Inspection on 08/09/09 for Cedar Lodge

This is the latest available inspection report for this service, carried out on 8th September 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cedar Lodge 11/10/06

Cedar Lodge 11/01/06

Cedar Lodge 27/09/05

Similar services:

Coopers Mill Ltd

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Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cedar Lodge 169 Westbury Road Southend on Sea Essex SS2 4DL The quality rating for this care home is: Three star excellent 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: Vicky Dutton Date: 0 8 0 9 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. They reflect the things that people have said are important to them: 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) 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 32 Information about the care home Name of care home: Address: Cedar Lodge 169 Westbury Road Southend on Sea Essex SS2 4DL 01702301652 01702217625 bronwynoldham@hotmail.co.uk 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) : Westelm Homes Ltd care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8 The registered person may provide the following categories of service only: Care Home only - Code 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 - Code LD Date of last inspection 0 3 0 9 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home Cedar Lodge is a care home where eight people who have a learning disability can live and be cared for. The home is a detached eight bed roomed chalet which is situated in a quiet residential area in Southchurch which is near to Southend on Sea. The home is located close to local bus routes and shops. The home also has their own transport to help people get around. Cedar Lodge has nice communal areas that include a spacious lounge, a dining room and large kitchen. There is an attractive patio area to the rear of the home and car parking facilities at the front of the house Everyone has their own bedrooms that they can arrange as they want. The home provides day care facilities for the people who live there. The cost of staying at Cedar Lodge is between £690.00 and £910.00 each week. The amount paid depends on peoples needs and services provided. People living at the home pay £69.92 each week as their contribution. Good information was available about the home. 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: Three star excellent 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home When we went to Cedar Lodge, we did not tell people that we were coming. This was so we could see the home as it usually is. Before we went we sent surveys to people living at the home, their families and staff so that they could tell us about what it is like there. A lot of people sent surveys back to us and this gave us good information about the home. Also before we visited Cedar Lodge, we asked the manager to tell us about the home. We asked them to fill in a form to tell us how the home make sure that they keep up good standards in looking after people, and make sure that the home is safe. When we went to Cedar Lodge we spent time with people living at the home. They were happy, got on well with staff and said that they liked living at the home. We also spoke to the manager and staff at the home. We looked around the building to see if it was nice for people to live in. We spent some time in the office looking at different paperwork that would let us see how peoples care is arranged and Care Homes for Adults (18-65 years) Page 7 of 32 how the home is managed. What the care home does well People living at Cedar Lodge were relaxed and happy. They told us that they liked living there. Families told us that they are very happy with the care that people receive. One person told us, Cedar Lodge has always provided an excellent service and continues to do so. Another person said that Cedar Lodge provides people with, A high quality of life. Everyone at Cedar Lodge is encouraged to say how they like to be cared for and the things they like to do. This is recorded in care plans so that staff know how people like things done. Most staff at the home have worked at the home for some time. They know the people living there very well, and can look after them in the ways that they are familiar with and prefer. Agency staff are not used at Cedar Lodge so people are always looked after by people that they know. People are encouraged to make choices in their daily lives. Cedar Lodge has their own day care service. Staff at the home help people to lead interesting lives. People can go to day care, take part in different activities Care Homes for Adults (18-65 years) Page 8 of 32 and go out and about in the local community. People can stay in touch with their friends and families and have visitors whenever they wish. Cedar Lodge is a nice place for people to live. The owners of the home make sure that the home is suitable to meet the needs of the people who live there. People all have their own comfortable rooms and there is plenty of shared space where people can enjoy each others company if they wish. Staff at the home make sure that peoples health is looked after. They support people in seeing doctors or other professionals needed to help them. Staff working at the home have nearly all undertaken a recognised training course so that they understand good care practices. Care Homes for Adults (18-65 years) Page 9 of 32 The manager is very experienced and makes sure that the home is run safely and well. What has got better from the last inspection People living at Cedar Lodge are getting older. The owners have made sure that the home remains able to meet peoples needs by improving bathing facilities and making aids such as grab rails available. Other areas of the home have been redecorated or improved. Good information about the home has been developed in different formats. This will help anyone new thinking of moving into Cedar Lodge, and their families, to be able to see what it is like. Some staff training has taken place so Care Homes for Adults (18-65 years) Page 10 of 32 that staff can continue to meet peoples changing needs and keep up to date with new laws. What the care home