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Care Home: Glenside Manor - Old Vicarage Wing

  • Glenside Manor - Old Vicarage Wing South Newton Salisbury Wiltshire SP2 0QD
  • Tel: 01722742066
  • Fax: 01722744443

Glenside Manor - Old Vicarage is registered to provide nursing care for 24 people with complex mental health conditions relating to acquired brain injury. The accommodation is provided over two floors offering single en-suite bedrooms and several large communal rooms. The Old Vicarage is one of seven homes and a private hospital located on the Glenside Manor campus. The registered manager is Shelia Pickering; she leads a team of nursing, care assistant and anciliary staff. The nominated responsible individual is Mr Andrew Norman. Some services are provided centrally for 24 24 24 the whole campus; this includes therapists, the psychology service, catering, laundry, maintenenace, training and human resources. The group of homes is situated in the village of South Newton, on the A36, five miles north west of the city of Salisbury. The service users` guide is freely available. The fees are 1,750 pounds a week and include podiatry, hairdressing and trips off site. Residents pay for personal items such as sweets and cigarettes.

  • Latitude: 51.106998443604
    Longitude: -1.8769999742508
  • Manager: Mrs Sheila Marion Pickering
  • Price p/w: £1750
  • UK
  • Total Capacity: 24
  • Type: Care home with nursing
  • Provider: Glenside Manor Healthcare Services Ltd
  • Ownership: Private
  • Care Home ID: 7017
Residents Needs:
Dementia, mental health, excluding learning disability or dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Glenside Manor - Old Vicarage Wing.

Key inspection report Care homes for adults (18-65 years) Name: Address: Glenside Manor - Old Vicarage Wing Glenside Manor - Old Vicarage Wing South Newton Salisbury Wiltshire SP2 0QD     The quality rating for this care home is:   three star excellent 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: Susie Stratton     Date: 1 9 0 1 2 0 1 0 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 34 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 34 Information about the care home Name of care home: Address: Glenside Manor - Old Vicarage Wing Glenside Manor - Old Vicarage Wing South Newton Salisbury Wiltshire SP2 0QD 01722742066 01722744443 oldvicarage@glensidemanor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Glenside Manor Healthcare Services Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who may be accommodated at any one time is 24 The staffing levels set out in the Notice of Decision dated 11 October 2004 must be met at all times Date of last inspection Brief description of the care home Glenside Manor - Old Vicarage is registered to provide nursing care for 24 people with complex mental health conditions relating to acquired brain injury. The accommodation is provided over two floors offering single en-suite bedrooms and several large communal rooms. The Old Vicarage is one of seven homes and a private hospital located on the Glenside Manor campus. The registered manager is Shelia Pickering; she leads a team of nursing, care assistant and anciliary staff. The nominated responsible individual is Mr Andrew Norman. Some services are provided centrally for Care Homes for Adults (18-65 years) Page 4 of 34 24 24 Over 65 24 24 Brief description of the care home the whole campus; this includes therapists, the psychology service, catering, laundry, maintenenace, training and human resources. The group of homes is situated in the village of South Newton, on the A36, five miles north west of the city of Salisbury. The service users guide is freely available. The fees are 1,750 pounds a week and include podiatry, hairdressing and trips off site. Residents pay for personal items such as sweets and cigarettes. Care Homes for Adults (18-65 years) Page 5 of 34 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: three star excellent 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: As part of the inspection, 37 surveys were sent out and 11 were returned. Comments made by people in the surveys and to us during the inspection process have been included when drawing up the report. The homes file was reviewed and information obtained since the previous inspection considered. The manager also submitted an Annual Quality Assessment Audit (AQAA). This is their assessment of the quality of their service provision. It also provided numerical information on services provided. We looked at the AQAA, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what areas we should focus on when doing the inspection. The site visit was performed by one inspector. This person is referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). The site visit took place on Thursday 19th January 2010, between 9:10am and 4:10pm. The visit was unannounced. Mrs Pickering, the manager was in charge of the Care Homes for Adults (18-65 years) Page 6 of 34 home when we commenced our visit and was available for the feedback at the end of the inspection. During the site visit, we met with a range of residents and also observed their care. We toured all of the home and observed care provided at different times of day and in different areas of the home. We reviewed care provision and documentation in detail for three residents, reviewed an assessment for a prospective new resident and looked at specific records relating to a further two residents. As well as meeting with residents, we met with Mr Andrew Norman the responsible individual, the head of nursing for the provider, the human resources manager for the provider, two registered nurses, three carers, the activities coordinator, a domestic and a chef. We observed a lunchtime meal. We reviewed systems for storage of medicines and observed one medicines administration round. A range of records were reviewed, including staff training records, staff employment records, complaints records and the fire log book. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: No statutory requirements were made as a result of this inspection. We did make some good practice recommendations. Currently care assistants do not routinely document in residents daily records, we recommend that they do document matters which they have directly observed or taken Care Homes for Adults (18-65 years) Page 8 of 34 part in with residents, rather than them reporting such issues verbally and them being documented by a third party. Some documentation could be made more precise. When developing care plans for diabetic residents, parameters for blood sugar levels should be written in numerical terms and there should be clear directions as to what actions staff are to take if a persons condition falls outside these parameters. Where people need thickening agent to enable them to swallow safely, their documentation should state the consistency of the drink aimed for, rather than the number of scoops to be used, as this can vary depending on a range of factors. As regards medicines, as the controlled drugs cupboard is small, we recommend that a larger one is provided, as currently it would be difficult to fit many more such drugs in the cupboard. Where a resident is prescribed a medicine which can affect their daily lives, such as a mood-altering drug, reference should be made to this in the persons care plan so that the effectiveness of the drug can be evaluated.Further documentary systems should be put in place so that the home can consistently show that residents have been given prescribed supplements and topical applications. Certain polices would benefit from development. As some visitors to the unit may be under 18 and some residents present complex behaviours, a child protection policy relevant to the unit needs to be developed. The home should also develop individual fire evacuation plans for each resident. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 10 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are to be admitted to the home will have a full needs assessment completed before they are admitted and the home can demonstrate that it can meet the needs of residents who have a complex acquired brain injury. Evidence: In their AQAA, the home manager reported in detail about the pre-admission assessment process, including involvement of other relevant parties, such as therapists. She reported on regular reviews of documentation to support the admissions assessment and how this is a on-going process. She also reported on an open day they had held for funders, social workers and other relevant parties, to inform them of the services which can be provided in the home. During the inspection, the manager reported that for the majority of the residents admitted, the Old Vicarage will be their home for life. This means that the home has a stable population, with a low turnover in residents. Occasionally the home may be able to rehabilitate certain residents and when this happens, they will be supported in moving from the home to accommodation suited to their needs. This had happened Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: recently for one resident. This meant that at the time of the inspection, the home had one vacant room. The manager reported that when they had a vacancy, the senior manager with responsibility for the Glenside campus admissions process, would pass on information about a person suitable for admission to her. She would then assess the information provided and would only proceed to meet with the prospective resident if she felt the home would be able to meet their needs. If she did feel that they could meet their needs, she would go and meet with the resident, taking relevant people with her to support her in making the assessment, this could include a therapist or the persons prospective lead nurse or key worker. After the assessment, she and her team would decide if they could meet the persons needs and if the person would fit in with the other residents in the home. The Old Vicarage specialises in meeting the needs of people who have had complex acquired brain injury and associated conditions. The home is able to provide nursing and care for people with complex behaviours. They are also able to meet the needs of people who have additional complex disability needs due to their brain injury. At the time of the inspection, all the residents were male. The manager reported that this was because most referrals were for males. They were considering how female residents could be supported in the future, this was to ensure that both males and females could be protected from behaviours which could be associated with some acquired brain injuries. When we discussed peoples needs with staff, it was clear that clinical staff all had a detailed awareness of medical causating factors for residents behaviours. Care assistants also showed an awareness of how residents cognitive conditions could affect the person, particularly on admission to what would be a strange environment for them. None of the residents we met with had been admitted recently and none could recall their admissions process. We reviewed documentation relating to a person who might be a prospective admission to the home. This persons assessment was very clear, detailing their individual needs in the light of their brain injury. The assessment detailed the persons behavioural needs. This was written in non-judgemental language and analysed how the home would be able to meet the persons individual needs, particularly in respect of their behaviours. Mrs Pickering reported that ensuring