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Inspection on 25/03/09 for Gilead Foundations Charity

Also see our care home review for Gilead Foundations Charity for more information

This inspection was carried out on 25th March 2009.

CSCI found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Comments about Gilead Foundation include: "The home provides a drug and alcohol free environment in which some residents thrive" and "Gilead always supplies a good homely surrounding for clients. There are high levels of respect for all clients and every effort is made to accept their weaknesses and help them through difficult times". The management and staff live on the premises, providing 24 hour care and support to people who use the service in a sensitive and respectful, but structured way while they withdraw from drug and alcohol dependency and review and make changes to their lives. The care is holistic. The therapeutic methods used is described very favourably, one staff saying; "Genesis is excellent". The pre admission information (written and verbal) ensures that people are fully aware of what to expect at Gilead. Assessment of their needs is detailed. Any additional information needed is sought. This is then translated into a plan of care, which is equally detailed and regularly reviewed with the person themselves and all staff who are supporting them. People are protected; their vulnerability is understood and risk managed in their best interest. There is a structured routine at Gilead at a time people need that structure. There and also opportunities to learn new skills such as farm work. The atmosphere is friendly and welcoming. All the staff are helpful and show a sincere willingness toward continuing improvement and better outcomes for people they care for.

What has improved since the last inspection?

The home benefits enormously from the employment of a qualified mental health nurse with much experience in the treatment of drug and alcohol misuse. Staff are now properly informed under what circumstance a medicine, prescribed to be given `as required` or `as necessary`, may be given. The home reports that the therapeutic work (recovery programme) now includes more counselling, group therapy and study, also practical skills such as numeracy and literacy. They have increased the numbers of people completing the therapeutic programme. The laundry has been refurbished and is more suitable and hygienic. There is now a client data base making recording of relevant information more efficient.

What the care home could do better:

Medicines, known as Controlled Drugs, must be stored according to the specific legislation required and only a named person must be responsible for access to medicines at any one time. This reduces the likelihood of mistakes, mishandling and ensure a full audit of medicines will be possible, thus protecting people more.Recruitment must be fully robust. All checks, necessary to confirm that staff are suitable to work with vulnerable adults, must be completed before they start work at the home. Accommodation still needs to be improved through the completion of the long overdue building works. All health and safety training must be kept up to date and staff should receive training in seizure management so they will be confident and competent should this occur. Staff should also receive a more structured, individual supervision of their work because they need that support.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gilead Foundations Charity Risdon Farm Gilead Foundations Charity Jacobstowe Okehampton Devon EX20 3AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anita Sutcliffe     Date: 3 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Gilead Foundations Charity Gilead Foundations Charity Risdon Farm Jacobstowe Okehampton Devon EX20 3AJ 01837851240 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Gilead Foundation Charity Name of registered manager (if applicable) Miss Beth Rosanna Taylor Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: No more than10 Service Users undergoing detoxification programme for substance abuse may be accomodated at any one time. The first of the three new bungalows must be completed and available for occupation by Service Users by 31st March 2009. Upon completion of the first new bungalow, Service Users must only be accomodated in this bungalow and the Farmhouse Date of last inspection Brief description of the care home The Gilead Foundation is a Registered Charity. The home provides care services and supported living in an extended family community, which follows the principles of Christianity. It is registered to provide care and accommodation for people who wish to Care Homes for Adults (18-65 years) Page 4 of 30 care home 10 Over 65 0 0 10 10 Brief description of the care home recover from drug and alcohol dependency and related issues. The approach is an holistic one aiming to get to the root of problems through the Genesis relapse prevention course, which gives people the knowledge of how addiction has affected their lives. The current registration allows for the admission of up to 10 people, referred to as students, of both sexes between the ages of 18 and 65. Care is divided into phases, phase one known as detoxification and stability and lasting ten weeks. This is the part for which the home is registered. There follows a phase two and a phase three should people choose to continue. The home is part of a working dairy and livestock farm, which provides opportunities for work and an income to support the charity. It is set in a rural area near the town of Okehampton in Mid Devon. Female students are accommodated in the farmhouse and male students in temporary static caravans, which are to be replaced with three large bungalows with modern amenities and single rooms. Communal areas are provided in the caravans, farmhouse and the community centre. Currently the fee for phase one is 590 pounds per week. This covers care, support, accommodation, food, basic toiletries, personal protective clothing (for use in the dairy), study materials and skills training. The most recent report is displayed in the office and the report summary is included in the pre admission material sent to prospective students. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We collected information toward this inspection since the previous inspection of the service 18th March 2008. We looked at compliance with the National Minimum Standards for Younger Adults, using the Commissions guidance on how those standards relate to drug and alcohol addiction. Prior to the inspection the service provided current information on the service and we (the Commission) anonymously sought opinion from the people who use the service and staff. A G.P. also provided information and opinion. We did two unannounced visits to the service. We were accompanied by an Expert by Experience for the first. They are people who, because of their shared experience of Care Homes for Adults (18-65 years) Page 6 of 30 using services, and /or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We looked at records of peoples assessment, care and medication, staff records and some policies and procedures. We were given the current pre admission information (Service Users Guide). What the care home does well: What has improved since the last inspection? What they could do better: Medicines, known as Controlled Drugs, must be stored according to the specific legislation required and only a named person must be responsible for access to medicines at any one time. This reduces the likelihood of mistakes, mishandling and ensure a full audit of medicines will be possible, thus protecting people more. Care Homes for Adults (18-65 years) Page 8 of 30 Recruitment must be fully robust. All checks, necessary to confirm that staff are suitable to work with vulnerable adults, must be completed before they start work at the home. Accommodation still needs to be improved through the completion of the long overdue building works. All health and safety training must be kept up to date and staff should receive training in seizure management so they will be confident and competent should this occur. Staff should also receive a more structured, individual supervision of their work because they need that support. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make a fully informed choice as to whether Gilead Foundation is suitable for them. Their needs and aspirations are fully assessed prior to admission. Evidence: We looked at whether the admission process fully informed people about the service on offer and whether peoples assessment was sufficiently detailed. Both people who completed surveys told us they were asked if they wanted to be admitted to Gilead. One said: I was interviewed, shown around and offered a place and accepted. They also said they had received enough information about Gilead so they could decide if it was the right place for them. One person said they chose to come to Gilead and is funding themselves. They visited before making any commitment. People using the service when we visited told us about their experience of the admission process. They said it had been very thorough. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: People receive a booklet on health and safety and policies and procedures which operate at the home. We were shown the most recent update of the booklet. It contains a lot of detail of what people can expect, both in service provided and restrictions during different phases of the stay at Gilead Foundation Charity. Each person told us they had been shown around the premises and each said they had met the registered nurse employed to oversee peoples health needs during a stay. We found that people had a clear understanding of the Gilead Foundation Charity ethos and the specific programme of rehabilitation they undertake. The Expert by Experience, who accompanied us during the inspection visit, said he was impressed by how thorough the admission process was. We looked at the assessment records of two people who use the service. There was sufficient detail in them for staff to be able to plan care very well. They also showed that people had been involved in the assessment. Appropriate contacts and other enquiries were made with outside agencies (health and social professionals also working with the person). This helped to ensure the peoples specific needs could be understand on admission. It also helps to reduce any risk associated with the admission. Care Homes for Adults (18-65 years) Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a detailed and clear programme, which helps them towards achieving their goals in a safe and measured way. Where they might fail they are protected. Evidence: We looked closely at the care of two people who receive the service. People who use the service told the Expert by Experience that care plans are an integral part of the treatment process at Gilead. They meet their named staff supporter twice a week to re-assess how well they are doing and update the plan if necessary. The provider reports that they are able to discuss needs and make decisions and plan for their future. People were clear what expectations and restrictions were placed on them through the information provided about the service and their individual care planning. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: We saw that the care plans were very detailed. There were clear goals set and information on how those goals were to be achieved. The plans included an understanding of any risk and how it should be managed. People who use the service told us that they were more than happy with the treatment and care they received. Staff told us: We have a very good programme which deals with the client holistically, relapse prevention, work ethic, education, family issues, financial issues etc. We attempt to meet a person as an individual and help in any needs they have. We saw that each of these areas mentioned are addressed through the care planning. Risk associated with people cared for in Phase 1 of the programme at Gilead is high and quite specific to this circumstance, for example, stopping alcohol. This risk is managed through care planning, the family support system, the student review meetings, group leadership and shadowing/mentoring of staff. There is now also a registered mental health nurse employed who specialises in substance abuse and risk associated with detoxification and rehabilitation. As the risk to people reduces they are able to be more independent. However, risk management continues. Aftercare is understood and we saw that it is part of the programme. One person said through survey that they would prefer it if Gilead was more proactive helping them transition back into society. However, people told the Expert by Experience that nobody left without a home to go to unless they walked out on their own accord. We saw that there are safety measures in place should this occur. Confidentiality is very well managed with clear written information for people using the service as to which, and when, people will have access to their information and how this may be breached where their safety is a concern. People are expected to work on the farm, in the kitchen and in the office dependent upon their abilities, health and preferences. This is seen as part of the therapeutic approach for recovery. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The structured routine and opportunities to learn new skills helps to promote a positive lifestyle, but leisure and social activities available are still not considered sufficient. People receive a nutritious and varied diet. Evidence: Opinion of the lifestyle and activities available varies. People told us through survey and the Expert by Experience that time is rostered for the majority of the week. Each person is expected to work twenty hours a week, incorporating therapeutic duties, cooking for the community and working on the farm or office. However, they only do this when they feel ready. All work is on a rota system and anyone can talk to their appointed support staff if they are not happy with what they have been asked to do. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: People told us that on the whole Gilead is very flexible around each individuals needs. One person said: When I got here I wanted to work as I hate being bored and I am helping with the calves which are brilliant because it takes my mind off my problems for a while. It was apparent that there are no set rules around starting work and that any person, if not feeling ready to start the programme, is given all the time they need. The Gilead Foundation is a Christian based community and expects everyone to abide by their codes of conduct and Christian beliefs. For example, every person has to go to church on Sunday. This is made very clear in the information provided before admission and when people visit before admission. One complaint that each person raised was the question of their free time, that they had nowhere to go. Each person has one day off a week and there is not provision put in place for them to have any fun time. The nearest village is eight miles away so they live on the farm with no outings/activities to look forward to. However, when we visited an outing had been arranged for the afternoon. The home reports that there is now a designated activities team, which includes people using the service. We were told that staffing has improved therefore enabling people to get out more; an outing planned now for at least once a month. Arts therapy will begin again soon and a teacher comes to Gilead every Friday to teach guitar. Some people, at the end of Phase 2 of the programme, have started attending a gym. Where basic literacy, numeracy or computer skills are lacking people have the opportunity to develop these through training at a local college when well enough to do so. People are also able to take nationally recognised qualifications in the farm work they do. People are initially restricted from using a mobile phone, leaving he premises unsupervised or having visitors unless part of planned care. Intimate relationships are also discouraged for the same reasons and also because of the Christan ethos of the Gilead Foundation. These restrictions are understood and agreed when people are admitted. The home provides a well balanced healthy diet and caters for individual dietary needs as necessary. People told us they have tried new things, such as pheasant and veal. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a whole person approach to their mental and physical health care and their needs are met. Controlled medicines are not kept securely. Evidence: People who use the service consent on admission to having their health care and medication needs dealt with by staff as this is when they are most vulnerable. Their care records show that all aspects of their care is fully planned, delivered and reviewed in a structured way. The Expert by Experience was told by one person that he had detoxed before he arrived; another said this happened at Gilead. Both said they were more than satisfied with the way they had been treated. They said that at any time they could see the nurse at Gilead for help. A G.P. who takes the medical responsibility of people using the service when at Gilead, Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: told us that what they do best is: Provides a drug and alcohol free environment in which some residents thrive. She felt that staff usually have the right skills and experience to support peoples health care needs. However, she raised several detailed concerns. The nurse employed at Gilead was new when the surveys were completed. He confirmed that he knew the G.Ps concerns and showed us evidence that they have been addressed. We feel that the one remaining omission