Care Home: 3 Cherry Tree Close

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What the care home does well The two people at 3 Cherry Tree Close have lived together at the home for several years and appear to be well settled. They have well established daily routines, which help to provide a sense of security and well-being. Meetings are arranged when people can talk about new things that they would like to do, and make plans for the year ahead. At a recent meeting for example, one person had said that they would like to visit London Zoo and to go to an antiques fair. People receive support which helps them to be part of the local community and maintain good contact with their families. They take part in activities during the week which reflect their interests and abilities. One person has a work placement which they go to independently. Risk assessments are undertaken, which help to ensure that people are safe when doing things in the home and when out in the community. People enjoy going to places locally, such as cafes and a garden centre. One person at the home has some very specific interests relating to transport and history. They have several collections which they have built up over the years, and like to add to by visiting the local charity and second hand shops. People are supported by staff they know well and are familiar with. They are encouraged to be independent in their personal care, but receive support which helps to ensure that health and emotional needs are met. We were told that there was an excellent relationship with the local health centre. People are offered a healthy diet and have meals that they enjoy. They are encouraged to assist with the household tasks and to take responsibility within the home. This helps people to develop their life skills and promotes their self-esteem. The accommodation is meeting people`s needs and it is kept clean and tidy. People have bedrooms which reflect their individual interests and preferences. One person is also able to use a spare room in the home for their model railway, which provides a lot of enjoyment for them. What has improved since the last inspection? People`s care records have been updated and their personal files reorganised. As a result, the contents of the records are more clearly presented and there is better information about people`s individual needs. People`s health has been promoted through activities in the home and the involvement of outside professionals. A consultant psychiatrist has been involved with one person and reviewed their medication. The staff have worked hard to support one person who has reduced their weight though exercise and a healthy diet. The people who live at the home have been given new guidance about how to complain. They have also been given a `Say no to abuse` booklet, so that they know what to do if they feel that they, or somebody else, are being mistreated. Staff members have received new guidance about abuse and attended safeguarding adults training outside the home. This helps to ensure that any concerns or allegations are followed up correctly and investigated by the appropriate agencies. A training schedule has been produced for the staff team, which shows a more planned approach to staff training. The service has registered with a local college, which has provided staff with the opportunity to attend a range of courses. New staff will receive an induction that meets the appropriate standard. This will help to ensure that people are supported by staff who are developing their skills and knowledge. A new plan for staff supervision has been produced. This helps to ensure that the people who use the service benefit from staff who are well supervised and can discuss their work on a regular basis. One person who lives at the home showed us the kitchen that had been newly refitted and decorated. They said that they liked the kitchen and were involved in its planning. The home has been looking at how to consult with people and obtain feedback from them about the home. A system is being put into practice and an annual development plan has been produced. People`s views have been sought through the use of questionnaires. Overall, the arrangements in place for monitoring the service are being more consistently applied. This means that people can be more confident about the way in which the home is being managed and how the provider is meeting their statutory responsibilities. What the care home could do better: We have made a number of recommendations which build on the improvements that have been made during the last year. Some of these concern the need for more detail or information in certain policies, records and assessments. This is so that they provide better guidance, or reflect a more `person centered` approach. We have made a requirement concerning the need for staff to have clear guidance about how to support a person with epilepsy when having a bath. This is to ensure that there are no misunderstandings about the type of supervision that is needed so that the person is safe when in the bath. The home needs to keep a better record of the food that is provided to people at the home. This is one of the records that the service is required to keep under the Care Homes Regulations. Without a full record, it is difficult to determine whether the range of meals is satisfactory, particularly in relation to variety and nutrition. We have also recommended that the need for additional staff support at the weekend is kept under review. This is so that, as people`s needs change, support is readily available with social activities and events outside the home. Key inspection report Care homes for adults (18-65 years) Name: Address: 3 Cherry Tree Close 3 Cherry Tree Close Nailsworth Stroud Gloucestershire GL6 0DX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 1 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: 3 Cherry Tree Close 3 Cherry Tree Close Nailsworth Stroud Gloucestershire GL6 0DX 01453835023 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jo@ggh.org.uk Gloucestershire Group Homes care home 2 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 accommodated is 2 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 3 Cherry Tree Close is one of a number of homes that are run by Gloucestershire Group Homes (GGH). This organisation specialises in the care of people with Asperger Syndrome. 