that residents and their supporters were fully aware of what the unit could and could not offer was a key area of their admissions process. She reported that honesty was crucial at this time, so that misconceptions did not arise at or soon after admission. Care Homes for Adults (18-65 years) Page 12 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have detailed care plans, which are drawn up with them as far as possible and residents are supported in a safe environment. Evidence: In their AQAA, the home reported on their comprehensive plans of care, which address residents cognitive, behavioural, social, psychological and physical needs and which emphasise the promotion of independence, dignity, rights and choice. They also comment on the importance of supporting risk-taking, in a safe environment. The home has an established key worker and lead nurse system to support residents. One resident reported I like [name of person] as my key worker and I like [name of person] as my primary nurse, another person reported key worker [name of person] always good to me. An external health care professionals reported that one of the homes strengths was respecting peoples dignity and privacy. During the inspection we met with two key workers and a lead nurse. They all knew their individual needs of their residents in detail, including both how their disability and cognitive needs were to Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: be met. We concentrated on observing nursing and care provision, as many of the residents could not discuss how the home met their needs with us. We observed that some of the residents had highly complex disability needs, others had additional mental health care needs and some could exhibit complex behaviours. We looked at residents records and observed that they all had detailed care plans in place. These fully described how their needs were to be met. Where the person had a risk associated with their condition, a full risk assessment was drawn up, together with details on how risk was to be reduced for them. All documentation was regularly evaluated, including when a persons condition changed. One persons care plan about meeting their personal care needs was very detailed and cross-referenced to other of their care plans, for example about mobility and dexterity. A care assistant described to us how they supported this person in personal care, using small steps, so that the person could be as independent as possible. Another persons records showed that they had been overweight and had smoked heavily before admission. Their care plan detailed how the home planned to reduce the persons weight and reduce smoking, with the persons full involvement. Records showed that the persons had been supported in reducing a significant amount of weight and that they now smoked fewer cigarettes. These records were supported by what staff reported. Another persons care plan documented the triggers for complex behaviours for them and detailed what actions staff were to take if complex behaviours were observed. All this was written in a non-judgemental style. Staff we spoke to were aware of the importance in involving people in decisionmaking. A carer reported on a resident who found making decisions stressful, which could distress them and how they supported the person in making small steps in the decision-making process and being aware of what the person wanted in areas where they were not yet able to make decisions. They reported that if you offered the person a choice of meals, they found this difficult to cope with and they had the potential to become very distressed, therefore it was important to discuss amongst the team what the person was observed to prefer to eat and give that to them, thus letting the person chose by their presenting behaviours, rather than actively asking the person what they would like. Risk assessments were personalised and related to the person themselves. Where relevant, external health-care advice was sought. For example one person had a clear risk assessment relating to them going swimming, which had included an occupational therapy report. Another resident had a clear risk assessment abut going out of the Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: home and the supports to be given to them to enable them to do this. The person was able to tell us that they did go out of the home at times, always accompanied by a carer and a therapy aide. We observed that, due to the complexity of residents conditions, that their records were wide ranging and long. As such they may be complex to access and we did discuss with the manager that it might be beneficial to produce a summary of the persons main needs at the front of their records, so make the care plans more approachable to residents and their relatives. We discussed that such records could be drawn up by the persons key worker, with support from the lead nurse, to ensure that what the person needed on a day to day basis was documented. Care Homes for Adults (18-65 years) Page 15 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home will be supported to live the life they wish, within the constraints presented by their brain injury. They will be supported in participating in therapeutic activities both in and outside their homes. Meals are regraded as a key area in supporting residents in their lifestyle choices. Evidence: In her AQAA, Mrs Pickering reported on the challenges presented in this outcome area, particularly in relation to residents with more complex brain injuries. She reported that the home employs and activities coordinator and that the home is also supported by the occupational therapy department on site. Mrs Pickering reported on how important relationships with residents relatives were in supporting different peoples lifestyles. The importance of meals and meal-times was emphasised, with one key area reported to be in providing improved choice to residents who need soft meals. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: People commented on this area to us when we visited. One resident reported on how they had a job taking the mail round the site, reporting I get out and about doing drops. A full risk assessment had been completed about the person doing this, to ensure that the person was safe and able to continue performing this role, which they enjoyed. Another person reported to us that they were able to go out of the home at times with the help of a member of staff and an occupational therapy aide, which they appreciated. Two residents reported that they had just been supported by an occupational therapist in learning how to perform their own laundry, one person reporting how good this was and another that the new laundry room was so convenient. All residents have timetables about activities which they are able to perform. Some peoples were detailed, others less to. The timetable related to the persons degree of brain injury and associated behavioural and or physical disabilities. Staff informed us about on the Coffee Shop in the hospital on site, which many residents enjoyed going to. Residents can also go to the Day Centre at Horizon close, which is also on site. One resident was reported to show frequent shouting behaviours and to be verbally abusive on occasion. A member of staff reported on how time out of home was worked round the persons behaviours, so as to ensure that the person was able to go out. Another resident was in bed throughout the morning. Staff reported that this person was usually up late, preferring to be in bed, sometimes taking all day to get up. Staff knew this persons preferences well and worked with them to ensure they could chose how to spend their day. Some residents found concentration complex and for these it was reported, and records showed that short activities were offered, which the resident could dip in and out of, depending on how they were. Certain DVDs had been found to be beneficial for residents who needed such support. During the inspection we observed that the activities person was running a group activity of BINGO, which several residents clearly enjoyed. Where residents were not able to cope with such stimulation, they sat more quietly in other lounges. Staff were always available and ready to support residents when needed. Several of the residents continued their interests in football, with posters and other associated football materials in their rooms. Many residents had televisions, CD players and DVDs in their rooms, with media which reflected their interests and preferences. Some residents continued to wish to engage with life outside the home. One resident had been supported in working with staff and others to arrange fund-raising activities for the Haiti earthquake. Staff reported on the importance of supporting residents relatives. Some residents relatives had been actively involved in decorating the residents rooms. A key worker Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: reported on the relationship which they had with their key residents relatives and how they supported them. The manager reported that residents relatives would often phone up to find out how their relative was, at times asking to speak to the persons key carer, as they were in the best position to let them know how their relative was on a day-to-day basis. Full records were maintained of contacts with residents relatives and where possible, they were involved in care planning. Residents commented to us about the meals. One person reported the food here is excellent - I DO like the food and another that the food was good - plenty of chips. Residents are offered a choice of three meals for lunch. The choices on the day of the inspection included a Chinese- style meal which some residents clearly enjoyed. Meals were served by staff from a hot trolley. We observed that residents were given a good sized portion, suitable for younger active men. Staff were flexible when serving meals. One resident asked as their meal was being served up to have mashed potato, instead of the rice they had ordered and staff here happy to give them this. Tables were served sequentially, so that people on each table received their meal at the same time. When a resident was unwilling to eat, staff offered them different choices, trying to give them what they wanted. A wide range of different aids to support residents in eating independently were available. Where a resident needed thickening agent in their drinks to enable them to swallow safely, this was mixed correctly using the manufactures equipment, before transferring the liquid to an ordinary domestic glass. Several residents needed to have a soft or liquidised meal. Where this was the case, staff set their meal out on their plate in an attractive manner, with attention to colour and appearance of the meal. Where a resident was unable to feed themselves independently, a member of staff sat with them assisting them to eat, in a non-hurried manner. Where a resident had a complex difficulty in swallowing, they were assisted to eat by a registered nurse. Staff were available to support residents throughout the meal. Residents who ate in the quiet lounge had at least one member of staff with them at all times. We observed that a resident who was eating in the main dining room restlessly got up from their chair and walk into another room. This was very promptly observed by a member of staff, who supported them and intervened, moving them and their meal to a quieter place, where they would experience less stimulation and be able to continue to eat their meal. Care