Inspection on 10/07/09 for The Old Vicarage, Easton

This inspection was carried out on 10th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Vicarage, Easton 18/07/08

The Old Vicarage, Easton 12/07/07

The Old Vicarage, Easton 28/12/06

The Old Vicarage, Easton 29/01/06

The Old Vicarage, Easton 18/03/05

The Old Vicarage, Easton 25/10/04

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 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 The Old Vicarage, Easton 8 All Hallows Road Easton Bristol BS5 0HH Lead Inspector Jacqueline Sullivan Key Unannounced Inspection 10th July 2009 11:00 The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage, Easton Address 8 All Hallows Road Easton Bristol BS5 0HH 0117 9399910 0117 9399910 Carole.tooze@brandontrust.org www.brandontrust.org The Brandon Trust 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) Ms Carole Theresa Tooze Care Home 9 Category(ies) of Learning disability (0) registration, with number of places The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 9 Date of last inspection 18th July 2008 Brief Description of the Service: The Old Vicarage is a large building converted for 9 people with learning difficulties to live in. Currently the home provides nursing care but with a social focus. However Brandon Trust are looking at changing the registration of the home from nursing to registered care. The home is in Easton, Bristol and near to local amenities. There are recreational facilities, shops and services near to the home. There are two large communal areas and 9 single bedrooms in the home. The home is in the process of converting one of the extra bedrooms into a second lounge. The home is surrounded by garden, has its own off-road parking and is situated in a quiet road near to a cycle path. Brandon Trust has a mission statement that includes “supporting and enabling people to live the lives they choose and to empower the users of our service to determine their futures and enable them to reach their goals.” Fees payable are around twelve hundred pounds per week. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection carried out over two days. Before the visit we looked at information received since the last inspection. During the inspection we case tracked the care and support people using the service receive by looking at various records and documents. These included assessments care plans how people are supported in taking risks safely and how they are given their medication. We also looked at staff training records. We were shown around the house and spoke with people, staff, and the manager. We looked the interactions between the people who live in the house. We looked at the requirement and recommendations of the last report to see how fat these had been met by the staff team. What the service does well: People have a good relationship with staff. Staff support their complex needs well and encourage them to be independent and make decisions about their lifestyle. There is an open atmosphere in the home and people can be confident that they will be listened to. The home has good links with local health and social care professionals and responds to advice given. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People who use the service would have better information about the service they receive if their agreements were fully completed. Risk assessments support people to take risks as part of their lifestyle. However these could be further developed in order to protect people. People who use the service would be more assured that their health needs were fully known to the staff team in health care plans were fully completed. People who use the service would be more assured that the staff team know and understand their needs if their monthly reviews were used to inform six monthly or yearly reviews. People cannot be assured that staff are fully aware what they eat as this is not recorded. People would be better protected if staff training in safeguarding were upto date. This training helps keep staff informed of current practice and further ensure people are kept safe. The current dynamics between the people that live in the home must be further addressed so the staff team can promote the welfare of the people who live at the home. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 7 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 8 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 The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not all given full information about the service they will receive. Peoples’ needs are assessed before moving to the home to help ensure they can be met. EVIDENCE: We looked at the Statement of Purpose and Service User Guide and saw that both documents reflect the needs of people living at the home, current practices and services in the home. A Service User Guide is in an easy read format to help people understand what the home has to offer. The Trust document called a place to live agreement was not fully completed for all people. In two that we looked at we saw it did not state the rooms which people occupy, the total fee payable for care and accommodation and peoples contribution. A requirement has been made that this information is available to people that live in the home. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 10 One person showed us that they kept both documents in their room. They said ‘I have been here a long time.” There are currently 6 people living at the home with one vacancy. The last report stated that it has recently downsized to provide a service to 7 people. However the registration certificate states they are registered for 9 people. The manager was going to clarify the position with her manager. Peoples’ needs are assessed before moving to the home to make sure the home can meet them. Most of the people choose to move together as a group many years ago. We looked at three peoples, files and saw that one each there was a detailed assessment of their needs, which forms part of their care plans. Staff members spoken with were able to demonstrate a good understanding of peoples needs. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people have very detailed care plans that show how they want to be supported with their needs. People can make decisions about they wish to be cared for. Risk assessments support people to take risks as part of their lifestyle. However these could be further developed in order to protect people. EVIDENCE: We looked at four people’s care files and saw that they included personal details, daily records, support plans, and risk taking. As noted at the last inspection, some care plans showed the home has improved in recording peoples preferences and lifestyles. One person had a The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 12 PCP (person centred plan), which was very detailed including their needs, wishes and aspirations. This was seen to be displayed in his room and he was able to tell us about it. Another persons PCP was almost completed and the manager said there were plans to complete another two. She said “I plan to finish them all by the end of the year.” She said that they had an outside facilitator but they were going to “lose them” and this may mean the process will be slower. The manager told us that the persons PCP belongs to them and they could all keep them in their rooms. The format they choose may be different. One we saw had pictures and we were told that other people can choose to have their plans in a CD’s or video format .We noted that accessible information such as pictures and photographs to helps people understand their lifestyle and their needs. Some of the plans were very detailed about how the staff team can best support people. For example, in one plan we read, “X is keen to help put away the laundry and enjoys it when gets praised for helping. If X refuses then don’t pressurise but offer another activity.” This person said, “I like helping around the house.” The care files that did not include the detailed PCP had sufficient information but not the wide range .A recommendation has been made that all the PCPs are completed. Care files showed peoples care had all been reviewed recently by their social worker in 2008. This was also confirmed by people using the service. The Trust has procedures in place for peoples care to be reviewed monthly by the home. The manager said this enables them to complete their quality assurance and discuss peoples choices, development and “new things “they would like. A requirement was made at the last inspection that care plans are kept under review .At this inspection a recommendation has been made that the staff team compile all the information into one yearly or six monthly review so that none of the information in the smaller monthly reviews gets lost. Monthly house meetings are in place so people can discuss aspects of their care. Brandon Trust organise ‘forums’ for people so that they can be asked what they want and have a say in their service. We looked at three peoples care files and saw that risk assessments are in place showing how people are being supported to take risks safely. These included how people are supported with their personal care, in accessing the community and travelling independently. Discussions with the manager, staff members and information in the care documentation showed that two people who live in the house experience frequent conflict with each other .A third person is also involved. On one The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 13 persons file we saw a positive support plan which included triggers, known behaviour and strategies for the staff to manage the behaviour. The plan describes how this person finds it difficult to live communally and identifies areas in the house where confrontation between people take plan. We saw that there were risk assessments about using the Hoover, interactions with woman and communication. However there is none about the dynamics of these three individuals and their collective challenging behaviour. We spoke to one of the people who said, “I don’t like the shouting.” We looked at the regulation 37(Notifications to the Commission about things that happen in the home effecting peoples welfare) and the incident book. There were many entries about this issue. The manager told us that a recent review had identified that one person may be better placed in another home and she was looking for alternative arrangements. She said that none of the people actually chose to live together. She thought it would be resolved when the home became supportive living with individual flats. We are concerned that this dynamic has been going on form several years and that it may be a substantial time until the home moves to supportive living. We discussed with the manager the need to complete individual risk assessments and compile a diary of all the incidents .A requirement has been made about this issue. This issue is discussed further in the section about protection. The manager is aware of the depravation of liberty safeguards that will start in 2009 and has started looking at restrictions in place that may deprive people of their liberty. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15,16, & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of people benefit from taking part in educational, social, and recreational activities. People are helped to keep in contact with family and friends if wanted. People are supported in making choices about their lifestyle and are helped to take responsibility in their daily lives. People benefit from a varied menu, and are able to choose the food they prefer and like. EVIDENCE: The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 15 As noted at the last inspection, the majority of the people using the service take part in meaningful activities during the week. These include farm and college placements, and work. This was seen through activities recorded on their care record and activity sheets. People access the community for different activities such as going to pubs, bowling, and day trips. At the last inspection staff felt there are times when there are not enough staff on duty for activities to take place. At this inspection a staff member told us that in the week it is “fine” but at weekends it is more difficult. A vehicle has been provided to support people with activities. A staff member said that this is now really useful. The manager explained that one person who exhibited challenging behaviour in a care could now be transported safely in the mini bus. So they are more able to access the community. Holidays include trips to Cornwall and Devon. We were told that twp people like to go on holiday together and others alone with the staff team. One person told us,” I like going on holiday.” Discussions with the manager, people who use the service and evidence in the care files confirmed that the home has good relationships with peoples’ families. As noted at the last inspection, people are involved in the daily routines of the home, and are encouraged to make snacks and drinks independently. People are offered a varied choice of food. Menus showed that peoples’ cultural background is respected and reflected individual choice. We looked at the menu and it stated that lunch was a choice of sandwiches. We recommend that the staff team write down the food that people actually eat so they can be assured that they are eating a healthy diet. We saw that on a kitchen cabinet there were picture of what was going to be eaten later in the day. There were pictures of quiche, baked potatoes and salad. Alongside was the picture of the person who chose this food. There was also a person’s plan in pictures to show him his eating routines. This person explained to us how it worked. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 16 The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the 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 be assured that they will receive appropriate healthcare in a way that they choose. People are treated in a respectful way by staff Medication procedures keep people safe. EVIDENCE: Discussion with two staff members confirmed that they had a good understanding of peoples health needs. We saw staff members treating people respectfully. On one persons file we saw a detailed support plan about the management of their diabetes, which included nine people’s pieces of guidance for staff to assist them. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 18 People are helped to use different healthcare services, including going to dentist, opticians, chiropodist, occupational therapists and GP’s. Discussions with the manager and evidence in the care files confirmed that people receive annual health checks and peoples’ medication is reviewed regularly. At the last inspection it was recommended that health action plan were introduced. This would help to support staff and provide more detailed information about individuals specific health needs. At this inspection we saw that there was a format on file but they were not consistently completed. The manager said that it was a” work in progress”. This recommendation will remain until all the health action plans contain the information that will assist staff care for people. As noted at the last inspection, the Trust has policies and procedures for the administration, storage, recording and disposal of medication. Medication profiles had a photograph with the record to make sure people are given the right medication. We saw that the information includes detail of possible side effects. Medication is kept safe in lockable cabinets in an office and is given by senior qualified staff. There are no controlled drugs kept on the premises. We looked at the medication records and saw that medication is received monthly and is checked in by staff. This was seen recorded on medication administration records (MAR). The home keeps a record of medicines disposed At the last inspection a requirement was made that a record to be kept of all medication administered so that people are supported safely. At this inspection this was seen to be met. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people that live at the home can be confident staff members will listen and act upon their concerns. The dynamics between some people living at the home often leads to distressing incidents and must be further addressed by the staff team. Staff members would benefit from being updated in safeguarding training to further ensure people are kept safe. EVIDENCE: We looked at the recording of complaints and saw that the home follows the organisation’s complaints policy and procedures. There is a complaints form for people to use in an easy read format to help them understand the process better. The complaints log showed that there has been one complaint since the last inspection. The manager had responded to the complainant in a pictorial letter so that it was easier to understand. One person said they knew how to make a complaint, while two other people told us they knew would tell staff members. The manager said that advocates support people with their views. We saw that an advocate has worked closely with one person to enable them express their views. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 20 We looked at the staff files and saw that not all the staff have had recent safeguarding training. The manager said that she wanted all the staff to go on training together so we saw that a team day had been booked. We were concerned that this had not taken place before in the period in between inspections. At the last inspection it was noted that not all staff have received updating in this area. A recommendation was made for staff to attend training in safeguarding to keep staff informed and updated with current practice. We were aware that there have been some safeguarding incidents within the home and we spoke with the Inspector at the Commission who had information about these. We were told that the home was dealing with these appropriately. Through out our discussions at inspection it was clear that the manager has insight into the problematic dynamics between the people who live in the home. In the 2008 AQAA (Annual Quality Assurance assessment) she stated that the root of the issue is that, “Most people were placed from the Hospital they had little choice in the original decision to move from Hospital or where they would live or who they would live with.” As stated in a former section there are many examples confrontational behaviour between three people who live at the home. We saw examples in the incident books and these peoples care files. One of these people benefits from routines to help him make sense of the day; these routines are sometimes disrupted by the other two people, which can lead to distress. We spoke to this person and he said “I don’t always like living here” The manager told us how another person would benefit from living independently as they find it difficult to live communally which can lead to some of the confrontation .We saw examples of these incidents in their care file. Discussions have taken place at the last review about alternative arrangements for this person (the notes of which were not, as yet on file). However these have not been formalised in to a plan of action. We are concerned at the length of time this situation had been going on for and the, at times, distressing outcomes for all the people involved. In order for the situation to be resolved we recommend that the staff team make a safe guarding referral so that the placing authorities and other relevant parties can make a judgement about the safety and well being of all the people involved. So that this judgement can be most effective the staff team should make a detailed chronology of all the incidents in the last year and provide an assessment of the impact of each on these three people. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 21 In order to encapsulate the above a requirement has been made that the staff team promote the welfare of the people who live at the home The lack of current safeguarding training and the above situation has lead to rate this outcome group as adequate. We note the moves to resolve each but the current outcome for the people who live in the service is not good. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the 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 live in clean, safe, and comfortable environment. EVIDENCE: The Old Vicarage is a listed property built over two floors. There are nine single rooms, a lounge, kitchen, dining room and various bathrooms. An attic is used for storage space. The home has two offices one on the ground floor that is used for daily recording and another on the first floor that holds other care files and is also a sleep in room. We looked at some peoples rooms and saw that they were comfortable and individualised. One person has “star trek” bedding and a Dalek in their room. However, another person’s room we saw was quite bare and basic. We were told that the walls were stained as this person threw drinks when they were The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 23 upset. We recommend that the rooms are refurbished or more regularly cleaned. The carpet in the lounge is stained as we were told people drop drinks on it. We recommend that this be cleaned. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, & 35. People using the 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 benefit from a staff team who have a good understanding of their role and responsibilities and who are trained to meet the individual needs of people. EVIDENCE: All staff spoken with were positive about the staff team and the manager. This was confirmed through discussion and observation. As noted at the last inspection, staff spoken with showed that that they had a good understanding of the aims of the home, their role and responsibilities, and a good knowledge of peoples needs. There is a core of staff that has worked for several years providing consistency for people. Three staff are on both an early and afternoon shift and two staff The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 25 on duty at night with one on a ‘waking’ duty. Regular bank staff are used so that people know who will be supporting them. Three staff are on both an early and afternoon shift and two staff on duty at night with one on a ‘waking’ duty. We looked at the training records confirmed staff are given relevant training to their role helping them to understand and meet the needs of people. Staff records are kept at the Trust’s headquarters and these did not form part of this inspection. The manager has also copies of relevant staff information including information about Criminal Records Bureau checks and references. These were sent o be satisfactory. New staff complete an induction programme that includes the Learning Disability Award Framework and then are offered to register for National Vocational Qualification level two. There are currently three care staff that have a National Vocational Qualification. We asked one person who live in the home about the staff and one person said,” I like them” and named a particular member of staff they were fond of. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is committed to improving standards within the home. People can be assured that their views will be listened to by the staff team. EVIDENCE: Ms Tooze is qualified, competent and experienced to run the home. She is a qualified nurse (RMA), and is a National Vocational Qualification assessor and internal verifier. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 27 Since April 2009 she has been jointly managing another similar home and has made an application to the Commission to be the registered manager for both homes. She explained that in 2010 the Trust plans to introduce supportive living and an area in the garden has been identified for four flats. She is supernumerate when she works in either home. She described the two roles are challenging and said it can mean she is less “hands on” and be more office based. As stated in the section on protection it was clear she has insight into the problematic dynamics between the people who live in the home and has taken steps to resolve these. As stated in that section these measures need to be further developed. We spoke to staff members about the manager. Their comments include,” warm and supportive… helpful.” We saw she related warmly and kindly to people who live in the home. As noted at the last inspection, there have been no annual questionnaires sent out to people using the service this year asking them about the service they receive. People are helped to express their views through 1:1 meetings. The Trust also consults with people through quality monitoring processes. The staff team have set targets and goals including accessible care planning for people and more support through advocates. Annual Health and Safety audits and in house checks are carried out regularly helping to keep people safe. The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 28 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 2 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 N/A 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 X 35 2 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 3 12 3 13 3 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 29 The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc 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 YA1 Regulation 4 Requirement All the required information in the contracts/user guide is available for people who live at the home. The staff team promote the welfare of the people who live at the home. This refers to the standards on protection. Risk assessments are in place about the challenging behaviour and dynamics between individuals living in the home. Timescale for action 01/03/10 2 YA23 12 1 (a) 01/12/09 3 YA9 13(c) 01/12/09 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 YA17 YA6 YA19 Refer to Standard Good Practice Recommendations The staff team record the food that the people in the home actually eat. The monthly reviews of people who live in the house are used to inform six monthly or yearly reviews. Health action plans that help show how peoples healthcare is met should be fully completed. DS0000020336.V377363.R01.S.doc Version 5.2 Page 30 The Old Vicarage, Easton 4. YA35 Update staff with training in safeguarding to help keep staff informed of current practice and to further ensure people are kept safe. The staff team make a safe guarding referral so that the placing authorities and other relevant parties can make a judgement about the safety and well being of the people living in the house. 5 YA23 The Old Vicarage, Easton DS0000020336.V377363.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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