Inspection on 12/02/09 for The Old Dairy

This inspection was carried out on 12th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Dairy 16/02/07

The Old Dairy 27/01/06

The Old Dairy 22/07/05

The Old Dairy 11/10/04

The Old Dairy 14/07/04

The Old Dairy 01/12/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Dairy Market Street Nailsworth Glos GL6 0BZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: The Old Dairy Market Street Nailsworth Glos GL6 0BZ 01453835380 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): glynys@ggh.org.uk Gloucestershire Group Homes Name of registered manager (if applicable) Miss Joanne Wheeler Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home The Old Dairy is run by Gloucestershire Group Homes, which specialises in the care of people with Aspergers Syndrome. The home is in a central area of Nailsworth, and close to the towns facilities. The Old Dairy is a three storey house and there is a garden at the rear of the property. Five people live together in the main part of the house and each person has their own room. One person lives in a separate flat, which is attached to the main house but has its own entrance. The people who live at The Old Dairy receive support from a permanent staff team. Gloucestershire Group Homes also employ relief staff who are available to support Care Homes for Adults (18-65 years) Page 4 of 36 care home 6 Over 65 0 6 Brief description of the care home people at the home when the need arises. The fees ranged from 650 - 1373 pounds per week. Information about the home is available in a Statement of Purpose. Copies of inspection reports are available from Gloucestershire Group Homes and are also available through the Commissions website at www.csci.org.uk Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We looked at all the information that we have received about the home since the last key inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 12th February 2009. During this visit we met with the people who live at The Old Dairy and we had a look around the house. We also met with members of staff, including a senior support worker, who we were told managed the staff team. We also met with Ms J. Wheeler, the homes Care Homes for Adults (18-65 years) Page 6 of 36 registered manager who came to the home after our arrival. Prior to the visit we had sent surveys to the home so that these could be given to staff members. We received four surveys back. We looked at some records when we visited the home. We also visited the Gloucestershire Group Homes office on 24 February 2009, in order to look at the staff recruitment records that were being kept there. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. The previous inspection of The Old Dairy was in February 2007. What the care home does well: What has improved since the last inspection? At the last inspection we had reported that some windows on the ground floor were in urgent need of painting, and that there was damp in the activities room that needed attention. We saw that these items had received attention. In the case of the windows, new double glazed units had been fitted. We were told in the AQAA about other changes that had been made to the accommodation, which had improved the environment for the people who lived at the home. These had included internal decoration and changes to one persons individual accommodation, so that they had a more private space. Staff members have attended a course in medication, so that they have a better understanding of how to support people safely in this area. Care Homes for Adults (18-65 years) Page 8 of 36 What they could do better: We were told that there were occasions when some people spent time in the home without staff on the premises. The assessment of this did not include the aims of the practice, or the potential benefits. There was also a lack of detail about the circumstances, such as the length of time, and when it would not be appropriate for a person to be left alone. The assessments need to show that any risks in relation to people being left alone in the home have been identified and addressed. We thought that it would also be useful to review staffing levels, to assess the impact that these were having on the decision to leave people in the home without staff present. The lack of a staff training plan, and of consistent recording, meant that it was difficult to get an accurate picture of the training that staff had attended or were expected to attend. A plan should be produced, which sets out the subjects that are to be covered and shows how staff will receive the training that is appropriate to their role and necessary to meet peoples diverse needs. It was reported in the AQAA that the home provided staff induction and development programmes, which met the National Minimum Standards (NMS). When we visited the home we found that new staff were provided with a two week in-house induction, although there was no accredited programme of induction, or one that met the standards that are expected in the NMS. The staff induction and development programmes should be developed, so that the people who use the service benefit from staff who have received the range of training that is expected in a care setting. During the visit we found that there had been shortcomings in relation to the administration of medication and the checking of fire precautions over a period of time. It was not clear who was taking responsibility for addressing these, and for ensuring that risks to the people in the home were being reduced. We were told in the AQAA that one of the things that could be done better was to put pressure on the housing association that owns the property to improve their response time for maintenance. People were not fully protected by the homes recruitment procedure. Criminal Records Bureau (CRB) disclosures had been obtained for new staff, and these included a check of the persons name against the Protection of Vulnerable Adults (POVA) list. However, staff members had started their in-house inductions, and were working with people, before their CRB disclosures were returned, and the outcome of