Inspection on 12/09/07 for Leonard Cheshire Of Gloucestershire

This inspection was carried out on 12th September 2007.

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

The inspector found 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Leonard Cheshire Of... 15/05/06

Leonard Cheshire Of... 11/12/05

Leonard Cheshire Of... 11/05/05

Leonard Cheshire Of... 25/11/04

Leonard Cheshire Of... 18/06/04

Leonard Cheshire Of... 07/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Leonard Cheshire Of Gloucestershire Charlton Lane Leckhampton Cheltenham Glos GL53 9HD Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 12 and 13 September 2007 10:00 th th Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leonard Cheshire Of Gloucestershire Address Charlton Lane Leckhampton Cheltenham Glos GL53 9HD 01242 512569 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) glos@cent.leonard-cheshire.org.uk www.leonard-cheshire.org.uk Leonard Cheshire Mr Gareth Jones Care Home 36 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (2), Physical disability of places (36) Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user (under a Learning Disability Category) until they leave the home. 27th November 2006 Date of last inspection Brief Description of the Service: Leonard Cheshire of Gloucestershire provides residential and nursing care for people with a physical disability. The home also provides care for one named person with a physical and learning disability and one person over 65. The home is owned and managed by The Leonard Cheshire Foundation. The home is located in Leckhampton, not far from Cheltenham town centre, and close to local facilities and amenities. The home was purpose built some 14 years ago, providing a main building divided into five lodges for six people, communal spaces, offices and a hydrotherapy pool, a sensory room and a physiotherapy room. There are six bungalows that enable service users to have greater independence but also retain some support from staff. The home has four mini buses and a car; people also use public transport, local taxis and the community transport system. The Statement of Purpose and Service User Guide are available from the main office and information about the home is available in the foyer. Fee levels range from £404 to £999 per week. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in September 2007 and included two visits to the home on 12th and 13th September. An additional nurse inspector was present on the second visit. The registered manager was available on the first day and the care supervisor was present throughout. A pre-inspection questionnaire had been returned prior to the inspection. Surveys were returned from three people living at the home and one parent. A health care professional was spoken to during the visit. Time was spent talking to people and observing the care they were receiving. A sample of records were examined including care plans, staff files, health and safety systems, medical and financial documents. What the service does well: What has improved since the last inspection? An assessment of each person’s nursing needs has been put in place that assesses their physical, emotional, social and intellectual needs. Improvements to care plans and risk assessments have been maintained with evidence that these documents are regularly reviewed. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 6 Significant improvements to the environment have resulted in lounges which are attractively decorated and gardens which provide a pleasant setting for patio areas, trees and water features. Improvements to the laundry facilities provide better access to people wishing to do their own washing and safeguard staff from possible injury. 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. The summary of this inspection report can be made available in other formats on request. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A full assessment of people’s needs is completed alongside visits or trial stays at the home. People then make a decision about whether they would like to live there and whether the home is able to meet their needs. EVIDENCE: Four people have moved into the home since the last inspection. Two people were spoken to and said how happy they were living there. Both were assessed by the home and an assessment and care plan had been received from their placing authority. There was evidence that information had also been obtained from previous placements and healthcare professionals involved in their care. Information about the condition of one person had also been obtained prior to admission. One person had several visits to the home prior to moving in. The other person was supported with a carer from their previous placement for a week’s trial stay before deciding to remain at the home. On the day of the first visit a placement review was being held for one person. Their social worker was extremely satisfied with the placement and the admission process. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 9 Contracts were seen to be in place and where continuing care funding was required this was indicated. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are involved in decisions about their lives and play an active role in planning the care and support they receive. Risk assessments safeguard people from possible harm. EVIDENCE: The care for five people was looked at in depth. One person had recently moved into the home, three people needed some kind of nursing input and one person was living in the bungalows. Each person had a holistic nursing assessment in place indicating the levels of care needed. These will be reviewed every 6 months or sooner if needs change. These assessments indicated where care plans and risk assessments had been developed. It was evident that assessments were being monitored and where needed amendments made. People living at the home said that they were given a choice where to keep their individual service plans or ISP’s. One person kept their care plan in their room and discussed the contents and their involvement in the process. Others said that they wanted their plans kept securely in the Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 11 office in the lodges. People living at the home had signed documents in their care plans where able. Care plans were comprehensive providing a range of personalised goals for people such as ‘getting a job’, ‘going to college’, ‘maintaining weight’ and ‘cooking meals’. Daily notes were kept which referred to whether people’s identified needs had been met and provided a record of daily appointments and social activities. A range of monitoring charts were also being used. Not all people living at the home were having an annual review. Those people who had involvement from their placing authority were having reviews arranged and a copy of their revised care needs had been supplied as a result. A number of people do not have input from the placing authority and there was no system in place to formerly review them. A number of people said they were involved with a local organisation called ‘Gloucestershire Lifestyles’ and they were able to access an independent advocate from them if they wish. One person had an advocate who met with them regularly. Some people were being supported to manage their personal finances. Detailed records were in place. Receipts were being cross-referenced with expenditure and where possible people were signing for any money they had received. Bank statements were being checked as well as cash balances. An inventory was also in place for any personal items kept by the home. Each person had a range of risk assessments and there was evidence that they were being regularly reviewed. A health and safety co-ordinator ensured that assessments were being completed for a range of activities and health care needs such as moving and handling, showering, holidays, using transport and cooking. A missing person’s procedure was in place and each person had a completed missing person’s record with a current photograph. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Excellent systems are in place to enable people to lead a fulfilling lifestyle should they wish, accessing education, work and social activities. People are supported to maintain relationships with family and friends. The nutritional content of some meals could be improved to ensure that people have access to a healthy diet. EVIDENCE: There have been continued significant improvements in the opportunities available to people living at the home to access a range of educational, work and social opportunities both within the home and in the local community. Staff have been appointed with specific responsibility for appointing and supervising volunteers, finding work placements and employment opportunities and arranging social and recreational activities. The result is that people were able to lead a fulfilling lifestyle if they choose. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 13 During the visits people were observed taking part in a cultural awareness day celebrating Greece, meeting players from the local football team, completing application forms for a local college and doing arts and crafts. Several people access local colleges or were participating in social and educational groups. One person said that they have employment three days a week and another person said that they were being supported to find a work placement. Within the home people were observed making good use of the activity room where they had access to the Internet in addition to regular scheduled activities. Photographic evidence of the activities provided had been put into a folder. The walls of the home were also adorned with photographs of visits, day trips and holidays as well as paintings, silk prints and mosaics completed by people. A sensory room has also been provided for people. Several people were away at the time of the visits in Spain. Another person said they enjoyed a holiday in England and others were looking forward to going to Lourdes. On the evening of the second visit a group had planned a trip to the theatre. People confirmed that they continue to go to concerts as well as football and rugby matches and to Wimbledon. Staff volunteer to work additional hours to ensure that people can attend these events and without their willingness some people would be unable to take up these opportunities. People said that their relatives visit them at the home. People also go home for short stays. Daily records provided evidence of contact with relatives or friends. Some people like to use the telephone or email to keep in touch. People living at the home have shared responsibility for two cats that were based in one of the lodges. People were observed being supported to make decisions about their daily lives. People decided where to spend their time and with whom, what activities they would participate in and when they wanted to spend time alone. Some people choose to lock their rooms. Staff were observed knocking on doors before seeking permission to enter. Regular house meetings were being held with a new chairperson taking over during the summer. She stated that as part of her preparation for the meeting she would talk to most people in the home for contributions towards the agenda. At the last meeting they discussed staffing and the quality of meals. The home promoted a non-smoking environment for people living there and staff. Provision