3 Cherry Tree Close is in a residential area of Nailsworth, and is close to the towns facilities. The home is located in a cul de sac and the style of the house is in keeping with the neighbouring properties. The two people who live at the home have their own bedrooms on the first floor. On the ground floor there are a lounge, and a kitchen with a dining area. There is a garden at the rear of the property. Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 2 0 6 1 1 2 0 0 8 Brief description of the care home The people who live at 3 Cherry Tree Close receive support from a permanent staff team. GGH also employ relief staff who are available to support people at the home when the need arises. Information about the home is available in a Statement of Purpose. The fees at the time of the inspection ranged from 650 - 1373 pounds per week. Copies of inspection reports are available from GGH and can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 36 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: two star good 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: We asked the homes manager to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how the home was performing. The AQAA gave us statistical information about the home, and also told us 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 included an Action plan, which told us how the home was responding to the requirements and recommendations from that inspection. We visited the home on 15th October 2009 at 9.20 am. During our visit we met one of the people who live at the home. We also spent time with the homes manager and with two staff members. We looked at some records and went around the accommodation. Care Homes for Adults (18-65 years) Page 6 of 36 The judgements contained in this report have been made from evidence gathered during the inspection and takes into account the views and experiences of people using the service. The previous inspection of 3 Cherry Tree Close took place on 6th November 2008. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? Peoples care records have been updated and their personal files reorganised. As a result, the contents of the records are more clearly presented and there is better information about peoples individual needs. Peoples health has been promoted through activities in the home and the involvement of outside professionals. A consultant psychiatrist has been involved with one person and reviewed their medication. The staff have worked hard to support one person who has reduced their weight though exercise and a healthy diet. The people who live at the home have been given new guidance about how to complain. They have also been given a Say no to abuse booklet, so that they know what to do if they feel that they, or somebody else, are being mistreated. Staff members have received new guidance about abuse and attended safeguarding Care Homes for Adults (18-65 years) Page 8 of 36 adults training outside the home. This helps to ensure that any concerns or allegations are followed up correctly and investigated by the appropriate agencies. A training schedule has been produced for the staff team, which shows a more planned approach to staff training. The service has registered with a local college, which has provided staff with the opportunity to attend a range of courses. New staff will receive an induction that meets the appropriate standard. This will help to ensure that people are supported by staff who are developing their skills and knowledge. A new plan for staff supervision has been produced. This helps to ensure that the people who use the service benefit from staff who are well supervised and can discuss their work on a regular basis. One person who lives at the home showed us the kitchen that had been newly refitted and decorated. They said that they liked the kitchen and were involved in its planning. The home has been looking at how to consult with people and obtain feedback from them about the home. A system is being put into practice and an annual development plan has been produced. Peoples views have been sought through the use of questionnaires. Overall, the arrangements in place for monitoring the service are being more consistently applied. This means that people can be more confident about the way in which the home is being managed and how the provider is meeting their statutory responsibilities. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 9 of 36 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 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 36 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. Procedures are in place for admissions to the home. These include assessing the needs of people who may like to move in to the home, should a vacancy arise. Evidence: The two people at 3 Cherry Tree Close have lived together at the home since July 2002. There have been no changes in occupancy since then. Gloucestershire Group Homes (GGH) had a policy for admissions. The admissions process included obtaining an assessment from the placing authority, an assessment undertaken by GGH, and visits to the home. We were told in the AQAA that the home would provide prospective service users, their families and relevant professionals with the information they need to make as informed a choice as possible. It was also reported in the AQAA that peoples individual needs and aspirations would be considered during initial meetings and assessments. A decision would then be made about the ability of the service to meet these. Care Homes for Adults (18-65 years) Page 12 of 36 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. People receive support with making decisions and taking risks in their daily lives. Peoples needs and goals are generally well reflected in their individual plans. Evidence: When we arrived at 3 Cherry Tree Close we were told that one person was away from the home visiting their parents. We met with the other person who was spending time in their room. They had a well established morning routine, which included watching television