Inspection on 11/05/04 for The Vicarage

Care Homes For Adults (18 ­ 65)The Vicarage59 Andover Road Tivoli Cheltenham Gloucestershire GL50 2TSUnannounced Inspection11th May 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment The Vicarage Address 59 Andover Road, Tivoli, Cheltenham, Gloucestershire, GL50 2TS Email address sheather@gloscc.gov.uk Name of registered provider(s)/company (if applicable) Gloucestershire County Council Name of registered manager (if applicable) Mrs Judith Metcalf Type of registration Care Home No. of places registered (if applicable) 5 Tel No: 01242 521918 Fax No: 01242 227646Category(ies) of registration, with (number of places) Learning disability (5), Learning disability over 65 years of age (5) Registration number D030000462 Date first registered 6th May 2003 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 6th May 2003 YES NO 28/1/04 If Yes refer to Part CThe VicaragePage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 311th May 2004 14.00 Ms Lynne BennettID Code097004Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionK. Shelly, E. Gurney, I. James. P. RoperThe VicaragePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards for Care Homes for Adults (18 ­ 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: D.1. D.2. D.3. Compliance with Conditions ( if applicable) Providers Response Providers Comments Action Plan Providers AgreementThe VicaragePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the CSCI in respect of The Vicarage. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Adults (18-65) published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.The VicaragePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. The Vicarage provides respite care for 5 adults with a learning disability. The home is one of a number of homes run by Gloucestershire County Councils Social Services Department. The Vicarage is a large detached house, conveniently situated close to local amenities and within easy access of Cheltenham town centre. The house is secluded, set in its own grounds with a pleasant rear garden, which is accessible for wheelchair users. This respite service offers service users overnight stays and longer stays of several weeks. Most service users attend local colleges or day centres during the day. The home has its own `people carrier to enable service users to go out in the evening and at weekends. The home provides 5 single bedrooms, 4 of which are en suite, additional bath and shower rooms and a large comfortable lounge, dining room and spacious kitchen.The VicaragePage 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) This inspection took place on a day in May 2004. It found that the majority of the National Minimum Standards inspected had been met or exceeded and that the overall quality of care was excellent. There were three residents staying for the week and three visitors for tea, they all appeared to be very happy with the care they were receiving. The manager was not present at this inspection. Choice of Home (Standards 1-5) 5 of the 5 standards inspected were met The Statement of Purpose and the Service user guide have been reviewed. The Service user guide is produced in picture, text and symbol. To complement this a video has also been produced and service users have been involved in the production of both versions. This is excellent practice. Several new referrals have been received for a respite service. Files sampled confirmed that introductory visits have taken place and assessments have been received from the placing authority and previous placements. A service agreement has been produced by Gloucestershire Social Services and copies were in place on the files examined. Individual Needs and Choices (Standards 6-10) 2 of the 5 standards inspected were met New service user plans are being introduced to existing service users. The plans for all new service users will be in the new format. It is evident that care plans and risk assessments are monitored and reviewed on a regular basis, and that service users are involved in this process where appropriate. This is good practice. Discussions with staff confirmed their knowledge and awareness of how to support service users who may challenge the service and reasons for any limitations to choices or restrictions. Requirements have been made to ensure that their good practice is recorded in care plans and risk assessments.Lifestyle (Standards 11-17) 7 of the 7 standards assessed were met The Vicarage Page 6 Service users have access to a wide range of leisure and recreational activities whilst staying at the home. During the week they continue to attend colleges, day centres or work placements as well as going to clubs in the evenings. At weekends they have been on trips to Hereford Cathedral, Gloucester Docks and Lydbrook, as well as the cinema, pubs, restaurants and shopping. Service users are involved in the choice of menu, which offers a variety of meals using fresh ingredients, frozen food or meals out. Alternatives are always available to the main meal. Roast dinners appear to be very popular and are offered during the week as well as on a Sunday. Personal and Healthcare Support (Standards 18-21) 3 of the 4 standards assessed were met The home maintains records about service users health care needs. Close contact is kept with family and carers to ensure this information is current. If concerns arise during a visit about the health or well being of a service user staff will refer to the appropriate healthcare professional for advice (in consultation with parents or carers). The home ensures robust procedures are in place for ensuring the administration and control of medication. Lockable storage facilities have been provided in individual rooms should service users wish to administer their medication. Concerns, Complaints and Protection (Standards 22-23) 1 of the 2 standards assessed were met The home has a complaints procedure in place. Service users also have the opportunity to feedback to the home after each stay. There were no complaints in the complaints log. The home also keeps a record of compliments made by parents and carers. Environment (Standards 24-30) 4 of the 4 