Inspection on 11/06/09 for Cedar House

This is the latest available inspection report for this service, carried out on 11th June 2009.

CQC 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.

Other inspections for this house

Cedar House 05/01/07

Cedar House 22/08/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cedar House Barnet Road Arkley Barnet Hertfordshire EN5 3LF     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teferi Degeneh     Date: 1 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 27 Information about the care home Name of care home: Address: Cedar House Barnet Road Arkley Barnet Hertfordshire EN5 3LF 02084404545 02084403273 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : CareTech Community Services (No.2) Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home 12 12 Cedar House is a care home registered to provide nursing care for a maximum of twelve service users between the ages of 18 to 64 who have learning disabilities and/or physical disabilities. The home is operated by CareTech. The home is now divided into two units each with a kitchen, sitting room and dining room and bathroom. Staff and service users have moved from another unit near by into one of the units in Cedar House. The stated aim of the home is to enable service users to live as full a life as possible and to provide them with support in their daily activities. The home is a large detached bungalow. The home is situated in a residential area of Barnet and about half a mile from restaurants, shops, public transport and other community facilities. Fees charged at the home range from £1500-£2000 per week. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home A copy of this Inspection report can be requested directly from the home or via the CQC website. Care Homes for Adults (18-65 years) Page 5 of 27 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: This was a surprise inspection which means that the home had not been told that we were visiting. The inspection took approximately six hours beginning at 08:45 am and ending at 15:00 pm. The care manager was present throughout the inspection. During this inspection we toured the premises and saw the rooms and facilities. We chose five residents files and checked them to see care plans and risk assessments. We also examined the homes policies and procedures and various records such as staff rota, menu, health and safety, and incident and accident record books. We observed and talked to some residents. We also interviewed two members of staff and talked to a relative who was visiting the home. The homes annual quality assurance assessment (AQAA) which we had received before the inspection was considered for this inspection. Care Homes for Adults (18-65 years) Page 6 of 27 The AQAA is a self assessment which the home is required to complete and send to the Care Quality Commission (CQC) to tell us what they are doing and how they intend to improve outcomes for the people who use the service. We have also considered the homes last inspection report. What the care home does well: What has improved since the last inspection? 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 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 8 of 27 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 9 of 27 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. New residents can be confident that their admission to the home is based on the outcome of their assessments and the ability of the home to meet their needs. Evidence: The AQAA explains that the home receives referrals for new residents from care managers or social workers. The manager or the deputy manager visits the residents at their homes to complete further assessment to check if the residents needs can be met by the services and facilities of the home. The manager said new residents are admitted on the basis of their needs assessment and the ability of the home to meet their needs. The manager gave an example where a referral was turned down because the assessed needs of the person could not be met by the home. We checked five residents files and confirmed that information about the residents has been received and pre-admission assessments completed for them. A relative we spoke to said they had visited the home before a resident started using the home for a respite stay. Care Homes for Adults (18-65 years) Page 10 of 27 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. The needs of the people who use the service are met by the homes good care plan and risk assessment systems. Evidence: The manager said she was in the process of reorganising the files to make them easy to use. Each resident has two types of files. The first type is one in which all the information including assessments, care plans and risk assessments are kept. The second file is a working file which is used by the staff for quick reference and recording of daily events. All the five residents files seen contained detailed care plans. The plans contained information about the needs of the people and the care to be provided. Each residents likes and dislikes are also given in the care plans. The care plans are reviewed and updated yearly or six monthly. It was evident from the residents files that healthcare professionals, families and the staff from the home are involved in the review of the care plans. The home has a key working system which means that named staff are assigned to monitor and review the support provided to Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: certain residents. A named nurse is also assigned to monitor the needs of some residents. A key worker is a member of staff who has a special or additional interest in the care of the resident they are a key worker for. All the residents files also contained risk assessments of the residents. We noted in all the residents files we checked that the manager keeps a general risk assessment which may or may not be relevant to a resident. However, we were satisfied to see that individual risk assessments are completed for each of the residents. The risk assessments are detailed and contain information about the action needed by the staff to ensure that the residents are safe. Copies of general risk assessment and procedures to be followed, for example, in a case of choking, are displayed in the dinging room for the staff. The manager said there is a qualified nurse on duty on every shift. However, while talking to and observing the residents we noticed a resident who had a strap around their waist. When we asked the manager about this, she said that