Inspection on 08/09/09 for The Retreat, Quedgeley

This inspection was carried out on 8th September 2009.

CQC 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Retreat, Quedgeley 14/01/10

The Retreat, Quedgeley 24/03/09

The Retreat, Quedgeley 31/03/08

The Retreat, Quedgeley 06/07/07

The Retreat, Quedgeley 09/08/06

The Retreat, Quedgeley 18/11/05

The Retreat, Quedgeley 09/03/05

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 26/11/2009.

Key inspection report CARE HOME ADULTS 18-65 The Retreat, Quedgeley 116 Bristol Road Quedgeley Gloucester Glos GL2 4NA Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 8th September 2009 09:30 The Retreat, Quedgeley DS0000060002.V377433.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 Retreat, Quedgeley DS0000060002.V377433.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 Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Retreat, Quedgeley Address 116 Bristol Road Quedgeley Gloucester Glos GL2 4NA 01452 728296 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) manager@retreatgloucester.co.uk Mr Grant Marcus Taylor To be appointed Care Home 14 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (1) of places The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th March 2009 Brief Description of the Service: The Retreat is a large detached property on the Bristol Road in Quedgeley providing accommodation and personal care for up to fourteen people with a learning disability. The home is staffed twenty-four hours a day and has waking staff at night as well as a member of staff sleeping in. People are accommodated in single rooms on ground and first floor levels, some with ensuite facilities others with hand wash basins or shower cubicle washing facilities. On the ground floor there is a lounge, separate dining room, kitchen, communal toilet and bathroom. Laundry facilities are located in a conservatory room at the back of the house adjacent to the kitchen. Located to the rear of the property is a patio area with a table and seating and a substantial garden that is laid to lawn. The outdoor unused swimming pool area has been fenced off. There is a car park for several cars to the front and side of the property. The home is located close to a residential development with supermarket, post office, garage and out of town business park with several consumer stores and restaurants/ take-aways. The home is on a main bus route that can take people into Gloucester city centre, which is approximately three miles away. The fees range from £600 upwards depending on the individual’s assessed need. The fee is determined by whether the needs for care are high, medium or low. The fees do not include the cost of items such as newspapers, toiletries, magazines, chiropody and sundry items and there may be charges for some transport, outings/trips and holidays. A copy of the Statement of Purpose is available from the office. Copies of our inspection reports are displayed in the entrance hall. The Retreat, Quedgeley DS0000060002.V377433.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 inspection took place in September 2009 and included two visits to the home on 8th and 9th September. The manager was present throughout. An Annual Quality Assurance Assessment (AQAA) had been supplied to us for the previous inspection in March 2009; we had not requested another AQAA for this inspection. We (the Care Quality Commission CQC) had conducted a random inspection in July 2009 to check on compliance with requirements issued at that inspection. We found that 12 requirements had been met and that work was in progress to meet one other requirement. We issued a further 4 requirements at this inspection. Since the last key inspection a new manager had been appointed to post and had been working with us to improve the quality of the service being provided. We spent time with people living in the home talking to them and observing the care and support they were receiving. We talked to visitors and to staff. We also had feedback from health professionals supporting people in the home. We talked to 3 people living in the home, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also looked at staff files, health and safety records and quality assurance systems. We walked around the home and several people showed us their rooms. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The Retreat provides a relaxed, friendly and homely environment and people spoken with confirmed that they are happy living in the home. Daily routines appear flexible and staff accommodate individual lifestyle choices, whilst enabling individuals to remain as independent as possible. The overall impression following the visit was that the individuals living at the home are happy, settled and secure and the staff have a good rapport with them. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. 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 have access to a Statement of Purpose, Service User Guide and a statement of terms and conditions which are produced in formats using symbol and pictures providing them with information about the service they will receive. EVIDENCE: The Statement of Purpose and Service User Guide had been revised since our last inspection and produced in formats using plain English, symbols and pictures. Each person had a personal copy of the Service User Guide which was also available in the entrance hall. Information contained within these documents met with our requirements. Details about the size of rooms were provided clearly showing that two rooms were less than 10 sq metres in size. This requirement has now been met. There had been no new admissions to the home since our last visit. There were two vacancies. It was evident that the changing needs of people were being monitored and the appropriate health professionals involved in a reassessment of their needs. Previous new admissions to the home have involved completing The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 9 an assessment of needs by the home and obtaining an assessment and current care plan from the placing authority. Each person had a statement of terms and conditions in place which complied with the National Minimum Standards and had also been produced in a format using pictures and symbols. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. 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. A person centred approach to care planning will ensure that people are able to take control of their lives and plans will reflect their wishes and aspirations. Risk assessments need to be reviewed to make sure they reflect the hazards people currently experience and they are safeguarded from possible harm. EVIDENCE: New person centred plans (PCP) were being introduced in the home using a format using pictures and symbols. The existing care plans were being kept up to date, monitored and reviewed as needed. (These had been produced since our last key inspection providing a more individualised overview of each person’s needs.) A person was observed discussing their new PCP with their key worker and agreeing on information to be put into the plan. Three people were case tracked and each had a new PCP which was in different stages of completion. They also had existing care plans which had been reviewed within The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 11 the last six months. The care plans for one person were missing and staff thought that they had been archived by mistake. The new plans need to be completed as a matter of urgency. Previous inspections had commented on the jargon used in daily records and care plans. Those examined were respectful and used plain English. Staff were observed interacting in a positive and respectful manner with people. Each person case tracked had recently had a review with attendance from a representative of their placing authority. They had also been supplied with a copy of the placing authority assessment of need and care plan. We examined three files for each person and a daily file containing monitoring records and daily notes. We also sampled files for other people. The new PCP’s would provide a holistic assessment of people’s needs from which care plans would be put in place for their emotional, social, intellectual and physical needs. Each person would have a communication profile. They were being asked to supply information about ‘what I like’, ‘what I don’t like’, ‘what I do now’ and ‘what I would like to do.’ People said they had not been involved in care planning before. They appeared to have positive relationships with their key workers who they said were working hard to develop the new plans. This is a significant improvement. Previous comments had indicated that care plans were not person centred and people were unaware of the content. At this inspection people were talking about their ‘person centred plans’ and appeared to be totally involved in the process. This work must be taken forward so that each person has a PCP which contains full, accurate information about their wishes, choices and support and which provides sufficient guidance for staff in order to inform and underpin practices within the home. There was evidence that goals and objectives were being developed to provide staff with information about how to support people to develop new skills. During our visit these were being put in place for people wishing to do their laundry. Other goal plans were in place for people wishing to manage their personal finances. Staff spoken with had a good understanding of the needs of the people they support. They were able to describe how to support people to manage their fears and anxieties, how to support people to maintain their mobility and how to help people cope with changing personal care needs. They were observed providing lots of opportunities for people to make decisions and choices about their day to day lives. People were asked about how they wished to spend their time – one person chose to go out shopping, another said they would go to the library and one person went out for a drive. There was evidence of the use of photographs and symbols around the home to illustrate activities and daily responsibilities. A board in the dining room contained symbols relating to household tasks opposite which photographs of the person responsible for doing these would be placed. Staff described how The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 12 they were planning to extend the use of photographs and symbols to other areas and illustrate documents. One person used a communication device and was observed using sign language with staff, although not all staff appeared to understand her. People were supported to manage and budget their personal finances. A care plan for one person indicated that they had agreed to budget their weekly allowance so they would not overspend or get into debt. They were observed being supported to access this and signed their financial record. Another person asked for some money and also signed a petty cash receipt to acknowledge they had received this. For people who required more support receipts were obtained and could be cross referenced with records. Checks were being carried out several times a day. We discussed with the manager restrictions to freedom or choice which may be in place such as the use of the keypad on the front door and locking away certain food items. He explained the rationale