Inspection on 07/12/05 for St George`s

This inspection was carried out on 7th December 2005.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St George`s 20/12/06

St George`s 06/02/05

St George`s 12/08/04

St George`s 26/02/04

Similar services:

2 Perhaver Park

The Vicarage

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Stallcombe House

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

CARE HOME ADULTS 18-65 St George`s Well Close House Lansdown Parade Cheltenham Glos GL50 2LH Lead Inspector 0Kath Houson Unannounced Inspection 7th December 2005 09:30a St George`s DS0000016585.V271045.R01.S.doc Version 5.0 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 St George`s DS0000016585.V271045.R01.S.doc Version 5.0 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. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St George`s Address Well Close House Lansdown Parade Cheltenham Glos GL50 2LH 01242 511237 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) St George`s Association Mrs Pamela Joan Osbaldstone Care Home 9 Category(ies) of Learning disability (9) registration, with number of places St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: Saint George’s is a Regency Grade II listed building that provides residential accommodation for nine women with learning difficulties. The Well Close House is part of Saint George’s association that was set up 109 years ago. Well Close house is one of three projects owned by the charity. The home is set in its own attractive and extensive grounds in the front and a water garden to the rear of the building. Additionally within the grounds there are four bed-sit accommodations for supported living tenants. The home is close to Cheltenham Town centre a mile away from Montpellier and its facilities. There is good local transport and the home has the added advantage of a volunteer car service. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place one day in December 2005. The manager was unavailable. However assistance was provided throughout the inspection and all relevant documentation was made available on request. Nineteen of the core standards were assessed and included an examination of documentation; three residents’ records were case tracked, a short and informal discussion was conducted with residents’ and staff team member, a tour of the environment and a short succinct feedback was given to conclude the inspection visit. The inspector would like to thank the providers, staff and service users for their time and assistance during the inspection What the service does well: What has improved since the last inspection? The recommendations and some of the requirements were met from the last inspection. The Missing persons’ procedure is in place and care plans are reviewed every six months. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 6 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. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 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 St George`s DS0000016585.V271045.R01.S.doc Version 5.0 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 Service users benefit from having their needs and aspirations assessed within the home and support provided to meet goals. EVIDENCE: The home has produced a recent leaflet with the service users in mind, with an inclusive approach to include all relevant information on admissions for potential service users. The staff provides ongoing support based on the needs of residents. The support from staff is very visible, in the manner that all needs are regularly assessed and documented in care plans. Aspirations are meet via the Individual Programme Plans (IPP) then the care plans are reviewed with the idea to put in place the main objectives and outcomes all in discussion with the service user and key worker. This procedure demonstrates good practice involving the service user at every step and very much giving a voice with encouragement to share service users own ideas. An example, any activities that take place on the premises such as book club have to be decided with the residents of the home which is conducted via a voting system. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 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): 8 The resident’s benefit from being involved in how their home is managed. EVIDENCE: Service users are consulted on every aspect of the home and are involved in the household chores on a rotational basis. Any chores; activities, outings forthcoming shows menu options for instance are discussed in a meeting which take place once a week. Clients have the added support from key workers. The residents are currently updating their personal manual, which outlines how clients wish their home to be managed. Service users are consulted on every aspect of their home to include every household chores to include staff and service users. Weekly meetings are arranged to discuss issues about the home this is good practice and demonstrates inclusive nature of the home. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 Service users benefit from having their personal progression monitored and have opportunities for development external to the home in which they live. EVIDENCE: Residents regularly attend a day centre. This centre provides a wide range of activities, such as Café/sandwich bar where work experience in food hygiene, food preparation is available. All activities are tailored to meet individual needs, with outcome focused care plans and in-depth assessments to monitor improvements at the day centre. Employment is another topic made accessible at the day center issues such as job applications forms, interview techniques CV’s for those who wish to participate and gain a useful career. In which residents have the opportunity to access and have the choice to obtain useful skills. One service user was able to gain skills for personal development that will become useful when participating in social events and seminars. The residents are able to develop their social skills accessing local facilities using bank and post office, computers basic computer skills access to internet, group discussion looking at behaviour through discussion and role play, client St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 11 committee, regular meetings to discuss activities and the running of the day centre and part of the decision process. The day centre was developed for women with mild to moderate learning disabilities in Gloucestershire. It was mentioned that Friday is the most popular day in which the day centre becomes a social gathering. The home additionally has links with the local stables, as some of the clients are keen horse riders and regularly attend with the view to become advanced and proficient horsewomen. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 and 21 The service users benefit from having the support they need in the manner in which is preferred, which is documented in the service user care plan. EVIDENCE: The manner in which residents wish to be supported was documented in the care plan for example the key worker would work very closely with the resident and discuss preference to support. The service user is a keen horsewoman, and wishes to ride in Solvinia as part of her aspirations. The support given is to ensure that the service user in agreement and consent that she had regular training, and continual practice rides at the local stables. The service user was dressed in her horse riding gear ready to go riding and said “I like riding its good for my hands.” The same service user will be heading a seminar on the history of Saint George’s at the women’s institute, the positive outcome was to encourage the client to put forward her own ideas. The room in which to administer the medication is a little tight but the safety aspect is satisfactory. The home has a “medication officer” who is a staff member with a specialist role. The home has met the requirement from the last inspection in regards to the purchase of a new and updated version of The British National Formulary (BNF). The care worker discussed with the service user how and which medications she would like to take. On the whole a good system exists for handling medication and staff training and updates. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 13 In preparation for the aging process and death, which is discussed and monitored. The assessment takes place as it happens according to the needs of the service user. For example alternative accommodation is made external to the home in the event of illness. An example was a precious service user requested that the residents’ from the home visit her at the local hospice. The home has a “grow older proforma” which outlines the changes in lifestyle and physical ability, good preparation in place for when this occurs and demonstrates good practice in awareness of service users’ needs. The residents’ have the opportunity to prepare for death and is documented in the care plan. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Residents are protected by a robust complaints system and their views are taken onboard. EVIDENCE: There is currently a complaint between two clients and the staff is dealing with issue in-house. The clients are very vocal and able to voice their concerns well. There are good processes in place to deal with any problems. Weekly meeting are set aside for discussion and feedback forms seen. There has been no complaint about the service or staff. The staff team training records showed in protection and self-harm issues. This is beneficial for the clients as it aids protection from potential harm. One staff member said, “The clients participate in-house training as part of running their home.” The staff members spoken with are additionally aware of the whistle blowing procedure and will take the relevant steps to deal with any concerns. The staff team are reminded by the manager of training up dates which is good practice for the staff team and clients. Information about the home is continually shared with the clients to ensure that informed choice is maintained. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25,26, and 29 Residents’ benefit from an environment that matches their individual requirements. EVIDENCE: Well Close House is a large detached house set in its own gardens. The home has nine bedrooms, two communal lounges, a dinning room, kitchen with dinning facilities and a separate laundry room. The residents discuss and agree on what lounge activities should take place such as the book club that meets regularly. All bedrooms have a hand sink and there are three bathrooms and two separate shower rooms. The doors have locks and the residents each have their own key. One of the bathrooms named “the purple bathroom” has a condensation problem that will require addressing. This bathroom has severe mould on the walls and the current ventilation is not suitable or safe. Additional ventilation must be provided and the bathroom redecorated. The service users bedroom suits their life style and that the décor fixtures and fittings reflect the individual taste of service user. One service user said that her room “is cosy and comfortable.” The environment is in good decorative order. There is a spacious kitchen and that is well organised. Service users said “ there is a rota for all household St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 16 chores” such as cooking the evening meal, shopping and putting the groceries away and cleaning the fridge. One service user has specialist equipment to aid her mobility both at the home and at the day center that promotes her independence. The garden is well maintained and the pool garden has bungalows, which caters for supported living tenants who are not part of the house and have their own private contracts. The environment is homely and comfortably decorated and is within easy access into Cheltenham and its surrounding area. The residents live in a family type atmosphere in a household that is exclusively for women with learning disabilities. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 17 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): 33, 34, 35,and 36 Staffing levels are generally satisfactory although there have been incidents where insufficient staffing levels may have been placed service users at risk. EVIDENCE: There currently exist committed long-standing, staff who deliver good levels of support to the clients who have an understanding of the service users needs. This was evident from the continuous conversation and written documentation that demonstrate that the clients are supported in the home. The staff team is effective in the range of tasks they perform. Additionally there is a positive element of respect. A member of staff had said, “I really enjoy working here and I constantly participate with the service users’ We encourage the clients to run their home.” However the rota confirms that there are usually two staff members on duty during the morning and evening with an additional member during the day. On the day of inspection it appeared that the service users were left unattended for a short while. The home must ensure that home is staffed in sufficient numbers at all times unless a risk assessment demonstrates otherwise. A risk assessment would determine the length of time that the clients are allowed to be left unsupervised. This was highlighted from the previous inspection and will be monitored at the next inspection. Inadequate staffing levels were identified as St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 18 a shortfall at the last inspection and the home must ensure that this is addressed. Another issue that requires some attention is that staff in the registered home are being “shared” with supported living (SL); Staff working in the care home must not be used to support or supplement the needs of those living in nonregistered accommodation The home has a robust recruitment policy and procedure. Although there has been no new appointee for a while the home does have staff team that is committed. Supervision sessions take place monthly and training updates are arranged and ongoing, this is good practice and beneficial for the clients. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 19 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, 38,40 and 41 The clients of Saint George benefit from an organised home, this home involves the clients in a totally inclusive manner. The home fulfils its statement of purpose thus maintaining a secure and homely environment for residents. EVIDENCE: The communications officer and health and safety officer document all relevant issues and have regular monthly meetings to discuss various topics relating to the home and the needs of the clients. An example, such as how to revamp the policy and procedures book displays strong input from the clients. The residents have rewritten the policy and procedures book, this demonstrates the inclusive manner in which the home is run with the input from the residents combined with support from an effective staff team. A committed manager who is client focused and knowledgeable runs the home. The manger has a strong commitment to partnership working with the Commission in order to maintain a good standard of care within the home. There are procedures in places according to the size of the home and it is evident the openness and respect towards the clients. The approach of the manger creates an open, positive atmosphere this was evident during previous St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 20 conversations prior to inspections and witnessing the extensiveness to which the clients feel at ease within their own surroundings. Furthermore, the responsible person has displayed warm commitment to the home and guests over a long period of time to enable members of staff to grow with training and support. For instance the clients said “staff very friendly I like being here the staff very good.” The record keeping in regards to client information is kept in satisfactory order adhering to data protection policy. Additionally documentation is kept in a secure and confidential place within the home. All documents were produced on request with detailed explanation to how procedures are conducted. For instance the opinions of the clients are addressed to ensure involvement, openness and respect in which the residents are valued and that their voice matters. This was very evident in the revamping of the policies and procedures document that show pictures of residents and hand written comments made by residents on how they would like their home to be managed. Additionally, the equal sharing of household chores between clients and the staff team demonstrates how the home functions on a homely and consistent basis. St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 4 4 X X 4 X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St George`s Score 3 X 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 X X DS0000016585.V271045.R01.S.doc Version 5.0 Page 22 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 YA33 Regulation 18 (1) (a) Requirement Timescale for action 28/02/06 2 YA24 There must be at all times be sufficient numbers of staff employed in the home (deadline of 4/08/05 not met) 23(2)(d)(p) All parts of the home are kept clean and reasonably decorated and that the ventilation particularly in the named bathroom is suitable for service users. 28/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St George`s DS0000016585.V271045.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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