Inspection on 15/05/06 for Leonard Cheshire Of Gloucestershire

This inspection was carried out on 15th May 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Leonard Cheshire Of... 12/09/07

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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Fairfields Country Rest Home

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Poldhu

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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 15th & 16th May 2006 15:30 Leonard Cheshire Of Gloucestershire DS0000016491.V291920.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 Leonard Cheshire Of Gloucestershire DS0000016491.V291920.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. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Leonard Cheshire Of Gloucestershire Address Charlton Lane Leckhampton Cheltenham Glos GL53 9HD 01242 512569 01242 253284 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.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.V291920.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user (under a Learning Disability Category) until they leave the home. 11th December 2005 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 two people 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; service users also use local taxis and the community transport system. Fee levels range from £365 - £906 per week. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 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. Two inspectors took part in this inspection in May 2006. It included two site visits to the home on the evening of 15th May and on the 16th May. The registered manager was present during both visits. A pre-inspection questionnaire formed part of the inspection as well as comment cards from people living at the home. Staff were spoken to during the site visits and a handover was observed. Discussions took place with people living at the home and their care was also observed. A visiting relative and a volunteer were also spoken with. Four people living at the home were case tracked. This involved examining their records, chatting with them, looking around their rooms and talking to staff about the care they are receiving. Other records examined included training records, health and safety records and staff files. What the service does well: What has improved since the last inspection? There has been an improvement in the quality of care plans (Individual Service Plans) for people living at the home providing staff with information about how Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 6 to meet their needs. One person went through their plan with an inspector. Many people choose to keep their plans in their rooms and most have signed them. There has been an increase in the opportunities for people living at the home to access activities in the evenings, activities at the home, holidays and work placements. Further consultation has taken place with people about the meals provided at the home. There has been a significant improvement in the monitoring of people’s dietary needs in particular their fluid and food intake. The policy and procedure for the protection of vulnerable adults has been reviewed and all staff are receiving training in this area. 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. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 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.V291920.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User Guide give prospective people moving into the home details of the services the home provides and a series of visits enables them to make an informed choice about whether they wish to live there. EVIDENCE: The home presently has no vacancies and has a waiting list of people wishing to live there. Prospective people wanting to move into the home complete an admission form. An assessment of need and care plan is obtained from the placing authority. They are given a Statement of Purpose and Service User Guide. The latter document is being reviewed to include pictures as well as text. Visits to the home are encouraged and there is a three-month probationary period during which people can decide whether or not they wish to continue living at the home. A person who moved into the home last year said that they have settled in well and are enjoying living there. They said that they thought they had a threemonth review including representation from their placing authority but no records could be found. The registered manager confirmed that they were still waiting for these from the care manager. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An assessment of the social, emotional and intellectual needs of people living at the home should be included in their individual plans ensuring that their personal goals and wishes are identified. There has been a significant improvement in the quality of record keeping providing staff with the information they require to meet the personal care needs of people living at the home. People living at the home are provided with information enabling them to make decisions about activities of daily living. Improvements made to risk assessments need to be sustained in order that the hazards faced by people living at the home are reduced. EVIDENCE: The care of four people was case tracked during the site visits. There is a considerable improvement in the quality of care plans or Individual Service Plans (ISP). There was evidence that some care plans are being amended as Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 10 changes in need occur. People case tracked said that they are involved in the care planning process. They had signed their care plans. Some people choose to keep the plans in their rooms whilst others wish to have them locked away in the lodge. People spoken with said they have positive relationships with their key workers. A visiting relative confirmed this. ISP’s include a Personal Care Needs Assessment that links to Nursing or Support Plans and Goal Plans. There was a discussion with the registered manager about a full assessment of the holistic needs of people living at the home including a social, intellectual and emotional assessment of their needs. He said that he would discuss this with other managers at their next meeting. It is recommended that a full assessment of need based on the social model of disability be promoted within the home. All people living at the home must have an assessment of needs in place. It appears that not all people living at the home have annual reviews. Copies of a review for one person were dated 2004. The registered manager said that another person had a review recently that included relatives and a care manager although a copy of the minutes of this meeting had not yet been supplied. The registered manager stated that he had attempted unsuccessfully to arrange meetings with care managers. Annual reviews must be put in place. It was suggested that he and the people