could do better Cedar Lodge continues to offer a very good service to people. Where minor issues were identified at the site visit the manager undertook to address them straight away. Most staff have worked at the home for a long time. Although they have had training in a number of areas, some courses were undertaken a long time ago. The home should make sure that refresher training takes place regularly to make sure that staff are up to date in their practice. Care Homes for Adults (18-65 years) Page 11 of 32 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Vicky Dutton CQC East Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 Email: enquiries.eastern@cqc.org.uk 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 12 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 13 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. People considering moving into Cedar Lodge will be given every assistance to ensure that it is the right place for them to live. Evidence: People will have good information available to them about Cedar Lodge. We saw that there was a Statement of Purpose and Service Users Guide in place. These documents were detailed and up to date. The Service Users Guide was in an easy read format and contained photographs, pictures and symbols to aid understanding. Since the previous inspection a Parent/Guardian/Carer Users Guide has also been developed. This again contains photographs and much useful information. Although not viewed at this site visit the AQAA said, An audio-visual version of the Service Users Guide is available on a CD Rom and is meant to compliment both the Service Users Guide, Statement of Purpose and Relative/Guardian/Carers Guide. Everyone living at Cedar Lodge has lived there for a long time, and there have been no admissions since the previous inspection. The manager outlined the procedures that would be in place for any future admissions. The AQAA said, When a new admissions occurs in the future the manager is confident in being able to follow the homes admission procedure, to ensure that both the prospective service users needs would be considered and assessed within the context of the other service users already living Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: in the home. Admission procedures were also well described in the Service Users Guides. Information highlighted that pre-admission visits would take place so that people can feel confident that the home will be right for them. Care Homes for Adults (18-65 years) Page 15 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 feel confident that the home will be responsive to their changing needs and respect their choices. Evidence: Each person living at the home had a care file in place containing Care plans, Personal plans, personal lifestyle plans and other documentation. Care plans and information in place was colourful, user friendly and made good use of pictures and symbols where these were appropriate. Everyone has lived at Cedar Lodge for some time and most staff have also worked at the home for a long time. Therefore peoples needs and preferences are well known. Care plans are however responsive to peoples changing needs as we saw in the case of one person whose needs have changed significantly in recent times. The manager and staff spoken with during the day, and observations showed that staff are very aware of peoples individual needs and behaviours. Whilst care plans would certainly allow good person centred care to be delivered, there were differences in the level and format of information available. For example one persons file concentrated on their personal hygiene plan, risk assessments and assessment and monitoring tools, but had little other information. Others had a good range of care plans in place. Good daily records are maintained for all residents. The manager agreed that information available and consistency of approach could be improved. The Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: AQAA also identified that the home would like to explore a more audio/visual approach in relation to care planning to assist peoples participation and understanding. It was clear that people had been involved in developing their care plans, saying how they like things done and what routines they prefer. Seven people living at Cedar Lodge were helped to send surveys back to us, (CQC.) Most people said that they sometimes make decisions about what they do each day, but then had made comments such as, I am asked what I would like to do, I go out when I want to or stay in if I want to, and I get a lot of choices from staff so I can decide what to do. During the site visit staff encouraged people to be involved in what was going on, but respected their needs and choices if they did not want to. We saw that regular residents meetings are held so that people can discuss the service and express their views. Although not currently relevant to the residents at Cedar Lodge, senior staff at the home have undertaken training, and understand how peoples rights are protected through assessments under the Mental Capacity Act and Deprivation of Liberties safeguards. Advocacy services are available to support residents when necessary. Care documentation viewed showed that risks associated with peoples care is well understood. Risks were identified and action plans in place to minimise hazards. Care Homes for Adults (18-65 years) Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a lifestyle that suits their needs and preferences. Evidence: People are encouraged to take part in a variety of different activities and recreation both in and outside the home. Some people attend regular formal day care at privately run centres on some days each week. Cedar Lodge run their own in house day service every weekday with its own designated staff. Timetables, a residents board and records showed us that this service is structured and provides people with a wealth of opportunities. People can undertake activities such as ceramics, cooking, fitness, friendship group, and swimming. Some courses are undertaken at a local college. A PAT (Pets as Therapy) dog and a person who does music with the residents also visit the home weekly. On