Inspection on 26/04/07 for The Vicarage

This inspection was carried out on 26th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Vicarage 21/02/06

The Vicarage 19/10/05

The Vicarage 21/03/05

The Vicarage 11/05/04

The Vicarage 28/01/04

Similar services:

2 Perhaver Park

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

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

CARE HOME ADULTS 18-65 The Vicarage 59 Andover Road Tivoli Cheltenham Gloucestershire GL50 2TS Lead Inspector Tim Cotterell Unannounced Inspection 26th April 2007 11:30 The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Vicarage Address 59 Andover Road Tivoli Cheltenham Gloucestershire GL50 2TS 01242 521918 01242 227646 thevicarage@gloucestershire.gov.uk www.gloucestershire.gov.uk Gloucestershire County Council 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) Mrs Judith Brookes Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5), Physical disability (5), of places Physical disability over 65 years of age (5) The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2006 Brief Description of the Service: The Vicarage provides respite care for guests’ with learning difficulties. The facility is owned and operated by Gloucestershire Social Services. The home is a large detached two-storey house based in the local area of Tivoli and has easy access to Cheltenham town centre, the house is secluded and set within its own grounds with a pleasant garden at the rear of the building which additionally has wheelchair access for users. Sensitive adaptations have been made to accommodate individuals with physical disabilities. The premises has five very large bedrooms four of which are en-suite. There is an additional bathroom and shower room. There is also a large communal lounge dinning room, spacious kitchen. The large hallway is comfortably furnished into a quiet space where guests can sit and is close to the telephone for guests’ to have conversations in relative comfort with the added option to take private calls into their rooms with mobile phones. Guests were observed using this part of the house, which looked welcoming. There is an intercom system available on request. All rooms have fitted furniture, colour TVs, portable CD, tape and radio player. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. The inspection was unannounced and undertaken over two visits. The total time spent was 7 hours. During the inspection the Registered Manager and three staff were seen. All of the service users using the service on 27 April were seen and spoken to. Whilst service users surveys were not sent from the Commission the inspector looked at a number of the homes questionnaires, which are completed after every respite period. It was evident that guests enjoyed their stay and were happy about the services provided at The Vicarage. The inspection consisted of looking at the accommodation, care plans, risk assessments, administrations of medicines and activities. It was clear that the manager and staff were competent and committed to providing a flexible service, which ensured individual needs and wishes were paramount. There was also evidence that the home continues to look for improvements and involve all interested parties in this process. What the service does well: What has improved since the last inspection? No areas identified The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Vicarage DS0000037184.V338986.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 Vicarage DS0000037184.V338986.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Guests needs and wishes are clearly indicated on the assessment of need record. EVIDENCE: The home has recently completed a new information booklet and this is seen by the home as the Statement of Purpose. It was rewritten as there has been a number of changes to the first floor and this will enable the home to admit more guests who have multiple/complex needs. The information is comprehensive and relevant and gives the potential user and their family a clear idea of the services that will be provided. This inspection looked at the core standard, which refers to guests having a full assessment before admission. There is a formal assessment of need before any admission and this is completed by Gloucestershire County Council. The home then undertakes a further assessment, which would identify more specifically what the needs are and how the home will meet them. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 9 The Vicarage DS0000037184.V338986.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. JUDGEMENT – we looked at outcomes for the following standard(s): 67&9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The needs of guests are clearly expressed in the plan of care. Staff provide appropriate assistance to enable guests to make decisions and undertake responsible risk taking. EVIDENCE: All guests have individual plans of care. They are detailed and clearly indicate respective needs and wishes. Where risks are identified with an activity a written assessment is completed. In spite of the problems of communication every effort is made to ensure guests rights are secure and that they are able to determine how they spend their lives. The only restriction would be where limitations are made and noted in the plan of care. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 11 The assessment of need clearly indicated the abilities of the guests and this enables a more objective decision to be taken in respect of responsible risk taking. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 12 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): 12 13 15 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home makes great efforts to ensure the period of respite provides an appropriate and varied lifestyle for guests, which includes the security of their rights EVIDENCE: The guests see the break at The Vicarage as a holiday and they are able to determine how their time is spent. At the time of the inspection the three guests were all attending day facilities in Cheltenham, which is managed by Gloucestershire County Council. The respective plans of care indicated the centre they preferred and the activities requested. Staff at The Vicarage make great efforts to ensure the guests are part of the local community and wherever possible the community facilities are used. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 13 There are excellent links between the families of the guests and the home. This is the result of the parents involved in the assessment and care planning and then close contact during the periods of respite care. Parents are also encouraged to join the meetings held at the home several times a year, and the minutes of the last meeting showed how good the attendance of parents was. There is little doubt that the manager of The Vicarage encourages parents to play an active role in shaping the services at home to ensure their views are known and, where necessary, for them to act as an advocate for the guest. The lack of understanding and ability to communicate does not affect the principle of choice and independence for guests at The Vicarage. The evidence of this was seen in many ways. This included the inspector’s observations between staff and guests during the inspection, the views expressed by a guest, and finally the records held of what each guest has done during each stay. Staff were aware of specific needs and wishes through the assessment of need and whilst there were no special diets at the time of the inspection it was evident that choice was available and that guests are encouraged to eat “healthily”. On the day of the inspection one guest approached a carer and asked for a specific meal for her tea. The response was excellent and prompt and resulted in that meal being prepared specifically for the guest. The kitchen and associated areas were clean and well organised with sufficient stocks of food. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Guests are supported in the manner they choose. The administration of medicines has now been amended and is seen as safe practice. EVIDENCE: The programme of care is based on individual needs and the service is therefore flexible to ensure the wide range of expectations are met in a manner which respects privacy and dignity. The aids and adaptation recently installed in the home ensure that guests are moved and supported in an appropriate manner and one which provides safety for guest and carers. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 15 Included in the assessment of need are the healthcare needs of the guest and the records included the required information. Guests remain registered with their own doctors during the period of respite and this enables continuity and consistency of health care. The records in the home showed that there was close contact between the home and the doctor. The registered manager would support and where appropriate encourage guests to self medicate after an assessment of risk was completed. At the time of the inspection all medicines were being held and administered by staff. The procedure and records were inspected to include a record of the medicines received, administered and disposed of. The home had encountered a recent problem regarding medication and had advised the Commission of the event. One guest had arrived at The Vicarage with his medicines, which had up to this point been managed by a carer at his own home. There had been a change in the prescribed doses, and the home carer had placed in the medicine box, brought to The Vicarage, medicines which were not as described on the box. After a number of administrations it was noted that there were insufficient tablets to last for the period of respite and the home carer was contacted. It was then noted that what had been prescribed was not what had been supplied to the home. The doctor was contacted and the correct medicines obtained without further delay and the guest suffered no ill effects. The registered manager has treated the matter in a prompt and efficient manner and is anxious that this does not happen again. To provide a more secure service staff will now check the contents of medicines at the beginning of each period of respite. The issues of the safe administration are being addressed at a staff meeting on Friday 4 May 2007, and the home has contacted the Training Officer of the County Council who are now considering how best to amend the existing advice to staff in the written medication procedure in the home. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Guests are safeguarded by the procedures of the County Council and the practices of the home. EVIDENCE: There is a formal complaints procedures and this has been completed in several formats, which assists the guests to understand the contents. The inspector felt that that the atmosphere in the home and the positive relationships between guests and staff would significantly reduce the need for any complaint. The home appreciated the need for a procedure and all guests and parents are made aware of this. However, it was felt that any concerns about the day to day living would and is being addressed in a prompt and informal manner by staff at The Vicarage. At the end of each period of respite care the guests are asked to fill in a pictorial questionnaire, and this relates to their view of the services provided during their stay. The home would record any complaint received. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has been maintained to a high standard and provides a comfortable and pleasant environment. EVIDENCE: The home was found to be clean, appropriately furnished and in good decorative order. All of the accommodation was inspected. A new shaft lift was being installed and this, together with more appropriate moving and handling equipment, will mean that the first floor can accommodate guests who have multiple/complex needs. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 18 All bedrooms are single and the majority ensuite. The home was seen as providing an appropriate but domestic type physical environment. The grounds have been developed and provide a pleasant outside area. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home were seen as competent, good listeners and caring. EVIDENCE: The staff records were not inspected on this occasion as all recruitment details are held centrally at Shire Hall, Gloucestershire County Council offices. All staff are inducted in the home and the programmes are in their individual profiles. The two carers that were on duty were seen individually. On the following visit the housekeeper was seen. The registered manager was on duty on both occasions. Everyone had a positive attitude towards their job and were clear about the function of the home and the needs of the individual guests. All staff had completed NVQ studies (levels 2 or 3) and were able to show the inspector their files, which included details of all training. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 20 All staff are supervised and the records of recent supervision sessions were seen. The records were clear and indicated that where issues were raised by care staff they were recorded and dealt with in a prompt and professional manner. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was seen as well run with guests having the opportunity to influence day-to-day practice. EVIDENCE: The registered manager was seen as suitably qualified and competent. The manager is anxious to assess and wherever possible improve the quality of the services provided. There is a continual evaluation of services and this is undertaken through staff, other professionals’, parents/advocates and the guests. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 22 Health and safety issues are seen as important and the home has, through the policies and procedures, sufficient information for the staff to ensure that all practices are safe and risk assessed. The physical environment was seen as safe and the new equipment had been tested before use. The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 23 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 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 X 34 X 35 X 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 4 X X 4 X The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement The registered manager must ensure the written medication procedure is amended. Timescale for action 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Vicarage DS0000037184.V338986.R01.S.doc Version 5.2 Page 26 - 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. 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