their POVA check was known. This meant that the people who used the service were at risk of being supported by somebody who is unsuitable to work with vulnerable adults. We have talked to Gloucestershire Group Homes about the need to establish a system for evaluating the quality of services, which included consultation with the people who live at the home, and their representatives. This was to ensure that standards in the home are monitored, and so that peoples views can be taken into account in the homes development plans. We were told that surveys were shortly to be sent out, in connection with this, so a system of quality assurance has yet to be fully implemented and reported on. Care Homes for Adults (18-65 years) Page 9 of 36 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Nobody had moved into The Old Dairy for several years. Gloucestershire Group Homes has a procedure in place for new admissions, and for assessing whether it can meet peoples needs before they move in. Evidence: It was reported in the AQAA that Gloucestershire Group Homes had a policy on new admissions. However, there had been no vacancies at The Old Dairy for the last few years and nobody had moved into the home since February 2004. In the absence of any changes in occupancy, it was not possible to look at recent outcomes in relation to standard 2. We were told in the AQAA that the suitability of the admissions policy would continue to be monitored, and that initial assessments gave full consideration to peoples autism needs, wishes and aspirations. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are reflected in their individual plans and they are supported with making decisions. People can take risks as part of an independent lifestyle. However, further information is needed about the safeguards that are in place and the benefits for the individual. Evidence: People had individual files where information about their needs and personal support was recorded. The homes senior support worker told us that these were new files that had recently been put together and they were still work in progress. We looked at three peoples files. Each contained a personal profile that was designed to give an overview of the support that the person needed. The profiles had a number of sections, which included autism specific information and medical information. There were also some separate guidelines about the support that people needed in specific areas. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: We asked staff in their surveys whether they we given up to date information about peoples needs, for example in the care plans. The four staff members responded Always to this question. One staff member commented We work as a close team sharing all information regarding each client. We saw records of review meetings that had taken place during the last year. People had discussed changes in their needs and new things that they would like to do. Actions were agreed at the meetings and peoples personal profiles were then updated. We read about decisions that had been made in relation to peoples day activities and weekly routines. We were told that it was now the intention to focus more on peoples wishes and aspirations, and on recording these as individual goals in their personal files. We met with the person who was living in the separate flat. The accommodation was arranged for independent living, although staff were on hand to provide support where needed. The person was pleased with this arrangement and they could make a lot of decisions, for example about how to spend their time, and what to eat. When we spent time in the main house we saw that other people were able to choose what to have for lunch. People received support with managing and safekeeping their personal money. We were told that people could be actively involved, for example by looking after a weekly amount, or saving an amount of money each week for a particular hobby. We saw that individual accounts were being kept of peoples personal money. A staff member confirmed that receipts were obtained when people received support with shopping and other expenditures. Each person had a general risk policy on their file. These outlined the hazards and support needed in areas such as medication, diet and personal care. Information had been recorded about specific risks. We looked at examples of records that had been completed in September 2008. These included risks in relation to peoples relationships and to their behaviour, such as self-harming. We saw that one person had a risk assessment for being left alone in the home. The assessment did not include the aims of this practice, or the potential benefits. There was a lack of detail about the circumstances, such as length of time and when it would not be appropriate for the person to be left alone. It was agreed with Ms Wheeler that more information needed to be recorded about this, to show the safety measures, and any limitations that were in place. During the visit we were told that other people sometimes spent time in the home without staff present, either on their own, or Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: together. We thought that this showed further the need for thorough assessments to be undertaken and recorded, to show that any risks in relation to people being left alone in the home have been appropriately identified and addressed. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People participate in a range of activities that reflect their interests and abilities. They are part of the local community and receive support, which helps them to maintain relationships. People have meals that they enjoy, and they are encouraged to participate in the household tasks. Evidence: People were engaged in different activities when we arrived at the home. Some people were out at a supermarket with a staff member. They returned to the home and then helped out in the kitchen. People told us about their plans for the day, which included going to the swimming pool at a nearby town. Other people were having home-based days and spending time in their rooms and in the communal areas. We heard that one Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: person was particularly keen on gardening and they had an area for growing vegetables in the garden that was at the back of the house. We saw that individual timetables had been written, which showed the activities that people usually took part in during the week. People had a mix of planned activities and unstructured time. Some activities were available at the day centre nearby which was run by Gloucestershire Group Homes. People took part in other occupation and activities in the local community, such as a work experience placement at a garden nursery. The home was well placed for people to be able to get to a range of shops and town facilities. There was information in peoples files about their backgrounds and relationships. Some people told us that they visited family members on a regular basis. The home had a domestic type kitchen, which we saw people using with varying degrees of support from staff. Somebody was preparing breakfast when we arrived at the home. They had made themselves a poached egg, which they said was what they liked. We also met with people at lunchtime, when people had chosen what they wanted to eat and helped to prepare this. During the morning, people had returned from their shopping trip with a selection of pastries and cakes, which we were told was a weekly treat that people could have on a Thursday. The main cooked meal was prepared later in the day and people told us that they helped to choose the meals each week. There was a menu on display in the kitchen, which people had written to show the meals that they had chosen. There was a separate laundry room, which we saw when we went around the home. As with the cooking, people received varying degrees of support from staff with their washing. One person was able to do most tasks independently and there were some instructions and notices displayed in the laundry to assist with this. The provision of a separate flat meant that one person had the use of their own facilities and they could exercise a lot of choice and independence in their daily routines. Care Homes for Adults (18-65 years) Page 17 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported in ways that respect their individual needs and assist them with managing their personal care. There are shortcomings in how medication is being dealt with, which mean that people are not as well protected as they should be. Evidence: There was guidance in peoples individual files about the way in which they wished to be supported. The support covered a range of areas and tasks, such as bathing and advice about managing money. The guidance showed that a lot of support was provided by way of verbal prompting and encouragement, so that people could be as independent as possible. There was evidence of this when a staff member felt that it was a good time to suggest to somebody that they had a bath, and they encouraged them to do this. There was also a Guide to Working at The Old Dairy, which was designed to provide an overview of the support that people needed. We saw examples of individual guidelines that had been produced, for example in relation to Intimate Personal Hygiene support, responding to specific behaviours, and about peoples preferred Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: routines at different times of day. During our visit, we saw that staff members were respecting peoples privacy and talked to people in a respectful way. There were records on peoples files about their contact with GPs and other healthcare professionals. Health check forms were being completed with each person, usually on a monthly basis. These gave a summary of appointments and the health related matters that had arisen during a month. We looked at the arrangements being made for the storage and administration of peoples medication. Medication was kept in a lockable desk drawer, rather than in a cabinet that was designed for the purpose. The storage arrangements did not meet the requirements for the storage of controlled drugs although we were told that nobody was being prescribed any controlled drugs at the time of the inspection. Peoples medication came to the home as part of a monitored dosage system, which the pharmacist had prepared. We saw that one persons supply of medication included a separate packet of an antipsychotic drug, which was medication that they were also receiving through the monitored dosage system. The packet had an expiry date of December 2008 and should therefore have been disposed of appropriately before that date. We were told that this medication had been kept in order to have a supply available, which was in addition to the monitored dosage system. The packet had an original date of March 2007, and back up only had been written on the label. We had confirmed at the last inspection that any changes to medication provided by the pharmacist needed to be clearly recorded, and include the name of the person who made the alteration, the date on which it was made, and the authority. We saw a number of occasions when changes had been made, or handwritten instructions entered on the medication forms, but not signed by staff. We saw that records were being kept of medication received into the home, and of its administration to people. We looked at two peoples records and saw that there were gaps in the recording of its administration during the last three months. This meant that it was unclear whether people had received the medication that they needed, for example because they had refused it, or because staff had not given it to them. The monitored dosage system enabled the medication to be taken from the packs and given directly to people at the appropriate time. We saw three peoples medication being taken from the packs and put into plastic pots an hour before it was due to be administered. This was not a safe or hygienic practice. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: There was information on peoples individual files about the medication that they were prescribed. The details on one persons file needed to be updated, so that it included all the current medication that this one person was being prescribed. Care Homes for Adults (18-65 years) Page 20 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can express their views and are listened to by staff. There are procedures in place, which help to protect people at the home, although some staff are in need of training. Evidence: Gloucestershire Group Homes had produced a procedure that people could use for making a formal complaint. It was reported in the AQAA that the home had not received any complaints since the last inspection. We saw records of the annual review meetings, which showed that people had the opportunity to express their views and talk about things that mattered to them. During our visit, people were open in talking about the home and the things that they did. We observed staff listening to various issues that were raised, and helping people to make decisions. We were present for part of a staff meeting, which included a discussion about the suitability of DVDs. This had arisen because of the content of certain DVDs that were being brought into the home and watched in one of the communal areas. Staff discussed issues in relation to the right of somebody to watch their choice of DVD, and the need to consider other people who might be offended or disturbed by the subject matter. We thought that this was an important matter to discuss, so that a decision Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: could be made that was in the best interests of all the people who used the service, and their rights were protected. It was reported in the AQAA that no safeguarding referrals had been made during the last 12 months, and there had been no incidents which had involved restraint. Staff members confirmed in their surveys that they knew what to do if somebody had concerns about the home. A staff member told us during our visit that there was guidance about protecting people from abuse and they were aware of the procedure for this. We were told in the AQAA that the home needed to ensure that protection of vulnerable adults (POVA) training is regularly updated to include any new staff. Care Homes for Adults (18-65 years) Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have accommodation that is meeting their needs in most areas. They have benefited from some improvements to the environment during the last year, but could be at risk from a lack of attention in some areas. Evidence: The Old Dairy is a period property in a central area of Nailsworth. The home is very close to the towns shops and facilities. It did not stand out as being a care home, although the lack of a visible house name meant that it could be difficult for people to find it if they were visiting their friends or relatives at the home for the first time. The accommodation consisted of a main house where five people lived, and a flat for one person that was attached to the main house but had its own entrance. There was a garden at the rear of the property. This looked like a very useful area that people could use for recreation and for growing plants. Ms Wheeler, the manager showed us around the home, although bedrooms were not seen at this time. We were told in the AQAA that people had been able to personalise their own rooms and had their own keys to maintain privacy. We saw people preparing their own food and drinks, and having meals in an open plan kitchen and dining area. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: There was a lounge on the first floor with a sofa and television. At the side of the house, with its own entrance, there were two rooms that were used for recreation and different activities. It was reported in the AQAA that improvements during the last year had included numerous internal decorations and adaptations to the living space. We were also told that one of the things that could be done better was to put pressure on the housing association that owns the property to improve their response time for maintenance. At the last inspection we had reported that some windows on the ground floor were in urgent need of painting, and that there was damp in the activities room that needed attention. We saw that these items had received attention. In the case of the windows, new double glazed units had been fitted. The accommodation generally looked clean and tidy at the time of our visit. The first floor lounge was homely and well furnished. The activities and communal rooms at the side of the house were used for a variety of recreation and storage purposes, and were kept more informally. We saw that one of the electrical sockets in this area had tape around the casing, indicating that it was damaged in some way. Ms Wheeler did not know the condition of it, or for how long it had been in this state. After we visited, Ms Wheeler told us that it would be followed up with the housing association. Doors in the main house had been fitted with overhead self-closures, so that they would remain closed when not in use. This was to ensure that the doors, when closed, would provide resistance and protect people for a period of time in the event of a fire. When going around the home we saw that wedges were being used to hold open the doors to a bedroom and to the laundry. These rooms were not being used at the time. We discussed this with Ms Wheeler and confirmed that this practice should be stopped. We talked to Ms Wheeler about safe ways in which some doors could be kept open and a fire safety officer can advise further about this. Care Homes for Adults (18-65 years) Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not fully protected by the homes recruitment procedure. Staff training should be developed so that the people who use the service are supported by staff who have received the range of training that is expected in a care setting. Evidence: We were given information in the AQAA about some training courses that staff had attended, or were due to attend. It was reported that autism specific and antidiscriminatory practice training had recently been provided. In their surveys, the four staff members said that they were being given training which was relevant to their role and helped them to understand and meet the individual needs of the people who the people who used the service. Three of the staff members confirmed that the training kept them up to date with new ways of working. When we visited the home we saw that training records were being kept, although these did not include details of all the courses that we were told that staff had received. Staff had received medication training during 2008. Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: It was reported in the AQAA that the home provided staff induction and staff development programmes, which met the National Minimum Standards (NMS). When we visited the home we found that new staff were provided with a two-week inhouse induction, although there was no accredited programme of induction, or one which met the standards that are expected in the NMS. The senior support worker told us that they which were not familiar with the Skills for Care organisation, or with the common induction standards that should apply to the service. There was no overall plan for staff training, although we were told in the AQAA that staff training would continue to be developed. We thought that a plan needs to be produced, and that this should set out the subjects to be covered and show how staff will receive training that is appropriate for their role and reflects peoples diverse needs. When we spoke to the senior support worker about this they said that they thought it was a grey area as to who had responsibility for drawing up a training plan, and that this was something that needed to be discussed. They said that one priority was to look at what training needed to be renewed. We asked in the AQAA about the number of care staff who had received training in safe food handling. We were told that this wasnt applicable for the home. We were also told that no staff had received training about the prevention of infection. We thought that these were subjects were relevant and needed to be included in a staff training plan. We were told in the AQAA that there was a team of four staff of whom three had achieved a National Vocational Qualification (NVQ) at level 2 or above. When we met with the homes senior support worker, they told us that were currently seven permanent staff members, but they did not know whether they had achieved a NVQ. We were told that two new staff had been recruited since the last inspection, who were now working at The Old Dairy. Staff recruitment files were kept in the organisations office, which was a few minutes drive from the home. There was a recruitment file for each of the two new staff members. These included application forms and a record of the checks that had been carried out during their recruitment process. We saw copies of references that had been received, and copies of documents that had been obtained as proof of identity. Criminal Records Bureau (CRB) disclosures had been obtained, which included a check of the persons name against the Protection of Vulnerable Adults (POVA) list. A recruitment checklist was being maintained although this did not show the date on which the new staff members were appointed and started work. From the records of induction and CRB disclosures we saw that both staff members had started their inhouse inductions, and were working with people at the home, before their CRB disclosures were returned. This meant that the people who used the service were at Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: risk of being supported by somebody who may be unsuitable to work with vulnerable adults. Care Homes for Adults (18-65 years) Page 27 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Action needs to be taken so that people benefit from a well run home and to ensure that their health, safety and welfare are better protected. Evidence: Gloucestershire Group Homes has a management structure that includes a General Manager, and two Service Co-ordinators who, between them, are registered to manage the organisations homes. We were told in the AQAA that the senior support worker took responsibility for the day to day running of The Old Dairy and is supported by the homes registered manager, Ms Wheeler. This arrangement involved the delegation of management tasks to the senior support worker. The senior support worker had responsibility for supervising the staff team. We were told in the AQAA that one thing that the home could be better was to Maintain more regular section 26 visits. Before visiting The Old Dairy we had talked to Gloucestershire Group Homes, in connection with another service, about the need for visits to be made to the home each month in accordance with Regulation 26 of the Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: Care Homes Regulations 2001. Under this regulation, a report of each visit needs to be completed, and a copy of the report kept in the home and available for inspection. When we visited The Old Dairy we saw that there were reports of visits that had been made to the home, the most recent being in January 2009. Ms Wheeler said that the visits had been inconsistent, but were now being undertaken routinely each month. These monthly visits are important because they are a way in which the provider monitors standards, for example by looking at the outcomes for people and whether the organisations policies and procedures are being put into practice. During the visit we found that there had been shortcomings in relation to medication and the fire precautions over a period of time, and it was not clear who was taking responsibility for addressing these, and ensuring that risks to the people who used the service were being reduced. One requirement that we made about medication at the last inspection had not been met. We had also talked to Gloucestershire Group Homes about the need to establish a system for evaluating the quality of services, which included consultation with the people who live at the home, and their representatives. This was to ensure that standards in the home are monitored, and so that peoples views can be taken into account in the homes development plans. We spoke to Ms Wheeler about