the day of the site visit three people went to day care placements. Others went out to ceramics in the morning and did flower arranging at home in the afternoon. Records and discussion showed that people are supported in using, and being part of the local community. The home have their own people carrier to facilitate community access and undertake trips further afield. The AQAA said, We offer an excellent range of activities to cater for all different tastes and needs both in Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: the home and out in the wider community. The service users are known throughout the town and have built up a large set of friends from the local church to stall holders at the local market. People said, I enjoy Walks along the seafront, painting and going to clubs, I like going swimming, having picnics and going to clubs. Relatives felt that this aspect of care was good and said, The staff ensure that our [relative] has a varied and full life, X decides what they want to do i.e. sports, social and leisure activities. X is encouraged in their interests but not coerced into doing anything they dont want to. It truly is their home. I am very happy with all the activities available to my [relative], and, Since my [relative] has been at Cedar Lodge they have had a much better quality of life, and seem happy there. People living at Cedar Lodge enjoy trips out to places like London zoo and holidays. A recent holiday to Yarmouth was enjoyed by all. One person said that they, Liked getting their feet wet in the sea. Most people living at Cedar Lodge have families who are involved with their ongoing care and wellbeing. Some residents go to stay with their parents for regular weekends. Friendships are supported by the home and residents are helped to visit people close to them. Families felt welcomed in the home. We are always welcomed into the home - X regards Cedar Lodge as their home. Discussion and information such as risk assessments showed that people are encouraged to be independent and take responsibility. Each person has a day each week when they help to change their bed, clean their room and so on. People are helped to choose and make their own packed lunches and assist with cooking when appropriate. Staff interacted well with residents during the day. Staff showed that they were sensitive to when people might want time alone. When this happened people were assisted to, and settled in their rooms. Menus are planned on a weekly basis in discussion with residents. Menus viewed and records of what people had eaten showed that a range of different foods are offered. Fresh fruit was readily available. People living at Cedar Lodge enjoy eating out and having barbecues. Favourite takeaway menus were on the residents notice board. People said, Good food, and, I had a nice lunch. Care Homes for Adults (18-65 years) Page 19 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. People receive good personal and health care support to meet their individual needs. Evidence: People living at Cedar Lodge benefit from being looked after by a team of staff who have mostly worked at the home for some time. Staff know the residents very well and support them in maintaining their preferred routines and style. This is supported by a good key worker system and care planning. People living at Cedar Lodge said, I like living at Cedar Lodge, and I am happy. All looked relaxed and comfortable and had an easy and friendly relationship with staff. Relatives felt that residents receive good care: Medical, dental, chiropody needs are all taken care of, Very vigilant - notices any changes and acts on them. I was very impressed, when it became necessary for my [relative], how Cedar Lodge pulled together all necessary services and how they worked as a team to provide the best solutions were some of the comments made. People living at Cedar Lodge can feel very confident that all their health care needs will be well catered for. Records viewed showed that people access good health care support to meet their varied needs. A range of different professionals are involved in individual residents ongoing care including doctors, chiropodist, optician, dentist pharmacist, and specialists relevant to individual needs. As indicated by relatives comments, because the home is small and the residents very well known by staff, any concerns or changes are quickly picked up and appropriate actions taken. Peoples Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: weight is also monitored so any changes can be noted and actions taken as necessary. As well as information in care planning each person has a Health Information file in place. These are small ring binders that contain all relevant heath and other details about the person. Detailed records are kept of all appointments and health related contacts. Any changes, follow up, or actions required are carefully noted. The AQAA said, and it was demonstrated at the site visit that, The home has built up an excellent relationship with the local doctors surgery and receives very good treatment and quick advice in the event of a health issue. Training records viewed showed that across the staff team people have undertaken relevant training to support the needs of residents such as epilepsy, nutritional assessment and dementia. No one living at Cedar Lodge is able to manage their own medication. We looked at systems in place to ensure that this aspect of their care is managed safely. We saw that each resident has their own section in the medication folder that included a photograph, details of their medication, administration records and other information. No errors or shortfalls were noted in the system. To ensure that good standards are maintained we saw that medication is audited between each shift. The manager described good practice in medication administration ensuring residents safety and privacy. Staff training records showed that staff had received training in the safe handling of medicines, but that this dated from some time ago such as 2004 and 2005. As there is a long gap between formal training, it would be advisable for a system recording that peoples ongoing competence is monitored and