standards assessed were met and exceeded The décor of The Vicarage is of the highest standard and is complemented by tasteful and good quality fixtures and fittings. Overall, the home presents a cheerful, bright, clean and relaxed atmosphere, welcoming to service users and visitors alike. All service users have single accommodation with en suite facilities and access to spacious comfortable communal rooms and level gardens. The home is to be commended for maintaining an excellent standard of accommodation.Staffing (Standards 31-36) 2 of the 2 standards assessed were met (1 was exceeded) Staff were observed being open and accessible to service users treating them with dignity and respect and demonstrating a professional approach to their work. A service user said he The Vicarage Page 7 was very happy with the staff team. The Manager has a strong commitment to ensuring that staff are supported through regular staff meetings and her proactive approach to training, which has enabled all of the staff to complete NVQ awards, exceeding the requirements of the standards. Conduct and Management of Home (Standards 37-43) 1 of the 2 standards assessed was met The managers skills, experience, qualifications and commitment have established a home with extremely high standards of care, a dedicated and motivated staff team and a satisfied and appreciative group of service users and parents. On the day of the inspection the manager was absent, the inspector would like to thank the service users and staff for their time and hospitality during the inspection.The VicaragePage 8 Requirements from last Inspection visit fully actioned? If No please list belowYESSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for actionAction is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations StandardCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).MET (YES/NO)The VicaragePage 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action 12(1)(b) 14(1)(a) 17(1)(a) 2 Sch. 3 Para 3(q) 13(4)(c) 13(6) 13(6)(7) YA7 Service users plans must indicate how staff support service users when presenting with behaviour which may challenge the service. Plans must be drawn up with an appropriate specialist/professional. Any restrictions to choice or decision-making must be agreed with the service user and recorded. Risk assessments must clearly identify the hazards, how controlled and action to be taken. A protocol for the use of a maxi belt must be put in place and signed by the family of the service user.1YA631/7/0431/7/043YA911/6/044YA2330/6/04RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * The Vicarage Page 10 * Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: YES YES NO YES YES YES NO NO YES NO YES YES YES NO NO NO NO YES YES YESThe VicaragePage 11 Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs)6 X X YES YES YES YES 10 X 11/5/04 14.00 3.5The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Adults (18-65) have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.The VicaragePage 12 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 ­ 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. 56.85 X Range of fees charged From To £ £ (per week) YES Any charges for extras If yes, please state what the extras are Day Care £4.20 3 Key findings/Evidence Standard met? The Statement of Purpose and the Service user guide have been reviewed and comply with the standards. The Service user guide has been produced in picture, text and symbol and a video version has been completed. Service users were involved in the production of the service user guide. This was confirmed in staff meeting minutes. These documents were not examined at this inspection.The VicaragePage 13 Standard 2 (2.1 ­ 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. 3 Key findings/Evidence Standard met? There have been several new referrals to the home since the last inspection. The inspector sampled information being collated for two prospective service users. The most recent has just visited the establishment with parents to see whether or not they would like to apply for respite. Initial details have been set up on a file and a record of this visit has been kept. These initial assessments will enable the manager to make an informed decision whether or not a placement can be offered. The other prospective service user had also visited the home with a teacher from his present school; again a record had been kept of this visit. A file had been set up and a Joint Assessment of Needs had been obtained from the placing authority as well as a report from the school. The home had also recorded key contacts such as the Community Learning Disabilities Team. This is good practice. Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? At previous inspections the manager has demonstrated that respite would only be offered to a service user whose needs could be met and in consultation with other appropriate professionals where necessary, such as physiotherapists or occupational therapists. Staff indicated that this is still the position, and if after such consultation needs could not be met, a service would not be provided. From observation of staff and examination of records, it was evident that the team have a wealth of experience and skills necessary to support people using the respite service. Staff were observed using makaton sign language with service users. The Statement of Purpose, assessment process and service user plan are designed specifically for service users using a respite service.The VicaragePage 14 Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis before making a decision to move there, and unplanned admissions are avoided wherever possible. 4 Key findings/Evidence Standard met? From records examined and discussions with staff it was clear that service users are invited for informal visits prior to making a decision to apply to stay for a respite service. Once they have received funding, visits are set up to reflect each individuals needs, building up to an overnight stay and then stays of longer duration. For some service users this may take months. Service users can indicate which room they would like to stay in and this is respected wherever possible. Service users may also request to stay when their friends are at the home. The home has an emergency admissions procedure which meets with the standards. Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 3 Key findings/Evidence Standard met? All service users have a service agreement with the home, which broadly follows the requirements of standard 5.2. The service user or their carer, and the registered manager had signed these. Copies of this record were on service users files.The VicaragePage 15 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · 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.Standard 6 (6.1 ­ 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 2 Key findings/Evidence Standard met? New plans are being introduced for all service users. The inspector case tracked three service users; one of these plans was in the new format. The plans examined cover all aspects of personal and healthcare needs as identified in Standard 2. It was evident from a summary sheet that care plans are reviewed every six months. Key workers sign and date when this is completed. Some plans had been signed by service users. This is commendable practice. There were copies of a Community Care Summary and Care Plan provided by the reviewing officer of the placing authority. These are taking place annually. One plan indicated that the service user may present with behaviour that challenges the service and it was unclear from the records, how staff support him to manage his behaviour. Staff stated that they are aware of the triggers and use diversionary tactics to de-escalate the situation. The care plan suggested calming the service user, but not how this should be done. Care plans must clearly indicate how staff support a service user in such a situation, identifying the triggers and the action they must take. Such plans must be drawn up with input from an appropriate professional such as a member of the Community Learning Disabilities Team. Reg. 12(1)(b), 14(1)(a)The VicaragePage 16 Standard 7 (7.1 ­ 7.7) Staff respect service users right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. 2 Key findings/Evidence Standard met? Staff were observed providing service users with information to make decisions and choices about activities of daily living. Records for one service user indicated restrictions to the kitchen, when staff were not in the vicinity. Care plans or risk assessments did not indicate why this restriction was in place. Staff said that although snacks are available throughout the day, there had been a problem with a service user over indulging in snacks and the restriction was done in the best interests of the service user. Staff stated that although the door had initially been locked it had become less of a problem during this stay. Any restrictions or limitations must be recorded with the reasons why they are in place. Reg. 17(1)(a) Sch.3 Para. 3(q) Standard 8 (8.1 ­ 8.5) The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 3 Key findings/Evidence Standard met? The home provides a service user guide and activities timetable in a format appropriate to the needs of service users. Service users have been involved in developing the service user guide. Staff confirmed that service users are involved informally in staff selection. New members of staff would be invited to meet people staying for respite prior to their interview. All service users give feedback about their stay; records were examined on the files sampled. They all gave favourable feedback.The VicaragePage 17 Standard 9 (9.1 ­ 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 2 Key findings/Evidence Standard met? Risk assessments were in place on the files sampled and had clearly been developed from risks identified in care plans. Risk assessments are being reviewed every six months, and had been signed and dated. One risk assessment identified the risk of challenging behaviour but did not identify the triggers or how this behaviour was managed. Discussions with staff confirmed their understanding of how to support the service user but this must be recorded as stated in Standard 6. Reg. 13(4)(c) 13(6) Likewise a moving and handling risk assessment and `risk to self assessment indicate that a maxi belt is to be used when a service user is sitting in a chair or lying on a bean bag but the reasons why this belt are used are not clear. This must be clearly indicated on the risk assessment, see also Standard 23. Reg. 13(4)(c) Copies of the homes missing persons procedure were on files sampled, including current photographs of each service user and a description. Standard 10 (10.1 ­ 10.6). Staff respect information given by service users in confidence, and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 3 Key findings/Evidence Standard met? All information about service users is kept in locked cabinets or in the office. Some service users had signed their plans. Observations and discussions with staff confirmed their awareness of the homes confidentiality procedure.The VicaragePage 18 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 11 (11.1 ­ 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 3 Key findings/Evidence Standard met? Discussion with staff confirmed a proactive approach towards total communication with service users. They are keen to develop meaningful and appropriate methods of communication. Staff were observed using sign language and there was evidence of symbols and the use of pictures around the home. Staff were observed enabling service users to make positive contributions towards determining their lifestyle whilst staying at the unit. Service users have the opportunity to fulfil their spiritual needs whilst staying at the home. This is identified in their plans. Standard 12 (12.1 ­ 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 3 Key findings/Evidence Standard met? Records on service users plans and the daily diary confirmed that service users are supported to continue to attend colleges, day centres and work placements which they would normally attend when living at home. Those files sampled had a copy of a current weekly activity timetable indicating where each service user should be.The VicaragePage 19 Standard 13 (13.1 ­ 13.5) Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 3 Key findings/Evidence Standard met? Service users access local facilities, including shops and pubs. They use a mixture of transport ranging from local taxis, voluntary car service, day centre minibus and the homes people carrier. Staff said that they were enabling one service user, who spends a lot of time in his room, to use local shops with staff support. They said this was proving quite successful. Rotas confirmed that staff time is provided flexibly. This has also been confirmed in Regulation 26 visits to the home. Notes in the daily diary confirmed that staff support service users to access facilities outside the home. Standard 14 (14.1 ­ 14.6) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. 