to keep up to date with news and events. During the morning they left the home to go to a work placement at a local business park. They told us that they liked to walk there and had been doing this for some time. Each person had an individual file which contained information about their needs and daily routines. The files included records of assessments that had been undertaken in relation to activities which involved a degree of risk. For example, we saw that assessments had been carried out in respect of people doing things by themselves and using facilities such as the kitchen cooker. We read that one person did some things Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: independently outside the home, but the other person was not able to stay at the home or to go out without staff being with them. The assessments were being kept under review. The risk assessment forms that we saw were dated September 2009. The hazards associated with certain activities had been identified and guidance produced about the safety measures. The risk assessments did not refer to peoples rights and the benefits of taking part in a particular activity. This meant that they lacked a person centered approach. There were also occasions when the guidance for staff could be clearer. For example the risk assessment for somebody who spent time alone in the home did not specify a maximum length of time that they could be without staff support. People also had a General Risk Assessment on their files. This provided more information about peoples needs, although it was not clear who had written these and how the people who use the service had contributed to the contents. Peoples individual files included personal profiles and guidelines for support. The profiles provided a good overview of the impact that the persons diagnosis had on their daily lives. People received support with managing and looking after their personal money. There were individual arrangements in place, which reflected the level of support that people had been assessed as needing. One person managed their own money during the week. They signed a form to confirm that they had received their money from staff. They also had a savings account, although it had been agreed that staff would look after the passbook. The other person received support from staff with looking after their money. It was kept safe on their behalf and we saw records which showed when money had been taken or used for a particular purpose. Receipts were being obtained as evidence that the money had been spent appropriately when the person had received support from staff with their shopping. We had been told in the homes Action plan that the financial records would be regularly audited, and the records signed and dated. Mr Bird confirmed that a manager from GGH was checking the account records on a regular basis to ensure that they were being accurately maintained. This was one of the checks that formed part of the monthly Regulation 26 visits, although the financial records were not being signed and dated. We saw records of review meetings that had taken place in June and July 2009. Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: Peoples future needs and aspirations had been discussed. They had talked about and agreed the things that they would like to do in the year ahead, such as going to an antiques fair and visiting London Zoo. One person had bought a new flat screen television, which was something that had been talked about at a previous meeting. Objectives had been recorded within peoples care records, which highlighted the sort of activities that would be taking place during the coming months. Peoples objectives, for example, included making regular and quality visits and putting money aside for expensive railways items. We talked to Mr Bird about making the goals more specific, so that it would be easier to measure the progress that people were making. Care Homes for Adults (18-65 years) Page 15 of 36 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 receive support which helps them to maintain relationships and to be part of the local community. People are offered a healthy diet and have meals that they enjoy. Evidence: The two people who use the service had lived at 3 Cherry Tree Close for several years. We saw timetables on peoples individual files, which showed how they spent their time during the week and the activities they attended. One person had a work placement that had been arranged with a local employer. This had become a well established part of their weekly routine. People had a mix of regular, planned activities, and others that were arranged on the Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: day. Mr Bird and staff said that that familiarity of routine and activities was very important to the people who live at the home. One person liked to visit a local garden centre regularly, where they could have one of their favourite meals for lunch. Other regular activities were linked to peoples interests and preferred routines. One person had several collections which they had built up over the years. They liked to visit the local charity and second hand shops to add to these. These trips were also seen as an opportunity to participate in the community in other ways, for example by going to a cafe or buying things that were needed for the home. Nailsworth town centre was within walking distance of the home. The home was well placed for people to get to a range of local facilities, either by walking or using the house vehicle, which was shared with another home that was run by GGH. One person at the home was very keen on model aircraft, train sets and naval history. They spent a lot of time working on a model railway which was set up in a spare room in the home. This was an on-going project and the person received some individual support with it on one day a week. We thought that it was very good that the home was able to provide a space where the railway could be displayed and worked on. The other person showed us their room. This had fewer things in it, but the person said that they were happy with how it was. They had a collection of DVDs and were particularly keen on watching television in their