this when we visited The Old Dairy. We were told that surveys were shortly to be sent out, in connection with the homes plans for quality assurance. A system of quality assurance has yet to be fully implemented and reported on. We also talked to Ms Wheeler about other more informal ways of obtaining feedback, as part of quality assurance, that may be appropriate with the people who used the service. When we visited the Gloucestershire Group Homes office we met with the General Manager, who said that the organisation had previously had a system of external accreditation in place, but this had not been maintained. During our visit to the home we looked at the arrangements being made for health and safety. The senior support worker told us that the bedroom windows had restrictors fitted, and nobody was considered to be at risk from window openings. A fire risk assessment had been undertaken in December 2008. This needed to be signed by the person who carried out the assessment. A number of assessments had also been undertaken in relation to particular areas of the accommodation, which also concerned the risk of fire. These referred to the undertaking of regular checks of the fire precautions. We saw that weekly tests of the homes alarm system were not Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: happening consistently, and neither were the monthly checks of the emergency lighting. The senior support worker said that the alarms should have been tested each week on a Wednesday. Care Homes for Adults (18-65 years) Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 20 13 The home must ensure all additions/amendments on the administration of medication sheets include the details specified in this report 14/03/2007 Care Homes for Adults (18-65 years) Page 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 When staff administer 13/03/2009 medication to people who use the service, this must always be clearly and accurately recorded, and the medication records kept up to date. This will help to ensure that people receive the correct levels of medication and are not put at unnecessary risk because of inadequate medication records. 2 20 13 The procedures relating to 27/03/2009 the administration of medication must be reviewed and action taken to ensure that appropriate standards are maintained in all aspect of medication practice. This is to make sure that staff are clear about their role in dealing with medication, and the people who use the service are not Care Homes for Adults (18-65 years) Page 32 of 36 put at unnecessary risk because of inadequate procedures relating to medication. 3 34 19 People must not work in the 13/03/2009 home until their names have been checked against the Protection of Vulnerable Adults (POVA) list. This is to ensure that the people who use the service are not at risk of being supported by somebody who is unsuitable to work with vulnerable adults. 4 35 18 The record of staff training must be fully completed and kept up to date. This is so that there is an accurate record of the training that staff have received and to show that staff have received the training that is appropriate for their role and necessary to meet peoples diverse needs. 5 39 24 A system for evaluating the 15/05/2009 quality of services provided at the home must be established and maintained. The system must provide for consultation with the people who live at the home, and with their representatives. This is to ensure that Gloucestershire Group Homes is making the improvements that are needed, and that the views 27/03/2009 Care Homes for Adults (18-65 years) Page 33 of 36 of the people who live at the home and of their representatives are being taken into account and acted on. 6 42 13 Unnecessary risks to 13/03/2009 peoples health or safety must be identified and so far as possible eliminated. This includes ensuring that safety measures are maintained in accordance with the outcome of the risk assessments that have been undertaken. This is to ensure that people are not at risk because checks in relation to health and safety are not being undertaken in accordance with the required frequency. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 That the assessment records for people spending time alone in the home show the aims and the potential benefits for the people who use the service, and the practical circumstances such as the length of time, and when it would not be appropriate for a person to be left alone. It is also recommended that staffing levels are reviewed, to assess the impact that these are having on the decision to leave people in the home without a staff member present. This is to ensure that the policy of home alone is in the best interests of the people who use the service and that any risks in relation to people spending time in the home without a staff member present have been appropriately identified and addressed. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed. This is Page 34 of 36 2 20 Care Homes for Adults (18-65 years) so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. 3 4 24 35 That advice is taken from an appropriate source about safe ways in which a fire door can be left open. That a training plan is produced, which sets out the intentions for training and how this is to be prioritised and provided. Initially, a training needs assessment for the staff team should be undertaken, to ensure that the training provided is matched to statutory requirements and peoples individual needs. That the homes policy and procedure about induction is reviewed to ensure that it reflects the current standards that are expected. That the management roles and areas of delegated responsibility are reviewed. This is to ensure that people who use the service benefit from clarity of management roles and responsibilities. That a system of regular health and safety checks is implemented, as a way of identifying works that are in need of attention, and so that people who use the service benefit from a well maintained and safe environment. 5 35 6 37 7 42 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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