Inspection on 24/02/09 for Wortley Villa

This inspection was carried out on 24th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wortley Villa 27/02/07

Wortley Villa 06/01/06

Wortley Villa 25/08/05

Wortley Villa 01/11/04

Wortley Villa 14/07/04

Wortley Villa 02/12/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wortley Villa Bath Road Nailsworth Glos GL6 0HH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Wortley Villa Bath Road Nailsworth Glos GL6 0HH 01453833140 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): admin@ggh.org.ukorjeff@ggh.org.uk Gloucestershire Group Homes Name of registered manager (if applicable) Mr Jeffrey Michael Bird Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accomodated is 5 The registered person may provide the following category of service only: Care home only - code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning Disability (Code LD) Date of last inspection Brief description of the care home Wortley Villa is run by Gloucestershire Group Homes, which specialises in the care of people with Aspergers Syndrome. The home is in a central area of Nailsworth, and close to the towns facilities. Wortley Villa is a three storey detached house and there is a garden at the rear of the property. Five people live together at the home and each person has their own room. The people who live at Wortley Villa receive support from a permanent staff team. Gloucestershire Group Homes also employ relief staff who are available to support people at the home when the need arises. Care Homes for Adults (18-65 years) Page 4 of 35 care home 5 Over 65 0 5 Brief description of the care home Information about the home is available in a Statement of Purpose. Details of current fee levels, and copies of inspection reports, are available from Gloucestershire Group Homes. Inspection reports can also be seen on the commissions website at www.csci.org.uk Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Before visiting Wortley Villa, we had asked Gloucestershire Group Homes to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how the home was performing. It also gave us information about what has happened during the last year, and about their plans for the future. We looked at all the information that we have received about the home since the last key inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 24th February 2009. During the visit we met with the people who live at Wortley Villa and we had a look around the house. We met with Mr J. Bird, the homes registered manager, and with members of staff, including the senior support worker. It was reported in the AQAA that the senior Care Homes for Adults (18-65 years) Page 6 of 35 support worker took responsibility for the day to day running of the home and was supported by the registered manager. We looked at some records during our visit to the home. We also went to the Gloucestershire Group Homes office, where the staff recruitment records were being kept. Prior to the visit we had sent surveys to the home so that these could be given to staff members. No surveys were returned to us. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. The previous inspection of Wortley Villa was in February 2007. What the care home does well: What has improved since the last inspection? What they could do better: Under Regulation 37 of the Care Homes Regulations 2001, we must be notified of certain events that occur in the home. We had not been notified of one persons serious medical condition and the impact that this was having on their care and daily routines. We had also not been consulted about alterations to the accommodation, which had significantly changed the communal space that was available to the people who used the service. We need to be informed of these events, to ensure that we are kept up to date with significant events affecting the people who use the service, and we can look at whether the action being taken is in peoples best interests. Care Homes for Adults (18-65 years) Page 8 of 35 The latest monthly Regulation 26 report did not identify any maintenance or health and safety items as being in need of attention. However, we were concerned that the path to the front door had not received attention, as had been discussed at the last inspection. We reported then that the path was in need of attention to ensure that it was well kept and safe for people. We have recommended that a system of regular health and safety checks is implemented, so that people who use the service benefit from a well maintained and safe environment . We were told that there were occasions when some people spent time in the home without staff present on the premises. The assessment of this did not include the aims of the practice, or the potential benefits. There was also a lack of detail about the circumstances such as the length of time, and when it would not be appropriate for a person to be left alone. The assessments need to show that any risks in relation to people being left alone in the home have been appropriately identified and addressed. We thought that it would also be useful to review staffing levels, to assess the impact that these were having on the decision to leave people in the home without a staff member present. The lack of a staff training plan, and of consistent recording, meant that it was difficult to get an accurate picture of the training that staff had attended or were expected to attend. A plan should be produced, which sets out the subjects that are to be covered and shows how staff will receive the training that is appropriate to their role and necessary to meet peoples diverse needs. It was reported in the AQAA that the home provided an induction programme, which met the National Minimum Standards (NMS). We found that new staff were provided with a two-week in-house induction, although there was no accredited programme of induction, or one that met the standards that are expected