room. Mr Bird told us that both the people who lived at the home paid extra so that they could receive channels from a satellite broadcaster. Mr Bird told us that GGH had a day facility that people could attend from the home. This provided the chance to use computers and to spend time with people from the other GGH run homes. It was reported in the AQAA that the day provision also offered people the opportunity for educational and recreational trips both within the local community and further afield. People followed their own routines at the weekends. One person was able to go out by themselves for a limited period of time and the other person needed support at all times. One staff member was usually deployed to support people at the weekends. The lack of double cover limited what people could do at the weekends, although Mr Bird said that additional staff cover was being provided on occasions in response to some pre-arranged events and outings. We were told in the AQAA that the plans for the future included developing a greater understanding of the aging process and the implications for discrimination on that Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: basis. Peoples personal files included information about their family backgrounds and important contacts. We read about the visits that people made to their relatives. One person was having a weeks stay with their parents at the time of our visit. We were told in the AQAA that the staff team had very good relationships with the parents of the people who live at the home. It was also reported that their parents were involved in helping to develop the individual plans and meet individual goals. People contributed to the day to day tasks in the home, such as helping with the recycling, taking the rubbish out, and cleaning their rooms. As reported under Individual needs and choices, risk assessments had been undertaken, which helped to ensure that people were safe, for example when working in the kitchen or using cleaning materials. Peoples meals during the week were being planned and prepared on an individual basis. A staff member said that they sat down each week with one person to plan their meals for the week ahead. We were also told that people received support with baking cakes and other items, which helped them to learn about nutrition. We read about the foods that one person in particular liked to eat, and would choose to have in preference to a more varied diet. However, there were concerns, for example about the high fat content of these foods. As a result there was a written plan in place, which had been agreed with the person and meant that they would only have certain foods on particular days during the week. This was with the aim of providing the person with a healthy and balanced diet. We were told about a variety of meals that were prepared on other days, although the details of these were not being formally recorded. It was reported in the AQAA that the staff team had worked hard to support one person who has reduced their weight by exercising and a healthier diet. Care Homes for Adults (18-65 years) Page 18 of 36 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. Peoples personal and health care needs are being met. There are generally suitable arrangements for handling medicines, but there are areas where more attention to detail is needed. Evidence: There was guidance in peoples individual files about their personal care needs and the way in which they wished to be supported. People managed much of their own personal care, with support being provided in the form of encouragement and prompting. This included for example, reminders about brushing teeth and advice about clothes and personal appearance. A staff member told us that people managed their own nail cutting well. People also received support with dealing with emotional states and maintaining life skills. This included, for example, help with budgeting, making appointments and dealing with outside agencies. Peoples needs were being discussed at review meetings and we saw that Annual Review of Assessed Skills forms had been completed in September 2009. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Peoples care records included Health Profiles, which gave an overview of health related matters and medication. There were records on peoples files about their contact with GPs and other healthcare professionals. Monthly health check forms were being completed with each person. These gave a summary of appointments and the health related matters that had arisen during the month. We saw records relating to well man checks and a staff member said that people had recently had flu jabs. They also described the dentist that people saw as brilliant. We were told in the AQAA that there was an excellent relationship with the local health centre. Peoples weight was being monitored as part of the monthly health checks. As reported under Lifestyle, we were told that the staff team had worked hard to support one person with reducing their weight. One person had epilepsy and charts were being used for the recording of any epileptic activity. Since the last inspection, the home had been in contact with a consultant psychiatrist, who had undertaken a quarterly medication review with the person. We were told in the AQAA that an epilepsy profile and management plan had been updated following the review. A risk assessment had been undertaken in relation to the safety of the person with epilepsy when having a bath. It was recorded that the person must be supervised at all times when bathing. A staff member told us that they supervised this person from outside the bathroom, but kept in contact with them with the door being kept ajar. We discussed this with Mr Bird, so that that the appropriate guidance could be confirmed with staff members. This is needed so that there are no misunderstandings about the type of supervision that is needed to ensure that the person is safe when having a bath. There was information on peoples individual files about the medication that they were prescribed. A staff member told us that they had received training about medication and that this was a prerequisite before being involved in its administration. Apart from