3 Key findings/Evidence Standard met? It was evident from records examined and discussions with staff that service users have access to a wide range of leisure and recreational activities. Wherever possible staff endeavour to support service users to attend social clubs which they usually attend when at home. In the past few weeks service users have also been on trips to the Cotswolds, a fete at Lydbrook, Gloucester Docks, a garden centre, meals at pubs or restaurants, the cinema and Hereford Cathedral. The home provides a range of home entertainment equipment for each service user in their room and for communal use. Service users also like to bring possessions from home. Standard 15 (15.1 ­ 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? The home endeavours to maintain strong links with family and friends. After each stay a feedback sheet is provided for carers giving information such as health and well being and any leisure activities undertaken. Service users can have visitors whilst staying at the home. There is sufficient space for visitors to be seen in private if wished.The VicaragePage 20 Standard 16 (16.1 ­ 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? Service users may have a key to their room if they wish. Staff were observed knocking on doors seeking permission to enter. Service users preferred form of address is noted in their care plans. At the time of the inspection staff spent time with service users relaxing in the lounge prior to tea chatting over the days events. Service users had unrestricted access to the home, some spending time in their rooms, others in the lounge or in the office. If service users wish to be involved in household tasks they can do so, such as helping prepare tea. Standard 17 (17.1 ­ 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? Meals are recorded in the daily diary and showed that a range of fresh ingredients and frozen products are prepared. Alternatives to the main meal are always available. On the day of the inspection several different alternatives were being cooked. Staff confirmed that this may often be the case, although when a roast meal is produced this seems to be very popular with everyone. Snacks and fresh fruit are available, and service users were seen helping themselves to hot or cold drinks. Most service users have their meals in the dining room, but if they wish can have their meal in their room.The VicaragePage 21 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · 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 homes 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.Standard 18 (18.1 ­ 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 4 Key findings/Evidence Standard met? Service users plans identify how they would like to be supported by staff with their personal care needs. Their likes and dislikes are recorded. Discussions with staff confirmed their awareness of how service users staying for respite at the time of the inspection would like to be supported. Daily notes confirmed that times for getting up and going to bed are flexible, largely dictated during the week by service users commitments. The manager ensures that any specialist or technical equipment needed to help service users maintain their independence is supplied, with the advice of occupational therapists. There was evidence that the needs of service users are monitored and any changes would result in a referral for an assessment by an occupational therapist and any recommendations implemented. The home strives to ensure that positive relationships are maintained with family and carers. Families have regular feedback at the end of visits and meetings with staff in their own home, updating information. Staff and records confirmed this.The VicaragePage 22 Standard 19 (19.1 ­ 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No. of service users with pressure sores at the time of inspection (from information taken from care notes) XX3 Key findings/Evidence Standard met? Plans sampled contained information about service users healthcare needs. The home can support service users to attend appointments if necessary. Staff said that if they have concerns about a service users health or notice any changes they will refer to the appropriate healthcare specialist. There were records verifying that a referral to a service users Doctor had resulted in an appointment with a consultant Psychiatrist. Standard 20 (20.1 ­ 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 3 Key findings/Evidence Standard met? The inspector examined the homes system for administration and control of medication. Staff confirmed that they had attended an accredited medication course. Medicines are supplied from home in their original containers. The home uses medication administration records, which are a stock control and record of medication administered. These were all satisfactory. No homely remedies are kept by the home. Staff said that there is only one Pro Re Nata medication presently given and a protocol for its use was on the service users file. All service users have been provided with lockable storage facilities in their rooms should they wish to self medicate. Standard 21 (21.1 ­ 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.The VicaragePage 23 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 ­ 22.7) The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days X X X X X X X 4 Key