in the NMS. The staff induction and development programmes should be developed, so that the people who use the service benefit from staff who have received the range of training that is expected in a care setting. People were not fully protected by the homes recruitment procedure. A staff member working at the home had started their in-house induction before their Criminal Records Bureau (CRB) disclosure was returned, and the outcome of their Protection of Vulnerable Adults (POVA) check was known. This meant that the people who used the service were at risk of being supported by somebody who may be unsuitable to work with vulnerable adults. We have talked to Gloucestershire Group Homes about the need to establish a system for evaluating the quality of services, which included consultation with the people who live at the home, and their representatives. This was to ensure that standards in the home are monitored, and so that peoples views can be taken into account in the homes development plans. We were told that surveys were shortly to be sent out, in connection with this, so a system of quality assurance has yet to be fully implemented and reported on. Care Homes for Adults (18-65 years) Page 9 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. Evidence: Four people had lived at Wortley Villa for number of years. We were told in the AQAA that one person had moved into the home since the last inspection. The homes manager, Mr J. Bird, had completed the AQAA and he told us about the admission arrangements. The home had worked closely with other agencies and with family members to identify the persons autistic needs and how the service could meet these. At the time of our visit, this person had been living at the home for over a year. Mr Bird told us that the move had been very successful. We met the person during our visit and heard that they had settled in well. Each person who used the service had an individual file which contained their assessment and care records. We looked at the records for the person who had moved Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: into the home since the last inspection. These included assessments that had been undertaken by Gloucestershire Group Homes prior to admission, and by the persons funding authority. Other reports had been obtained, including one from the persons previous placement. This helped to ensure that the home knew the persons needs, and that staff had information to assist them with communication and with establishing a relationship with the person. Following the admission, the persons personal details had been recorded on a Client Information sheet and a Personal Profile was completed. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are reflected in their individual plans and they are supported with making decisions. People can take risks as part of an independent lifestyle. However, further information is needed about the safeguards that are in place and the benefits for the individual. Evidence: People had individual files in which information was recorded about their needs and personal support. We looked at three peoples files and each contained a Personal Profile. These were designed to give an overview of the support that the person needed. The profiles had a number of sections, which included autism specific information and medical information. There were also separate guidelines about the support that people needed in specific areas. We saw records of review meetings that had taken place during the last year. People Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: had discussed changes in their needs and new things that they would like to do. Actions had been agreed at the meetings. We read about decisions that had been made in relation to peoples day activities and weekly routines. We saw Goal plans that had been recorded and were kept on peoples personal files. These identified particular areas of need or new things that people wanted to do. During our visit to the home we met with three people in their own rooms. The rooms reflected peoples interests and their choice of decor. One person we met had recently had their room redecorated in their choice of colours. We heard about choices that people made in their day to day routines. Some people were able to go out and use the local shops by themselves. Within the home, we saw that people could use the accommodation as they wished. We were told about one restriction that was in place concerning access to the kitchen after people had gone to bed. Each person had a general risk policy on their file. These outlined the hazards and support needed in areas such as medication, diet and personal care. We saw that information had been recorded about some specific risks, including those relating to peoples autism and how this affected their daily lives. Other risks were more general, such as the safety of somebody going out into the community late at night. Staff told us that the local authority was proposing a change in the street lighting, and they were considering what impact that this would have on the people they supported. We thought that this showed a good awareness of the factors that could affect the outcome of the assessment, and result in a greater risk to the people concerned if not addressed. We found that the assessment of the risks to people who spent time alone in the home had not been well documented. The assessment did not include the aims of this practice, or the potential benefits. There was a lack of detail about the circumstances, such as length of time and when it would not be appropriate for the person to be left alone. Information needed to be recorded about the safety measures, and any limitations that were in place, so that there was clear guidance for staff about the practical arrangements. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People participate in a range of activities that reflect their interests and abilities. They are involved with the local community and receive support that helps them to maintain their relationships. People have meals that they enjoy, and they are encouraged to participate in the household tasks. Evidence: We were told in the AQAA that the people who used the service enjoyed an active lifestyle, which included their involvement in the local community and annual holidays. We were also given information about two day services that people used in the local area. These provided people with computers, Internet access, exercise equipment, and other recreational facilities such as a pool table. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: We heard more about peoples activities when we visited the home. People had individual programmes during the week, which included a mix of planned activities and unstructured time. Two people were able to go out into Nailsworth by themselves. Staff accompanied other people, and a vehicle was available for trips out. We heard that one person who used the service had developed an interest in fishing, and as a result this had been built into their weekly programme. Staff also told us about some one-off activities that took place with individuals, such as going to sporting events. We were told in the AQAA that one improvement during the last year had been the introduction of more one to one support for individuals. There was normally one staff member working at the weekends. A second staff member was deployed at certain times. The staff members we spoke to said that it would be beneficial to have more double cover at the weekends, as this would allow for more flexibility in what people could do. There was information in peoples files about their backgrounds and relationships. Some people visited family members on a regular basis. We were told in the AQAA that there was a key working system, which helped people by giving them the opportunity to discuss matters on an individual basis with staff. During our visit, we saw that staff members were respecting peoples privacy and talking to people in a respectful way. Staff explained the reasons for our visit and asked people how they would like to be involved and when it would be a good time to meet with us. We met with three people in their own rooms and they talked about their individual interests. They had their own televisions and music facilities, as well as other personal items, such as photographs and certificates of courses attended. We were told in the AQAA that healthy eating was encouraged, and a balanced diet was promoted, whilst taking into account peoples autistic behaviour. We saw information had been recorded in peoples files that highlighted particular needs in relation to fluid intake and diet. One persons goals included maintaining a healthy weight, and this was being monitored on a regular basis. People told us that they were happy with the meals and sometimes they had a takeaway. A menu was being kept each week, which showed a range of different main meals being provided. However there was a lack of detail recorded, and further details would provide better information in relation to nutrition and the overall content of the meals. We brought this to the attention of staff. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: During our visit people had lunch together in the dining room, supported by staff. Changes had been made in the accommodation since our last inspection, which meant that the dining room was now the only communal area, and people no longer had the use of a separate lounge. This is commented on in the Environment and the Conduct and Management of the Home sections in this report. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported in ways that respect their individual needs and assist them with managing their personal care. People are protected by most aspects of the homes medication arrangements, although some procedures are not being consistently followed. Evidence: There was guidance in peoples individual files about their care needs and the way in which they wished to be supported. The support covered a range of areas, such as personal care tasks, assistance with managing behaviour, and specific fears arising from peoples autism. The guidance showed that a lot of support with care tasks was provided by way of verbal prompting and encouragement, which would help people to maintain their independence in these areas. Staff told us that some people managed their own nail cutting, and staff checked how well they were managing this. Other people received a podiatry service. We were told in the AQAA that people at the home were all registered with local GP practices, and were supported by staff when attending appointments. We saw records on peoples files about their contact with GPs and other Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: healthcare professionals. Health check forms were being completed with each person, usually on a monthly basis. These gave a summary of appointments and provided a good overview of the health related matters that had arisen during a month. Recent appointments had included general check ups with GPs, blood tests, and attendance at a well man clinic. Staff members told us that people at the home had access to the health services that they needed. One persons file included a lot of information about an ongoing medical condition that they were receiving support with. We had not previously been notified of this, although it was a serious condition and it was having an impact on the persons ability to use some of the homes facilities (refer to the Conduct and Management of the Home section of this report). The condition had necessitated regular hospital admissions, and the close involvement of the homes staff and health professionals. Staff told us about the possible outcomes of the condition, and the decisions that would need to be made in the future. We also met the person concerned, and they described