in-house training, staff had also undertaken a six week course in the safe handing of medicines. The staff member showed us the medication storage arrangements and we looked at the records that were being kept in relation to medicines. There were suitable facilities in place for peoples medication. The home did not have a cabinet for the storage of controlled drugs, although these were not being prescribed at the time of the inspection. A monitored dosage system was being used, which meant that most medication was Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: received from the pharmacist in individual blister packs for each person. These were pre-prepared with a weeks supply of medication, which reduced the amount of medication which needed to be kept in the home. Creams were being appropriately stored and the boxes labeled with the date opening. It is also good practice to date the tube itself, as it may become separate from the box. One cream was prescribed for use three times daily but was being administered on an as required basis. The staff member said that this was consistent with the GPs advice. It was agreed that this needed to be followed up to ensure that the correct instructions were on the label and the cream was being applied in accordance with these. Medication was being checked when received into the home and two staff members initialed the record to confirm the quantities. Stock levels of medication were then being checked and recorded on a daily basis. This is good practice as it will enable any discrepancies to be identified quickly. The medication administration records were being completed to show that medicines had been given at the appropriate times. On occasions, the administration of medication records had been amended by hand. The amendments were initialed by a staff member, although the involvement of a second person helps to ensure that any instructions have been accurately transcribed on to the medication administration forms. There was a list of homely remedies that had been approved as being suitable for the people who use the service. Care Homes for Adults (18-65 years) Page 21 of 36 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. Staff members receive training and guidance, which helps to protect people at the home from harm. Evidence: GGH has produced a procedure for people to use if they wanted to make a complaint. The written procedure had been updated since the last inspection and a new easy to understand copy given to the people who use the service. The procedure had not been amended to reflect the recent changes in how people could contact the Commission. We confirmed the correct details with Mr Bird. We talked to Mr Bird about different formats for the complaints procedure and the ways in which people could contact outside agencies. It was agreed that it would be useful to look at alternatives to the present written procedure, so that a range of formats were available to the people who use the service. We were told in the AQAA that no complaints had been received during the last year. It was reported that the people who use the service were encouraged to resolve any complaints with their key worker (one of the staff). We read reports in the home which referred to various matters and concerns that people had discussed with staff. We thought that these showed that staff were listening to people and wanted to resolve any issues. It was also evident from talking with staff that they saw their role as needing to give people the time to talk through any anxieties and concerns. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: Since the last inspection, the people who live at the home had been given a Say no to abuse booklet, so that they knew what to do if they felt that they, or somebody else, were being mistreated. We looked at the policy that GGH had produced in relation to Safeguarding adults and the prevention of abuse. This covered the main areas, including the need to report allegations to outside agencies. However, the policy did not mention some details, for example about the need to preserve any evidence that may be in the home at the time that an allegation of abuse is made. There was also a lack of clarity about the role of the GGH Executive board chairperson in the reporting process. We discussed these matters with Mr Bird. GGH had produced a policy about the disclosure of bad practice (whistle blowing). The staff team had received new guidance about abuse and attended safeguarding adults training outside the home. This helped to ensure that any concerns or allegations were followed up correctly and investigated by the appropriate agencies. We were told in the AQAA that no referrals had been made using the local procedure for safeguarding adults. There had been no incidents which had involved restraint. Care Homes for Adults (18-65 years) Page 23 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is meeting peoples needs and is kept clean and tidy. Evidence: 3 Cherry Tree Close is located in a residential area of Nailsworth. The property looked like an ordinary domestic dwelling and did not stand out as being a care home. There was a garden at the rear of the property. Each person had their own bedroom. As reported under the Lifestyle section, one person was able to use a spare room in the home for displaying their model railway set. Another room was being used as an office and for staff to use during the night, when they provided sleeping-in cover. Neither of the two people who were using the service had any physical disabilities which required the use of aids or adaptations within the home. People had the choice of using a bathroom or a shower room on the first floor, which were both close to their bedrooms. The communal rooms included a lounge and a kitchen with a dining area. This looked like sufficient space for the two people who live at the home. One person who lives at Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: the home showed us the kitchen that had been newly refitted and decorated. They said that they liked the kitchen and were involved in its planning. Other areas of the home have also been redecorated since the last inspection. The accommodation looked clean