living at the home arrange an annual review to which they invite representation from their placing authority. Documentation appertaining to reviews that have been held is kept in the manager’s office. It is recommended that these be kept on main files so that staff have access to any changes of needs identified to update ISP’s. People living at the home spoke about how they are supported to make choices about activities of daily living. Information is supplied to them from a variety of sources, their key workers, the activities co-ordinator and the training coordinator. People are being supported to self manage their medication and finances. Assessments and risk assessments are in place. Care staff described the processes they put in place to ensure that these are done safely whilst promoting the person’s independence. A volunteer was observed supporting a person during a site visit. They said that they accompany the person for outings into Cheltenham. They appear to have a good understanding of the person’s wishes including their communication needs. They supported the person during a discussion about their care using a Dynavox and a Bliss symbol book. Some staff have completed risk assessment training and are completing individualised risk assessments for people living at the home. Those in place are being monitored and reviewed. It was noted that risk assessments for one person being case tracked had not been reviewed since 2003 and 2004. The registered manager said that these would be reviewed. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 11 A missing person’s procedure is in place and there are missing person’s records on individual files giving a description and outline of their personal needs. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been a significant improvement in the range of leisure and social activities being offered to people living at the home, enabling them to access activities in the evenings. Contact with family and friends is encouraged and supported. Staff promote the independence of people living at the home respecting their rights and responsibilities. Whilst the nutritional content of meals is better there is still room for improvement to increase the variety offered. The systems for medication are good with clear arrangements being in place to ensure medication needs are met. EVIDENCE: Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 13 People living at the home said that there has been a considerable improvement in the levels of activities provided during the day at the home and during evenings and weekends. This has been achieved by an influx of volunteers and also the goodwill of staff who work in their own time to make sure evening activities can take place. An activities co-ordinator said that she discusses with people living at the home what they wish to do and researches opportunities locally. Events and activities are then circulated and people sign up to attend. Staff commented that activities tend to be scheduled well in advance and are rarely spontaneous. The activities co-ordinator recognises that many activities involve group outings so that staff and transport can be used effectively. She arranges for each person going out to be supported by a member of staff. People living at the home said that they have been to lots of concerts at the Town Hall and Everyman Theatre, day trips to local places of interest and ten pin bowling. The activities co-ordinator said that she is also planning activities such as shopping or going to the pub for people on an individual basis. She is also keeping a written and pictorial record of all activities undertaken by people. This provides good evidence of what opportunities are available. People living at the home indicate that opportunities to go out at weekends were still limited. The activities co-ordinator said that she could be flexible with her time and is willing to arrange activities for weekends. She thought that during the summer opportunities would increase. During the day some people living at the home attend local colleges or the local university and some have work experience placements. Four people help out on the reception at the home answering the telephone and greeting visitors. On the evening of the site visit a group of people went to a dancing class at a local college. Some said they also do a pottery evening class. A group of four people living at the home were away on a boating trip during the site visits to the home. Several other people living at the home said that they were going on similar trips as well as a holiday to Spain. An audit completed by Leonard Cheshire in January 2006 indicated that ‘service users participate in a wide variety of activities outside the home’. People living at the home have their own swimming pool for which they have individual schedules. People were observed taking full advantage of this during the site visits. Individual activity timetables are kept in their rooms or on their personal files. There is also a sensory room that operates a booking system. People living at the home said that they now have Internet access which they enjoy using. Arts and crafts and cookery sessions are organised in the activities room. People were observed taking part in arts and crafts sessions and also continuing with artwork in their lodges once the session had finished. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 14 The walls in the home are adorned with their work as well as photographs of outings. People living at the home said that they use a variety of transport including the home’s buses, community transport and taxis. People using the home’s vehicles are charged a set rate per mile. If a group of people use the bus this is shared between them. Some people commented that they found the costs expensive for longer journeys. People are in receipt of their full mobility allowances and Leonard Cheshire makes no other charges for transport. People living at the home said that they visit their parents or friends and invite them to the home. A visiting parent said that they are made to feel welcome. People living at the home are encouraged to be as independent as possible in activities of daily living. A visiting relative said that staff encouraged people to develop skills and that this is done diplomatically and at the right pace. There was evidence in individual ISP’s of people learning to administer their own medication and being supported to manage their own finances. Routines are flexible guided by the daily schedules of people living at the home. People were observed helping to put laundry away in their rooms with the support of staff, doing their own laundry, preparing drinks, washing up and loading the dishwasher. Good systems are in place to enable people living at the home to express their wishes and needs. Regular house meetings are held for which minutes are available. Lodge meetings are also held enabling people living together to meet with staff supporting them on a regular