Care Home: Stroud Lodge

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What the care home does well People said they liked living at the home. They showed us their rooms which they had chosen the colour schemes for and where they kept their personal possessions. People said they liked to go out to the cinema, shopping, bowling, horse riding and into town. One person liked to go for walks and another went to the local shop without staff support. People were supported to learn skills such as managing their medication, cooking, washing and cleaning. People received payments for helping around their home.Staff have access to a robust training programme to provide them with the knowledge and skills to support people.People take part in staff interviews.The quality assurance process includes obtaining feedback from people about their home. What has improved since the last inspection? More accessible information is being made available to people producing policies and procedures in easy read formats, as well as the Service User Guide, terms and conditions and complaints procedures.Photographs and pictures are being used to illustrate activity schedules and will be used for menus and staff rotas. What the care home could do better: Fire exits must be accessible and free from hazards. Key inspection report Care homes for adults (18-65 years) Name: Address: Stroud Lodge 319 Stroud Road Gloucester Gloucestershire GL1 5LG 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: Lynne Bennett Date: 3 1 0 3 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 37 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Stroud Lodge 319 Stroud Road Gloucester Gloucestershire GL1 5LG 01452306449 01452312078 manager.stroudlodge@orchardendltd.co.uk www.orchardendltd.co.uk Orchard End Limited care home 9 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 9 3 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home Stroud Lodge is a residential home for 8 adults with learning disabilities and challenging behaviour. The home is a large detached building, situated approximately one mile from the centre of Gloucester. The home is close to local amenities and within easy access to public transport. Accommodation is provided over three floors, with communal areas on the ground floor and bedrooms on the other floors. Care Homes for Adults (18-65 years) Page 5 of 37 There is a garden for the residents use and a parking area at the back of the house. Stroud Lodge is part of Orchard End Ltd, a subsidiary of C.H.O.I.C.E. Ltd. The Statement of Purpose and Service User Guide are displayed in the entrance hall along with the summary of the last report. Fees for the home start from 1158.78 pounds per week upwards according to individual need. Care Homes for Adults (18-65 years) Page 6 of 37 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 Care Homes for Adults (18-65 years) Page 7 of 37 How we did our inspection: This is what the inspector did when they were at the care home This inspection took place in March 2010 and included two visits to the home on 30th and 31st March by one inspector. The registered manager was present throughout and the Area Director joined us for feedback. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). Page 8 of 37 Care Homes for Adults (18-65 years) We received surveys from 6 people living in the home and 2 members of staff. We also spoke with a visitor. We talked to 3 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also spent time observing other people and their interactions with staff. What the care home does well Care Homes for Adults (18-65 years) Page 9 of 37 People said they liked living at the home. They showed us their rooms which they had chosen the colour schemes for and where they kept their personal possessions. People said they liked to go out to the cinema, shopping, bowling, horse riding and into town. One person liked to go for walks and another went to the local shop without staff support. People were supported to learn skills such as managing their medication, cooking, washing and cleaning. People received payments for helping around their home. Care Homes for Adults (18-65 years) Page 10 of 37 Staff have access to a robust training programme to provide them with the knowledge and skills to support people. People take part in staff interviews. The quality assurance process includes obtaining feedback from people about their home. Care Homes for Adults (18-65 years) Page 11 of 37 What has got better from the last inspection More accessible information is being made available to people producing policies and procedures in easy read formats, as well as the Service User Guide, terms and conditions and complaints procedures. Photographs and pictures are being used to illustrate activity schedules and will be used for menus and staff rotas. Care Homes for Adults (18-65 years) Page 12 of 37 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lynne Bennett CQC South West Citygate, Gallowgate, Newcastle upon Tyne NE1 4PA 0300 616161 Care Homes for Adults (18-65 years) Page 13 of 37 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 14 of 37 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 15 of 37 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. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. A comprehensive assessment of the persons wishes and needs are taken into consideration before offering them a place. Evidence: The homes Statement of Purpose and Service User Guide had been reviewed in February 2010 and both were available in formats accessible to people living in the home using photographs of the home, pictures and large text. Each person had a copy of these documents in their room and also on their personal files. People also had copies of their terms and conditions which again were produced with personalised photographs including their own photograph, photographs of their room and activities they liked to take part in. People had signed these. CHOICE has a robust system in place to process applications for people who wish to live in the home. A referrals manager completes an initial assessment and supporting information was being obtained such as assessment of need and care plans from the placing authority. The home had an admissions file containing copies of this information for all people currently living in the home. We case tracked the last person who moved Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: into the home who had transferred from another home in the group. There was evidence that this comprehensive system of admission was completed for them including transition meetings to arrange visits to the home. We spoke with this person and they said they were happy living at Stroud Lodge. People were being encouraged to visit the home on several occasions which included