the support that they had received from staff, both practically and emotionally, which was helping them to deal with the situation. There was information on peoples individual files about the medication that they were prescribed. We saw a written policy, which stated that peoples medication would be reviewed annually, or six-monthly if a psychologist was involved. We did not see evidence of this on peoples files and staff told us that formal reviews were not happening consistently. The senior support worker confirmed that this would be followed up with the appropriate people. There was a medication folder, which included a list of the homely remedies that people might have. We looked at the arrangements being made for the storage and administration of medication. Medication was kept in a lockable cabinet. The storage arrangements did not meet the requirements for the storage of controlled drugs although we were told that nobody was being prescribed any controlled drugs at the time of the inspection. Records were being kept of medication received into the home, and of its administration to people. We saw that on occasions changes had been made to the printed instructions, or handwritten instructions had been entered on the medication records. The records did not include the name of the person who made the alteration, the date on which it was made, or on whose authority. These details are needed in order to show that any changes have been appropriately made and are accurate. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can express their views and are listened to by staff. There are procedures in place, which help to protect people at the home, although some staff are in need of training. Evidence: Gloucestershire Group Homes had produced a procedure that people could use for making a formal complaint. It was reported in the AQAA that the home had not received any complaints since the last inspection. We saw records of annual review meetings, which showed that people had the opportunity to express their views and talk about things that mattered to them. It was reported in the AQAA that the home operated a key working system, which helped people at the home to express their concerns and to comment on any issues that arose. During our visit, people were open in talking about the home and the things that they did. We observed staff listening to various issues that were raised, and helping people to make decisions. It was reported in the AQAA that no safeguarding referrals had been made during the last 12 months, and there had been no incidents which had involved restraint. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: Staff members told us during our visit that they had received guidance about safeguarding vulnerable adults and what to do if they had any concerns. It was reported in the AQAA that one of the things that could be done better, was to continue to update POVA training and understanding of vulnerable adults by the staff team. The staff members we met said that they were due to attend a course at a local college about the protection of vulnerable adults. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in premises that are generally suitable for the homes purpose. Changes have been made to the accommodation during the last year, which have brought mixed benefits for the people who live at the home and reduced the choice of communal areas. Evidence: Wortley Villa is in a central area of Nailsworth, and close to many of the town shops and facilities that people used on a regular basis. It is located in a residential area and did not stand out as being a care home. There was a garden at the rear of the property. We were told in the AQAA that this had been improved during the last year by the development of areas specifically for flower and vegetable growing. We had a look around the home and three people showed us their own rooms. We were told in the AQAA that people had their own room keys so that they could maintain privacy, and that they were encouraged to personalise the rooms according to their own interests and hobbies. We saw that people had decorated and personalised their rooms as they wished. The accommodation was on three floors. There were bedrooms on each floor. Staff Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: members told us about changes that had been made to the accommodation since we last inspected the home. One of the two bedrooms on the second floor had been changed into a bathroom for the use of one person. The lounge at the front of the house on the ground floor had been changed into a new bedroom with an en-suite shower and toilet. We were told about the benefits that these changes had had on the people involved, The change in the use of the rooms had had an impact on the amount on communal space that was available to people. There was now one communal room, which was originally just the dining room. The layout and size of the room meant that it did not provide people with the space and choice of outlooks that they previously had when there were two separate communal areas. We will be talking to Gloucestershire Group Homes about how they intend to addess this shortfall in the communal space. There was a cleaner working in the home at the time of our visit. The accommodation generally looked clean and tidy. At the last inspection we had reported on some items that were in need of attention. These included some internal decoration and the repair of a back gate. These items have been completed. We had also reported on the condition of the path which led up to the homes front door from the road. The path was uneven and had a lot of moss growing on it which could be slippery if wet. We reported at the last inspection that the path was in need of attention to ensure that it was well kept and safe for people. We saw that the condition of the path had not changed. Staff confirmed this and agreed that it needed to be improved. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not fully protected by the homes recruitment procedure. Staff training should be developed so that the people who use the service are supported by staff who have received the range of training that is expected in a care setting. Evidence: We were given information in the AQAA about some training courses that staff had attended. This included training in the safe handling of food, infection control and antidiscriminatory practice. All staff had received training in the administration of medication during the last year. Training in the protection of vulnerable adults had not yet been provided, but we were told that staff were booked to go on a course in March 2009. Staff members mentioned some training that they had received from a community nurse, but this had not been included in the staff training records. It was reported in the AQAA that there was a team of four full time staff members and one part time staff member. We were told that four staff had completed the induction training expected by the National Minimum Standards (NMS). However, the organisations policy referred to a two-week in house induction, and there was no evidence of an accredited programme of induction, which met the standards that are expected in the NMS. It was reported in the AQAA that one thing the home could do Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: better would be to continue to review and develop the training opportunities for staff. There was no overall plan for staff training. We thought that a plan needs to be produced, and that this should set out the subjects to be covered and show how staff will receive training that is appropriate for their role and reflects peoples diverse needs. We were told in the AQAA that staff were supported and encouraged to undertake specialised training in autism, and that one staff member was currently undertaking a degree course in autism studies. Four of the permanent staff were reported to have a National Vocational Qualification (NVQ) at level 2 or above. When we met with two staff members they said that they had not completed a NVQ, but would be interested in this. We will be asking the organisation for clarification about the arrangements that are being made for staff to undertake a NVQ. Staff recruitment files were kept in the organisations office, which was a few minutes drive from the home. We visited the office on 24th February 2009 as part of our inspection of Wortley Villa and another home which was run by the organisation. We looked at records there, including one for a new staff member who was mainly working at another home run by the organisation, but also covering shifts at Wortley Villa. Their recruitment file included an application form and a record of the checks that had been carried out during their recruitment process. We saw copies of references that had been received, and copies of documents that had been obtained as proof of identity. A Criminal Records Bureau (CRB) disclosure had been obtained, which included a check of the persons name against the Protection of Vulnerable Adults (POVA) list. A recruitment checklist was being maintained although this did not show the date on which the new staff member was appointed and had started work. From the records and CRB disclosure, we saw that the staff member had started their in-house induction before their CRB disclosure was returned. This meant that the people who used the service were at risk of being supported by somebody who may be unsuitable to work with vulnerable adults. Care Homes for Adults (18-65 years) Page 26 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further action needs to be taken so that people benefit from a well run home and to ensure that their health and safety are protected. Evidence: Gloucestershire Group Homes has a management structure that includes a General Manager, and two Service Co-ordinators who between them are registered to manage the organisations homes. Mr Bird is the registered manager for three of the organisations homes. He has a Diploma in Social Work, Certificate in Management Studies and is a Bachelor of Philosophy in Autism Studies. As the registered manager, Mr Bird has responsibility for the running of the home, although day to day management tasks, such as supervision, were being delegated to the senior support worker. Before visiting the home, we had talked to Gloucestershire Group Homes about the need to establish a system for evaluating the quality of services, which included Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: consultation with the people who live at the home, and with their representatives. This was to ensure that standards in the home are monitored, and so that peoples views can be taken into account in the homes development plans. We spoke to Mr Bird about this when we visited Wortley Villa. He confirmed that surveys were to be sent out, in connection with the homes plans for quality assurance. Care managers were to be asked for their feedback at review meetings. An action plan for quality assurance would then be drawn up. A start had been made with developing a system of quality assurance, but this has yet to be fully implemented and reported on. We have also talked to a manager from the organisation about other more informal ways of obtaining feedback, as part of quality assurance, that may be appropriate with the people who used the service. When we visited the Gloucestershire Group Homes office we met with the General Manager, who said that the organisation had previously had a system of external accreditation in place, but this had not been maintained. The senior support worker told us that a manager from the organisation made visits to the home, in accordance with Regulation 26 of the Care Homes Regulations 2001. We saw that a manager had visited Wortley Villa in February 2009 and a report of the visit was available in the home. Under Regulation 37 of