and tidy at the time of our visit. Care Homes for Adults (18-65 years) Page 25 of 36 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 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 by competent staff who are developing their knowledge and skills. There are procedures in place which help to ensure that new staff members are suitable to work with the people who use the service. Evidence: There were four permanent staff members in the staff team, who between them had several years experience of working with the people who live at the home. Bank staff were also available to provide cover if one of the permanent staff was not available. Staff members worked a 24 hour shift, which included a sleep-in. They usually worked alone apart from when they had an end of shift handover. We have recommended at previous inspections that a lone working policy and procedure is put in place. A lone working policy has now been introduced and we were told in the homes Action plan that all staff members had been issued with a copy. Mr Bird showed us the staff employment files, which he brought from the GGH office where they were normally kept. The office was a few minutes drive from the home. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: We looked at the files for three staff members, including relief staff, who had been employed since the last inspection. Application forms had been completed. Mr Bird said that the same type of form had been in use for a number of years. The form included a self-declaration in relation to whether the applicant had been convicted of a crime resulting in a prison sentence. Applicants were not being asked about offences which did not result in a custodial sentence. The applicants had completed a separate form in relation to medical matters and their fitness to work. There was evidence on the files that we saw to show that the appropriate checks had been completed. References and proof of the applicants identity had been obtained. They had started work after their names had been checked against the Protection of Vulnerable Adults (POVA) list, and a CRB (Criminal Records Bureau disclosure) had been obtained. Dates had been recorded to show when the various checks had been undertaken and the required information had been received. This included the dates on which the CRB disclosures were returned, although the disclosure reference number had not been recorded on the checklist. We confirmed with Mr Bird that this detail needed to be added to the record. We had made recommendations at the last inspection in relation to staff training. These, for the most part, had received attention. We were told in the Action plan from the last inspection that a training plan would be produced to identify the requirements for statutory and specialist training. During our visit we saw that a new training file had been set up, which included details of training completed and proposed. This provided a much better overview of the arrangements being made for staff training. A training plan had been written, which identified the priorities for training, and the training that was required for staff in different roles, for example support worker and senior support worker. The qualifications and experience expected of a staff member were also listed. We talked to Mr Bird about the range of subjects that were covered in the training plan. The homes Action plan had mentioned a number of subjects that would be included, but these were not all listed in the training plan. The training plan, for example did not include the subject of medication, although we saw other records which showed that staff had attended a course in the safe handling of medication. Mental capacity and autism were mentioned in the training plan, although equality and diversity and health related topics, such as epilepsy, had not been included. Since the last inspection, the home had registered with a local college to provide training to new staff, which covers the common induction standards. A staff member Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: said that the college was being used for other training, such as safeguarding adults. They told us about the training that they had received during the last year, which included fire safety, first aid, POVA and Asperger syndrome. They were due to attend training in mental capacity and the Deprivation of Liberty Safeguards. We were told in the AQAA that three staff members had achieved a National Vocational Qualification (NVQ) in care at level two, or above. The senior support worker had recently completed a degree course in special education (autism). We made a requirement at the last inspection concerning the supervision of staff. We were told in the homes Action plan that a new form would be kept for the recording of bi-monthly supervision meetings, in line the GGH policy and procedure. During our visit we saw that this form was being used and that staff members were attending supervision meetings on a regular basis. Care Homes for Adults (18-65 years) Page 28 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Action has been taken during the last year to develop the service and the way in which standards are monitored. This means that people can be more confident about the way the home is being managed and how the provider is meeting their statutory responsibilities. Evidence: Mr Bird is the registered manager for three of the homes that are run by GGH. He has a Diploma in Social Work, Certificate in Management Studies and is a Bachelor of Philosophy in Autism Studies. Training undertaken during the last year has included risk assessment and fire safety. Some management tasks were delegated to a senior support worker, although Mr Bird had overall responsibility for the running of the home. At the last inspection we had looked at how Mr Bird was involved in the home on a day to day basis, and had made the following recommendation: That the day to day management arrangements are reviewed to ensure that the registered manager is in a good position to discharge his responsibilities fully, and to monitor the day to day affairs of the home, for example Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: through his attendance at