for these which were clearly to safeguard people from harm and to promote their wellbeing. He stated that some people had access to the number of the keypad or a key fob enabling them to leave the home independently. People were observed having access to snacks such as crisps or fruit. These restrictions should be discussed in a best interests meeting and noted in people’s care plans. Other restrictions included the use of keys to people’s rooms, bedsides, lap belts and use of a listening device. Incident records were being kept detailing episodes when staff had to support people with their anxieties or fears. Staff spoken with had a good understanding of how to support people and what the triggers may be and how to avoid these or divert people when upset. Records indicated that for one person there had been a reduction in the number of incidents over the last few months. There was evidence that they had been involved with a Psychologist who had provided guidelines and recommendations to be followed. A risk assessment referred to this guidance but it was not on their file. During our visit the manager contacted the Psychologist to obtain a copy of this guidance. Some new risk assessments had been put in place for people such as accessing the community and individual fire risk assessments. Other risk assessments were out of date which the manager said would be reviewed, amended or removed where appropriate. The new person centred plans provided a format for a personal description of each person with accompanying photograph which would provide missing person information. People were being supported to take risks whilst minimising hazards. Several people were totally independent out and about in the community and had been provided with mobile phones and identity cards. They always informed staff where they were going and estimated time of their return. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 13 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: 11, 12, 13, 14, 15, 16 and 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. People have some say in their day to day lives and as a person centred approach is adopted within the home will have an increasing role to play in the planning of their lifestyles. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. EVIDENCE: We chatted with people about their lifestyle and choices they made on a daily basis. One person said they went to a Salvation Army Meeting and to church on a regular basis. People were observed using local facilities, popping out to the shops or garage. During our visit one person asked if they could go to a local pub and another person said they were going to the library. An activity schedule was displayed in the kitchen confirming each person’s commitments The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 14 at colleges, a working farm and day centres. People were supported in paid jobs and voluntary work. Daily records provided evidence of people’s daily activities and also indicated if they had refused the opportunity to go out. People said they were planning holidays and day trips for later in the year. One person was looking forward to a shopping trip in Birmingham and another to a trip to Cadbury World. We sampled daily records for two weeks in August when people had been supported to go to the cinema, shopping, the pub, day trips or drives, social clubs, a sports centre and bingo. Staff said they were gradually introducing activities in the home such as bingo and arts and crafts. Feedback from visitors, staff and people living in the home said that people could at times get bored and we observed some people spending a considerable amount of time in the lounge with the television on. During our visits there were 3 care staff on duty throughout the day who also had responsibilities for cleaning communal areas. A cleaner was due to be appointed which staff said would release them to do more activities with people. A notice board indicated people’s responsibilities around the home and they were observed helping to prepare meals, setting tables and clearing away, doing their laundry and helping with the shopping. People helped themselves to drinks and snacks throughout our visits. The manager and staff said they were creating more opportunities for people to help around the house and maintain or learn independent living skills. People said they were supported to visit relatives or relatives could visit them in the home. Visiting relatives said they were made to feel welcome and that when there was a driver on duty their relative could visit them at their home. People were also supported to write letters to friends and relatives and also kept in touch via the telephone. People did not have keys to their rooms and not all rooms had the facility to be locked. Some people said they would like to be able to lock their rooms. The manager said that this would be looked into. Care plans need to indicate reasons why people do not have keys to their rooms. People and staff who smoke do this in the garden. They were observed doing this just outside one of the doors near to communal areas. The smoking area should be further away from doors and windows. People were being involved in the planning of meals at house meetings. Minutes noted their personal choices. A selection of fresh vegetables, salad ingredients and fruit was provided for people and freshly produced meals were provided. People were observed having a lunch of egg salad or an alternative if they preferred and vegetarian lasagne or sausages for tea. People asked if they could have a take away and the manager said they would be having a The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 15 takeaway once a month. People expressed their personal choice about the type of takeaway. Menus were displayed in the kitchen and staff said they would be producing a pictorial version of the menu starting with the takeaway menu. Concerns about risks of choking were referred to the Speech and Language Therapist and thickeners were being used with fluids where appropriate. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 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’s health and personal care needs are being met helping them to stay well. Their health and wellbeing are promoted by satisfactory arrangements for the handling of medication. EVIDENCE: The new PCP’s will clearly indicate how people would like to be supported with their personal care needs. People’s likes and dislikes will be discussed with them and their care will be delivered in the way they prefer. Staff were observed being responsive to people’s requests for support with their personal care and mobility. People were being supported with changes to their personal care needs and encouraged to be as independent as possible. Staff had received the appropriate training from the District Nurse. A tissue viability risk assessment was in place for one person and they had been provided with the appropriate equipment. Moving and handling guidelines The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 17 were in place and staff were observed following these. When two members of staff were required to complete a task they were observed doing this. A Physiotherapist had provided a series of exercises to be completed with one person each day to maintain their mobility. Staff said they did not always have time to complete these although they did encourage the person to walk to the dining room for meals. They were observed doing this several times throughout our visits. When developing the new PCP’s it is important that people are asked about the preferred gender of staff providing their personal care. This had not been noted in the existing care plans. Each person had a Health Action Plan in place and staff said they had appointments with the General Practitioner to complete these documents. A record was being kept of appointments with a range of health professionals. People had regular contact with their General Practitioner, Optician, Dentist and Chiropodist as well as members of the local Community Learning Disability Team. It was evident that any changes in the wellbeing of people was being investigated and reported to the appropriate health professionals. One person was supported to go to an emergency appointment with their Dentist during our visit. Health professionals commented that communication between the home and themselves was good. Systems for the administration of medication were inspected and found to be mostly satisfactory. Staff confirmed they completed training in the administration of medication and some staff had completed the ASET course in the ‘Safe handling of medication.’ A medication audit was being completed regularly to check that stock levels were correct. Medication was administered from a blister pack and boxed items. There were some handwritten entries on the medication record which need to be countersigned as correct by a second member of staff. This process was put in place during our visit and staff were observed asking for a second member of staff to complete this process. Liquids and creams were labelled with the date of opening. Stock records were being maintained on the medication administration record. Protocols were in place for the use of ‘as necessary’ medication. A staff signature list was on the medication file. The temperature of the cabinet was not being monitored. This was put in place during our visit. There was no system in place to assess staff competency in the administration of medication. Some had completed their training a significant time ago. We discussed with the deputy manager how this could be put in place as part of the supervision process. She described how new staff would shadow existing staff until assessed as competent to administer medication. A copy of the British National Formula was not seen by us during our visit. The home is advised to purchase a copy if they do not have one. A record of consent to have medication dispensed by staff was not seen during this inspection. This must be in place if it has not already been completed. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 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. People are confident in the knowledge that any concerns they may express will be listened to and acted upon. Systems are in place that should safeguard people from possible harm or abuse, although they could be more robust. Staff need to have the skills and knowledge in the management of verbal and physical aggression to make sure that people are protected from possible abuse. EVIDENCE: The complaints procedure had been reviewed and produced in a format using pictures, text and symbols. A copy of this was displayed in the entrance hall and each person had a copy on their personal file. Information about us had also been amended to reflect our current contact details. People spoken with said they would talk to their key worker or the manager if they had concerns. People were observed knocking on the door of the office to talk to the manager throughout our visiting indicating that he was accessible to them and they were confident that he would listen to and respond to their concerns. People were having house meetings and we read the minutes for two meetings held in June and July. Another meeting had been scheduled for September and staff were heard discussing this with people adding their agenda items to the list displayed in the entrance hall. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 19 New staff confirmed they had completed training in the protection of adults as part of their induction. Existing staff had completed ‘alerter’s guide’ training with the local adult protection team some time ago and they will need to have refresher training. They had not received training in the Mental Capacity Act or Deprivation of Liberty Safeguards. A copy of the alerter’s guide and Department of Health’s ‘No Secrets’ were available in the office. Staff spoken with said they would report any concerns to the deputy or manager and they had confidence they would act on these. The manager had made contact with the local adult protection unit for advice. The manager said that he was still trying to source training for staff in the management of challenging behaviour. This requirement will be repeated but training must be arranged. Failure to meet with repeated requirements may result in enforcement action being taken by us. (See Standard 32) As mentioned incident records were being kept although guidelines describing how staff were to support one person when anxious or distressed could not be found. These must be in place to provide staff with the necessary information they need to provide a consistent approach to people. Guidance in an ‘as necessary’ protocol gave clear information about likely triggers and how to divert or de-escalate the person. This information had not been evident in their care plan. For another person there were guidelines in place indicating a low arousal approach using distractions and moving others to a place of safety should they become distressed. It stated that physical intervention would not be used. Staff confirmed they would not use physical intervention. Financial records were examined and found to be satisfactory. A discrepancy on one person’s record was immediately resolved. Receipts were being obtained for Chiropody appointments. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30. 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. People are being involved in the refurbishment and redecoration of their home, choosing colour schemes and furniture. Specialist equipment is provided to people should they need it. Further work is required to bathrooms and ensuites to make sure they meet a satisfactory standard. Infection control measures in the home have improved minimising the risk of harm to people. EVIDENCE: We walked around the home with the deputy manager and several people showed us their rooms. Since our last key inspection a significant amount of work had been completed to comply with our requirements. We discussed long term plans with the manager for further improvements. These included people being involved in the re-decoration of their rooms. They were busy choosing colour schemes and had been provided with paint charts. People were also choosing their own bedding to complement their new rooms. New curtains and The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 21 nets had been provided around the home. There were plans to replace carpets in some communal areas and hallways with a washable floor covering. A new sofa had been ordered for the lounge. A new wet room had replaced a bathroom and people said they liked using this. Repairs had been made to other showers and bathrooms. Some work was outstanding in a bathroom (taps) and further refurbishment had been identified for one en-suite shower. A shower head was also missing from one person’s en-suite shower. A maintenance file was examined which indicated day to day environmental issues and when they had been completed. Equipment had been provided for one person both for their room and for use in communal areas. They had been assessed by a Physiotherapist and Occupational Therapist and recommendations about the equipment they should have in place had been implemented. Staff were feeling positive about the appointment of a cleaner to maintain communal areas. At the time of our visits the home was clean and tidy. Paper towels and liquid soap had been provided near all communal hand wash basins. Colour coded mops and buckets were in use and staff were completing an Infection Control open learning course. Hazardous products were stored securely. Data sheets for hazardous products and a risk assessment were not seen during this inspection. All recommendations from an Environmental Health visit had been complied with. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. 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. A competent and skilled staff team support people living in the home. Their continuing professional development must mirror the complexity of people’s needs. Improvements in recruitment and selection processes will safeguard people from possible harm. EVIDENCE: Staff were observed positively interacting with people living in the home, treating them with dignity and respect. On one occasion they were observed having to leave one person, who they were supporting with their personal care, to help another member of staff to carry out moving and handling tasks. The person patiently waited for the staff member to return but their care plans had indicated that they would not always do this and an event like this could easily upset them. Staff indicated that mornings were always a busy time, with one member of staff taking people out to their activities for the day leaving two staff members to support others in the home. The manager usually covers morning shifts with two members of staff when he does the driving duties. This The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 23 needs to be monitored to ensure that the needs of people remaining