bringing along relatives or social workers. As many visits as were needed were being arranged to include overnight stays. The AQAA stated that the home would like to ensure that people living in the home are involved more in the admission process and giving feedback on people wishing to move in with them. The changing needs of people living in the home were closely monitored and one person had been supported through periods of anxiety and anguish which had directly impacted on others living in the home. There was evidence of close working with a range of health and social care professionals and regular reviews to discuss how best to support this person. At the time of our visits a decision had been reached to support the person to move to a more independent living environment which would better suit their needs. Care Homes for Adults (18-65 years) Page 17 of 37 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. A person centred approach to care planning ensures that people are able to take control of their lives. Peoples needs are being assessed and they are being supported to make decisions about their lifestyles. Risks are being managed safeguarding from possible harm. Further planned improvements in the accessibility of information for those with limited communication will ensure they are involved in these processes. Evidence: We case tracked the care of three people living in the home. Each person had a full assessment in place providing a holistic assessment of need from which person centred plans were developed for their physical, emotional, intellectual and social needs. There was evidence that plans were being regularly reviewed and any changes noted. Meetings with key workers were taking place regularly and were recorded. Annual reviews for 2009 had taken place and copies of an assessment of need and care plan had been provided by placing authorities who had attended. Schedules for reviews for 2010 were seen. The AQAA stated, we listen to the individual, we take into account all aspects of the service user when documents are being drawn up. Each document is person centred. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: Staff spoken with had a good understanding of the needs of the people they support and were knowledgeable about peoples care plans and risk assessments. Each person had several files providing staff with information about their identified needs including an additional file providing a short aide memoir. A questionnaire had been developed for all staff to complete testing their knowledge of peoples current needs. The registered manager said that this was due to be given to staff. Support guidelines developed from assessments of need provided succinct and clear guidance about how people would like to be supported. People had signed these. Where risk management plans were in place the support plans made reference to these. Any changes to need had been noted on plans and where necessary new plans put in place. Care plans clearly stated how staff were to support people to make choices and decisions about their day to day lives. For instance one plan stated, do not influence decisions, encourage ..... to make decisions about what he would like to do. Further guidance was given about how to offer informed choice. Where there were restrictions in place these were recorded with the rationale for them clearly described. Restrictions included use of the kitchen at busy periods, such as when preparing meals, use of knives and access to hazardous products. Information around the home was being produced in accessible formats using photographs, pictures and symbols to illustrate documents and activity timetables. Further work was in hand to illustrate menus and produce a pictorial rota of staff working each day. The registered manager said she was looking for makaton training for new staff. Each person had a communication care plan and communication passports were being developed for each person. CHOICE has recognised that people living in their homes could have better access to advocates. They were setting up a project with an external agency to provide an advocacy post within the organisation. If necessary people living in the home would have access to a local IMCA (Independent Mental Capacity Advocate). One person said they had access to a PCP (Person centred planning) officer to help them to monitor how the home were supporting them to gain skills to move into a more independent living environment. Risk management plans were developed with CHOICEs psychology team and used the Traffic light system to highlight high risk areas. Strategies to minimise risks were identified enabling people to take risks in a managed and safe way. For instance one person with epilepsy had strategies which stated that staff were to monitor discreetly while bathing or showering. Another person wishing to use the community independently had a programme in place to support them to achieve this in small accessible steps. They said they had achieved the first step to go to a local shop without staff support and were now working towards the next goal. Missing persons procedures were in place and each person had a profile with current photograph on their files. Page 19 of 37 Care Homes for Adults (18-65 years) 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 who use the service are able to take part in appropriate activities inside and outside of the home, have links with the local community and pursue a range of leisure interests. People are offered a varied and balanced diet appropriate to their needs, promoting their health and wellbeing. Evidence: Peoples religious or spiritual beliefs were noted in their care plans. Most people are Christian and currently no one at the home wishes to worship at church. One person occasionally visits a church to light a candle in remembrance and another person is interested in history and had visited Gloucester Cathedral. The registered manager stated that people had previously been supported to follow their beliefs and staff would enable them to do this if they so wished. Some people were attending a social club attached to a local church. People were observed making use of local facilities including a nearby shop and going for walks. Some people use public transport to go into Gloucester city centre or can use the Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: homes transport. Other people use the rail network to visit towns and cities nearby. Each person had an activities schedule in place which had been produced using photographs, pictures and symbols. Management and staff said this was a guide only because most people liked to make choices or decisions about their activities each day. Some people were attending local colleges and most had the opportunity for paid work with CHOICE. Opportunities