it was to protect the resident from falling and hurting themselves. We could not see written evidence in the residents file to show how or why the decision to use the strap was made. We have asked the manager to liaise with all relevant people and complete a risk assessment for this person. Care Homes for Adults (18-65 years) Page 12 of 27 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. The activities and the food provided at this home are good. There are sufficient staff and facilities to enable the residents to be engaged both within and outside the home. Evidence: The AQAA and the residents files give the details of the activities the home arranges for the people who use the service. For example, the AQAA says: Each resident has a life and leisure plan which is individually planned for the year with the resident (this has monthly plans). Each month this is reviewed and changes made where necessary. The residents activities are included in the care plans and the manager said these are reviewed monthly. On the day of the inspection three residents were out attending a day centre and one person was supported by staff to attend a hospital appointment. The home has an activities co-coordinator and minibuses. The manager told us that one resident attends a day centre five days a week and the others have activities at Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: day centres two to four days a week. From discussions with the manager and observations it was evident that the residents are engaged at the home by listening or playing music, having massages or going out to parks, shops and restaurants. We looked at the visitors book and confirmed that the residents are visited by their friends and families. A relative who was visiting the home informed us that they are happy with the staff and the manager and they feel welcomed whenever they come to the home. The manager said all the residents have their own bank accounts and the home is not an appointee for any one of them. However, the home supports the residents to cash money and pay for their expenses such as holidays and toiletries. The manager said the home encourages and supports the residents to exercise their rights. She said that all residents are registered on the electoral register and one person has voted at the last election. The vehicles are accessible for the residents. We checked the menus of both units and confirmed that they are reviewed weekly. The manager said two to three residents and a member of staff review the menus. From discussions with the manager we noted that a housekeeper and care staff do shopping weekly and spend about £240.00 for both homes. We also noted that the home does extra shopping in between the week whenever items run out. The menu was detialed and contained the names of the residents to show their preferences. It was evident that cultural, medical and dietary needs of the residents are considered in the menu. The lunch provided on the day of the inspection reflected the menu for the day and the food looked nutritious and balanced. We observed that there were care staff in sufficient number to support the residents with their meals. The residents in both units seemed to have enjoyed their lunch. Care Homes for Adults (18-65 years) Page 14 of 27 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. The people who use the service can be confident that their health and personal care needs are met by the systems of the home and the staff. However, the medication administration and recording systems need to be improved in order to minimize risks to the residents. Evidence: The residents files showed that the residents health needs are identified and the home has helped them to attend appointments to receive medical care. The staff were observed to be treating the residents with respect and dignity. Two care staff, who were interviewed, were able to explain how they provide personal care by ensuring the residents rights to privacy, choice, and dignity. The manager said the residents have their eye sights checked by an optician who comes to the home. A speech and language therapist also visits the home to assess some residents. There was evidence in some residents files to indicate that a speech therapist not only visited and assessed but also advised the staff how to support a resident who is prone to choking while swallowing food. Discussions with the manager Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: and examination of the files indicated that residents have been seen by a chiropodist and people with a diabetic condition have been provided with a special diet. Medication is administered and signed by a qualified nurse. Medicines are received in blister packs from a pharmacist. We checked the medication administration record sheets (MARS) and the medicines and found that on one occasion the MARS was not signed for one resident to confirm that they were given their tablets. As the tablets were taken out from the blister packs, we accepted the suggestion by the manager that this was an oversight and the medicines were given to the resident. However, we advised that it was important for the home to ensure that errors in recording or administration of medication are dealt with with strict guidelines and auditing system. Care Homes for Adults (18-65 years) Page 16 of 27 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. The people who use the service are reassured by the homes complaints and safeguarding policies. They are confident that their concercerns can be listened to and addressed. Evidence: There have been no recorded complaints. The AQAA says that the manager has an open door policy which means that people can talk to her if they have a concern. At the last inspection a requirement was made for the manager to update the policy and procedure on complaints. This has been done. A visitor we spoke to said they know who to complain to if they are not happy about the home. A resident said they can speak to the staff if they are not satisfied with the care provided. The AQAA states that the staff have attended training on safeguarding. The two members of staff interviewed were able to give satisfactory description of how they can safeguard the residents and how they can report allegation or cases of real abuse. The homes policy on safeguarding reflects the local authoritys adult protection policy, a copy of which was obtained and made available for inspection. There is evidence in the AQAA to confirm that all staff have a satisfactory current certificate from the criminal record bureau (CRB). Care