Inspection on 14/02/08 for Blue Cedars

This is the latest available inspection report for this service, carried out on 14th February 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Blue Cedars 67 Avenue Road Farnborough Park Farnborough Hampshire GU14 7BH Lead Inspector Anita Tengnah Key Unannounced Inspection 14th February 2008 10:00 Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 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 Blue Cedars DS0000070678.V357012.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 Adults 18-65. 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. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blue Cedars Address 67 Avenue Road Farnborough Park Farnborough Hampshire GU14 7BH 01252 542138 01252 510675 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) Congress House Ltd Mrs Helen Mary Jones Care Home 6 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2. Physical disability (PD). The maximum number of service users to be accommodated is 6. Date of last inspection New Service Brief Description of the Service: Blue Cedars is registered as a care home to provide personal care and accommodation for six people in the younger adult category with learning disability (LD) and physical disability (PD). Congress House Ltd owns the service and there is a registered manager at the home. Accommodation is provided in a large house situated in a residential area with easy access to the shops and local amenities. There is a small secure garden to the side and rear of the property that is accessible to the residents including wheelchair access. There is a shaft lift that allows access to all parts of the home. The fees charged are according to the financial assessments. The current fee charged is £1550- £2100 per week. Blue Cedars DS0000070678.V357012.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 was the first inspection of the service since it was registered in August 2007. An unannounced visit was undertaken to the service on the 14th February 2008 as part of the inspection. There were two people accommodated at the time of the visit. The process included a tour of the home, where a number of the bedrooms, communal area, kitchen and bathrooms were viewed. As part of case tracking 2 staff, and the 2 residents accommodated at the time of the visit views were sought, practices observed and care records were looked at. Service users’ survey forms were also sent to the people living at the service and their relatives in order to gain their views. Information gained from the Annual Quality Assurance Assessment (AQAA) was also used and included, as was information gathered by the commission since the last inspection to contribute in assessing judgements in this report. We have not received any response to the surveys we carried out. The home has a registered manager responsible for the day –to –day management of the service. Positive comments were received from the people we spoke to regarding the care that they were receiving at the home. Care practices observed at the time of the visit showed that the staff and people using the care service had developed good relationships and care was provided in a respectful manner. What the service does well: The service provides individualised care that is based on detailed assessments to ensure that care needs are met. The care plans are detailed and provided clear information about the support that people required. The staff are aware of the residents needs and responded to them in a respectful and dignified manner. The staff and the people using the service have developed good relationships and people say that they receive the support they require. The residents are provided with a well- maintained and homely accommodation that meets their needs. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 2 A pre- admission process was in place. Information was available to staff to ensure that the needs of people can be met. EVIDENCE: The care records of both of the residents were looked at as part of case tracking. Detailed pre admission assessments of needs were carried out and staff reported that this information is used to formulate their care plans on admission. The assessments of needs included medication, personal risk taking, maintaining independence, personal hygiene, communication and social skills. Care manager’s assessment was also sought at the time of referral and this was available for one of the residents. The staff discussed that part of the pre admission process includes the opportunity for prospective clients to come in and spend some times at the service and overnight stay is offered. The home has a statement of purpose that staff said was available to prospective clients as required. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 6,7,9 Care plans were formulated fro people living at the service. Further development and review of care plans would ensure that they are person centred and reflect current needs. Service users are supported to live independently within a risk assessment framework. EVIDENCE: The care records of two people were looked at as part of this visit. The service has a key worker system in place with a nominated carer are responsible for the individual carer’s needs. The care plans seen contained detailed information about personal care, likes and dislikes, family links, communication style diet and included risk assessments. There was evidence that relative inputs were sought as appropriate and they were involved in the formulation of the care plans. Some of the risk assessments included personal safety, Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 10 hygiene, fall assessments, challenging behaviour, accessing kitchen, and going out. The care plans were person centred and provided staff with information of the person’s needs in order that care could be provided safely. Detailed risk assessment and care plans were in place to manage one of the resident’s medical conditions. As discussed the care plans would benefit from reviews to ensure that information is current. We noted that some of the assessments and care plans for one of the resident related to his last service. This should be reviewed to ensure that they meet his current needs. The staff in charge stated that this would be addressed. The staff confirmed that a six weekly review had been completed for one of the resident who was recently admitted. The report from the review was not available and the staff would be following this up. The service has the facility of sharing transport with another service staff said that this benefited to the residents. They are supported to take risks as part of independent living within a risk assessment framework. This included assessment road safety and 1:1 care when out in the community. Comments received included: “It is good living here.” “The staff are very nice”. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 12,13,15,16,17 There is a range of activities available to meet their needs and people are encouraged to be part of the local community. The care practices ensured that people’s privacy and rights are respected. Meals provided the people with variety and choices that met with the residents’ satisfaction. The way that choices are offered would benefit from further development. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 12 EVIDENCE: The home has system in place to ensure that the residents are supported to take part in activities of their choice. Some of the activities included attending clubs in the community, going to the local restaurants, personal shopping, arts and crafts, home cooking, gardening. Both of the residents talked about enjoying a meal out the previous day. Another resident had a variety of videos of his choice in his room that he told us he is supported to access and enjoyed them. Staff reported that the service shared the transport facilities with another service nearby and that this worked well. Interaction observed and care practices seen showed that the staff treated the residents with respect and their rights to privacy respected when receiving personal care. A staff member was observed to knock prior to entering the people’s bedrooms. It was evident that the staff and people living at the home had developed good relationships. Comments included “the staff are very good”. “I like living here”. The residents are supported to maintain links with their family and they are involved in planning the care of their relative as preferred. One of the resident said that they enjoyed weekends away with their family. The service had a supper menu that was varied and offered choices. The staff reported that the menu was flexible and the residents were involved in the choice of the menus. The care plans included food shopping and food preparation as part of their learning/ developing life skills within a risk assessment framework. Hot and cold drinks and snacks were available at all times. Detailed records of meals taken were seen in both residents daily diary as kept by the home. Any areas of concerns regarding dietary needs are addressed through referral to dieticians as appropriate. Comments included “the food is very nice”. The way that meals choices are offered as discussed at the time of the visit should be further developed. There was no menu available for lunch and breakfast. Staff reported that this would be put in place including menu board in pictorial formats and coloured food charts to meet the needs of people. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 18,19,20 Support was provided that met with the satisfaction of the residents. Medication records were maintained. Procedures to support medication management were in place for the protection of people accommodated. EVIDENCE: Care records seen indicated that people are supported to be independent with their personal care, however where prompts are needed these were recorded in the plans. All personal care are provided in private and where resident’s wishes indicated for care to be provided by person of the same gender this is respected and recorded in plan of care. All the residents are accommodated in single rooms and staff stated that keys to their rooms are available to them as requested. The residents are registered with the local GP and staff reported that they have the support of the local trust. One of the resident had been referred to an Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 14 Occupational therapist and detailed assessment was in place. Staff reported the home was also sourcing out hydrotherapy access for one of the residents through a physiotherapist. The service has procedures in place for receipts of medication that was brought into the home. Records seen indicated that these were recorded on the Medication Administration Record (MAR) sheets. Medication administered was recorded on the MAR sheets as required. Medication was stored safely. There was no one administering his or her own medicines at the time of the visit. None of the residents were receiving controlled drug at the time of the visit. The provider must look into appropriate storage facility for controlled medication, as currently the home does not have this facility and the change in legislation relating to storage of controlled drug in care homes. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good information in a pictorial format for the residents on what to do if they are unhappy. However there was no complaint procedure available for relatives and others and this must be put in place. Procedures were in place for the prevention of abuse and ongoing training ensured that staff had the necessary information to record and report any allegation. EVIDENCE: There was clear information available for the residents on what to do if you are unhappy. The home has a system of monthly key worker review and staff stated that these involved the family of the residents as appropriate. There was no complaint procedure available and the complaint log could not be located. This did not give people using the service the information required on how to raise concerns/complaint. Information from the AQAA stated that the home had not received any complaint. Staff said that they would bring any concerns to the attention of the manager or the responsible individual and would record any complaint in the complaint form. The home has the adult protection procedures in place and information received from the AQAA indicated that the procedures for disclosing bad practice and abuse including Whistle blowing had been reviewed in August 07. Staff spoken with said that they would report any allegation to the manager. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 24,30 The people were provided with a well- maintained and homely environment that met their needs. The infection control procedures ensured that people are protected. EVIDENCE: This was the first visit since the home was registered last year. The residents were accommodated in a well- maintained, warm, bright, clean and homely environment. Furnishing was of very good standard and appropriate to the needs of the residents. The service users are provided with comfortable communal areas where activities are undertaken. The bedrooms were nicely furnished, highly personalised. It was evident that the residents are offered choices and supported in making their bedrooms their own. People were encouraged to bring in items of personal belongings. An inventory of items Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 17 brought in was kept. Both residents spoken with said that they liked their room and comments included “ I am very happy living here”. The service has a shaft lift that was appropriate for wheelchair and allowed access to the first floor. Equipments such as hoists were available and included an overhead ceiling hoist in one bedroom. The communal bathrooms and toilets facilities were good and had rooms to manoeuvre wheelchairs/ hoists. Assisted shower facilities were also available to maintain and promote the residents’ independence. There is an internal laundry that was clean and well maintained. Infection control procedures were inn place that included dedicated bins for pads. The staff reported that the residents supported and undertook their washing as part of their independent living skills. Equipment such as gloves and aprons were available and staff practices showed that they were aware of the infection control procedures. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 32,34,35 The staff ratio and skills are adequate to meet the present needs of people living at the service. There is a good recruitment process in place and all checks are completed prior to employment. The lack of induction and training for some staff do not protect people. EVIDENCE: The home has a planned staff roster in place that the staff stated that there was adequate staff to meet the current needs of the people accommodated. On the day of the visit there were two staff caring for two residents. The staff also undertook cleaning and cooking duties as part of their work. Staff reported that this worked well as there are only two residents at present. Night duty has one sleeping and one waking staff. Interaction observed showed that the staff had developed good relationships with the residents. Care was provided in a relaxed and respectful manner. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 19 There is a training programme in place for all staff and a number of trainings had been planned for March 08. These included health and safety, moving and handling, food hygiene and safeguarding. The staff reported that they had recently completed training in management of medication and epilepsy. Information from the AQAA showed that the home has five permanent staff and three of them had achieved National Vocational Qualification (NVQ) 2 or above. The service has a recruitment procedure in place. The records of two staff seen showed that new staff completed an application form and references are sought as part of the recruitment process. Checks such as POVA first and CRB are received prior to employment. The records of two newly recruited staff showed that one of them had completed induction training and other training included health and safety, medication and first aid. There was no induction record for the other staff member and no record of any other training such as medication, moving and handling, health and safety. The staff member works on night duty and would be working alone. The registered person must ensure that staff have structured induction to include training in the principles of care, safe working practices, needs of particular service users’ group are completed for the safety of people accommodated. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 37,39,42 There is a satisfactory management structure within the service. There is a satisfactory internal audit in place; further development of the quality assurance programme would ensure that people using the service views are sought. The health and safety of people using the service are promoted. However the lack of training in moving and handling for some staff, do not protect people using the service. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 21 EVIDENCE: The service has a registered manager who was away on the day of the visit. Staff spoken with said that they worked well as a team and the organisation supported them. The home was developing the audit process, as the service has been operational since November 07. Information from the AQAA stated that the home was planning to introduce weekly residents’ meeting and involving their family. The operational manager undertakes monthly visits as Regulation 26 and staff said that the manager would take action and address any issues identified. Information received and a sample of record seen showed that there is a system in place for regular servicing of equipment. Fire safety training was available and good records were maintained of weekly fire alarm testing. Daily visual checks fire safety checks were carried out for fire doors and ensuring that exits are kept free. Doors were fitted with guards that allowed them to remain open and would automatically close in the event the fire alarm is triggered. All materials that are hazardous to health were maintained safely at the time of the visit. The fire exit door from the dining room that was key operated was discussed with staff and would be looked into. As identified in the training section, the lack of moving and handling training for some new staff must be addressed to ensure the safety of people using the service. Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 23 N/A Are there any outstanding requirements from the last inspection? 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. 1 Standard YA22 Regulation 22 Requirement The registered person must put in place a clear and effective complaint procedure so that people know how and to whom they can raise their complaint. Staff must complete an induction to the service that includes health and safety training to protect the people receiving care. Records of this must be available. Timescale for action 30/03/08 2 YA32 13(4) 30/03/08 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 Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Blue Cedars DS0000070678.V357012.R01.S.doc Version 5.2 Page 25 - 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. 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