the Care Homes Regulations 2001, we must be notified of certain events that occur in the home. We had not been notified of one persons serious illness and the impact that this was having on their care and daily routines. We had also not been consulted about alterations to the accommodation, which had significantly changed the communal space that was available to the people who used the service. During the visit we spoke to Mr Bird about the change in use of one room from a bedroom to a bathroom, and have asked for confirmation that this work has been carried out to the appropriate standards. The monthly Regulation 26 report did not identify any maintenance or health and safety items as being in need of attention. However, we were concerned that the path to the front door had not received attention, as had been discussed at the last inspection. There needs to be a system in place for ensuring that items in need of attention are identified and action taken, where necessary. We recommended that a system of regular health and safety checks is implemented. It was reported in the AQAA that assessments in relation to the Control of Substances Hazardous to Health (COSHH) had been undertaken. We were also told that the fire precaution systems, the heating system and electrical circuits had been serviced or tested during the last year. The AQAA did not give information about the testing of Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: portable electrical equipment. The arrangements for this should be checked to ensure that this equipment is being maintained appropriately. We saw that a fire risk assessment had been carried out in October 2008. A staff member told us that they had responsibility for fire safety in the home and had recently attended a fire safety course. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The condition of the path to the front door must be assessed and maintenance work undertaken as appropriate. This is to ensure that the path is well kept and safe for people to use. 10/04/2009 2 34 19 People must not work in the 31/03/2009 home until their names have been checked against the Protection of Vulnerable Adults POVA list. This is to ensure that the people who use the service are not at risk of being supported by somebody who is unsuitable to work with vulnerable adults. 3 35 18 The record of staff training must be fully completed and kept up to date. This is so that there is an accurate record of the training that staff have 31/03/2009 Care Homes for Adults (18-65 years) Page 31 of 35 received and to show that staff have received the training that is appropriate for their role and necessary to meet peoples diverse needs. 4 39 37 The Commission must be 10/04/2009 notified, without delay, of particular events as detailed in Regulation 37 of The Care Homes Regulations 2001. We also need to be notified of significant changes to the services and facilities. The Commission needs to receive notifications in relation to the matters identified in this report. This is to ensure that the Commission is kept up to date with significant events affecting the people who use the service, and we can look at whether action is being taken which is in peoples best interests. 5 39 24 A system for evaluating the 31/05/2009 quality of services provided at the home must be established and maintained. The system must provide for consultation with the people who live at the home, and with their representatives. This is to ensure that Gloucestershire Group Homes is making the improvements that are needed, and that the views of the people who live at the home and of their Care Homes for Adults (18-65 years) Page 32 of 35 representatives are being taken into account and acted on. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 That the assessment records for people spending time alone in the home show the aims and the potential benefits for the people who use the service, and the practical circumstances such as the length of time, and when it would not be appropriate for a person to be left alone. It is also recommended that staffing levels are reviewed, to assess the impact that these are having on the decision to leave people in the home without a staff member present. This is to ensure that the policy of home alone is in the best interests of the people who use the service and that any risks in relation to people spending time in the home without a staff member present have been appropriately identified and addressed. 2 20 A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed. This is so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. When a persons medication is altered or new information recorded, the record should include the name of the person who made the alteration (including a witness when this is possible), the date, and on whose authority. These details are needed in order to show that any changes have been appropriately made and are accurate. That a training plan is produced, which sets out the intentions for training and how this is to be prioritised and provided. Initially, a training needs assessment for the staff team should be undertaken, to ensure that the training provided is matched to statutory requirements and peoples individual needs. That the homes policy and procedure about induction is reviewed to ensure that it reflects the current standards that are expected. Page 33 of 35 3 20 4 35 5 35 Care Homes for Adults (18-65 years) 6 37 That the management roles and areas of delegated responsibility are reviewed. This is to ensure that people who use the service benefit from clarity of management roles and responsibilities. That a system of regular health and safety checks is implemented, as a way of identifying works that are in need of attention, and so that people who use the service benefit from a well maintained and safe environment. 7 39 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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