Homes for Adults (18-65 years) Page 17 of 27 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 location, facilities and cleanliness of the home are good and the residents live in a safe and comfortable environment. Evidence: The home is accessible to people with a physical disability. The rooms and corridors are wide to allow the use of wheelchairs. All the rooms were clean, tidy and bright with no trace of unpleasant smells. The visitor we spoke to said the home is always clean. The AQAA confirms that the carpets are cleaned every three to six months. It was clear from observations that the cracks in the walls of the corridor in the newer built areas of the home have been repaired. Communal areas and the bedrooms are well furnished and decorated reflecting the residents preferences. Infection control policies and procedures are in place and the staff the procedures, for example, by using gloves and aprons. The AQAA confirms that the home has been recently visited by the local fire officers who said that the facilities and services meet the fire safety regulations. The laundry is maintained by the housekeeper and was in good order. There is a washing machine that works at high temperatures and one dedicated machine for doing the laundry of one person who has an infection. Care Homes for Adults (18-65 years) Page 18 of 27 Care Homes for Adults (18-65 years) Page 19 of 27 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. The residents are confident that there are experienced, trained and sufficient number of staff to meet their needs. Evidence: We were not able to examine the staff files during this inspection as they are kept at the head office. However, we were able to confirm from discussions with the manager and the AQAA that all staff working at the home have a satisfactory CRB certificate and written references. The residents and a visitor we spoke to told us that the staff are good. From observations it was evident that the staff treat the residents well. The staff we spoke to said they always give opportunities to the residents to do things for themselves whenever possible. The AQAA says that the staff are diverse in their ethnic background and gender. This has helped the home to meet individual needs of the residents. It was confirmed from discussions with the manager and the AQAA that all new staff attend a full induction programme before starting work at the home. Also there is a wide range of training progarmmes for the staff which includes infection control, first aid, health and safety, manual handling, medication, safeguarding, basic food hygiene and fire safety. The manager said most of the staff have achieved a care qualification which is equivalent Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: to national vocational qualification (NVQ) level 2. The staff rota, which was examined, showed that there are six care staff and a nurse on shift during the day and evening times. There are also a housekeeper, driver and an activities coordinator during the days. The night shifts are covered by three waking night staff and a nurse Care Homes for Adults (18-65 years) Page 21 of 27 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. There are good arrangements to ensure that the residents are safe and the home is managed in their best interest. Evidence: The manager is a qualified nurse and has worked at the home for ten years. She has been a registered manager for one year. A relative and the staff talked positively about the manager. The manager has been updating herself by attending various training programmes and management meetings organised by the company that owns the home. She is supported by a deputy manager and the area manager. We found the manager to be an enthusiastic person with energy, commitment and creativity to improve the quality of the service. She was fully cooperative with the inspection and we are confident that she will continue to make improvements to the facilities and services. The manager has devised a questionnaire for relatives as part of the homes quality assurance system. These questionnaires have been sent out and collected from the Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: people. An example of a questionnaire completed by a relative reads: I appreciate the friendliness towards my [service user]...because it is a small residence everyone knows [the service user]. A relative said they were able to meet with other families and talk about how services can improve. The area manager also visits the home once every month to carry audit of the quality of the facilities and services. The manager said she will prepare relevant survey questionnaires for professionals and service users to complete once a year as part of the quality assurance. The AQAA confirms that maintenance and services of the homes equipment have been carried out and are up to date. For example, the gas boiler was last checked on 31st October 2008 and the fire extinguishers serviced on 16th March 2009. There is a person responsible for maintenance who comes once every week. Records showed that fire drills take place once every three month and the fire alarm test are done weekly. The AQAA confirms that a local fire safety officer has recently visited the home and has said that the home meets fire safety regulations. During one of our observations we noticed a resident who had a strap around their waist. The manger told us that this was done to protect the resident from falling and hurting themselves. However, records of how, and why the decision to use the strap was made was not available in the residents file. We have asked the manager, under risk taking above, to ensure that proper risk assessment is completed for this person. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 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 1 9 12 The wishes of the residents 15/07/2009 and, as appropriate, their representatives must be taken into account when completing risk assessments and making decisions. This ensures that the residents or their representatives wishes are considered in all decisions affecting the residents. 2 19 13 Medication must be administered as prescribed by a doctor and the staff must record and sign to confirm that the medicines are administered. This ensures that the residents receive their medication as prescribed by their doctors 15/07/2009 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 Care Homes for Adults (18-65 years) Page 25 of 27 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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