had been made for people to smoke outside. These facilities did not appear to be the recommended distance from windows and doors. People living at the home were being involved in the choice of meals. They confirmed that a representative from each lodge meets with the cook to discuss the menus for the next season. During the visits fresh vegetables and Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 14 salads were available and all lodges had baskets of fruit. People complained that sometimes the main meal included convenience food such as ‘Kievs’ or ‘Burgers’ or ‘Pizza’ and that these meals could not easily be reheated if this was needed. Some people said that they enjoy the roast dinners. The kitchen supply ingredients for tea and some people said that they choose to cook an alternative. Some lodges were making good use of the new kitchen facilities and preparing a group meal whereas others were still using them to prepare drinks and snacks. Where there were concerns about the diet and fluid intake of people there was evidence that this was being monitored and referral made to a dietician where appropriate. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive personal support in a way in which they would prefer respecting their individuality and enabling them to be independent. Medication systems on the whole safeguard people from possible harm. EVIDENCE: Each person has a moving and handling risk assessment that gives staff information about the way in which they would like to be supported with their personal care. Care plans indicated the gender of the staff preferred by people when meeting their personal care needs. This was not always possible for one person who had stated that they would like to have all their personal care done by male staff. Discussions with the registered manager confirmed that this was an issue that the home was attempting to resolve. The home employs a physiotherapist and an aide who maintain an exercise regime for people living at the home enabling them to maintain their mobility and independence. People also have access to a hydrotherapy pool that was out of action during the visits. It had been recognised that the facilities Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 16 available to the physiotherapy team were inadequate and there were plans in place to provide additional accommodation. People living at the home also had access to beauty and health treatments that they book in advance. Chiropody was also being provided. Records were being kept of appointments with healthcare professionals although there was some inconsistency between the lodges in the robustness of this recording. For instance on one lodge it was not possible to ascertain whether people had see their dentist. A person living at the lodge confirmed that they had been recently and knew when their next appointment was due. Staff in one lodge were commended for the excellent care plans which had been put in place for a person who had complex nursing needs. The care supervisor stated that she observed the practice of nurses although this had not been recorded. Training records and certificates confirmed that nurses have the opportunity for professional development. The care supervisor stated that additional training was being looked into from the National Health Service. Records confirmed that people had access to input from a range of healthcare professionals including speech and language therapists, a nutrition nurse specialist and a dietician. It was noted that one person had ‘Do not resuscitate’ notes on their chart but when looked into the policy stated that the person wished to remain at the home in the event of being unwell. The family and registered manager had signed this document. If the intention was to put in place a ‘DNR’ policy then this should have been drawn up in a multidisciplinary forum. Some care plans had not been amended as changes have occurred. For example one person with a PEG was being fed a soft diet by staff. In other instances good records were being maintained with evidence that eating and drinking charts were being used. The care supervisor confirmed that no one at the home had a pressure sore. Tissue viability assessments had been completed and staff explained how they ensure that people have regular bed rest or access to alternative seating. Systems for administration of medication were examined. The care supervisor confirmed that all staff had training in the safe handling of medication. All lodges had a trolley that was locked in a secure room. Staff were observed administering medication. They did not take the administration record to the person when giving medication going back to the room to sign the record. There were some inconsistencies between the lodges with some following correct procedures and others failing in the following issues: • Handwritten entries should be countersigned by a second person DS0000016491.V332867.R01.S.doc Version 5.2 Page 17 Leonard Cheshire Of Gloucestershire • • • • A care plan for a person with allergic conjunctivitis needed to be put in place Care plans for the use of ‘as necessary’ medication must be in place Any ‘as directed’ entries should be removed from the medication records A person was refusing to take medication; their care plan had not been amended to reflect this. All people living at the home have a self-medication assessment and where possible they had signed these. The care supervisor confirmed that she regularly audits medication systems although she was not keeping records for this. The policy for the administration of medication was last reviewed in 2000. The home keeps good records for the administration and control of homely remedies. The GP had signed individual records for each person using homely remedies. The home has a copy of the last British National Formula and had registered on the Internet for updates to this. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are confident in the knowledge that any concerns they may express will be listened to and acted upon. Systems are in place that safeguard people from possible harm or abuse. EVIDENCE: The pre-inspection questionnaire indicated that one complaint had been received in the last 12 months and that this had been substantiated. The home keeps a complaints log that gave details of the complaint and outcome. The Commission had not received any complaints. People said that they would talk to staff or the manager if they had any concerns. Surveys received from people living at the home indicated that they knew how to make a complaint. Copies of the complaints procedure was displayed around the home. Although this did not have the right name for the Commission, the contact details were correct. The training database indicated that staff have training every two years in the protection of vulnerable adults and children as well as complaints and whistle blowing courses. Staff confirmed that they had received training in the protection of vulnerable adults. Discussion with them confirmed their understanding and awareness of identifying and reporting suspected abuse. Accident and incident forms were examined and found to be stored securely. Two forms were missing and both of these referred to incidents that were reportable under RIDDOR. The health and safety co-ordinator confirmed that Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 19 these had been reported and that the information had been filed together. She stated that copies of these records had also been forwarded to central office. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: The home provides purpose built accommodation for people with a physical disability. Each person has a bedroom with en suite facilities including a shower and an overhead hoist. Additional assisted baths were provided. People said that they were involved in the choice of colour scheme for their rooms. One person was having their room redecorated at the time of the visits. Communal areas around the home had been redecorated providing pleasant, homely lounges. Flooring had been replaced in the lounge of one lodge and carpets were gradually being replaced around the home. People were involved in the choice of carpet in their lodges. The main lounge is due Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 21 for a makeover by a group of volunteers. They have discussed with people living at the home how they would like the room. Significant work had been completed on the grounds around the home providing areas of patio between the lodges where sensory gardens were being developed. A health and safety co-ordinator oversees two maintenance staff to ensure that the day-to-day maintenance issues were being resolved. This has had a significant impact on the standard of accommodation being provided. Specialist equipment was provided which is regularly serviced. Where needed people were being referred to an occupational therapist or wheelchair assessment centre for a review of their needs. At the time of the visits the home was clean and tidy. Concerns about the provision of large containers for washing powder have resulted in an automatic feed being provided from containers to the washing machines. A domestic size washing machine and tumble dryer have been provided for people living at the home to use. Hazardous products were kept securely and each lodge had a copy of COSHH data sheets. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are not being safeguarded from possible abuse due to weak recruitment and selection procedures. Excellent training systems are in place providing staff with the opportunity to acquire the knowledge and the skills they need to support people living at the home. EVIDENCE: People living at the home benefit from a staff team who have been working together for some time. Over the past year six new employees were appointed to the home of these less than half were care staff. A new member of staff confirmed that they complete an induction programme which includes mandatory training. Staff then progress onto their NVQ Health and Social Care Awards. The training database confirmed that over 50 of care staff have an award. Recruitment and selection of staff is managed by the home. There were some significant inconsistencies in the staff files examined. All files have a top sheet which provides a summary of what information has been obtained during the recruitment process. Most of these confirmed that people had been appointed Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 23 with two satisfactory references and a Criminal Records Bureau (CRB) or povafirst check in place. However on several files there was no evidence of the references and in one case no evidence that a CRB check had been completed. One file also only had one reference in place. The registered manager was surprised that this was the case and had asked staff to make sure that the files complied with the National Minimum Standards. He stated that there had been a change of staff and thought that this might have been the reason for the missing information. After the visits he confirmed that additional copies of the missing information were being obtained. Other staff at the home confirmed that they had seen copies of references and the missing CRB verification during the interview process. There was no evidence that any gaps in employment history were being researched. One person was appointed upon receipt of a povafirst check. The registered manager explained the process that would