for respite and to ensure that those requirements are more effectively met. EVIDENCE: The home had recently had new consecutive admissions over a number of weeks. Although it was difficult to assess the length of time guests would stay it would have been good practice to formulate a care plan that was in keeping with the standards of the home. For instance service users were being care for based on the care plan devised by Social Workers (SW). It would have been more appropriate if the needs of care were assessed taking into account complexity of the health issues. The main objective is to take into consideration the changing needs of guests. Evidence was taken from a care plan that was written from another establishment and was used during the stay at the home. Although appropriate care was provided, the staff teams need to take into account the changing requirements of guests who are new to the service and devise a care plan accordingly to meet those needs. Guests each had information relating to the service offered at Cathedral View, and were held on file. A description of the care provided was made available which was personalised to the needs of the guests. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8,and 9 Guests would benefit from having their needs reflected in an organised manner within their care plan, in order that all members of staff can give care consistently and to avoid any event of error. EVIDENCE: Guests have protocols and written statements about their identified individual needs. What was lacking for a recent admission was up to date and current documentation that was not in an organised manner whose care needs are both multiple and complex. The standard of care is generally good and consistent. However lack of clear coherence in the care planning of complex consecutive new admissions will need to be addressed to avoid room for errors. Evidence is taken from care plans that contained information from a variety of sources. This was not written in an organised cohesive manner leading to the potential for error in care management. However, despite complex individual needs the manger did ensure that the care package was pulled together with the assistance from other health professionals to certify that all aspects of care was applied. The needs of the guests are met to a satisfactory standard that resulted in the improvement to Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 9 the guest’s physical condition. For instance the manager identified that the guest required a specialist mattress, this was promptly arranged which resulted in an improvement in the physical health of the guest who was having respite. Guests receive support where appropriate to promote and exercise their independence with support from staff. For example one guest requested to have her musical instrument delivered. Another guest made choices regarding her visitation rights, the staff team was very supportive. Guidance is given on how support and care is to be given to guests that is written in their care plan. The staff team were aware of the needs of clients and applied care accordingly utilising all aspects of information from a variety of sources. During the respite period guests are encouraged to have meetings, the manager must ensure that the meetings occur regularly to capture any queries service users may wish to share. Guests are active and maintain their existing activities programme during the respite period. Risk assessments are personalised and held in guest care plan that would assist service users to participate in appropriate lifestyle activities. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 15, 16, and 17 Guests benefit from care and support that enable guests’ to continue with a fulfilling lifestyle internal and external to the home. EVIDENCE: During the respite period guests are able to continue with external activities such as attending the day centre. The activities include games, music and dancing. Guests have the opportunity to discuss and request any activities and have the use of a buddying scheme. Some service users are collected on a regular basis and taken out to the cinema or theatre for example. The buddying scheme is an additional step to ensure that service users build and maintain relationships external to the home. Links with the day centre regular in which the home is informed on the progress of service users. This is recorded in a mini report from the day centre. One client plays a musical instrument to a good standard and has been encouraged to continue to play thus demonstrating consistent support from the key-workers and staff team. Cathedral View is located in the heart of Gloucester city that is very close to Gloucester Cathedral. The guests have the opportunity to be part of the community. Guests can enjoy the many facilities Gloucester has to offer, such Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 11 as the variety of shops that are close to the locality of the home. Many of the facilities are walking distance and transportation is available when required thus increasing and promoting the independence of the service users. The staff team additionally were able to sit and read stories of choice to service users. The staff team approach the service users with respect and dignity whilst applying ongoing treatment. The care and consideration is commendable ensuring that guests who are very ill are given the right care package to include psychological stimulation. The home is able to provide care to service users with complex needs by encouraging. Stimulating music, radio and TV programmes. Some of the activities are observed during the inspection and also included a service user playing the organ. The staff team encourage families and advocates to maintain contact with service users during the respite stay. Additional contact details have been submitted and written in guest’s file. Families and advocates engage with the home in which visitation by families are recorded. Service users are offered a healthy and balanced diet during their stay. Special dietary requirements are provided. The manager however must ensure that information for special diets must be updated to meet the needs of individuals with diverse backgrounds. For example knowledge of specialist butchers where to purchase Halal meat. Special diets offered for instance include gluten and dairy free, vegetarian and vegan diets. The home will cater for a variety dietary requirements of service users. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Service users receive the care and personal support in the manner that is individualised and recorded in their file. EVIDENCE: The home has established a key worker system for service users. This works in the manner that guests have a key staff member who is responsible for personal support and care given during the respite period. For example, the key worker arranges and support service users with health related appointments. Appointments and care related issues are recorded in care plans. Thus providing support and to manage the daily care for guests on arrival into the home. Complex issues are taken up with the manager of the unit and dealt with accordingly. Guests with complex care needs are documented in care plans. Healthcare packages are designed by the health professionals to ensure that health welfare needs are met and that recovery is progressively managed. A brief discussion took place with the manager of the home and a healthcare professional in the presence of the inspector. During the inspection the District Nurse was able to discuss the care package for the service user and was fairly Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 13 detailed with her approach to care. The meeting concluded with imminent action being taken to provide the best support on a regular basis. The manager ensured that specialist knowledge and support is available and information is shared between members of staff. All care included equalities and diversity to ensure significant aspects of health was taken on board. However knowledge on diversity issues will require addressing if the home is to oversee clinical governance for guests with diverse ethnic background. The manager is considering moving the medication cabinet as it is placed in communal area. The date of opening of medication will need to be noted and will be part of the improved medication protocol review. The manager said that they are currently reviewing the medication protocol and practical system to improve the homes method of handling medication to prevent error with medications. The guest’s medication kardex show consistency with medication administration. The staff members are suitably qualified to administer medication to guests and staff signatures demonstrate this regularity with the handling of all medication this was evidenced by records examined. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The views of guests are listened to with requests taken on board and actioned on. EVIDENCE: The staff and client meetings are satisfactorily recorded. The request of guests during the respite stay ensures that the stay at the home is comfortable and that all consideration for welfare is accounted. One guest said “I like it here I want to stay here” The home had a complaint that was dealt with in-house. The manager took the necessary steps to remain in contact with the complainant. The manager followed the home’s complaints procedure until a solution was found. The home additionally, receives compliments about the service provided by relatives and advocates. Complimentary statements reveal that advocates and the staff members communicate on a regular basis. Staff training matrix was seen. A new training programme schedule for 2006 had not arrived on the day of current inspection. The issue of staff development will continue and be arranged around the new schedule for this year and will be monitored at next inspection. The manager said that the home would be closed for staff training to include all members of staff. Specialist training such as positive response training informs staff members on knowledge on how to defuse a crisis situation with guests. The staff team additionally have the necessary skills and information to protect service users from harm and neglect. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30 Service users live in a comfortable and safe environment. The home is suitably decorated and pleasant with a community. EVIDENCE: Cathedral View is a comfortably decorated respite home for guests with learning and with physical disabilities. The home is a safe environment with a local community within the area of Gloucester. The home is suitable for its stated purpose and is adequately maintained. The manager ensures that the individual and collective needs of guests are met. The manager was in the process of arranging specialist equipment for a service user who had arrived with an inappropriate wheelchair. This demonstrates that the manager became proactive to ensure that the equipment on order would aid and maximise the independence of service users. The home is clean and free from offensive smells, suitably decorated and is a very pleasant environment. The laundry room is appropriately sited to ensure that soiled articles are not carried through to the living quarters of the home. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 Service users benefit from a supported staff team who are efficient and effective. EVIDENCE: The manager has a system that guests and staff have supervised meetings to discuss the progress of the guests and any changes to welfare and care. This can be seen as good practice, as it would indicate that any queries could be dealt with promptly and to ensure that the fluent flow of communication regularly occurs. A competent and effective staff team supports the guests. The service users needs are met based on the skill mix from the duty rota. For instance the staff team have skills that are necessary for the tasks required when caring for service users. Staff skills include administration of medication identifying individual needs of guests. The manager must ensure that additional training in regards to educating staff on health and identified personal care needs for ethnic and diverse guests who may use the service. This will need to include; skin care, hair care healthy dietary and specialist foodstuffs religion for individual with diverse background. This will be monitored at the next inspection. The home exercises a recruitment process in which the manager will ensure that service users are protected. The home has a long-standing staff team that demonstrate consistency with guests. The staff team are qualified to NVQ Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 17 levels 2/3 or Grade B. The deputy manager is currently participating in the Registered Managers Award (RMA) level 4. Due to the forthcoming financial constraints there maybe a change in the staff structure. This will continue to be monitored in light of the variation to registration. Although the standard for staff supervision was not assessed on this occasion supervision regularly occurs and is clearly documented. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Guests benefit from a home that is managed and organised to a good standard. The home fosters an atmosphere of openness and takes into account the views of service users with their advocates. EVIDENCE: The manager and staff team are long standing, and have been in the service for several years. The main strengths of the home were due to the dedicated staff team that currently exist in the home. The manager is undergoing a level 5 NVQ course and is qualified to run the home effectively. Guest’s feedback forms are sent quarterly and directly at the end of the respite stay. Positive comments were made about the service and were documented which was provided on request. The home was able to provide each document this would demonstrate the home’s transparency and openness with the service it provides. The manager of the home is aware of the limitations in regards to identifying nursing needs and will seek additional assistance when required from other professionals. The manager ensures that safe working practices within the home are carried out on a regular basis. This would include the moving and Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 19 handling of objects and or service users. Risk assessments are designed accordingly. Fire safety and the maintenance of equipment are routinely checked with staff signatures to show that work has been carried out for the safety of service users. Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 20 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 2 3 X 4 X 5 3 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 4 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 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 2 2 3 X 3 X 3 X X 3 X Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 21 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 YA18 Regulation 12, 1 (a) Requirement The registered manager shall ensure that the care home is conducted so as to promote and make proper provision for health and welfare of service users with a diverse background The registered manager shall make suitable arrangements to ensure that the home is conducted with regard to the sex religious persuasion, racial origin and cultural and linguistic background and any disability of service users. The manager must ensure that the provision of specialist foodstuff is available for guests with diverse backgrounds. The registered manager shall ensure that all staff has training on dietary knowledge, personal care to meet the needs of diverse service user. Timescale for action 15/02/06 2. YA18 12, 4 (b) 15/02/06 3. YA16 16 (i) 15/02/06 4 YA18 18 (i) 15/02/06 Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cathedral View DS0000032190.V286557.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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