basis. People living at the home said that they attend these meetings. Concerns were expressed at previous inspections about the nutritional content of meals being provided, about the practice of reheating food and the inadequate monitoring of the dietary intake of people living at the home. The registered manager said that the cook has received additional training in the dietary needs of people living there. This was confirmed in the record of a regulation 26 visit. Meetings are held with people living at the home to discuss the content of the menu. These occur with greater regularity to make sure that the menu reflects their wishes. There was evidence of an increase in the use of fresh vegetables and fresh fruit is being provided in the lodges. The registered manager said that advice had been sought from environmental health about the reheating of food and they said that this could be done if staff followed good practice guidelines. Records confirmed this. Staff were observed putting prepared meals, which were covered and dated into a fridge. Temperatures of the reheated food are being kept. There was a mixed response from people living at the home about the meals being provided. Some said that they enjoy them and others indicated that there was still room for improvement. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 15 Menus confirmed that there is a mixture of freshly prepared food with either fresh vegetables or salad and frozen food served with chips. Each day there is a choice of two main meals and two snacks for tea. Week 1 offers chips and peas on two consecutive days for both meal choices. On week 1 and week 4 on two consecutive days chicken/beef or turkey burgers are offered for the second choice meal. It is recommended that these summer menus are revisited to provide people with greater variety. There has been a problem with the kitchens that have been installed in the lodges and the registered manager thought this would be rectified soon. This has prevented people from taking full advantage of their cooking facilities. Staff have received training in basic food hygiene and good practice was observed in most of the lodges. Staff are reminded that any opened food in fridges must be labelled with the date of opening. People living in one lodge had individual evening meals cooked by staff. One person in another lodge indicated that they had purchased their own tea because they did not like what was being provided. The registered manager said that if people wish to purchase alternative ingredients then this could be refunded through petty cash. Freezers were stocked full with frozen meals provided by a large supermarket. The activities co-ordinator and staff said that they held an Italian evening when people living at the home helped to prepare Italian food and shared this with others in the home. They are planning a Mexican evening soon. Some lodges also have a Sunday evening get together where they bring and share food to a communal tea in the dining room. There is a significant improvement in the monitoring of the dietary needs of people identified as at risk. Fluid and food charts are maintained for people. Staff were observed caring for people who require peg feeds. Storage of syringes and fluids are satisfactory. A dietician provides advice and support to staff. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal care needs of people living at the home are clearly recorded giving staff the information they need to provide this support. Regular access to a range of healthcare professionals ensures that the physical health needs of people living at the home are attended to. Care plans need to reflect changes in physical health needs providing staff with up to date information. EVIDENCE: ISP’s provide staff with information about the way in which people living at the home would like to be supported. Much of this information is written in the first person and some people spoken with confirmed that they had been involved in preparing this information. A visiting parent said that staff are supporting her relative to become independent in areas of their personal care. Concerns highlighted at the previous inspection about bed baths and people being transported to the bathroom covered in towels were not evidenced at this inspection. People spoken to say that they are not having bed baths and that if they go to the bathroom they wear a dressing gown. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 17 The home has its own physiotherapist. Records confirmed that people have access to regular 1:1 physiotherapy sessions with a regular review of their needs. People living at the home spoke favourably about their key workers. A visiting parent was also highly complementary about the support provided by a key worker and the positive relationship that is developing. People living at the home have access to a range of healthcare professionals. Good records are being maintained on their personal files. There was evidence that staff are monitoring those people at risk of developing pressure sores and that action is being taken such as providing the appropriate mattress. Care plans do not always appear to have been reviewed when people are identified as at risk of developing pressure sores. These must be reviewed. One person who was case tracked had an entry in their daily records indicating a change to their pressure areas, however no further mention was made of this and it was not noted in their care plan. It was also noted that one person is repeatedly getting chest infections although the care plan indicated that there are no respiratory problems. This must be amended. The medication systems were checked in two lodges. Records were seen of medications received from the pharmacy and administered. The Nurse in charge said that records are maintained of medications returned, however these could not be found during the inspection as this task has been allocated to one nurse for consistency. Consideration should be given to ensuring all nurses are aware of where these records are kept. One staff member was observed administering medication to the people in the home and they ensured the safety of the medication at all times. People living at the home are able to self medicate following assessment. One person spoken with said they self medicate and were able to talk about the medications they take and what they are for. Safe storage is provided in people’s rooms. One-person case tracked has supervision from staff in checking their blood glucose levels and administering their insulin. The insulin is kept in a cooler in their room. Staff are advised to check the temperature of this fridge daily and to maintain records for this. Medication Administration Records were examined in the two lodges, however the home had changed over their months supply and it was the first day. No gaps were seen in these records and allergies are documented. Dates of opening were seen on all but one liquid medication checked in the two lodges. One cream was found to be six months old on the day of the inspection and consideration must be given to ensuring these are disposed of promptly to prevent any risks to the people living at the home. One member of staff explained their procedure for re ordering of medications, and another member of staff said they have received training in the administration of medications, however they were not sure if it was accredited. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 18 Since the last inspection the home has reviewed their homely remedy. A list of medications each person can have has been devised along with possible side effects. These have been signed by a GP and a record would be maintained if a person receives any of these medications. This is a vast improvement since the last inspection. A controlled medication register is available if any person is prescribed controlled medication. At the present time the home does not have any controlled medication. A drug reference book is stored in the duty room and the nurse in charge said the home has reviewed their specimen signature list but this could not be found during the inspection. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 19 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged to express their views although there is room for improvement so that they are confident that issues will be handled appropriately and action taken where necessary. There are vulnerable adults procedures in place and staff training is given in their use, providing staff with the knowledge and awareness to recognise and report incidences of abuse. EVIDENCE: The home has a complaints policy and procedure which is available to people living at the home. Those spoken with indicated that they would speak to their key worker or the registered manager if they have concerns. They said they could also speak out at the monthly house meetings. The registered manager gave examples of issues which he has actioned as a result of these meetings such as reviewing the security key pad at the front door and replacing fencing at the front of the property. It is recommended that any actions taken as a result of views expressed at house meetings are evidenced and feedback is given to people living at the home. The registered manager said that no complaints have been received. The Service User Guide is being reviewed and current information about how to complain to the Commission for Social Care Inspection must be put into this document. Since the last inspection the home’s policy and procedure regarding the protection of vulnerable adults has been reviewed. The registered manager also said that a copy of the local adult protection strategy had been obtained. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 20 Staff confirmed that they attend training in the Protection of Vulnerable Adults with a refresher course every 2 years. Staff said that they do not require training in the management of challenging behaviour. Daily records examined verified this. Accident and incident records were not available for examination. The registered manager must ensure that these records are accessible when the health and safety co-ordinator is away. He confirmed that no incidents had occurred which required a Regulation 37 notification. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 21 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is pleasantly decorated. There is an ongoing maintenance and refurbishment programme in place making sure that the home continues to meet the needs of the people living there. The environment is clean although minor changes need to be made to minimise moving and handling risks to people using the laundry. EVIDENCE: The home provides pleasant accommodation for people living there with access to large communal areas and accessible gardens. The registered manager has a developmental plan in place including developing a sensory garden with the help of volunteers from a local firm. Ongoing maintenance issues are dealt with as they arise. There was evidence of prompt referral and action through the processes in place. Some individual rooms have been redecorated. Family and friends often get involved in this. The lounges in some lodges have been redecorated and people living there said that they were involved in the choice of the colour scheme. The communal areas in Lodge B are in need of attention. The room Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 22 indicated in this lodge at the last inspection has been dealt with and chairs in the dining room replaced. An en suite in Lodge D is in need of attention around the base of the toilet. The inventories that are part of the ISP’s need completing for some people living at the home. Most people supply their own fixtures and fittings. At the time of the inspection the home was clean and tidy. Infection control measures are in place. Staff receive training in this area. New washing machines and tumble dryers have been fitted. There were problems with one of the new machines that normally fill automatically with washing powder and conditioner. Due to a mechanical failure the home had provided large containers of washing powder and conditioner for people to use. These containers posed a risk to health and safety. The registered manager said that smaller containers would be provided until the machine is mended. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 23 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Changes to the provision of care to people living in the bungalows may benefit people living at the home improving the levels of staffing. Robust recruitment and selection procedures are in place protecting the people living in the home. The provision of training for staff is excellent providing a staff team who have the necessary qualifications to support people living at the home. EVIDENCE: Concerns were raised at the last inspection when it was discovered that on several occasions the members of staff on the night shift had dropped to two from three. The registered manager investigated this and took action to prevent this from occurring again. Night staff were spoken with at this inspection and confirmed that numbers have not dropped below three members of staff a night with an additional person covering the twilight shift – 20.30-23.30. Leonard Cheshire is currently reviewing the provision of care to those people living in the bungalows. This would reduce the pressure on night staff who presently may have to leave the main building to provide care to them. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 24 All new staff complete a Leonard Cheshire Induction which is equivalent to the Skills for Care induction and foundation programme. This is complemented by an induction developed by the training co-ordinator about the home. Staff are then registered for their NVQ Awards. The pre-inspection questionnaire indicated that over 55 of staff now have a NVQ Level 2 Award in Care. The training co-ordinator confirmed this was the case with 6 people also completing NVQ Level 3 Awards. This is commendable. An experienced, skilled and qualified staff group support people living at the home. Those observed during the site visit were respectful in their interactions with people living at the home. At the time of the inspection a number of staff were on annual leave and others were accompanying people living at the home on a holiday. As a result agency staff were being used. The registered manager stated that there is one twilight shift vacancy for which he is short listing and he is appointing an additional qualified nurse. The file for one recently appointed member of staff and one prospective staff member were examined. These contained information as required under Schedule 4. He explained that he asks for a full employment history at interview if this is not provided on the application form and checks any gaps in employment. The registered manager stated that volunteer applications are processed in the same way as staff applications. People living at the home are involved in the interviewing of new staff and volunteers. The registered manager described the processes in place to ensure that equal opportunities are adhered to. A training co-ordinator is employed by the home to administer the training programme and to also deliver training and to verify or assess NVQ Awards. A training database is maintained which provides information about the training needs of staff plus courses attended. As courses or training are scheduled letters are sent to staff who require this training. Posters are displayed in the home identifying when courses are to be held, usually two alternative dates are offered. Training offered covers mandatory training, as well as protection of vulnerable adults, medication, care planning, key working, disability and the law and complaints and whistle blowing. In addition to this, training specific to the needs of people living at the home is provided such as learning disability awareness, epilepsy and cerebral palsy. Training is also offered to people living at the home. They have recently had opportunities to complete training in disability and you, infection control, complaints and the grievance procedure. Future training is planned on relationships. This is commendable. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 25 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has a clear developmental plan for the home that promotes the independence of people living there. The home’s quality assurance programme involves people living at the home in the review of services being provided. Systems are in place enabling the home to provide an environment that promotes the welfare and safety of people living there. EVIDENCE: The registered manager has long term developmental plans in place to increase opportunities for independence for example renegotiation of service provision for people living in the bungalows, installing domestic size washing machines and increasing opportunities for people to cook their own meals. Action has been taken to address issues highlighted at the last inspection. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 26 Leonard Cheshire completed a Home Service Audit in January 2006. This audit involved people living at the home, volunteers and staff. This comprehensive audit produced a report detailing the strengths of the home and producing an action plan. In addition to this other registered managers complete monthly-unannounced Regulation 26 visits. By request copies of these reports are forwarded to the Commission. A health and safety co-ordinator oversees the servicing and checking of equipment within the home. Records were examined confirming that these are done regularly. The fire record book also provides a record of training provided to staff. This does not presently give a record of the date training was provided. It is recommended that this be done. (The training database confirms when staff completed fire training). The pre-inspection questionnaire provides additional evidence of maintenance and servicing records. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 28 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 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. The registered person must make sure that the assessment of service user’s is kept under review. Individual risk assessments must be reviewed on a regular basis. The registered person must make sure that food in fridges and freezers is labelled with the date on which it has been opened or saved. The registered person must review care plans in line with changes identified: • Service user has respiratory problems • Service user has a risk of developing pressure sores. The registered person must ensure that the Service User Guide and the complaints procedure make reference to the Commission. The registered person must make sure that records identified DS0000016491.V291920.R01.S.doc Timescale for action 15/11/06 2. YA6 14(2) 15/11/06 3. 4. YA9 YA17 13(4) 13(4)(c) 15/07/06 15/07/06 5. YA19 15(2) 15/07/06 6. YA22 22(7) 15/07/06 7. YA23 17(3) Sch 3 15/07/06 Leonard Cheshire Of Gloucestershire Version 5.1 Page 29 8. YA24 23(2)(b) 9. YA24 17(2) 10. YA30 13(4) in Schedule 3 are available at all times for inspection by the Commission. The registered person must ensure that the communal areas in Lodge B are redecorated and the en suite in Lodge D is attended to. The registered person must make sure that inventories are completed for service users’ fixtures and fittings. The registered person must provide smaller containers for washing powder and conditioner. 15/09/06 15/07/06 16/05/06 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. 8. 9. Refer to Standard YA6 YA6 YA14 YA17 YA20 YA20 YA20 YA22 YA42 Good Practice Recommendations A holistic assessment of service users’ needs should be completed including their social, intellectual and emotional needs. Assessments must be made available to staff so that care plans can be updated. Opportunities access activities and outings at weekends should be made available. The summer menus should be reviewed as indicated in the standard to provide greater variety. Nursing staff should be aware of where the records are stored to document medications that are to be returned. The temperature of the fridge in which insulin is stored should be checked daily and the temperature recorded. Expired medication should be disposed of promptly. Feedback should be given to service users about action taken as a result of views expressed at house meetings. The fire record book should indicate the date when fire training was completed. Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 30 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. Extracts may not be used or reproduced without the express permission of CSCI Leonard Cheshire Of Gloucestershire DS0000016491.V291920.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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