Homes for Adults (18-65 years) Page 18 of 34 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. Residents will receive full supports in their personal, health care and medication needs Evidence: In their AQAA, Mrs Pickering reported on how important it was need for the residents to be supported in performing their own personal care as much as possible. She also reported on the supports from the Occupational Therapy department, including the provision of aids. The Old Vicarage is fortunate to be able to access a range of therapists on site, including physiotherapy, speech and language therapists and psychologists. Mrs Pickering reported that the use of mood-altering drugs is minimised as much as possible. She reported on the good working relationships with the local GPs and recent improvements in the medication supply service to the home. One resident reported to us in their survey that the home did their medication well. A carer reported on a persons limited speech and how they were working with the person, following advice from the speech and language therapist to support them in communicating more. A registered nurse reported on the supports given to a resident who had an additional medical need, how the person had been supported in attending the local hospital following referral to a consultant and how they were to support this Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: person in their ongoing medical condition. One resident had wounds, which the home were managing, with support from the local clinic at the local hospital. The persons records showed good evidence of communication between the home and the hospital. There were clear care plans relating to the persons wound, which evidence that the care plans were being followed and the wounds response to treatment evaluated. Another resident had an epileptic condition. They had a clear care plan about the condition, together with records of frequency of seizures. There was a very clear care plan relating to actions to be taken in an emergency, if the person did experience a fit. We reviewed the records of to residents who had diabetes. We observed that one persons care plan did not state the specific blood sugar measurements aimed at for them. As blood sugar levels may vary, depending on the person and other matters affecting them, blood sugar levels aimed at should be documented numerically. Additionally, actions to be taken by staff when a persons blood sugar levels are outside these parameters should be documented, to ensure all staff meet the residents needs in a consistent manner. As noted in Lifestyle above, at least one resident needed thickening agent to ensure that they could swallow safely. As the temperature of drinks and other factors can affect the consistency of thickening agent, the consistently aimed for should be documented, using accepted terminology - syrup, custard, jelly - rather than the number of scops of the agent to be used. Carers reported on how all staff worked as a team to meet residents needs. They reported that if they noticed any matter about a resident which gave them concern, that registered nurses always listened to them. We asked if they reported verbally or in writing. It was reported that they usually reported verbally and the registered nurse then documented relevant matters. We advised that if carers are reporting matters that they should also document their observations in the residents records as they were the person who had observed what had happened. This will further support accountability for staff. Registered nurses reported on the good working relationships with GPs and the therapists on site. All medical and therapy staff write in residents records and lead or support in the development on care plans, depending on the residents presenting needs. This supports communication across all staff groups involved in care. The manager is a registered nurse. She showed a very detailed knowledge of the clinical needs of the residents and how injuries in different parts of a residents brain could affect them and how other disease processes will impact on the persons condition. She is able to pass her detailed knowledge on to her staff, to ensure that each residents nursing and care needs can be understood and met. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: We observed a medicines administration round. This is generally performed by two registered nurses, although on occasion a registered nurse many be supported by a senior carer who has been trained in the area. This is to ensure that the medicines trolley and administration process can be observed at all times. One registered nurse remained with the trolley, whilst the other registered nurse took the medication to a resident. Registered nurses did not sign for any medication until the resident had taken their medication. We observed systems for storage of medication. The Controlled Drugs cupboard is quite small and the home has the potential to have a difficulty in storing any further such drugs if another resident were prescribed Controlled Drugs. All medicines were safely stored, including medicines needing cold storage. A full audit trail of medicines received into the home, administered to residents and disposed of was in place. A registered nurse reported that the home had commenced using a new pharmacy supplier at the end of the previous year and that their new service was brilliant. Where a resident was administered a drug via a feeding system, liquid preparations were used. The home had full information on which liquid preparations could be used together and which had to be administered separately. One resident who had an asthmatic condition was being supported by staff in using their own inhaler. Some residents were regularly prescribed medicines such as