for work placements locally had been researched and one person had tried out a work placement. Comprehensive activity records were being kept and monitored by CHOICE. We sampled daily records for two weeks in March which indicated that people had been out to the cinema, social clubs, bowling, pubs and shopping. One person said they had joined the local weight watchers club and were pleased to be losing weight. Other activities at home included baking, cooking, helping around the house with the cleaning and laundry, recycling and using the computer. People were observed doing arts and craft in the home and helping in the kitchen. Where people have been offered the opportunity to do an activity and refused records indicated this. Some people and staff said that recent events in the home had sometimes affected opportunities to do activities (See Concerns, Complaints and Protection). The management team were aware of this and had reviewed the provision of activities planning to make them more responsive to how people were feeling on the day rather than trying to impose the activities schedule on people. Guidelines were in place for staff describing activities which they could provide ensuring a consistent approach. Surveys from people indicated that staff offer activities to people when they want them. We questioned staff and management about the funding of activities and they confirmed this was funded through the homes budget. People living in the home were not expected to fund staff who supported them on activities. People said they were able to make choices and decisions about their daily lives and we observed them being supported to do this during our visits such as going out for walks or to town, deciding where to spend their time and with whom, and planning future events. House meetings were being arranged on a one to one basis each month with occasional group meetings to discuss specific issues. Each one to one meeting was being recorded and there was evidence that action was being taken to address issues identified such as putting a television on a wall in a persons room. We examined records for meetings in 2009 but those for this year were not seen. One person was being visited by a relative during our visit and they said they were made to feel welcome by staff and people living in the home. They said they could visit whenever they wished. Other people kept in touch with relatives and friends via the telephone, email or visits. Staff supported people to visit relatives who live some distance away. One person visited their family in Cyprus last year. People were being supported with sensitivity and respect with personal relationships. People living in the home choose the meals provided and their choice was indicated on the menu displayed in the kitchen. There were plans to illustrate this with photographs. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: People were encouraged to help prepare the meal of their choice. Most meals were freshly prepared, fresh vegetables, salad and fruit were available. People were supported to have a healthy and nutritional diet and some had access to a dietician where needed. Individual meal records were being maintained in peoples daily records and an additional food diary was being kept for one person case tracked. Care Homes for Adults (18-65 years) Page 22 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care which people receive is based on their individual needs that are reflected in their care plan. Medication processes are in place that should safeguard people from possible harm this includes supporting people to manage their medication if they wish. Peoples wishes in respect of ageing and death have been discussed with them and records reflect these. Evidence: Care plans noted What is important to me, What I like to do, and How best to support me. This provided staff with an overview of peoples likes, dislikes and wishes about how they would like their personal and health care needs met. Although plans clearly described how people wished to be supported with their personal care needs they did not identify whether people had a preference about the gender of staff helping them. The registered manager said that although not recorded that the staff team were aware of peoples preferences and that they were able to respect these. People were having access to a service providing chiropody and massages in the home. The AQAA stated some of the service users appear to enjoy this service. The AQAA also stated that personal support is given taking into account the individuals dignity at all times and the service users privacy, dignity and rights are always maintained. Four surveys from people using the service stated that staff look after me Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: well, take care of me and look after me. Daily notes and observations during our visits indicated that peoples day to day lives were flexible reflecting their personal choices about how they wished to spend their day. Some people liked to stay up later and some liked to have a lie in. As mentioned greater flexibility was being promoted for activities. Records confirmed that people were having access to a range of health care professionals including the local CLDT (Community Learning Disability Team), their General Practitioner (GP), Dentist and Opticians. Comprehensive records were being kept including a summary sheet of all appointments in 2009 enabling staff to check when further appointments were needed. The outcome of each appointment was recorded. Each person had a health action plan in place and there was evidence that annual health checks were taking place. Information in these plans was being monitored and reviewed. End of Life plans had also been developed with people. Personal profiles were in place for each person indicating their medication regime including a current photograph and noting any allergies. Protocols for the administration of as necessary medication had been authorised by the GP. Staff had completed training in the safe administration of medications and competency assessments were being carried out each year. Where there were concerns about the administration of medication investigations were conducted and the appropriate action taken with staff. Robust systems had been put in place to monitor the administration of medication. Two sets of records were being kept and staff administering medication were observed by another member of staff who signed the duplicate set. An audit of medication records was in place and there was evidence that where gaps or issues were identified prompt action was taken to correct or verify the recordings. We also noted that the reports of monthly Regulation 26 visits as required by us monitored medication records and processes. Systems were in place