Care Home: The Gloucester

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What the care home does well During this site visit we had the opportunity to speak with four staff members, and the registered manager. We also spoke with seven people who live in the home in communal areas including one person who had not long moved into the home. All spoken with demonstrated high levels of satisfaction with the services provided at the home, comments made are incorporated within this report. The home is well managed and is run in the best interests of the residents. The management at the home monitors the quality of the care and there are sound systems in place to underpin this. The manager and staff members appear to be very motivated and caring in their approach they understood the needs of people living at the home and had developed good relationships with them.The home has benefited from some refurbishments since our last visit and the home have been awarded a 4 star quality rating from Environmental Health for the standards of food hygiene. What has improved since the last inspection? All requirements and recommendations made at our last visit to the service have been met. The manager has kept us informed as to the wellbeing and welfare of those who live at the home and incidents that may have affected them. In order that those living at the home can be assured that staff have the knowledge and skills needed in order to perform their duties in a safe manner it was required that the four staff identified during our last visit to the home received manual handling training and those who had training in this area over a year ago must also undertake refresher training in this area. All staff have had, or are booked to do this training and have the required updates where needed, this requirement had been met. Those living at the home can feel confident that the manager has the knowledge and skills in order to perform her duties in line with the National Minimum Standards and Care Homes Regulations as the manager has registered and commenced a National Vocational Qualification at Level 4 in management. Those living and working at the home can be confident that the home is safe and is appropriate for the needs of those who live and work at the home. As since our last visit a fire detector self closure has been fitted to the kitchen door making the area safer should a fire occur. Those living at the home can be better assured of security within the home as medication is now stored securely. Those living at the home can be assured that staff are appropriately supervised as the home have developed a supervision proforma for consistent formal recording of these meetings, staff told us they think this recording is much better. CARE HOMES FOR OLDER PEOPLE The Gloucester 83 Gloucester Road North Filton South Glos BS34 7PT Lead Inspector Odette Coveney Unannounced Inspection 22nd May 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gloucester Address 83 Gloucester Road North Filton South Glos BS34 7PT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9699626 neilplumm@tiscali.co.uk Alutarius Ltd Karen Jane Headington Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: No conditions Date of last inspection 22nd July 2007 Brief Description of the Service: The Gloucester is registered with the CSCI to provide care and accommodation for up to 13 older people. The home is operated by Alutarius Limited and is managed by Karen Headington, who is supported by a deputy staff member and a full staff team there is an area manager, Steve Arthur, who visits the home on a regular basis, support her in her role. Neil Plummer is an associate director, the registered providers are Mr and Mrs Coombes, who also own three other homes in England. The property is situated on the A38 Gloucester Road approximately 4 miles North of the centre of Bristol. The home is on major bus routes and the M32 and M4 are easily accessible from the home. Local amenities are within walking distance of the home. Accommodation is provided on three floors. There is a passenger lift. There are nine single and two double bedrooms. The home has two lounges, a dining room and a kitchen on the ground floor. There are bathroom and toilet facilities on each floor. There is level access to a decking area to the rear of the premises and steps to a small garden area. There is access to the garden from the side of the property. Car parking is provided at the rear of the home. Fees at the home start from £460 and are based on individuals assessed needs. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced key standard site visit, it was carried out in one day over a 7-hour period by one inspector for the Commission. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individual’s living in the home. Prior to the site visit the Commission received from the manager a completed an annual quality assurance assessment (AQAA). The annual quality assurance assessment is a new process that is being used for all regulated services from April 2007. An opportunity was taken to spend time with those who live at the home and talk with them about their experience of life at The Gloucester. We were also able to view the home and a number of the records relating to the management of the home. We reviewed the plans of care for four individuals and also examined other associated care records. Records of staff recruitment, selection, supervision and training were also reviewed. What the service does well: During this site visit we had the opportunity to speak with four staff members, and the registered manager. We also spoke with seven people who live in the home in communal areas including one person who had not long moved into the home. All spoken with demonstrated high levels of satisfaction with the services provided at the home, comments made are incorporated within this report. The home is well managed and is run in the best interests of the residents. The management at the home monitors the quality of the care and there are sound systems in place to underpin this. The manager and staff members appear to be very motivated and caring in their approach they understood the needs of people living at the home and had developed good relationships with them. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 6 The home has benefited from some refurbishments since our last visit and the home have been awarded a 4 star quality rating from Environmental Health for the standards of food hygiene. What has improved since the last inspection? What they could do better: This was a very positive visit to the home and only four requirements and three recommendations were made. We found that contracts of the placement were not in the home and copies of these had to be faxed to us. These must be available on site, furthermore each person who uses the service must be provided with a copy of these in order that they are aware of the terms and conditions of the placement and of their rights and the responsibilities of the provider. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 7 Medication is generally well managed at the home, however in order to fully demonstrate that medication is disposed of appropriately the home should ensure that the receiving pharmacist or their representative sign for medication that is no longer required. In order to ensure full, safe access for those with a disability is it required that a handrail be provided to the exterior of the house, which leads from the front door to the car park in order to support those with mobility difficulties. To demonstrate a commitment from the provider in maintaining a good environment for those who live at The Gloucester consideration should be given to replacing ‘tired’ and ‘worn’ seating in the front lounge. Also consideration should be given to the redecoration of the ground floor toilet, as this area looks neglected. The home has dealt with accidents effectively and these are recorded, however accident reports must always record what action has been taken to minimise and prevent re occurrence. The home identified an area of risk on steps leading to the rear garden, yet action has not been taken to prevent falls, it is required that this health and safety risk assessment is reviewed and appropriate action is taken where it is needed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is comprehensive information describing the service available to individuals living at The Gloucester. Individual’s needs are assessed prior to admission and these are kept under review. Those who live at the home are not provided with a written contract/statement of terms and conditions with the home. EVIDENCE: The home has a comprehensive statement of purpose in place, at the time of the site visit this document was under review and the manager was looking into providing the document in a more accessible format. The information within this document was comprehensive and contains clear information for residents and their relatives about the services and facilities provided at the home and furthermore contained information about the staffing arrangements The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 10 at the home, information about the admissions process into the home and how to raise issues of concern and how these would be responded to was also well recorded. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose and full assessments of needs are undertaken. We spoke with the last person admitted into the home who told us that they had settled well at the home and that the staff and other residents had made them feel very welcome, ‘the staff here are lovely’ they told us. We decided to review the contracts of ‘terms and conditions of the placement’ for some of the people who live at the home. None of these documents were on site at the home and when we asked people if they had received a copy of this document they did not appear to know what we were asking. The manager confirmed that these were not on site and arranged for copies of these to be faxed to us from the head office. We were given copies of these the following day, this is not acceptable. It was evident that residents, nor their representatives did not have their own copy of the contract and therefore have no written information about the rights and responsibilities of the responsible provider and of the service, which they are provided with. It is required that these contracts must be available at the home and also that each person who uses the service must be provided with a copy of these. Intermediate care is not provided at this home. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual’s personal and health care needs are being met. Individuals are protected by the home’s medication practices and procedures EVIDENCE: Four care files for people who live at The Gloucester were reviewed by us during this site visit, these showed evidence of pre-admission assessments to enable staff to develop personalised care plans for people and these recorded how the needs were to be met. Care plans seen were detailed and explicit and the daily report contained entries of what, when and how care was provided. Information recorded on care documentation corresponded with information given from residents, staff and relatives about the level and individualised levels of support that residents received. It was clear that support provided was flexible and tailored to individuals identified and requested support needs. Within these records we also saw that the home were prompt to respond to the health needs of residents, specialist advice had been sought and obtained The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 12 where needed such as eye care and community district and psychiatric nurses. On the day of our visit one person was returning to the home from hospital they were warmly greeted by the staff at the home that were very attentive to ensure the person received the care and support they needed. Also during our visit an occupational therapist visited with a bed rail to support an individual to maintain their independence. People we spoke with stated that staff supported and assisted them with personal care and that they were treated with dignity and respect and kindness. One person said ‘The staff have helped me settle in and have been very supportive to me’ another said ‘I need help with the bath and staff are always very aware of my privacy’. It was very evident from talking with staff and the individuals living in the home that people receiving support at the home can choose when to get up and when to retire to bed. Each person had their own recorded daily preferred routines. One person chose to sleep in a chair at night and had been made comfortable by staff, another liked to spend time in their room and not mingle with the other residents. Individuals were safe, their wishes were respected and they were no coerced to do what the staff wanted them to. During this visit we reviewed medication practices at the home. When we last visited we were concerned as a cupboard where ‘stock’ medication was stored had not always been kept locked and we made a requirement that medication held at