assessed to be introduced. We saw that information and procedures were in place to guide staff practice. The manager explained that the pharmacy providing a service to the home were planning to come and undertake staff training. The manager has also recently undertaken Skills for Care training to enable them to deliver medication training in house. This is also planned. Care Homes for Adults (18-65 years) Page 21 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 are cared for safely through practice in the home Evidence: There is a clear complaints procedure in place. This is available in an easy read format to assist peoples understanding. No complaints have been received by the home since the previous inspection. No concerns or complaints have been raised with us, (CQC.) On surveys residents said that they knew who to talk to if they were not happy. Relatives mostly said that they were aware of how to make a complaint or raise concerns, although some could not remember. People said, Any concerns I may have usually already been spotted and dealt with, and, I have always found the staff at Cedar Lodge very approachable on any subject concerning my [relative], whether real issues or just questions asked on my own behalf. No safeguarding concerns have been raised at Cedar Lodge. The manager has completed a Safeguarding for Managers course so is aware of current procedures and practice. Training records showed us that staff have received training in safeguarding vulnerable adults. Again though for some staff this was as long ago as 2004 or 2005. However the AQAA said, The local SETSAF guidelines have been disseminated down to the staff team. These are kept in the office at all times for staff to refer to. The manager said that they have just completed training to enable them to deliver further safeguarding training in house. Local guidelines and procedures were available. A flow chart of procedures and actions needed was on display in the office. We saw that the home has recently received a Staff Safeguarding Handbook provided by the local authority. This had clear details of contact information so that staff would know where and how to report any concerns. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Some people living at Cedar Lodge have the potential for behaviours that may challenge staff we saw that very clear guidelines were available to staff on how to manage individual behaviours. This would ensure that people receive a calm and consistent approach. Care Homes for Adults (18-65 years) Page 23 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. People live in a pleasant and clean home Evidence: Cedar lodge provides comfortable and homely communal accommodation for people. There is a large kitchen, dining room and comfortable lounge area. There is a pleasant courtyard garden area with seating for people to enjoy. Residents showed us some of the garden ornaments that they had made in their ceramics class, and the vegetables that they have enjoyed growing this year. The home is set within the local community with public transport and other facilities close by. In the last year works have been undertaken within the property to accommodate residents increasing needs. A downstairs bathroom has been extended and a walk in bath installed. The local occupational therapy team have assessed needs at the home, and grab rails have been installed where needed. Some areas such as the dining room have been refurbished. Some new equipment has been provided in the kitchen. This shows that the provider has a good approach to ongoing works and renewal to ensure that the home is pleasant and able to meet peoples changing needs. Bedrooms are available on both the ground and first floors. No lift is available so people with bedrooms on the first floor need to be able to negotiate stairs. Everyone has their own bedroom. Peoples rooms were individually furnished and decorated, and reflected their own tastes. Residents spoken with said that they liked their rooms. At the site visit the home appeared clean and there were no offensive odours. A Small Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: but adequate laundry area is available. The home employ a cleaner for 20 hours each week. We saw that the home has a very thorough approach to keeping the home clean and hygienic. Cleaning schedules were in place to ensure that regular cleaning and deep cleaning take place on a regular rotational basis. Training records indicated that most staff have undertaken training in infection control. This was 2005 and 2006, so staff may benefit from refresher training. A relative said, The house is always clean and tidy. Xs privacy in their room is respected. Care Homes for Adults (18-65 years) Page 25 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 looked after by caring and well trained staff. Evidence: During the day we saw that staff had a very good understanding of peoples needs, and worked with them in a kind, caring and friendly manner. Staff at the home have mostly worked there for a number of years and know the residents very well. There is a very low staff turnover. Since the previous inspection only one member of staff has left. Agency staff are not used at Cedar Lodge. The only way the home feel they would like to improve is to have one or more male staff. At the moment the staff group is all female which does not give residents a choice of gender in attending to their needs. Five staff surveys received showed that staff are generally positive about their role and felt that there was good teamwork. They said, It is a very nice place to work. The staff get on well and the service users are happy, and, All the team work well together. On surveys relatives felt that staff had the right skills for the job. They said that, The staff are always kind and helpful, and, Staff are always pleasant. The home have achieved a good level of staff attaining National Vocational Qualifications (NVQ) in care. Out of ten support staff eight have achieved NVQ at level two or above. This shows that the provider is committed to having a well trained workforce. There are always two support staff on duty during the day and one person sleeping in at night. During