be in place until a satisfactory CRB was received. There was no formal risk assessment in place detailing this. Staff who needed a work permit had copies of this documentation in place. Where people had worked previously in care there was no evidence that the reason why they had left that employ was being obtained. Files had evidence that proof of identity had been obtained including a current photograph. The volunteer co-ordinator discussed the processes that were in place when selecting and recruiting staff. She was obtaining two satisfactory references and a Criminal Records Bureau check before offering a person a position. She was then offering supervision and support according to each person’s individual needs. The home has excellent systems in place to ensure staff have access to the training they need to perform their roles. A training database was in place and staff confirmed that this was being monitored to make sure that they attend refresher training when needed. In addition to mandatory training staff had access to disability and the law, disability and you, driver safety training and key working. People living at the home confirmed that they can access training if they wish. Recruitment and selection training was being held in September which people were planning to attend. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. Effective quality assurance systems are in place involving people who live at the home. Excellent health and safety systems are in place providing a safe environment. EVIDENCE: The registered manager has long term developmental plans in place to increase opportunities for independence for example the provision of new kitchens in all lodges, building a conservatory to provide additional space for activities and reallocating space for physiotherapy and appointing an employment advisor. Action has been taken to address issues highlighted at the last inspection. Comments from some people living at the home indicated that the registered manager spends time away from the home but when there is accessible to them. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 25 Leonard Cheshire has a quality assurance system in place which involves people living at the home. The registered manager confirmed that people living at the home are involved in an annual survey and had also just taken part in a survey about the name of the organisation. An annual quality assurance report is produced for the Central Region. Regular unannounced visits to the home were being conducted and reports produced. People living at the home hold regular house meetings and also attend the Central Region Service User Networking Association. A health and safety co-ordinator had put in place a range of excellent systems to monitor health and safety within the home. A fire risk assessment was in place with evacuation procedures which comply with Fire Regulations. Checks were seen to be in place monitoring such things as fire equipment, water temperatures, fridges and freezers and slings. Environmental risk assessments had been put in place with evidence of regular review. Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 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 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 4 X Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 27 Yes 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 YA6 Regulation 15(2) Requirement The registered person must keep the service user’s plan under review and where appropriate carry out consultation with the service user or a representative. (This requirement has been repeated from the last inspection). Where people are prescribed ‘as necessary’ medication there must be a care plan in place indicating when it can be given and the maximum dosage. This is to safeguard people from possible error. Staff must not be appointed until two satisfactory references, a CRB check, a full employment history and reasons for leaving former care positions are in place. This is to protect people from possible harm. Timescale for action 31/03/08 2. YA20 13(2) 31/10/07 3. YA34 19(1)(c) Sch 2.3,4,6 31/10/07 Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard YA16 YA19 YA19 YA19 YA19 YA20 YA20 Good Practice Recommendations Arrangements for people to smoke outside the home should comply with current guidelines. Records for healthcare appointments should be kept enabling people to ascertain when future appointments are due. Records should be maintained evidencing the observation of nurses by the care supervisor. A full detailed assessment should be put in place to include DNR and should be agreed by the home, family and GP and other healthcare professionals involved in their care. Care records should be amended as changes occur – this is in relation to the person with a PEG who is eating a soft diet with the support of staff. The medication administration chart should be taken with the medication to the person receiving the medication. ‘As directed’ entries should be removed from the administration record. Care plans should be updated as medication changes occur. Handwritten entries should be countersigned by a second person. Ensure that the complaints procedure refers to the Commission for Social Care Inspection. Where a member of staff is appointed with a povafirst check a risk assessment should be put in place detailing their responsibilities and supervision arrangements. 8. 9. YA22 YA34 Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 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 © 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 Leonard Cheshire Of Gloucestershire DS0000016491.V332867.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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