at home can be met. He said that he would be advertising for a peripatetic member of staff to cover sickness and holidays but there would be additional spare hours each week to provide additional cover in the home. New staff said they had completed an induction programme with an external provider which included all mandatory training. This is equivalent to the Skills for Care requirements and covered the common induction standards such as understanding the principles of care, understanding the role of the organisation and the worker, communicating effectively and maintaining safety at work. The manager confirmed that 80 of the staff team are working towards or have a National Vocational Qualification in Health and Social Care. We looked at recruitment and selection records for two new members of staff. Each had completed an application form although only one supplied a full employment history. The manager said he had requested a full employment history from the other person but they had not yet supplied this. This information needs to be in place before people are appointed to post. The reference request form did not ask previous employers to provide a reason why people left positions with adults or children. This was added onto the reference during our visit. People started work after two satisfactory references had been received. Criminal Record Bureau checks were examined and found to be satisfactory. These should be stored securely and separately from staff files. One member of staff started working on the 19th June and their CRB check was not returned until the 22nd June. A risk assessment must be in place describing what duties they can and cannot perform whilst working without this record. Copies of birth certificates should not be kept. This is to comply with Data Protection requirements. Proof of identity and a current photograph were in place. The manager said that a training matrix had not been developed. Copies of certificates were on staff files indicating that existing staff needed refresher training in many mandatory courses. New staff as mentioned had completed all mandatory training. Moving and Handling training had been booked with a local provider and staff were being asked to sign up for this during our visits. He said that other refresher training would be provided for staff in addition to training in epilepsy and autism. He had made contact with a number of local providers to access their training. Staff training needs had been identified in their supervision records. There was evidence that supervisions were now being scheduled and most staff had received two supervisions this year. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home will benefit from having a period of consistent management providing leadership and direction to the staff team which should promote improved outcomes for people. Systems need to be developed which will enable the home to operate in the best interests of people, seeking their views and enabling them to voice their concerns. EVIDENCE: The manager had been appointed to post after our last key inspection. He has considerable experience supporting people in care and managing a variety of care establishments. He said he is collating references ready to apply to us to become the registered manager for the home. Since his appointment he has forwarded documents and records he has updated to us for our consideration. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 25 He has kept in touch with us notifying us immediately of incidents in the home affecting the wellbeing of people. Health professionals said they were impressed with his professional and person centred approach. The manager confirmed that arrangements had been made to give him total management responsibility for key budgets in the home including staffing costs, training, provisions, utilities, repairs and vehicle costs. Although a significant number of requirements issued at the last key inspection have been met there are still some outstanding requirements which need to be complied with. There was some evidence that work was in progress to implement a person centred approach to care. The manager must now ensure that risk assessments are reviewed, staff have access to training in the management of challenging behaviour and restrictions and restraints are recorded. Failure to comply by the revised timescale may lead to the CQC considering enforcement improvement to secure compliance. The manager had completed training in the Mental Capacity Act and was due to attend training in the Deprivation of Liberty Safeguards. As mentioned staff had not yet completed this training. There was information in the home for staff and people living there about these regulations. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. Any restrictions and restraints in the home need to be recorded and evidence provided these are in people’s best interests. Staff must have access to refresher training in fire, first aid and food hygiene. Their certificates indicated that a number of staff had completed this training some time ago and was now out of date. The manager said that a Regulation 26 visit as required by us had been completed by the provider in August. We read this report which provided evidence that people living in the home had been involved in this process. An action plan had resulted from the visit which the manager said he was in the process of implementing. The manager said that surveys would be sent out to people living in the home, their relatives and other people involved in their care as part of the quality assurance process. Health and safety and medication audits were being completed. He said that a report would be produced once this