Care Home: The Vicarage

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What the care home does well The service provides well planned respite care for people with a learning disability who may also have multiple and complex needs. The planned care is detailed, including risk assessments and is updated for each visit. Staff from the service also attend peoples annual review to help ensure that changing needs are well met. The environment is well maintained and additional adaptations have been made to meet peoples needs. The recruitment procedures are robust to help protect people using the service. We received completed surveys with comments from people that use the respite service, with help from their families or day centre staff, and also direct comments from relatives about `what the home does well` as follows; `the staff are friendly, the home is clean and comfortable, and they try hard to accommodate everyday needs`, `the recently introduced phone call before and after a visit is a good idea, especially for non-verbal clients`, `its tidy, the beds and bathrooms are nice and the staff are nice`, `the staff make cups of tea, take us out to buy CD`s and go shopping`, `offer a choice of food/drink/activities and outings`, ` does all laundry prior to clients return home`, `regular feedback`, `as parents we highly value the service and know that .... is happy there his needs are well met and the staff are so caring and well trained`, `the staff are friendly, approachable and helpful` and`keep people safe, warm, entertained and stimulated`. Two relatives told us about `what the home could do better` comments included that the home should send home photos occasionally of a special trip/activity as this would be a treasured memory, provide parties twice a year so friends can catch up with people they meet at The Vicarage and to ensure that diaries are always written in and sent home after a visit. What the care home could do better: We recommend that there are some changes to the management of medication, to include; ensuring that all medication is stored at the correct temperature by recording daily temperature checks. There were clear protocols for administration of `as required` medication for people with epilepsy. We recommend that one protocol that had been in place for two years be reviewed by the community or epilepsy nurse. The method of medication administration should be reviewed to ensure that the administration record is with the staff member at the point of administration to reduce the risk of medication errors. One bedroom should have some minor decoration to the wall where a mirror had been placed. Random inspection report Care homes for adults (18-65 years) Name: Address: The Vicarage 59 Andover Road Tivoli Cheltenham Gloucestershire GL50 2TS three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Kathryn Silvey Date: 1 8 0 5 2 0 1 0 Information about the care home Name of care home: Address: The Vicarage 59 Andover Road Tivoli Cheltenham Gloucestershire GL50 2TS 01242521918 01242227646 keith.vardy@gloucestershire.gov.uk www.gloucestershire.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Keith Vincent Vardy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Gloucestershire County Council care home 5 Number of places (if applicable): Under 65 Over 65 5 5 learning disability physical disability Conditions of registration: Date of last inspection Brief description of the care home 5 5 The Vicarage provides respite care for people with a learning disability. The facility is owned and operated by Gloucestershire County Council. The home is a large detached two-storey house based in the local area of Tivoli and has easy access to Cheltenham town centre. The house is secluded and set within its own grounds with a pleasant garden at the rear that has wheelchair access. Sensitive adaptations have been made to accommodate individuals with physical disabilities, which includes a passenger lift to provide access to all areas. The home has five very large bedrooms, four of which are Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home en-suite. There is an additional bathroom and shower room. There is also a large lounge, separate dining room and a spacious kitchen. The home has a cordless telephone that people can use to make calls in the office or in the privacy of their own bedroom. An intercom system is available on request. All bedrooms have fitted furniture, colour television and portable CD players. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: This random inspection took place on 18th May 2010 and included a visit to the home by one inspector. We undertook a further visit to the Gloucester County Council (GCC) offices on 26th May to look at recruitment records for the service. The registered manager was on holiday on the day of the inspection, however, the deputy manager was present throughout. The manager had completed an Annual Quality Assurance Assessment (AQAA) as part of the inspection, providing considerable information about the service and plans for further improvement. The AQAA also included numerical information about the service (DataSet). We The Care Quality Commission (CQC) received completed surveys from eleven people using the respite service and their relatives, five from the care staff and one from a social worker. This random inspection focused on looking at two care plans in detail and speaking to the people, medication management, the environment, recruitment practices and any trends of concern. We looked at two care plans in detail, and spoke to the deputy manager about the people that were receiving respite care during the week of this inspection. The requirement made at the last inspection in April 2007 regarding medication had been met, as the procedures were amended then. However, GCC are currently reviewing and updating the services medication procedure. We found comprehensive care plans and risk assessments, that included peoples character and their individual choices, which helps to ensure that their personal needs are well met. The care plans contain core information about each person that receives respite care, this is updated before each visit to ensure there is continuity of care. A previsit telephone call is made each time a person visits the home to check with the families about any changes, and a record is kept . We saw an example of a medication change that was clearly noted, the risk assessment had also been updated as this related to seizure control. Body maps are completed to record any marks or bruises found on admission, and the relatives are informed immediately. The person centred care plans were excellent and individual actions were detailed and specific. Daily records were well recorded with information about how people spend their days, many go to day centres during the week. During this inspection one person had visited Saul Junction to look at the boats on the river. We also met a person who arrived back from day care, there was good interaction with the staff and the person appeared to be content at the home. Generally people visit for an average of 56 days each year. The staff from the home usually go to the persons annual review, which is mainly held at a day service. This helps to ensure that the staff know about any changes that may be required to meet their needs well. The care records included had some good examples of clear risk assessments for manual handling, epilepsy and individual fire risk plans to aid evacuation of the home. The risk assessment reviews were also well recorded. Where people need one member of staff each when out in the community this was recorded. The home was using assistive technology to alert night staff that one person was leaving their bedroom, as the stairs were a hazard for this person. We were told that most people look on respite care at The Care Homes for Adults (18-65 years) Page 4 of 10 Vicarage as a time for a holiday where they can meet friends and experience additional activities. The staff use Makaton hand signals and verbal communication to enable them to communicate with people, many of whom have little or no verbal communication. The home has a light projector which can be used on the bathroom or bedroom wall to project lights and shapes to help stimulate the senses. When people stay at the home they are able to retain the services of their own doctor. The district nurse is also able to continue any healthcare needs that may be required during the respite stay. The home liaise with healthcare professionals to ensure that peoples needs are appropriately met and protocols are in place to ensure that relatives are informed as requested. There were no people self-administering medication during the inspection. However, the AQAA told us that people are assessed and encouraged to retain and administer their own medication where possible. The AQAA also told us that consent is obtained for the administration of medication and that all staff that administer medication had completed accredited medication training. The homes policy is not to store homely remedies, however, parents often bring homely remedies that they give staff consent to administer. We recommend that each persons doctor or the pharmacist agrees what medication the staff may administer as a homely remedy. The storage of the medication was secure and well organised. The fridge used for medication storage did not have a regular temperature check recorded to ensure medication is stored at the correct temperature at all times. The administration records were well recorded, to include running totals for all medication. We completed two spot checks and both were correct with regard to amounts and administration records. There were clear protocols for administration of as required medication for people with epilepsy. We recommend that one protocol that had been in place for two years be reviewed by the community or epilepsy nurse. We looked at how medicines are administered as an error had recommend that the procedure includes taking the Medication sheet to the person with their medication. This will reduce the become distracted and inadvertently administer medication to been recorded. We Administration Record risk of errors should staff the wrong person. We recommend the home has a copy of the Royal Pharmaceutical Societys guidance for administration of medication in care homes, which is available from the Internet. The home was well maintained, clean and free from offensive odours. One bedroom had a mark where a mirror had been and this required minor attention. The home has been improved since the last inspection in April 2007, this includes a new shaft lift for easier access to the first floor, new carpets, new fire doors and three bedrooms now have permanent lifting hoists fitted. The home has suitable adaptations for meeting peoples bathing needs. We looked in all the rooms, including the laundry room, which was well organised. We recommend that infection control procedures are posted in the laundry to help ensure that any relief staff know how to maintain infection control there. Each person had their own ski pad to enable them to be evacuated quickly in the event Care Homes for Adults (18-65 years) Page 5 of 10 of a fire. The AQAA told us that the GCC have used many relief staff in the last three months, however, the staff used have been working at the home for many years. We looked at the homes recruitment procedures. The deputy manager told us that potential staff are shortlisted and attend an interview. The manager usually completes the recruitment interviews and staff do not commence work until an enhanced Criminal Records Bureau check has been completed. Recruitment record were not held at the home, therefore we visited GCC offices to see an example. Most staff transfer from other services within the GCC and are interviewed and a reference from the last place they worked is sought. Most of the recent transfers were employed many years ago and a full recruitment record was not available. The people recently transferred had an enhanced CRB completed. The staff have an induction and complete all mandatory training for residential care, including medication. We looked at recruitment details at Shire Hall on computer, for a carer externally recruited within the last two years, which was complete. The carer had a comprehensive training record at the home to include all mandatory training and epilepsy, people with a learning disability, health and safety, Deprivation of Liberty safeguarding, Percutaneous Endoscopic Gastrostomy (PEG) feeding and updated medication training in January 2010. Subsequently we contacted the manager at The Vicarage and informed him that there must be copies of recruitment records kept there securely for our inspection, which he agreed to do. We also recommended that interview notes are kept. The manager knew about the new Vetting and Barring registration for new employees and the relevant procedures. What the care home does well: The service provides well planned respite care for people with a learning disability who may also have multiple and complex needs. The planned care is detailed, including risk assessments and is updated for each visit. Staff from the service also attend peoples annual review to help ensure that changing needs are well met. The environment is well maintained and additional adaptations have been made to meet peoples needs. The recruitment procedures are robust to help protect people using the service. We received completed surveys with comments from people that use the respite service, with help from their families or day centre staff, and also direct comments from relatives about what the home does well as follows; the staff are friendly, the home is clean and comfortable, and they try hard to accommodate everyday needs, the recently introduced phone call before and after a visit is a good idea, especially for non-verbal clients, its tidy, the beds and bathrooms are nice and the staff are nice, the staff make cups of tea, take us out to buy CDs and go shopping, offer a choice of food/drink/activities and outings, does all laundry prior to clients return home, regular feedback, as parents we highly value the service and know that .... is happy there his needs are well met and the staff are so caring and well trained, the staff are friendly, approachable and helpful and Care Homes for Adults (18-65 years) Page 6 of 10 keep people safe, warm, entertained and stimulated. Two relatives told us about what the home could do better comments included that the home should send home photos occasionally of a special trip/activity as this would be a treasured memory, provide parties twice a year so friends can catch up with people they meet at The Vicarage and to ensure that diaries are always written in and sent home after a visit. 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 set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 10 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, 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 20 We recommend that each persons doctor or the pharmacist agrees what medication the staff may administer as a homely remedy to help ensure that incompatible medication is not administered. We recommend that the care staff have the MAR sheet with them when they administer medication to reduce the risk of errors. We recommend that as required medication protocols are regularly reviewed with the appropriate healthcare professional. We recommend that medication storage temperatures are recorded daily to help ensure that all medication is stored at the correct temperature. 2 20 3 20 4 20 Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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