findings/Evidence Standard met? The home has a complaints procedure, which is available in a format appropriate to service users needs. The home keeps a complaints log. There have been no complaints recorded. The inspector examined several compliments sent from service users and parents/carers, giving very positive feedback about the service being provided. All service users have the opportunity to give verbal or written feedback at the end of each stay. Records on files sampled verified this.The VicaragePage 24 Standard 23 (23.1 ­ 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists YESX2 Key findings/Evidence Standard met? The home has a copy of the Gloucestershire Adults at Risk policy and procedure, as well as the Department of Healths `No Secrets. Staff attend `Adult abuse and personal sexual relationships and `Protecting people with learning disabilities from abuse training. The inspector noted from a care plan and observation of a service user that a maxi belt was being used to ensure that the service user does not fall out of a chair or from a beanbag. Whilst the care plan and risk assessment detailed reasons for its use, a protocol outlining reasons for its use, must also be in place. This must refer to the assessment by an occupational therapist who has recommended using the belt. The family of the service user must sign the protocol. The use of a maxi belt is a form of physical restraint and documentation must be provided to explain its use. Reg. 13(6), (7) The inspector examined the homes system for monitoring personal finances and expenditures. These were satisfactory.The VicaragePage 25 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 24 (24.1 ­ 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 4 Key findings/Evidence Standard met? Single rooms and communal spaces within The Vicarage meet with the National Minimum Standards. The home is decorated to a high standard throughout, providing an extremely well maintained and first-rate environment for service users. The Vicarage is bright and cheerful with a homely atmosphere. The home is well furnished throughout. Fixtures and fittings are of a high standard. The ground floor and gardens are accessible to all service users. Carpets on the ground floor have been cleaned since the last inspection and look considerably improved. The home was spotless at the time of the inspection. The property meets with the requirements of the local fire services and has a planned maintenance and renewal programme. Since the last inspection part of the front garden has been transformed into an additional patio area. The rear garden provides parking and a patio with garden seating.The VicaragePage 26 Standard 25 (25.1 ­ 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) ­ single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite YES NO NO 5 4 X X 5 X1 X X X4 Key findings/Evidence Standard met? Each service user has a single room, four of which have an en suite facility. The fifth bedroom is close to a bath/shower room. All rooms exceed the spatial requirements of the national minimum standards. The downstairs bedroom, which is used by wheelchair users, exceeds the spatial requirements. This room also has an en suite with necessary specialist equipment.The VicaragePage 27 Standard 26 (26.1 ­ 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 4 Key findings/Evidence Standard met? All rooms are decorated to a high standard and fitted out with ample good quality fixtures and fittings. Four rooms have en suite facilities including either a bath or a shower. Personal home entertainment equipment is provided in all rooms. Each room exceeds this standard. Service users can bring their own possessions with them. All rooms have lockable facilities for service users to store medication or money.Standard 27 (27.1 ­ 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 4 Key findings/Evidence Standard met? The en suite bath and shower facilities are of a high standard. Towels are supplied by the home. The ground floor bedroom is specially fitted out with adaptations for wheelchair users, including a mobile hoist. The downstairs shower room is also suitable for a wheelchair user. The service user without en suite facilities uses the upstairs bathroom; this is just across the corridor. All bathrooms can be locked; staff on duty carry a master key, which opens all doors. Standard 28 (28.1 ­ 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 4 Key findings/Evidence Standard met? Service users were observed enjoying the comfort of the large lounge, which has several settees, chairs and a rocking chair. In the spacious hall there is an additional sofa. The dining room provides adequate seating for those staying on respite, additional seating is available should it be required. This room also doubles up as an activity room. The grounds outside are laid to patio, both back and front, with an area at the rear for parking. The spacious kitchen leads through to a laundry. Staff have a sleeping in room which has lockable facilities for personal items. The home has a no smoking policy.The VicaragePage 28 Standard 29 ( 29.1 ­ 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 4 Key findings/Evidence Standard met? Specialist equipment has been provided for the ground floor bedroom and bathroom. A mobile hoist, chair and an electric bed with cot sides (and bumpers) are in situ. An additional electric bed has been installed in one of the rooms on the first floor. All doors have automatic closures and light switches are lowered. Changes in needs of service users are monitored and if adaptations or equipment are required they will be provided wherever possible, after consultation with an occupational therapist.Standard 30 (30.1 ­ 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 4 Key findings/Evidence Standard met? At the time of the inspection the home was spotlessly clean and free from odours. Staff ensure that the homes infection control policy is adhered to. Any soiled washing is placed into sealed red laundry bags. Sanitary containers are available in toilets. The kitchen and laundry have hand wash facilities; soap and paper towels are provided. The home keeps records of water temperatures for all outlets in the home, monitoring for scalding and Legionella.The VicaragePage 29 StaffingThe intended outcomes for the following set of standards are: · · · · · · 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 homes 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.Standard 31 (31.1 ­ 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 32 (32.1 ­ 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. 