process had been completed providing people with a summary of their views and any actions taken. During our visit records were kept securely. All people had inventories in place although for one person case tracked this document had not been completed. Health and safety records confirmed regular checks and servicing of equipment in the home. The fire service had been consulted about a fire risk assessment and had advised developing individual fire risk assessments. These were all now in place. House meeting minutes indicated that people had been involved The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 26 in fire training and that at each meeting they would remind themselves of the evacuation procedure. This is good practice. Water, fridge, freezer and hot food temperatures were being recorded. Staff were advised to purchase wipes for the hot food probe. Food in fridges was labelled with the date of opening. The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 2 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 1 X 3 2 X Version 5.2 Page 28 The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The Registered Person must ensure that care documentation is person centred and reflects the individuals assessed and changing needs and personal goals for their health, safety welfare and lifestyle. (This requirement is repeated. Timescale of 1/3/08 and 30/09/09 not met, although there is evidence that work is in progress to meet this requirement) In particular, the Registered Person must ensure that all Person Centred Plans: Fully involve the service user. Are clear and concise and jargon free. Clearly identify the prioritised goals and objectives that staff should be aware of for the people concerned. This will inform and underpin practices within the home. Timescale for action 31/12/09 The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 29 2. YA7 12 The Registered Person must 31/12/09 make sure that any limitations to choice or freedom are recorded in their care plans. This is so that people are aware that any restrictions are done in their best interests to protect them from harm. The Registered Person must make sure that each person has a risk assessment in place detailing how any hazards they may face are minimised, with evidence that they are regularly reviewed. This is so that people are protected from possible harm. The Registered Person must make sure outstanding environmental issues – such as improvements in bathrooms and en-suites are completed. This is to make sure that the home is a safe, well maintained environment. 3. YA9 13 31/12/09 4. YA24 23 31/12/09 5. YA32 18(1a) The Registered Person shall ensure that all staff have the skills to deal with incidents of aggression and challenging behaviour and protocols for dealing with such episodes are documented. (This requirement is repeated. Timescale of 1/3/08 and 30/09/09 not met, although there is evidence that progress is being made to meet this requirement) This is to ensure that people in the home are supported in a safe and appropriate manner. 26/02/10 The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 30 6. YA34 19 The Registered Person must make sure that the records required by us are obtained prior to appointment. This is in respect of a full employment history and obtaining the reason for leaving former employment with children or adults. This is to safeguard people from possible harm. The Registered Person must make sure that where people are employed before their CRB check is returned, a risk assessment must be in place describing what duties they can undertake. 31/12/09 7. YA34 19 31/12/09 8. YA37 Care Standards Act Section 11 This is to protect people from possible harm. The manager must apply to us to 31/12/09 become the registered manager for the home. This is to make sure that there is effective and competent management in place in the home. The Registered Person must develop the homes’ quality assurance system by reviewing its performance and writing a quality assurance report to demonstrate continual improvement and development in the service. (Work is in progress to meet this requirement. Timescale of 31/3/08 and 30/09/09 not met) 9. YA39 24 (1-3) 31/12/09 The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard YA6 YA7 YA16 YA16 YA18 YA18 YA20 YA33 YA34 Good Practice Recommendations Copies of care plans and guidance should be kept on people’s files so that they are accessible to staff. Staff should understand and be able to use sign language. Where people do not have keys to their rooms the reasons for this should be recorded in their care plans. The smoking area should be situated away from doors and windows. People should be supported to do daily exercises as recommended by the Physiotherapist. Care plans should identify people’s preferences for the gender of care staff providing their personal care. Assessments of staff competency to administer medication should be completed at least annually. Staffing levels should reflect the needs of people living in the home. This should be monitored. Copies of birth certificates should not be kept. Criminal Records Bureau checks should be kept securely and separate from staff files. This is to comply with Data Protection Recommendations. Staff should have access to training in epilepsy and autism. Staff should understand the implications of the Mental Capacity Act and Deprivation of Liberty Safeguards. Wipes should be purchased for the hot food probe to ensure it is clean. 10. 11. 12. YA35 YA39 YA42 The Retreat, Quedgeley DS0000060002.V377433.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission 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. 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