mood-altering drugs or painkillers, which can affect their daily lives. Where this is the case, reference to this should be included in their care plan, so that the effectiveness of the drug can be evaluated. Where residents were prescribed dietary supplements or topical applications, there was not a consistent system, to show that they had been administered and a system needs to be developed, so that the home can provide evidence that residents have had their prescribed medication. Care Homes for Adults (18-65 years) Page 21 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have their complaints and concerns listened to and will be protected from abuse. Evidence: In their AQAA, the home commented on their transparent system for complaints and that both formal and informal complaints were encouraged. They also reported that all staff are trained in adult protection on induction and regularly thereafter. They reported that they are in the process of ensuring that all staff are trained in standards relating to deprivation of liberty, with the aim that all staff will have completed such training during the next year. We looked at the homes complaint log and it showed that all complaints are logged and investigated, including apparently small matters, which Mrs Pickering reported, will continue to be of concern to the individual or their supporters. The homes complaints policy is displayed in the front entrance hall by the lift. Discussions with staff indicated that some of the residents did have the potential to exhibit verbal or even physical violence at times. Staff reported that where this did occur, it was generally between different residents and not directed towards staff. One care assistant reported that they found the most effective measure of dealing with such situations was to distract the resident and that this nearly always worked. They also reported that they felt supported by the staff team in situations where conflict Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: could occur and that all of then had been trained in breakaway techniques. We observed that there was always at least one member of staff in each of the sitting rooms, so vulnerable people were not left alone at any time and staff would be able to support residents when needed. A registered nurse confirmed that it was policy on the Old Vicarage never to leave residents unattended in sitting rooms because of the risk potential. We observed that staff maintained their awareness of what residents were doing at all times. For example, we were discussing their role with two carers, sitting at a table in the large sitting room. Throughout the discussions, one or other of the carers would politely break off from the conversation to go and support a resident, to ensure that they were safe and were supported. We also observed that when a noise was heard from a toilet, both carers quickly and calmly attended a resident who had become confused about opening a door and was upset about this. They supported the resident in a very kindly and considerate way, calming them down and making the person feel less afraid about what had occurred. It was reported that generally carers will not document such matters, reporting them to the registered nurse in charge for documentation. We advised that the carer who was with the resident at such times should document what occurred, including and actions taken, to ensure that what occurred was documented by the person who was with the resident at the time of the incident. Mrs Pickering was fully aware of advocacy services and when they would be needed. She reported that the Glenside group employs a senior social worker who is available to support whenever needed. She was able to give several examples of how they had been able to provide advocacy for residents who did not have support from family member. Records showed that all staff were trained annually in safeguarding potentially vulnerable adults. Three members of staff we spoke with were fully aware of their responsibilities for safeguarding vulnerable adults when given a range of scenarios which might occur. All residents records consider risks to the person as a vulnerable adult and care plans are developed when risks are identified. All residents records consider deprivation of liberties issues in relation to the resident. This included where a resident might wish to go out of the building independently but be unaware of risks presented by the external environment, unless they were supported by a person. Mrs Pickering had experience of working within multi-agency safeguarding procedures. Care Homes for Adults (18-65 years) Page 23 of 34 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. Residents will be supported by an environment which meets their needs. Evidence: In their AQAA, the home reported on the homes accommodation and the benefits of having a large amount of communal space to provide choice for residents. They also commented on the benefits of being on a campus of different homes, which meant that residents could go out to local services, such as the Coffee Shop in the hospital and the day centre at Horizon Close. They reported on the on-going systems for redecoration and furniture provision. They reported that they continually review furniture and fittings to ensure that they are not damaged by certain residents behaviours, while trying to maintain a homely environment. The Old Vicarage is over two floors of an old vicarage building, which has been converted and extended over the years. All accommodation is provided in single rooms, all have en-suites, either with a shower or a bath. Sanitary facilities are also provided close to sitting rooms. As it is an older building, many of the rooms are different in size and shape from each other, making it easier