4 Key findings/Evidence Standard met? Two members of staff who had completed their NVQ Level 3 Awards in January were being presented with the certificates the day following the inspection. Another staff member confirmed she was completing her assessors award. All staff now have a NVQ qualification and the home exceeds the requirement for 50 of the workforce to achieve a NVQ Award by 2005. Observation of staff working practices and discussion with them confirm that they have the skills, qualifications and experience to support service users staying at the home. They were open, accessible, treated service users with dignity and respect and demonstrated a professional approach to their work.The VicaragePage 30 Standard 33 (33.1 ­ 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme 13 12 20 X 8 No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X X Nursing X X XX13 Key findings/Evidence Standard met? The home currently has three vacancies for care staff. These posts are being advertised. Agency staff are used at times. To ensure consistency, staff said that the same agency staff are used to cover shifts. Rotas confirmed that staff hours are flexible, reflecting the needs of service users staying at the unit. Occasionally waking night staff are required. There was evidence that staff meetings take place each month. Records were available to confirm this. Staff were observed using makaton sign language to communicate with some service users.The VicaragePage 31 Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion. The manager must ensure that the recruitment agency have carried out all the necessary employment checks for staff. This will be inspected at the next inspection.Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. Key findings/Evidence Standard met? This standard was not inspected on this occasion.0The VicaragePage 32 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · 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 homes policies and procedures. Service users rights and best interests are safeguarded by the homes 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.Standard 37 (37.1 ­ 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care [by 2005]. Key findings/Evidence This standard was not inspected. YES 0Standard met?Standard 38 (38.1 ­ 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 0 Key findings/Evidence Standard met? This standard was not inspected.The VicaragePage 33 Standard 39 (39.1 ­ 39.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 0 Key findings/Evidence Standard met? This standard was not inspected. The Commission is receiving copies of Regulation 26 visits to the home. A recent focus group meeting took place with parents of service users. Minutes of this meeting were available for inspection. This was so successful that others are planned.Standards 40 (40.1 ­ 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65). 0 Key findings/Evidence Standard met? This standard was not inspected.Standard 41 (41.1 ­ 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 2 Key findings/Evidence Standard met ? Records examined for service users were maintained in line with the requirements of Schedule 3. Photographs for service users are in place on most files, duplicates are being copied for all new service user plans. Some requirements have been made concerning care plans, risk assessments and protocols. (See standards 6,9 and 23) Service users sign their care plans where appropriate. These plans are kept securely within the home.The VicaragePage 34 Standard 42 (42.1 ­ 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? Staff confirmed that they have refresher training booked for moving and handling and basic food hygiene. Staff certificates confirm attendance at First Aid. Fire training was completed in October 2003 with an external provider and every three months by the home. Fire records confirmed that there are regular checks on fire equipment and emergency lighting. Fire drills are taking place every three months. Staff and service users names are recorded. Fridge and freezer temperatures are kept. Cooked food temperatures are also recorded. All fresh food which is frozen and food which is opened is labelled with date of opening and use by day. This includes food in the fridge. There are regular checks of water outlets around the house and these are recorded. Standard 43 (43.1 ­ 43.7 ) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 0 Key findings/Evidence Standard met ? This standard was not inspected.The VicaragePage 35 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateLynne Bennett Sheila Reynolds 14th May 2004Signature Signature SignatureThe VicaragePage 36 Public reports It should be noted that all CSCI inspection reports are public documents.The VicaragePage 37 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 11th May 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleAction taken by the CSCI in response to provider comments: The Vicarage Page 38 Amendments to the report were necessaryNOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateNONONONote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan by 11th June 2004, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request.You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationNOAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planNONONOOther: enter details here NOThe VicaragePage 39 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I Margaret Sheather of the Vicarage confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I Margaret Sheather of the Vicarage am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.The VicaragePage 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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