to manage and monitor stock control. A thermometer was in the cabinet but records were not being kept of its reading. This was put in place during our visits. The home had a copy of the British National Formula (BNF). Creams and liquids were dated with the date of opening and disposed of within the necessary timescales. No homely remedies were kept. People were being supported to self medicate. An assessment was conducted prior to being supported to self medicate and staff had access to a programme which they could work through to gain the skills to take charge of their medication. One person in the home was currently managing their medication. We discussed ways in which the procedures for pre-packaging the medication could be made more robust. Step by step guidance should be in place for staff describing the practice which was described to us and which is in line with our guidance on secondary dispensing of medication for social leave. The registered manager confirmed this process had been agreed with the persons GP. Care Homes for Adults (18-65 years) Page 24 of 37 Care Homes for Adults (18-65 years) Page 25 of 37 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. Systems are in place to enable people to express their concerns and they are confident that they will be listened to. People are safeguarded from possible harm or abuse. Evidence: The home has a complaints procedure which was displayed in the entrance hall. This had been produced in a format using pictures and symbols. Each person also had a copy in their room and on their personal files. People said they would talk to their key workers or to management if they had concerns. They also have one to one meetings with management and senior staff providing an additional forum to express concerns. Records of these confirmed that the complaints process was revisited with people at each meeting. Surveys indicated that 5 of the 6 people knew how to make a complaint. The DataSet indicated that the home had received 5 complaints in the past twelve months. A complaints log was kept providing a copy of each complaint and the response of the home to this including investigations where necessary. CHOICE had commissioned a company to produce the safeguarding policy and procedure in an easy read format. Staff spoken with had received training in the safeguarding of adults and were confident that the management team would not tolerate poor practice and deal with any concerns appropriately. The AQAA stated, the staff are aware of all types of abuse and are encouraged to report any discrepancies if they were to arise. All staff were completing SCIP (Strategies for Crisis Intervention and Prevention) training as part of their induction. There had been a significant increase in the use of physical Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: intervention in the home since our last inspection of which we had been informed. The AQAA confirmed that physical intervention had been used on 52 occasions over the past twelve months, with over 300 incidents, mostly with one person. Reactive management strategies were in place for all people which clearly described how to interpret their anxieties and anger, what triggers to look for, how to support them and to only use physical intervention as a last resort. We discussed with staff the use of physical intervention and whether it had become a response to managing the behaviour of one person rather than being used as a last resort. They stated that it was used only where distraction and diversion techniques had failed and to safeguard the person and themselves from possible harm. Statistics showed that in the first two months of 2010 the use of physical intervention had reduced by half. Intensive support had been provided by the psychology team to the person which staff said had some positive impact. Comprehensive records were being kept for all incidents and where physical intervention had been used. These were being monitored by CHOICE. People were being supported to manage their finances. Care plans and risk assessments indicated the level of support needed by people. We examined the financial records for the people being case tracked which confirmed that daily auditing of these documents was in place. People had inventories detailing their possessions. These had not been updated in the past twelve months. Care Homes for Adults (18-65 years) Page 27 of 37 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. People live in a spacious home which is kept clean and warm. A maintenance programme is in place to make sure that day to day wear and tear and any issues which arise are dealt with to maintain the standard of accommodation. Evidence: Stroud Lodge is conveniently situated close to local facilities and accessible to Gloucester city centre, which people living there take full advantage of. Some people showed us their rooms whilst we were walking around the environment. They have keys to their doors and were observed unlocking their rooms. People had decorated their rooms to reflect their interests and lifestyles. The shower in one en-suite was broken and needs attending to. Some curtains in bedrooms and blinds had been removed but the registered manager said that these would be replaced. On the second day of our visit the maintenance team were in attendance dealing with some outstanding issues. They confirmed a broken window on the landing was being attended to and would be replaced. The registered manager said that day to day issues were being reported, monitored and actioned. Long term plans included replacing the fittings in a first floor bathroom. The ground floor computer room was being refurbished during our visits. Since the last inspection carpets in communal areas had been replaced. There had been some wear and tear on the environment and fixtures and fittings but these were being addressed. People have access to a large garden with access to a trampoline. They were also taking responsibility for recycling waste for the home which was housed in a shed in the garden. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: The laundry is very compact and is used by people living in the home. Domestic appliances are in use. Each person had their own laundry basket and infection control measures were promoted. Persona protective equipment was provided around the home. The home had been inspected by environmental health and received 5 stars. Care Homes for Adults (18-65 years) Page 29 of 37 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. Peoples needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. People living in the home are involved in the recruitment and selection process. This process is robust and should protect them from possible harm. Evidence: At the time of our visits the home was fully staffed and had no vacancies. The rota indicated that a minimum of 4 staff were on duty during the day rising to a maximum of 9 at times, reflecting the support needed by people to complete scheduled activities. Surveys and comments from staff and people living in the home indicated that at times they would benefit from increased staffing levels. Staff spoken with said that the management team were very hands on and would help out if needed. Staffing levels appeared to be affected by the impact of one person living in the home who occasionally needed at least two to one support. When this person moves on this situation should not re-occur. New staff confirmed that they were completing an induction programme which is equivalent to the skills for care foundation standards. As part of the induction they were completing a questionnaire based on peoples individual care needs. After the induction programme staff have the opportunity to complete the Learning Disability Qualification Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: and then register for their National Vocational Qualifications (NVQ). The DataSet stated that over 70 per cent of staff have a NVQ Award. Staff have probationary meetings after 6 months and records on their files verified these had taken place. Staff confirmed they have regular staff meetings and hand overs as each shift changes. Communication books were also in place and those spoken with said communication within the home was good. We looked at staff files for four new members of staff. A front summary sheet was in place providing evidence of when records had been requested and when they had been received. All staff had application forms in place which provided a full employment history. Where there were gaps these had been explored with the applicant and evidence provided for these. Staff had been appointed after at least two satisfactory references had been received. There was evidence of proof of identity and a current photograph. One person had been appointed from overseas and the registered manager said that they had a work permit although a copy of this was not on their file. Where staff had started working in the home before their Criminal Records Bureau (CRB) check had been received there was evidence that an ISA (Independent Safeguarding Authority) Adult First check had been obtained. A risk assessment detailing what duties they could perform was also in place. Interview records evidenced that people living in the home were taking part in interviews. This was also confirmed by the registered manager. CHOICE has a robust training programme in place to make sure staff have access to mandatory training, refresher training and any additional training staff may need. A training matrix was examined for March 2010 which also highlighted staff training needs. We discussed with the registered manager that staff should have access to mental health training. A number of new staff had not completed this. Information about each persons condition or diagnosis was provided on their personal files. Training scheduled for the next few months included the Mental Capacity Act, Protection of Vulnerable Adults, First Aid, Epilepsy and a SCIP refresher. Copies of training certificates were kept on staff files both for training completed prior to working at the home and since working there. Care Homes for Adults (18-65 years) Page 31 of 37 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. The home is well run. Effective quality assurance systems are in place involving people who live at the home. There are systems to maintain and monitor the health, safety and welfare of people, which should safeguard them from possible harm. Evidence: The registered manager has worked for CHOICE for 4 years, has completed a NVQ at level 3 and is currently completing the Leadership in Management in Care Services Award. She had completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards. She has considerable experience and knowledge of learning disability. Staff said she was open and approachable. Staff and management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. The home had access to the relevant assessments and records should they need them. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. CHOICE have an effective quality assurance programme in place which involves feedback from people living in the home. People were being involved in the monthly visits to the Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: service by the Area Director as well as the annual quality assurance review of the service. Each year they take part in a survey of their service. The summary of their responses was available for 2009 and we examined the quality assurance report which was developed as a result. From this the home has a quality improvement plan which is monitored through Regulation 26 visits to the service. In addition to this health and safety and medication audits were being conducted. Systems were in place monitoring health and safety around the home. Records examined confirmed checks were in place for fridges, freezers, hot food temperatures, water outlets and portable appliance tests. Records in the home confirmed information supplied in the AQAA about the servicing of equipment. A current fire risk assessment was in place and each person had an individual fire risk assessment. Fire checks, drills and training were also in place. During our first visit to the home a garden hose had been left across the fire exit to the rear of the building. This was removed during our visit. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes  No  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 34 of 37 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 Description 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 Description Timescale for action 1 42 13 The registered provider must 30/04/2010 make sure that people are not put at risk due to hazards in front of fire exits. This is to safeguard people from possible harm. 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 2 18 20 Care plans should identify peoples preferences in relation to the gender of staff helping them with their personal care. The practice currently in place for secondary dispensing of medication for one the person self administering their medication should be clearly recorded. Inventories should be updated to reflect peoples current possessions. The shower in the first floor bedroom should be in good working order. 3 4 23 24 Care Homes for Adults (18-65 years) Page 35 of 37 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 5 6 34 35 Evidence should be provided that a work permit is in place for staff from overseas. Staff should have access to mental health training. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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