Care Home: The Old Dairy

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What the care home does well The Old Dairy is in the centre of Nailsworth and the town`s shops and facilities are within easy walking distance. People receive support so that they can do different things in the local area. People told us about the activities that they enjoyed during the week, such as working at a garden nursery, cycling, swimming, trampolining and going to a gym. People are able to follow their own routines and interests. Some people like to have busy lives outside the home; other people prefer to spend more time in the house and can decide on the day if they want to go out. Review meetings are being held when people can talk about new things that they would like to do. Some people showed us their rooms, which reflected their choice of decor and different interests. One person was very keen on the cinema and had collected a range of film related items. Another person liked pets and was looking after a tropical fish tank in their room. Somebody else had a large collection of books and records that they had built up over time. People can help to choose and prepare the meals. Their personal and health care needs are being met and they receive support with managing their medicines safely. Monthly Health Check forms are being completed. These help to ensure that any changes in health and well-being are identified and followed up. There is a main house where five people have their own bedrooms and a choice of communal rooms. This includes a communal area, known as the `social centre`, which has its own entrance at the side of the house. There are two rooms in this area which are suitable for a variety of recreational and social activities. The home`s garden is particularly well used by one person who likes to grow vegetables there. One person lives in a separate flat which provides good accommodation for more independent living. People at the home benefit from staff and managers who know them well and who provide good continuity of support. What has improved since the last inspection? People`s care records have been updated and their personal files reorganised. As a result, the contents are more clearly presented and there is better information about people`s individual needs. The arrangements being made for managing medicines in the home have improved, so that people are better protected from the errors which can result from poor practice. Staff members have received training in medicines through a local college. People have been given a new `Say No to Abuse` booklet, so that they know what to do if they feel that they, or somebody else, are being mistreated. Staff members have received new guidance about abuse and attended safeguarding adults training outside the home. This helps to ensure that any concerns or allegations are followed up correctly and investigated by the appropriate agencies. A training schedule has been produced for the staff team, which shows a more planned approach to staff training. New staff are to receive an induction that meets the appropriate standard. This will help to ensure that people are supported by staff who are developing their skills and knowledge. The home has been looking at how to consult with people and obtain feedback from them about the home. A system of quality assurance is being put into practice and an annual development plan has been produced. The checking of the home`s fire precaution systems has improved, which should ensure that any problems are identified and put right promptly. Overall, the arrangements in place for monitoring the service are being more consistently applied. This means that people can be more confident about the way in which the home is being managed and how the provider is meeting their statutory responsibilities. What the care home could do better: We have made a number of recommendations which build on the improvements made since the last inspection. Some of these concern the need for more detail or information in certain policies, records and assessments. This is so that they provide better guidance, or reflect a more `person centred` approach. The home should continue to look at how best to obtain feedback from people and include this in any development and improvement plans. On occasions, some people spend time in the home without staff on the premises. There should be better information about the circumstances in which this takes place, with evidence that it is a safe and well managed practice. The assessments should show that the arrangement is primarily in place to be of benefit to the person, for example because it is part of a planned programme for developing independence. We were told in the AQAA that pressure would continue to be put on the housing association which owns the property to ensure that any required works are carried out earlier. When going around the home we saw that a bathroom on the first floor and a WC on the ground floor were in need of refurbishment and redecoration. We were told that this work had been agreed with the housing association, although a date had not yet been confirmed. We have also recommended that appropriate action is taken which will make certain doors in the home easier to use for people. The staff training plan should be developed to ensure that it reflects people`s diverse needs and covers all areas of training that are appropriate to staff members` roles. Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Dairy Market Street Nailsworth Glos GL6 0BZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 1 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Old Dairy Market Street Nailsworth Glos GL6 0BZ 01453835380 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: glynys@ggh.org.uk Gloucestershire Group Homes care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home The Old Dairy is run by Gloucestershire Group Homes (GGH), which specialises in the care of people with Aspergers Syndrome. The home is in the centre of Nailsworth. The Old Dairy is a three storey house with a garden at the rear. Five people live in the main part of the house and each person has their own room. One person lives in a separate flat, which is attached to the main house, but has its own entrance. The people who live at The Old Dairy receive support from a permanent staff team. Gloucestershire Group Homes also employ relief staff who are available to support people when the need arises. The fees range from 650 - 