to personalise the rooms to suit the individuals likes an preferences. Many of the residents rooms reflected a range of interests for them, including football teams, celebrities or music preferences. There is a passenger lift between floors. It was reported that one resident was able to Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: use the lift independently and another with support. There are a choice of lounges for residents to use. There is a small enclosed garden which resident can go into and out of as they wish. A resident was observed going doing this several times during the morning. The manager reported that the home environment is to be further developed to improve lounge accommodation for the residents, during the summer of 2010. A high degree of equipment to meet the needs of residents with complex disability is provided, including profiling beds, pressure relieving mattresses and cushions and aids to manual handling. Where a resident needed a wheelchair, this was assessed by the on-site physiotherapy department and provided in accordance with the persons individual needs and disability. Occupational therapists have also given advice and support including advice on individual aids to daily living. A new domestic-style laundry has been provided for some of the more able residents to use. One carer reported weve got all the equipment we need. The home was clean throughout and smelt fresh. Many areas have wooden flooring, which give the home a light atmosphere and is easy to keep clean if any spills occur. We observed a domestic performing their role. The domestic carefully cleaned chairs, including under cushions, as well as on top and paid attention to cleaning down the cracks of chairs. Staff reported that domestic staff were very much part of the team and we observed that they also supported residents with comments, eye contact and smiles. Domestic staff were also observed to work quietly and calmly, so as not to disturb residents who were affected by noisy or restless actions. There is a central laundry on site. Infected and potentially infected laundry is handled correctly and all used laundry is separated at source. Care Homes for Adults (18-65 years) Page 25 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by the numbers and skill mix of staff. Staff are safely recruited, supported throughout their induction period and trained and supervised in their roles. Evidence: In their AQAA, the home reported We have an established team of registered nurses from a variety of professional and cultural backgrounds, including registered mental nurses and registered general nurses, who bring different personal and professional experiences, enabling us to meet the diverse needs of our service users. They reported on the induction programmes for new staff and the supports to training, both mandatory and non-mandatory. When we reviewed staffing records, we observed that the home has a very stable work-force, some of whom have worked in the home for a long period of time. One member of staff reported that although they had worked in the home for a long time, they did not get stale because every day is different. Care staff reported on the good supports from registered nurses and that they were listened to when they brought up issues. One person reported on how supportive the organisation had been when they had needed to change some of their hours, saying that it made them feel valued as member of staff. Mrs Pickering works clinically often, so that she can observe staff Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: performance and identify areas which may need her attention. We spoke with three staff about supports to new members of staff. They all reported that they appreciated how new members of staff could find the home not easy to work in when they took up post and that they needed extended support from established staff, to support them in gaining confidence on their role, only gradually letting newer staff work more independently as they gained in confidence and felt comfortable. Staff reported that new carers needed to learn about the residents as individuals and that due to their needs, this could take time. Mrs Pickering showed a very detailed knowledge of the medical pathology which affected each resident; this meant that she has a non-judgmental approach when residents show behaviours. By supporting her staff, she has been able to enable them in to understand how each persons brain injury affects them, to fully understand how residents may show certain behaviours or react in certain ways. Staff reported on the supports to training from the training department on site, including courses in cognitive rehabilitation therapy. Staff also reported that they are supported in undertaking National Vocational Qualifications. Other training has included staff being enabled to work working with therapists, including therapists coming in in the earlier morning to train night staff. Registered nurses have been supported in extending their skills base, for example in the management of leg ulcers and insertion of catheters to support tube-feeding regimes. The provider has a central training department on site, from where mandatory and other training is coordinated. Clear records of training, including induction were maintained. Mrs Pickering maintains a matrix, so she can see at a glance who is due to attend what training. Staff supervisions include training plans for staff. Several staff also reported on the Tuesday meetings, which are held by Mrs Pickering, where staff can discuss and find out more about how residents are affected by their brain injury. Glenside group has a central human resources department. A review of newly employed staff files showed that a full employment history, required police checks, two