weekdays from 09.00 to 16.00 an additional member of staff works as day service support assisted by one of the regular support workers on duty. Even if everyone is out there is always a member of staff left in the home and available to Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: answer the phone or deal with any situation. The manager works part time hours and is supernumerary. The assistant manager also has some supernumerary hours to attend to administrative and supervisory tasks. A cleaner is employed for twenty hours each week. These arrangements seem to provide sufficient staffing cover to meet peoples current needs. The manager indicated that staffing levels remained flexible. The AQAA said, The philosophy of the home has changed slightly over the past year as it has become apparent that the service users are aging and slowing down. Activities are more tailored to the service user and if necessary extra staffing brought in so that choices can be respected. Not everyone still wants to go out to discos anymore! Only one member of staff has been recruited since the previous inspection. We looked at their file to see that good recruitment procedures that protect residents are maintained. We saw that all appropriate checks such as POVA first, references, identification and Criminal Records Bureau, (CRB,) checks had been undertaken. A relative said, Their recruitment of carers is careful which leads to a high standard of care. On the AQAA the manager said that since the previous inspection all staffs CRB checks had been renewed for good practice. Records viewed showed that the new member of staff, with no previous experience in care, had completed a basic initial induction into the home. A Skills for Care induction pack was on file but had not yet been commenced. No core training had yet been undertaken but the manager confirmed that this was planned. Planned training included user led training called Learning from me. Staff had individual training profiles in place and a training matrix was available. This showed future planned training. Another matrix showed additional training undertaken by staff. This indicated that some staff have undertaken recent training in relevant areas such as personal care planning with dementia and dual diagnosis. The home were proactive in seeking relevant dementia training so that staff could understand and meet the needs of one particular resident. Other areas of training, as identified in other parts of the report, could be improved through the provision of regular refresher training. The manager is a qualified teacher and as previously stated is undertaking Skills for Care training to be able to deliver some subjects on an in house basis. We did not view supervision records in detail, but a timetable a timetable in place and discussion with the manager showed that staff receive regular supervision and support. A member of staff said, We all get supervision every other month, but if there is a need it could be done sooner than that. Staff meetings are done every month where we discuss any issues concerning clients, the way we work or any problems. Minutes viewed that regular staff meetings take place for staff and management to discuss any relevant issues and plan future developments. Care Homes for Adults (18-65 years) Page 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home where their views are sought and listened to. Evidence: Cedar Lodge is a family owned and managed home. The person managing the home competently and effectively on a day to day basis as the manager is a family member. They are also a director of the Company and the responsible individual for the service. The manager works part time hours supported by a full time competent assistant manager. The manager has a range of qualifications and is currently undertaking their Leadership and Management Award. Discussions have taken place regarding establishing a registered manager at the home. Staff were positive about the management of the home and felt that, The home is in good hands. The manager works well with all the service users and staff. Relatives clearly feel that the home is well managed and on surveys there were several comments such as, We cant imagine how Cedar could do better, and, Its difficult to suggest any improvements they could make. On the day of the site visit everything needed to carry out the inspection was readily available. All records and documentation were well organised. The manager had a clear understanding of the business, a clear vision for the service, and a clear aim to promote residents rights, choices and social inclusion. The AQAA identified different ways in which people are consulted about the service Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: through meetings, reviews, one to one discussions on a daily basis and so on. We saw that a Quality Management Plan was in place for 2009. This indicated that the monitoring of the service and ongoing development are a continual process. No health and safety issues were highlighted during the site visit. One relative said that the home were, Very safety aware. The AQAA and records seen during the inspection identified that systems and services are checked and maintained on a regular basis. We saw that any accidents are well recorded and appropriate actions taken. Fire records viewed were well maintained. We saw that regular fire drills take place and a fire risk assessment was in place. A recent fire service visit in March this year had highlighted no concerns. A visit from an environmental health officer in August 2007 had found good standards maintained and awarded the home four stars for very good standards. At the site visit the kitchen was clean and well organised. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes  No  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 30 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 Description 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 Description 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 Care Homes for Adults (18-65 years) Page 31 of 32 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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