1373 pounds per week. Information about the home is available in a Statement of Purpose. Copies of inspection reports are available from Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 2 4 0 2 2 0 0 9 Brief description of the care home Gloucestershire Group Homes and can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about the things that have happened during the last year and about their plans for the future. We sent surveys to the home so that they could be given out to the people who use the service and to staff. We received surveys back from two staff members. We looked at all the information that we have received about the home since the last key inspection. This helped us to decide what we should focus on during a visit to the home, which took place on 15th January 2010. During the visit we met with the people who live at The Old Dairy and with a number of staff members. We spoke to Mr J. Bird, a manager from Gloucestershire Group Homes. We went around the house and looked at some of the homes records. Care Homes for Adults (18-65 years) Page 6 of 32 The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. The previous inspection of The Old Dairy was on 24th February 2009. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? Peoples care records have been updated and their personal files reorganised. As a result, the contents are more clearly presented and there is better information about peoples individual needs. The arrangements being made for managing medicines in the home have improved, so that people are better protected from the errors which can result from poor practice. Staff members have received training in medicines through a local college. People have been given a new Say No to Abuse booklet, so that they know what to do if they feel that they, or somebody else, are being mistreated. Staff members have received new guidance about abuse and attended safeguarding adults training outside the home. This helps to ensure that any concerns or allegations are followed up correctly and investigated by the appropriate agencies. Care Homes for Adults (18-65 years) Page 8 of 32 A training schedule has been produced for the staff team, which shows a more planned approach to staff training. New staff are to receive an induction that meets the appropriate standard. This will help to ensure that people are supported by staff who are developing their skills and knowledge. The home has been looking at how to consult with people and obtain feedback from them about the home. A system of quality assurance is being put into practice and an annual development plan has been produced. The checking of the homes fire precaution systems has improved, which should ensure that any problems are identified and put right promptly. Overall, the arrangements in place for monitoring the service are being more consistently applied. This means that people can be more confident about the way in which the home is being managed and how the provider is meeting their statutory responsibilities. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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. Nobody had moved into The Old Dairy for several years. Gloucestershire Group Homes has a procedure in place for new admissions, and for assessing whether it can meet peoples needs before they move in. Evidence: It was reported in the AQAA that Gloucestershire Group Homes had a policy on new admissions. However, there had been no vacancies at The Old Dairy for the last few years and nobody had moved into the home since February 2004. In the absence of any changes in occupancy, it was not possible to look at recent outcomes in relation to standard 2. We were given information in the AQAA about the admission process - We provide prospective service users with as much information as is deemed necessary and appropriate for them to be able to make an informed choice as to moving into the care of GGH. - Specific information is given that relates to the aims of GGH and once assessments have been carried out and a placement offered, individuals, parents and social workers Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: will receive a guide to moving in. Where appropriate, prospective service users will be given an opportunity to visit the home in advance and may also receive outreach support through the transition. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can make decisions about how to spend their time and can take risks as part of an independent lifestyle. People have individual plans and their needs and goals are generally well reflected within these. However, the guidance in relation to people spending time unsupported in the home should be improved, to ensure that appropriate arrangements are in place. Evidence: People told us how they spent their time during the week. Some people had regular activities outside the home, such as work placements and attending the organisations day centre. There were a number of other options available, which included sports and social activities, going to the shops and helping with jobs around the house. People told us that they had particular interests, such as growing vegetables, cycling, swimming, trampolining and going to the gym. Staff members said that some people liked to have busy lives outside the home, while other people preferred to spend more time in the house and could decide on the day if Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: they wanted to go out. We heard for example that one person could become anxious about going out, but liked to visit a nearby charity shop regularly. Some people showed us their rooms, which reflected their choice of decor and different interests. One person was very keen on the cinema and had collected a range of film related items. Another person was interested in pets and was looking after a tropical fish tank in their room. Somebody else had a large collection of books and records that they had built up over time. People had individual files where information about their daily routines and personal support was recorded. We looked at examples of the files, focusing on three peoples records in particular. Information was recorded on a range of forms, which include Personal Profiles, Client information sheets, Guidelines for Support and Management Plans. The files had been reorganised during the last year to provide a clearer and more concise overview of peoples needs. Some of the forms had not been signed or dated, and it