is staff receiving training in seizure management. (See Section on Staffing). Peoples records were very detailed and we found no evidence to suggest that peoples emotional, mental and physical needs were unmet. One person was being assisted with a physical problem during the visits. There is liaison between Gilead and health and social care practitioners from peoples home area; they prescribe any detoxification schedule. We looked at the medication arrangements at the home. The home is currently keeping medicines (known as controlled medicines) insecurely. The storage cupboard/box does not meet the required legislation. The home has already taken steps to find the specified storage cupboard to comply with the regulation. We also found that several staff know the access code to the controlled medicines. This increases the likelihood of mishandling and audit is not fully possible, also increasing the likelihood of mishandling. There was a previous requirement that there is one person responsible for medicines at any one time. This requirment is not fully met. We saw clear medication records and evidence that stock is regularly checked. The registered mental nurse employed is currently reviewing the written information and medicine records used at the home. A previous requirement that care plans must include clear guidelines as to when medicines prescribed to be given as necessary may be given has been met. Care Homes for Adults (18-65 years) Page 18 of 30 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. Students are protected from abuse and self harm and there are adequate arrangements for responding to complaints. Evidence: Each of the three people who responded to survey told us they knew who to speak to if they were not happy and how to make a complaint and people told the Expert by Experience that they could approach their named support staff with any complaint or issue if they felt the need. The complaints procedure is within the pack of information provided prior to admission. People live in a family setting at Gilead. We are told this creates a safe environment. There is a weekly support staff meeting to discuss in detail care home issues and people who use the service have regular one to one meetings with a specific staff member, where concerns could be raised. We were told there have been no complaints made to the home and we have received no complaints about the service. The complaints and prevention of abuse policies (including whistle blowing) contain the contact details for taking any concern outside the home. We are told that many of the people who use the service will have experienced abuse or self harm in their lives. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Asked how these people are protected staff tell us it is through their knowledge and the way the programme at the home works. We saw that assessment information is very detailed in this so staff are fully informed of peoples vulnerabilities. One way people are protected is through separate accommodation and strict rules on separate gender management. We spoke with the registered manager about the safeguarding of vulnerable people and she was able to describe the correct method for responding to any concern which might be abuse. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples wellbeing is adversely affected by the standard of accommodation provided but it is none the less adequate. Evidence: People who use the service live in either static caravans or in the farmhouse, pending the completion of new bungalows. The first to be completed is now years over due and again we will need to revise the timescale for completion. However, we are informed that the charity now has the money to complete the project and we saw that the first bungalow is almost complete and a second two have been started. Currently all the men at Gilead have to live in the static caravans. Nobody complained about this and all agreed that their living conditions were adequate. Each caravan has an individual room for each person. Females live in the farmhouse which is out of bounds to men. Nobody lives on their own when they first arrive at Gilead; they are paired with a responsible person so they are not alone if they need help or advice. There is now a new laundry at Gilead with readily cleanable floor and walls for hygiene. The equipment available is perfectly adequate for the needs of people. People who use Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: the service told us through survey that the accommodation is always fresh and clean. Each person is involved in the cleaning of the accommodation. People have the benefit of the freedom that the farm and farmlands provide. The shared community areas are somewhat worn but homely. No specific environmental health and safety concerns were identified during the visits. We were shown records that fire safety is properly considered and managed. Care Homes for Adults (18-65 years) Page 22 of 30 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. Recruitment is not fully robust and staff need individual supervision of their work, but people benefit from a staff that are trained, committed to their work and understand their roles and responsibilities. Evidence: Gilead tell us that they have a very good staff structure to cover all roles and internal staff training and that this structure, roles and responsibilities, are made clear and understood by the people who use the service. We found that staff are very committed to their work and to the people undertaking the programme at Gilead. We looked at whether recruitment of staff protected people who use the service from those unsuitable to work with them. Recruitment records of two staff/volunteers were examined. We found that there had been no criminal record check for one and neither had a record of whether they had committed any criminal offences. Neither had the qualification of the nurse, recently employed, been checked. Otherwise recruitment checks had been completed. The registered manager told us that they often spend many months ensuring that a person will be suitable to work at Gilead, in one case eighteen months. In another they knew the person personally for many years. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Gilead have recruited and trained more staff since the previous key inspection. This includes a qualified mental health nurse. Staff told us: Now there are a lot more staff; lots more experience, including those who have been through rehabilitation themselves. Staff have the opportunity to study for diploma in addictions counselling. They told us how impressed they have been with the counselling system used. Two told us through survey that their induction training covered everything they needed to know to do the job well, and two said it mostly did. Asked about the training staff receive one told us: I have completed National Vocational Qualification (NVQ) 4 in care and am now starting another NVQ and also studies in eating disorders. We also do in house training and have weekly meetings to keep us up to date on what is going on and changes in the programme. We looked at some training records, spoke with staff and saw Gilead Foundation policy and procedure for staff training. Staff told us that several of them are now certified as drug and alcohol counsellors. Staff receive training in health and safety, such as first aid. Although we found some health and safety training to be out of date we saw confirmation that it is arranged. Other training includes: risk assessment, medication, deprivation of liberty and safeguarding adults. However, we were told staff do not receive specific training in seizure management, important should this be a consequence of detoxification. Although the likelihood of this occurring may be low staff should none-the-less be competent to handle the situation should it arise. Staff told us they have good systems for internal communication, including two weekly meetings, e mail and a client data base. We saw how this ensures that important information is readily available with staff who have a need to know. However, staff told us they do not receive individual supervision and how much they feel this improvement is needed. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from the commitment of management and staff and the caring culture at the home, which is generally well run. Evidence: Information provided toward the inspection and discussion with the registered manager, Mrs. Beth Taylor, shows that she has a good understanding of her responsibilities and a commitment to the people who use the service, the staff and organisation. She has achieved the Registered Managers Award an is currently taking an additional management course. The homes policies and procedures instruct staff and inform people who use the service what is expected. We find that they are regularly reviewed and updated. Management is keen to continue reviewing the quality of the service and raise standards. Toward this surveys are sent to people who use the service, staff and relevant professionals. We saw those for 2009. We are told that the feelings of people Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: are surveyed far more frequently through regular group meetings and staff review meetings, as well as one to one care planning. Asked through survey if staff listen and act on what people say to them two said they always do and one said sometimes they have to remind them to do things. The manger told us that they need to improve administration, general communication throughout the organisation and record keeping. We saw evidence that this is already taking place. The majority of health and safety training for staff is up to date. We saw that the home is insured so as to protect people and that each section of the environment has a fire safety risk assessment. We saw satisfactory records of environmental health and safety checks and maintenance. We saw no health and safety concerns during the two visits. Care Homes for Adults (18-65 years) Page 26 of 30 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) A full audit of medicines, 14/04/2008 including how they are handled, must be possible at all times. To this end all records must be up to date and the person who is responsible for medicines at the time must be the only person able to access them. Student accommodation 31/03/2009 must be of solid construction, meeting building regulations and national minimum standards so that they are safe and comfortable during their time at the home. Not met by the due date of 30/09/07 2 24 23(2) Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 (2) Medicines known as Controlled Drugs must only be kept in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. To reduce access to people and the likelihood of mishandling. 31/05/2009 2 20 13 (2) The person who is responsible for medicines at any one time must be the only person able to access them. So that a full audit is possible at all times, which protects people and reduces the likelihood of mishandling. 30/04/2009 3 24 23 (2) Accommodation must be 30/04/2010 of solid constructing, meeting building regulations and national minimum standards. Care Homes for Adults (18-65 years) Page 28 of 30 So they they are safe and comfortable during their time at the home. 4 34 19 (1) The required checks, 30/04/2009 which ensures vulnerable people are protected from staff unsuitable to work with them, must be completed before new staff or volunteers start employment at the home. To safeguarding vulnerable adults. 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 2 35 36 Staff should receive training in seizure management so they will be confident and competent should this occur. Staff should receive individual supervision of their work because they need that support. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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