references and proof of identity are required prior to employment. All potential members of staff are interviewed by two people who complete an interview assessment, to asses if the person meets the person specification for their new role. These were individually completed. The provider now has an occupational health advisor who can support the recruitment process when indicated. All staff are given a job description which they sign. Mrs Pickering reported that she is fully involved in the recruitment of new members of staff, so that she can assess their suitability for working on the Old Vicarage. Where members of staff transfer across different units Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: on site, a further recruitment process is always carried out. Care Homes for Adults (18-65 years) Page 28 of 34 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. Residents will be supported by the systems for conduct and management of the home. Evidence: In their AQAA, the home reported on the regular reviews of service provision held by the provider. they report that where issues are identified which need action, plans are put in place to ensure that they are addressed. Views of residents, their supporters and other people are sought, to ensure that the service meets their needs. Mrs Pickering the manager has been in post for a number of years. She remains enthusiastic about service provision and keen to develop services her residents, working with the multi-professional team and maintaining effective liaison with all relevant parties both on campus and externally. Mrs Pickering is supported by a deputy, who is also a registered nurse. A carer reported that the management team were definitely supportive to them in their role. We reviewed systems for audit of quality in the unit. This involves seeking the views of residents, and their supporters. Comments from external professionals such as Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: social workers and medical advisors are also sought. Regular staff meetings are held on a Tuesday, which staff reported they felt able to bring up items that needed attention and that they would be listened to. Mrs Pickering also maintains a review of factors which may affect residents such as accidents and incidents, infections and issues relating to tissue viability. Where issues are identified, she takes action to review service provision. We looked at systems for management of residents moneys. The home has an auditable system for moneys in and out. Accounts are spot audited during monthly inspections by the provider. As on occasion residents may be supported in taking moneys out of their accounts but spend different amounts on different days, it is advisable that a system is put in place to reconcile receipts to moneys taken out, to ensure a full audit trail. The home has clear systems to ensure the health and safety of residents. We noted as good practice that when a resident may be at risk of falling out of bed, that profiling beds lowered to the floor and crash mats are used, rather than safety rails, which have been shown to present a risk to residents. One person described how new members of staff were not expected to perform manual handling at first and that until they felt competent, they work with other staff until they can see and understand what is needed for each resident. There are clear systems to ensure that equipment is regularly serviced. Staff reported that any small items of maintenance are quickly dealt with. The home has a fire log book, which is fully up-to-date. We discussed as good practice that they should develop individual evacuation plans for residents in the event of a fire, so that they could ensure that they had the equipment and services that they needed in the event of residents needing evacuation from one fire zone to another, considering all factors throughout the 24 hour period. Discussions with staff indicated that where families were involved with residents, that visits from residents children were supported. The home does not have a policy relating to safeguarding children, which reflects the services and risks presented by the unit. To ensure that children are protected by the homes systems, a child safeguarding policy needs to be put in place. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 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 19 Where a carer makes an observation about a residents condition or changes in condition, they should document it in the residents notes, as well as reporting it to the registered nurse When documenting the use of thickening agent, the consistency required for the drink should be documented rather than the number of scops of the agent, as the temperature of the drink and other factors can affect the consistency. Where a resident has a diabetic condition, their care plan should document the blood sugar level aimed for in numerical terms and actions to be taken by staff, should their blood sugar levels fall outside these parameters. Full documentary systems should be put in place to provide evidence that residents have been given their prescribed dietary supplements and topical applications. Where a resident is prescribed a drug which can affect their daily lives, this should always be referred to in their care plan, so that the affect of the drug on them can be evaluated. Page 32 of 34 2 19 3 19 4 20 5 20 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 6 7 8 20 40 41 A larger controlled Drugs Cupboard should be provided. The home should develop a child protection policy relating to its service provision. Systems should be put in place to reconciliate receipts to residents accounts. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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