the home must be stored securely. There were no concerns about the safety or security of medication during this visit and the home had taken on board the importance of ensuring medication was secure. We saw medication was held in a locked trolley, which was secured to the wall by a metal wire. Staff confirmed that only staff that had received training were allowed to give individuals their medication. We viewed medication administration and staff training records, which also confirmed this. We saw that the home maintained a clear record of medication which was no longer needed and had been returned to the dispensing pharmacist, however, the representative of the pharmacy had not signed to record they had taken the medication away, it is recommend that this signature is obtained to validate these returned medication. We noted that individual’s personal privacy was respected as also was written documentation held about individuals who live at the home. We noted that cabinets containing personal records were always kept locked, however this would be improved if there were a door that could be locked to this small office area. The manger confirmed that the office will be being moved and will provide a more suitable area from which to manage a care service, we will review this during our next visit to the home. We also noted that staff never spoke about confidential issues, or talked about other residents where they could be overheard by others. Staff always spoke about people in a respectful manner. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 13 The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who live at the home are enabled to maintain contact with families, friends and local communities. Choices are given to residents in respect of meals and mealtimes. The home provides residents with meaningful activities and they are able to choose whether they wish to participate or not. EVIDENCE: Discussion with residents and staff showed us that the home supports residents to maintain contact with friends and family and the local community. One person spoken with stated, “My daughter visits when she can and my family comes to see me regularly and are always made welcome by the staff”. We saw that the home have planned activities arranged for each afternoon such as bingo, quizzes and gentle exercise and those who live at the home are able to participate or not. During our visit one of the residents was supported by a staff member to visit the local shops, another person goes regularly to a The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 15 local pub. The manager told us that they are currently planning a BBQ for those who live at the home and their relatives. During our visit we spent time with the new cook who had only been at the home for a week. They prepared steak, carrots, potatoes and broccoli or a ploughman’s for lunch. Although the cook had only been at the home for a week she had a good knowledge of the special dietary needs of individuals and was well aware of peoples likes and dislikes and the importance of ‘home cooking’ and offering people choices and portion sizes according to their wishes. The dining area has benefited from being decorated with new dining furniture. We noted an array of cutlery for people and were told that specialist ‘chunky’ cutlery was in place for those with gripping difficulties, people who use this type confirmed that this was much better for their use and they preferred it to new cutlery that had been purchased by the home. The kitchen was seen to be clean and tidy and the area had benefited from new kitchen cupboards. The home were visited in January 2008 by South Gloucestershire’s Environmental Health Officer and were awarded a four star quality rating, further demonstrating positive outcomes for those who live at The Gloucester. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sound and robust complaints and adult protection protocols in place. EVIDENCE: There is a copy of the South Gloucestershire Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidences of abuse occur. The manager was able to demonstrate a sound understanding of her responsibility in this area, she is aware of reporting protocols and ensures that staff members are trained in adult protection ensuring they have an awareness of what constitutes abuse. The complaints policy and procedure at the home shows a clear timeline and outlines what action is to be taken in event of a complaint. It also directs the complainant to the CSCI and South Gloucestershire Social Services. A copy is made available to residents and relatives should they request it. We saw a copy of this document on display in the entrance hall. People living at the home told us ‘I have no complaints, I am very happy here’; ‘If there was anything wrong I would speak to the manager’. The manager was named and individuals said that she would assist them if they had any concerns. We viewed the complaints logbook and saw that there had been two complaints raised at the home since our last visit. Both issues had been fully recorded and detailed what action had been taken to respond appropriately to the concerns The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 17 raised. The Commission have received no complaints since our last site visit to the home. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, and satisfactory Criminal Record Bureau disclosures, references and protection of vulnerable adults checks. Those who live at the home are supported to vote in the electoral process either by post or to visit the local polling station. Some discussion took place with the manager about individuals who have dementia and mental health issues, the manager was aware of the Mental Capacity Act and confirmed that training in this area is being arranged for her and staff. The home has clear policies in respect of the safe keeping and handling of peoples money, during our visit we checked some residents cash sheets and found that these corresponded with the monies held, receipts are obtained for purchases and a clear audit trail is in place. It was confirmed by a staff member that only senior staff have access to resident’s money that is held for safekeeping at the home. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those who live at the Gloucester live in a home that is comfortable and meets needs, however improvements are needed to ensure the environment is well maintained and suitable. EVIDENCE: The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 19 The Gloucester is a small residential care home, set within the residential area of Filton; the home is three storeys and is semi detached. There is a well tended front garden and an enclosed rear garden, which resident’s enjoy. The home is on a main bus route into Bristol city Centre and has easy access to the Motorways and the large retail area of Cribbs Causeway. There are adaptations in place throughout the Home and specialist equipment including mobility aids; sensory aids, sensor mats, a passenger lift and bathing aids are in place. There is a spacious dining area and two comfortable lounge area. A person who lived at the home told us that they sometimes have difficulty when walking out of the front door and on the tarmac area leading to the car park at the rear of the home. We looked at this and could see that there was no rail. It is required that a handrail be provided to the exterior of the house, which leads from the front door to the car park in order to support those with mobility difficulties. Individuals were observed sitting in the main lounge, the dining area and going into their rooms, looking very relaxed and comfortable in their environment. The whole home is very ‘homely’ with lots of soft furnishings such as plants, ornaments, side tables and pictures and photographs all enhancing the areas within the home. Those who live at the home have benefited from new carpets throughout the main communal areas. It was noted that in the front lounge the furniture is a mixture of various seating, some of the chairs look ‘grubby’ and threadbare on the armrests. It was also noted that a relative of an individual who lives at the home had raised this issue with the home and the manager has forwarded this to the registered provider. It is recommended that consideration should be given to replacing ‘tired’ and ‘worn’ seating in the front lounge, which is used by those who live at the home. The home has sufficient bathroom areas for individuals with both shower and bathing facilities in place. At the time of our visit a bathroom on the first floor was being refurbished and it was also noted that a doorway had been widened to allow easier access to a toilet area on the ground floor. Leading from the main entrance hall is another single toilet area, which is well used by those who live at the home. It was noted that the walls had differing paint colours where fixings had been changed and pipe work was not painted making this area looking neglected. It is recommended that consideration should be given to the redecoration of the ground floor toilet area to enhance this area for those who live at the home. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 20 During our last visit we noted that the kitchen door had no fire detector self closure and a requirement was made that one be fitted to the kitchen door. This had been done making the area safer should a fire occur. During our last visit some discussion took place with the manager about a proposal from the home to move the manager’s office and relocate in to the garage in the garden, we had some concerns over the manager’s accessibility to those who live and work at the home and the logistics of this. We made a requirement that the home must notify the Commission any proposals for change of use within the environment and include the impact that this could have for residents. We spoke with the manager who confirmed that this was no longer an option and that the proposal currently is to utilise one of the double bedrooms, making it a single room and dividing the other space into the office, the home are reminded that the newly created single room must conform to spatial standards for the resident concerned. In the main entrance is a residents/relatives notice board, which contains useful information such as the last inspection report, the homes registration certificate, and a copy of both the complaints and whistle blowing procedures. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who live at the home are supported by staff that are trained and caring in their approach, good relationships between those who live and work at the home appear to have been established. EVIDENCE: There is a well- established staff team at The Gloucester. During the visit staff were able to demonstrate a clear understanding and knowledge of the individuals who live at the home, and of their own role and responsibilities whether they were the manager, assistant manager, cook or care assistant. Staff knew specific details about individuals who live at the home and gave examples of what was important to them. Staff were clear that they were employed to ‘work for’ the residents and to support them in a way they wanted. On the day of the site visit there were sufficient numbers of staff on duty with flexible working by staff in order to meet individual’s needs and aspirations. Staffing provision appeared to be consistent with levels and skills needed due to assessed care needs of the individual’s. The staff team have a varied range of knowledge and skills; they were observed by us to be friendly, caring and warm in their approach to those who live at the home and their visitors. Staff The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 22 were also seen and heard to be professional and knowledgeable when dealing with professionals who also provide a service to people who live at the home. Morale is good within this home and staff spoke positively about their role and the work they do and were able to give a number of examples of areas within their role which gave them job satisfaction such as one to one time with individuals, supporting residents in they way they prefer and building relationships based on trust. The manager, Karen Headington said that she valued the staff and that they were an asset to the home. Staff files were viewed and all of the required documentation was in place in respect of recruitment and selection practices and it was found that these were robust. Records of formalised one to one supervision support sessions were seen, these evidence that staff are given appropriate information and advice and are supported by the manager within their role. Following a review of staff training records at the last site visit to the home a requirement was made that staff must received training in manual handling. Following discussion with the manager and staff and certification seen it was evident that this training had been completed. Staff spoken with said that the training had given them additional information in order to work safely and for the benefit of residents. National Vocational Qualifications (NVQ) have been achieved for all care staff at the home with the exception of two staff, (one of whom is currently on maternity leave). One staff member has an NVQ at level 3 and the manager Karen Headington is currently working towards NVQ at level 4 in management. We viewed the training file for staff at the home and saw that eight staff have attended specific training in respect of the use of oxygen that is being used by one resident, that staff have undertaken or are booked to complete training in first aid, basic food hygiene and the protection of vulnerable adults. We viewed the induction for the new cook and saw that it was being completed in line with guidance from ‘skills for care’; the cook told us that they were enjoying work at the home and had been well supported with their induction. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A manager who is fit to be in charge, of good character and who is fully aware of her responsibilities supports those who live and work at the home. There are clear policies and procedures in place for the effective running of the service, records are well maintained and it is evident that the home is run in the best interests of those who use the service, however, risk assessments and accident reports must be followed up. EVIDENCE: Karen Headington is the Registered Manager of this service; she has worked within the care profession, working with older people for a number of years and has worked at The Gloucester for over 10 years. During our last visit to The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 24 the service we made a requirement that the manager must register to undertake a National Vocational Qualification at Level 4 in management. We spoke with the manager about this who confirmed that she has registered and started her award. She explained that progress had been slow due to problems with her lack of assessor support, this has now been addressed, and we look forward to reviewing progress in this area at our next visit to the service. Staff spoken with said that they are positive that the manager is committed to ensuring the needs of those who live at the home are met, that ideas and suggestions are listened to with regular individual supervision being held for continuity of care and effective communication. Prior to the site visit the Commission received from the Registered Manager a completed an annual quality assurance assessment. The annual quality assurance assessment (AQAA), this is a process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the Registered Manager was fully completed and detailed. There was evidence that the home ensures so far as is reasonably practicable. the health and safety of resident’s staff and visitors. The home has robust policies and procedures in relation to aspect of health and safety. Accidents and incidents are well recorded, however, we did note that two accident reports did not record what action has been taken to minimise and prevent re occurrence. This is essential and must be completed in order to demonstrate a commitment to preventing accident and injuries. We also noted that two staff members, within a week of each other both slipped on steps leading from the raised decking area onto the garden. Within a week a representative of the home visited at the manager’s request and completed a full risk assessment of the area and identified actions that must be taken. Yet no action was taken and suggestions were not followed through, it is required that this health and safety risk assessment is reviewed and appropriate action is taken to prevent further accidents in this area. The home have manual handling assessments in place and these outline information about the support needed by residents and gave an indication of their level of risk in this area and contained clear information to support them safely as manual handling assessments contained full information of staff action/support. The fire logbook was viewed and was well maintained. The home was completing the appropriate checks on the fire equipments and recording of training and testing of equipments was satisfactory. It was recorded that a fault was noticed when a weekly check had taken place, this fault had been dealt with promptly to ensure fire safety was not compromised. Staff have attended fire drills to ensure that they have clear knowledge of action to be The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 25 taken in the event of fire emergency. Emergency call bells and lighting have been checked by a contractor to ensure they are working effectively. The home displays a current certificate of Employer’s Liability Insurance. During our last visit to the service it was required that the home to develop a supervision pro forma for consistent formal recording of these meetings. At this visit staff supervision was reviewed. Evidence from the records viewed showed that staff have received supervision, both formal and informally. Records for formal supervision were well written and contained appropriate information. The supervision given provides the opportunity for individuals to express their opinion about the services provided at the home and to discuss areas of concern in relation to residents’ care. Staff members we spoke with said that this support was valuable to them in order to ensure clarity of their role and the expectations upon them’. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 22/07/08 1. OP2 5 (1) b 2. OP19 23 92) b 3. OP38 17 (2) 4. OP38 13 (4) c Terms and conditions of the placement to be available on site also each person who uses the service must be provided with a copy of these. Handrail to be provided to the exterior of the house, which leads from the front door to the car park in order to support those with mobility difficulties. Accident reports must record what action has been taken to minimise and prevent re occurrence. Health and Safety risk assessment to be reviewed. 22/08/08 22/06/08 22/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 28 1. 2. 3. OP19 OP9 OP19 Consideration should be given to replacing ‘tired’ and ‘worn’ seating in the front lounge, which is used by those who live at the home. The home should ensure that the receiving pharmacist or their representative signs for medication that is no longer required. Consideration should be given to the redecoration of the ground floor toilet area to enhance this area for those who live at the home. The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gloucester DS0000061774.V360455.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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