was therefore not clear when certain guidelines had been written and who had been involved in drawing them up. The guidelines and assessments identified peoples needs, but their strengths and abilities were not well highlighted. We asked staff members in their surveys whether they were given up to date information about peoples needs, for example in the care plans. One staff member responded Always to this question. Another staff member said Usually. When we asked in the surveys What does the home do well? one staff member commented The staff team have a good understanding of Asperger Syndrome and the needs of individual service users. The other staff member told us Allows residents to make appropriate choices. Each person had a General Risk Assessment on their file. These outlined the hazards and support needed in areas such as road safety, medication, diet and personal care. There was further information recorded in relation to specific risks, including peoples relationships and being left unsupported at The Old Dairy. We read that one person was rarely left alone and when he is it is essential that he is informed and happy with the situation. The assessment did not state a maximum length of time that the person could stay in the home unsupervised, although it was stated in the General Risk Assessment that this should be recorded. At the last inspection we had also recommended that the assessments show the aims and the potential benefits for the people who use the service, for example whether the arrangement was part of a programme to increase a persons independence. This was to ensure that the policy of home alone was in the best interests of the people who use the service and that risks in relation to people spending time in the home without a staff member present were Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: being appropriately identified and addressed. Review meetings were being held when people could talk about new things that they would like to do. We saw that Annual Review of Assessed Needs forms were being completed. Peoples individual files also included Individual Goal Plan forms, which gave information about the personal goals that had been agreed. The goals covered a range of subjects, such as attending a college course, budgeting, purchasing a fish tank and exploring new areas of interest. The accommodation in the flat was self-contained, with staff on hand to provide support where needed. The person living in the flat told us that they were happy with this arrangement, which meant that they could exercise a lot of choice and independence in their daily routines. People received support with managing and looking after their personal money. We were told that people could be actively involved, for example by looking after a weekly amount, or saving an amount of money each week for a particular hobby. We saw that individual accounts were being kept of peoples personal money. Records of transactions were being signed by the people involved and receipts obtained when people received support with shopping and other expenditures. Mr Bird said that the financial records were checked regularly as part of the management visits that were made to the home. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People participate in a range of activities that reflect their interests and abilities. They are part of the local community and receive support, which helps them to maintain relationships. People have meals that they enjoy, and they are encouraged to participate in the household tasks. Evidence: As reported under the section Individual Needs and Choices, people took part in a range of activities outside the home and in the wider community. The home was in a central area of Nailsworth, and well placed for people to be able to get to the town shops and facilities. We were told about peoples plans for the day when we arrived at the home. One Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: person was out at their work placement at a garden nursery. Somebody else had arranged to go to the Cinema. Other people were having home based days. We heard that people had some regular activities during the week, such as aromatherapy, going to the gym, and swimming. One person was particularly keen on gardening and they had an area for growing vegetables in the homes garden. Computers were available for people to use when they attended the organisations day centre. We saw that individual timetables had been written, which showed peoples activities during the week. People had a mix of planned activities and unstructured time. We met with people who liked to spend time in their own rooms where they could follow their own interests and hobbies. People could also use an area known as the social centre, which was in an annex to the main house. This was set up for listening to music and playing games. One person had an electric guitar which they could play there. There was information in peoples files about their backgrounds and relationships. Some people told us that they visited family members on a regular basis. Staff members said that people were encouraged to take an active role in the household tasks, but there was a flexible approach as to how much people did. We were told that people helped out with the food shopping and with preparing the meals. At lunchtime we saw people using the homes kitchen, which was of a domestic, openplan style, with a dining area. The person who lived in the flat had their own facilities which enabled them to live more independently. The main cooked meal was prepared in the evening and people told us that they helped to choose the meals each week. There was a menu on display in the kitchen, which people had written to show the meals that they had chosen. We were told in the AQAA that there were plans to improve personal diets and fitness levels, while supporting peoples lifestyle choices. This was in order to promote a healthy lifestyle and to ensure that the needs of an ageing population were being met. There was a separate laundry room, which we saw when we went around the home. As with the cooking, people received varying degrees of support from staff with their laundry. One person was able to do most tasks independently and there were some instructions and notices displayed in the laundry to assist with this. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are being met. People receive the support that they need with managing their medicines safely. Evidence: There was guidance in peoples individual files about their care needs and the way in which they wished to be supported. People managed much of their own personal care, with support being provided in the form of encouragement and prompting. Monthly Health Check forms were being completed by staff. These gave an overview of peoples health and personal care, in areas such as hair and nail cutting. We read for example that one person was able to cut their own finger nails, but had assistance from staff with cutting their toe nails. Peoples weight was being recorded on the forms each month. This helped to identify any changes which might need to be followed up. The Monthly Health Check forms also showed when people had had appointments with GPs and other healthcare professionals. The forms gave a summary of appointments and the health related matters that had arisen during the month. Each of the three files we looked at also contained a Personal Health Profile that had Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: been written in November 2009. We were told in the AQAA that these were a new development and designed to incorporate all the relevant information and necessary guidance required to support an individual effectively. During our visit, we saw that staff members were respecting peoples privacy and talking to people in a friendly way. Staff recognised that bedrooms were peoples own spaces, in which they could be private and keep as they wished. There was guidance in peoples personal records about the impact that their diagnoses had on their daily lives. This was also reflected in the risk assessments. There was also information about the medicines that people were prescribed. New forms had been completed which showed the medicines and the times of day when they needed to be administered. We had reported at the last inspection that there were shortcomings in how medicines were being dealt with in the home, which had meant that the people who use the service were not as well protected as they should have been. We were told in the AQAA that this was one area that had improved since the last inspection, with staff members having received medication training at a local college. During our visit on 15th January 2010 we met with staff members who said that the arrangements for managing medicines had been discussed with the staff team, to ensure that the appropriate procedures were being followed. We looked at the storage and recording of medicines during our visit. Peoples medicines came to the home as part of a monitored dosage system, which the pharmacist had prepared. The medicines were then kept in a locked facility. There was no cabinet for the storage of controlled drugs, although we were told that these were not being prescribed at the time. We had recommended at the last inspection that a cupboard that meets the current storage regulations for controlled drugs was installed. This was so that any controlled drugs could be stored safely if they needed to be kept in the home in the future. In the absence of a cupboard for controlled drugs, we talked to Mr Bird about the need for a policy to be produced which sets out the action that will be taken if controlled drugs are prescribed. Records were being kept of the medicines received into the home and of their administration to people. The records that we saw were up to date and had been completed consistently. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can express their views and are listened to by staff. Staff members receive training and guidance, which helps to protect people at the home from harm. Evidence: It was reported in the AQAA that key workers and staff were an integral part of supporting individuals to resolve complaints or disputes. Annual review meetings were also seen as a time when people could raise concerns that had not been raised or addressed during the year. GGH had produced a procedure that people could use if the complaint was of a more formal nature. We were told that the complaints procedure had been updated during the last year, was easy to understand and had been given to each person living at the home. We saw that the procedure included details for contacting the Commission (CQC), although these were not all correct. The correct telephone number was confirmed with Mr Bird. It was reported in the AQAA that the home had not received any complaints since the last inspection. We saw records of annual review meetings which had taken place during the last year. These showed that people had talked about things that mattered to them and decisions had been made as a result. During our visit, people talked openly about the home and the things that they did. We observed staff listening to various issues that people at the home raised, and helping them to make decisions. Since the last Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: inspection, the home has improved awareness about abuse and the guidance that is available to staff. Information was displayed in the home about the local procedure for safeguarding adults. There was also Say No to Abuse guidance in the home, which was designed to increase the awareness of the people who use the service. We were told that this new guidance had been given to each person at the home. Staff members had attended safeguarding adults training at a local college during the last year. GGH had a policy about the Disclosure of abuse and bad practice (Whistle blowing). Staff members confirmed in their surveys that they knew what to do if somebody had concerns about the home. There were other polices and procedures, for example in relation to Gifts to staff, Managing peoples money and Equal Opportunities, which helped to ensure that peoples rights and interests were protected. Since the last inspection, the homes manager has informed us of an allegation that they followed up on behalf of a person at the home. This was responded to appropriately at the time. We were told in the AQAA that there had been no incidents involving restraint in the home. It was also reported that staff were trained in using a low arousal approach to managing any behaviour that may challenge the service. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is meeting peoples needs. People can personalise their own rooms. Some areas of the home are due to receive attention to ensure that all areas are well decorated. Evidence: The Old Dairy is a period property, owned by a housing association in the market town of Nailsworth. The home is in the centre of the town and therefore very close to the towns shops and facilities. It did not stand out as being a care home. However, the lack of a visible house name meant that it could be difficult for people to find it if they were visiting their friends or relatives at the home for the first time. The accommodation consisted of a main house where five people lived, and a flat for one person that was attached to the main house but had its own entrance. There was a garden at the rear of the property. This looked like a useful area that people could use for recreation and for growing plants. Each person had their own bedroom. There was a lounge on the first floor and a dining area that was off the kitchen. People could also use another communal area, known as the social centre, which had its own entrance at the side of the house. There were two rooms in this area which were suitable for a variety of recreational and social activities. We were told in the AQAA that people were encouraged to personalise their own Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: bedrooms and received support with managing their special interests. We saw good evidence of this when people showed us their rooms. The rooms reflected peoples interests and had different decor. We had recommended at the last inspection that advice was taken from an appropriate source about safe ways in which a fire door could be left open. This had arisen because we had seen a number of fire doors wedged open, which increased the risk of fire spreading throughout the building. A fire officer had visited the home since we last inspected and talked to people about the fire precaution arrangements that needed to be followed. A staff member told us that the advice about fire doors was being adhered to and people at the home were being reminded about their bedroom doors. The fitting of appropriate hold-open devices would enable people to keep some doors safely open, which would also be more convenient for people when moving between rooms. A number of fire doors on the landings were quite stiff to open. It was reported in the AQAA that the home was decorated to a very high standard, and that a programme of redecoration and home improvements would continue in the next 12 months. Pressure was also to be put on the housing association to carry out required work earlier. When going around the home we saw that a bathroom on the first floor and a WC on the ground floor were in need of refurbishment and redecoration. Mr Bird said that the carrying out of this work had been agreed with the housing association, although a date had not yet been confirmed. Apart from these areas, the accommodation generally looked clean and tidy. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by competent staff who are developing their knowledge and skills. There are procedures in place which help to ensure that new staff members are suitable for the work and receive an appropriate induction. Evidence: We were given information in the AQAA about the staffing arrangements for the home. There were seven permanent staff, of whom six had achieved NVQ (National Vocational Qualification) at level 2 or above. One staff member was undertaking NVQ at level 3. No staff had left employment since the last inspection. GGH had a policy and procedure for the recruitment of new staff. In their surveys, the staff members confirmed that their employer had carried out checks, such as a CRB (Criminal Records Bureau disclosure) and references, before they started work. We were told in the AQAA that staff had access to formal autism training through Birmingham University and could study up to and beyond degree level. In their surveys, the staff members confirmed that they were being given training which was relevant to their role, helped them to understand and meet peoples Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: individual needs, and kept them up to date with new ways of working. We had made recommendations at the last inspection in relation to staff training. These, for the most part, had received attention. During our visit we saw that a new training file had been set up, which included details of training completed and proposed. This provided a much better overview of the arrangements being made for staff training. A training plan had been written, which identified the priorities for training, and the training that was required for staff in different roles, for example support worker and senior support worker. The qualifications and experience expected of a staff member were also listed. We talked to Mr Bird about the range of subjects that were covered in the training plan. The plan covered a range of relevant subjects, but others such as medicines, were not included. We were however told that staff had attended a course in the safe handling of medicines. Mental capacity and autism were included in the training plan, although equality and diversity, and health related topics such as epilepsy, were not mentioned. Since the last inspection, GGH has registered with a local college to provide training to new staff, which covers the common induction standards. During the last year, the college had also been used for other training, such as safeguarding adults. Records in the home showed that staff training during 2009 had included fire safety, medication, deprivation of liberty safeguards and safeguarding adults. Training in first aid, mental capacity, moving and handling and infection control had been planned for the coming months. A plan had been written for staff supervision and appraisals for the year ahead. Records were being kept to show when supervision meetings had taken place. Staff members confirmed in the surveys that they had enough support, experience and knowledge to meet the different needs of people who live at the home. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Action has been taken during the last year to develop the service and the way in which standards are monitored. This means that people can be more confident about the way the home is being managed and how the provider is meeting their statutory responsibilities. Evidence: Gloucestershire Group Homes has a management structure that includes a General Manager and two Service Co-ordinators. The Service Co-ordinators are registered to manage the organisations care homes. The registered manager for The Old Dairy, Ms J. Wheeler, was on leave at the time of our visit. In Ms Wheelers absence we met with Mr Bird who, as part of the management team, knew the home well and was familiar with the staff team and the needs of the people who used the service. We also spoke to the homes senior support worker, who had been delegated certain management tasks, including the supervision of staff. We had made a requirement at the last inspection about having a system in place for evaluating the quality of services being provided at the home. During our Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: visit we saw that a system had been set up and was being put into practice. There was a Quality Assurance file, which contained an Annual Development plan for the home. The plan had a number of headings, including Health Improvement, Client Protection, and Management of the home. The plan was not dated and it was not clear when all parts of the plan would be implemented. However, we saw that some improvements identified in the plan, for example in relation to staff training and managing peoples medicines, had already been carried out. As part of the Quality Assurance system, surveys had been given to the people who use the service. Letters with questionnaires had also been sent to relatives. The improvements which were mentioned in the plan were of direct or indirect benefit to the people who lived at the home. However it was not clear how peoples views had been reflected in the plan. We also talked to Mr Bird about ways, other than through written surveys, in which feedback could be obtained from people on an on-going basis. Mr Bird has told us that GGH was considering using an accredited system of quality assurance, in addition to the current arrangements. We have confirmed at previous inspections that visits need to be made to the home each month, in accordance with Regulation 26 of the Care Homes Regulations 2001. We saw that these visits were being made consistently and reports of their outcome were being written. The reports have been amended since the last inspection to include an Action Plan section. This helps to ensure that any issues or improvements are identified and followed up. GGH had produced policies in relation to health and safety, including the Control of Substances Hazardous to Health (C.O.S.H.H.), Infection control, Food safety, Emergencies and Fire safety. We were told in the AQAA that gas appliances, and the heating and electrical systems had last been serviced in August 2009. Portable electrical equipment was being tested annually to ensure that it was safe for use. We had recommended at the last inspection that the management roles and areas of delegated responsibility were reviewed. The recommendation had arisen because we had found that some health and safety related tasks, such as tests of the homes fire alarm system and emergency lighting, were not happening consistently. During our visit on 15th January 2010, a staff member told us that they had now been delegated tasks in relation to health and safety. We saw that a new log book was being used to record fire alarm and other fire related checks. The alarm system was being tested each week and the emergency lighting was being checked monthly. A fire risk assessment had been undertaken in September 2009. Other risk assessments were being undertaken in relation to the home environment. At the last inspection we had also recommended that a system of regular health and Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: safety checks was implemented, as a way of identifying works that were in need of attention. The staff member told us that regular checks were not being made but it would be something that they would consider doing as part of their current responsibilities. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 That records such as Management Plans and Guidelines for Support are signed and dated consistently. This is so that it is clear when they were written, and who they have been drawn up and agreed by. That the personal profiles and assessments include more information about peoples abilities and positive attributes. This is so that there is a person centred approach, which will provide a more balanced view of peoples strengths and needs. That the assessment records for people spending time alone in the home show the aims and the potential benefits for the people who use the service, and the practical circumstances, such as the maximum length of time and frequency. This is to ensure that the policy of home alone is in the best interests of the people who use the service and that any risks in relation to people spending time in the home without a staff member present have been appropriately identified and addressed. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed. This is Page 30 of 32 2 6 3 9 4 20 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. Recommendation from the previous inspection. When an appropriate cupboard has not been installed, a policy needs to be produced which sets out the action that will be taken if controlled drugs are prescribed to people. The policy will need to ensure that the storage of controlled drugs will meet with current regulations at the time when they are received into the home. 5 24 That advice is taken from an appropriate source about safe ways in which a fire door can be left open. (Recommendation from the last inspection). It is recommended that such advice is implemented, so that people have easier access through the home and, where appropriate, doors can be kept open for their convenience. That the range of subjects which are included within the homes training plan is reviewed. This is to ensure that the plan covers all relevant areas, including statutory requirements, and reflects the individual and diverse needs of the people who use the service. That consideration is given to ways, other than through written surveys, in which feedback could be obtained as part of quality assurance from the people who use the service. When feedback has been obtained, the homes Annual Development plan should clearly show how this has been taken into account and acted on. That a system of regular health and safety checks is implemented, as a way of identifying works that are in need of attention, and so that people who use the service benefit from a well maintained and safe environment. (Recommendation from the last inspection). 6 35 7 39 8 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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