staff meetings. We were told in the homes Action plan that the registered manager would attend all staff meetings. During our visit we saw the records of the meetings that Mr Bird had attended. A meeting took place on the afternoon of our visit. Mr Bird had also been involved with producing a Quality Assurance file for the home. We had made a requirement at the last inspection about having a system in place for evaluating the quality of services being provided at the home. During our visit we saw that a system had been set up and was being put into practice. The Quality Assurance file contained an Annual Development plan for the home. The plan had a number of headings, including Health Improvement, Client Protection, and Management. The plan was not dated and it was not clear when all parts of the plan would be implemented. However, we saw that improvements identified in the plan, such as fitting a new kitchen, producing a training plan for staff, and reviewing risk assessments, had already been carried out. As part of the Quality Assurance system, surveys had been given to the people who use the service. Letters with questionnaires had also been sent to relatives. The improvements which were mentioned in the plan were of direct or indirect benefit to the people who live at the home. However it was not clear how peoples views had been reflected in the plan. We also talked to Mr Bird about ways, other than through written surveys, in which feedback could be obtained from people on an ongoing basis. Mr Bird said that GGH was considering using an accredited system of quality assurance, in addition to the current arrangements. We have confirmed at previous inspections that visits need to be made to the home each month, in accordance with Regulation 26 of the Care Homes Regulations 2001. We made a requirement at the last inspection that these visits must be undertaken consistently, a report of each visit completed, and a copy of the report kept in the home and available for inspection. This requirement had been met and during our visit we saw records of the monthly visits, which were being undertaken by another manager from GGH. The home looked well maintained. GGH had produced policies in relation to health and safety, including the Control of Substances Hazardous to Health (C.O.S.H.H.) and fire safety. We were told in the AQAA that the heating, electrical and fire precaution systems had been serviced in July 2009. Portable electrical equipment was being tested annually to ensure that it was safe to be used. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: The home was using a new log book to record fire alarm and other fire related checks. The fire alarms and emergency lighting were being tested regularly. Individual procedures for evacuating the home in the event of fire had been written for the two people who use the service. At the last inspection we had made requirements concerning the need to complete risk assessments in relation to fire and to hot water temperatures. These assessments had been undertaken and we saw risk assessment records concerning other aspects of the environment, such as using the garage and the kitchen. Care Homes for Adults (18-65 years) Page 31 of 36 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 32 of 36 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 17 17 A record must be kept of the 16/10/2009 food that is provided to people who live at the home. This is one of the records that the service is required to keep, as specified in the Care Homes Regulations 2001. The record must be kept in sufficient detail so that a person inspecting the record can determine whether the diet is satisfactory, particularly in relation to nutrition. 2 18 13 There must be clear 16/10/2009 guidance for staff about the support that the person with epilepsy needs when having a bath. This is needed so that there are no misunderstandings about the type of supervision that is needed to Care Homes for Adults (18-65 years) Page 33 of 36 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 ensure the person is safe when in the bath. 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 7 That details are added to the personal money accounts to show when they were audited and by whom, and whether any discrepancies were found. That more details, for example the timescales and frequency, are recorded about the arrangements being made for a person to spend time by themselves in the home. This is so that people are better safeguarded and it will show that the arrangement is primarily there to help the person to develop their independence. 2 9 3 12 That the need for additional staff support at the weekend is kept under review. This is so that, as peoples needs change, support is readily available with social activities and events outside the home. 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. 4 20 5 20 Two people should countersign any handwritten entries on the medication records. Checking by two people will help to ensure that the instructions are accurately transcribed on to the medication administration forms. 6 22 That the format of the complaints procedure is reviewed to ensure that the information is provided to people in a way that they can easily understand. Page 34 of 36 Care Homes for Adults (18-65 years) 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 7 8 23 34 That the content of the policy in relation to Safeguarding adults and the prevention of abuse is reviewed. That the content of the staff application form is reviewed to ensure that it reflects current recruitment practice in relation to equal opportunities and the information that applicants are asked to provide. That the range of subjects which are included within the homes training plan is reviewed. This is to ensure that the plan covers all relevant areas, including statutory requirements, and reflects the individual and diverse needs of the people who use the service. That consideration is given to ways, other than through written surveys, in which feedback could be obtained as part of quality assurance from the people who use the service. 9 35 10 39 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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