CARE HOME ADULTS 18-65
Cedar Avenue 5 Cedar Avenue Edgerton Huddersfield West Yorkshire HD1 5QH Lead Inspector
Jacinta Lockwood Unannounced Inspection 10th February 2006 10:05 Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 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 Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 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. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cedar Avenue Address 5 Cedar Avenue Edgerton Huddersfield West Yorkshire HD1 5QH 01484 530300 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) None United Response Mrs Deborah Newton Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th July 2005 Brief Description of the Service: Cedar Avenue is registered to provide personal care and accommodation for up to four male and female adults aged 18-65 with a learning disability and physical disability. The registered provider is United Response.The purposebuilt bungalow style accommodation is located in a residential setting within walking distance of Huddersfield town centre and local amenities.There is car parking available and the home has its own transport.The home is staffed twenty-four hours a day and there is one wakeful night staff member and one member of staff sleeping in on the premises. An on-call system is also in operation. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out an unannounced inspection of 5 Cedar Avenue on 10.02.06. The inspection lasted approximately 2.10 A range of inspection methods were used, including contact with a service user, observation, discussion with staff and management; inspection of a sample of records including service user plans, medication, monies, staff training and recruitment records, health and safety records, a tour of the premises. The inspector would like to thank service users and staff for their time and hospitality throughout the inspection. What the service does well:
Care is provided to service users in a person centred way taking account of their individual needs and aspirations. One example of this is that a support worker is making observations and working with a service user, on a one-toone basis, so that the service user’s cultural and spiritual needs can be more fully met. Staff working at the home reflect the cultural diversity of service users. Staff work in a multi-disciplinary way to ensure that service users’ health and welfare needs are met. Robust recruitment practices ensure that only staff who are suitable to work with vulnerable adults are employed. Staff are well trained, highly motivated and committed to providing individualised, person centred care to service users. They have a good understanding of service users’ needs. Staff are well supported by the home’s management and the organisation. Those staff spoken with commented positively on this. The inspector was informed that, where agency staff are used, they undergo United Response’s induction programme before they begin working and that the same agency staff are used to provide continuity to service users. The environment is suited to the service users’ needs and appropriate equipment is available to support service users and assist staff. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 6 Service users are supported to be a part of the local community and to use local facilities and public transport. 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.
Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 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 Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Service users’ assessed and changing needs are reflected in individual plans of care and support. EVIDENCE: Care records of two service users were inspected. These contained a good level of detail regarding service users’ support needs and assessment of risk. They had been kept under review and updated as necessary. It was evident from records and discussion with staff that they follow up any concerns and involve healthcare professionals when necessary. There were some gaps in recording on the daily records and staff did not always sign entries. Care should be taken in this area, so that full records are maintained. Staff spoken with had a good understanding of service users’ needs. And were observed to interact with a service user in a positive and supportive manner. There was evidence from reading a service user’s care plan and through observation that staff were following the plan.
Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 Service users’ physical and emotional healthcare needs are met. Service users’ medication is generally well managed by staff at the home. EVIDENCE: It was evident from records, observation and discussion with staff that service users’ needs are met at the home. Service users also access day care and other services in the wider community. Service users’ needs are kept under review and relevant professionals are involved as required. This was evident on the day of the inspection, when a healthcare professional was involved in a service user’s review of need. From records and discussion with one of the registered managers, it was evident that a healthcare professional was due to review the management of service users’ epilepsy. A previous recommendation regarding completion of the rectal diazepam authorisation sheet had not been fully addressed. The recommendation is carried forward. Owing to the high dependency needs of service users at the home, staff administer medication. Medication is generally well managed at the home, but there were some gaps in signing the medicines administration record. Care needs to be taken in this area.
Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users are protected from abuse, neglect and self-harm. EVIDENCE: The home has a whistle blowing and adult protection policy and procedure. It was evident from records and discussion with staff that they receive relevant training in adult protection. A booklet entitled “No More Abuse” was available and can be provided to service users in a format suited to their needs. Two samples of service users’ monies were checked and easily reconciled with records held. Previous requirements and recommendations in this area have been addressed. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 In general, Cedar Avenue provides a comfortable, homely and safe environment for service users. Planned redecoration works will enhance the environment for service users. The home is clean and hygienic. EVIDENCE: Standard 24 was only inspected to follow up a previous recommendation, elements of which have been addressed. Some areas are still outstanding and a recommendation is carried forward. For example, the shower head needs attaching to the wall in one bathroom and water damaged flooring in the hallway needs repairing. Internally, the home is showing signs of wear and tear with chipped paintwork and damaged furniture. The registered manager on duty explained that redecoration work is to start and that some new floor covering is to be installed in the near future. A fire officer recently visited the home and identified some areas of maintenance. Confirmation has been received from the service provider and a manager of the home, that action is being taken to address this. A requirement has been made regarding fire doors at the home, some of which require maintenance to ensure that they close into the frame. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 14 It is positive to note that an overhead tracking system has been installed in the bathroom adjoining two bedrooms. This has benefits for the service users concerned, as it means they are involved in fewer transfers using moving and handling equipment. The home was clean and hygienic. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 Appropriately trained staff meet service users’ individual and joint needs. Service users are supported and protected by the home’s recruitment practice. EVIDENCE: It was evident from talking to staff that they are enthusiastic, well motivated and committed to providing person centred care to service users. The inspector spoke with four members of staff. They reported feeling well supported by management and the organisation. They spoke highly of the training provided and of team working at the home. Comments such as “I love working here”; “Service users come first” and “The service is focussed on service users” were made during discussion with the inspector. Staff receive a thorough induction before they begin to work with service users. It was evident from discussion with staff and records inspected that the recruitment process is thorough and protects service users. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 The home is run in the best interests of service users. The health, safety and welfare of service users are promoted and protected. EVIDENCE: Monthly audits of the service are carried out by the organisation and an annual review is also conducted to ensure that the home is run in the best interests of service users. An annual report, dated 14.02.05, based on a specific assessment and routine visits conducted throughout the year, has been provided to the Commission and includes contributions from the parents of service users. Health and safety checks are carried out. And previous requirements and recommendations regarding health and safety issues have been addressed. Although water at the point of delivery should not exceed 43 degrees Celsius, so as to prevent a risk of scalding during whole body immersion, bath temperature records show a temperature range of between 31-39 degrees Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 17 Celsius. Appropriate advice should be sought regarding this, as bath water temperatures appear low at times. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 18 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 X 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 X 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X X X 3 X X 3 X Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 19 No 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 YA20 Regulation 13(2) Requirement The medicines administration record must be completed whenever medication is administered to a service user, so that there are no gaps in recording. (Timescales of 17.11.04 and 31.08.05 not met). Maintenance work must be carried out to fire doors so that they all close into the frame as noted in the fire officer’s report dated 26.01.06. Timescale for action 10/02/06 2 YA24 23(4) 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The homes service users guide and statement of purpose should be in a format accessible to those for whom the service is intended. (Standard not assessed on this occasion.) Service users’ daily records should be fully completed and signed by staff.
DS0000026335.V266465.R01.S.doc Version 5.1 Page 20 2. YA6 Cedar Avenue 3. 4. YA20 YA23 5. YA24 6. 7. YA32 YA35 The registered person should ensure that staff authorised to administer rectal diazepam signed the GP authorisation sheet. (This recommendation is brought forward.) An in-house procedure for current practice in relation to the handling of service users monies and valuables should be available to staff and for inspection purposes. (This recommendation is brought forward.) Outstanding maintenance issues should be addressed, for example, the shower head should be attached to the wall; the bar under the frame to a wheelchair should be secured; water damaged flooring in the hallway should be repaired or replaced. (This recommendation is brought forward.) 50 of care staff should achieve NVQ level 2 training or equivalent by 31.12.05. Standard not assessed on this occasion. Disabled trainers should provide disability equality training to staff. This recommendation is brought forward. Cedar Avenue DS0000026335.V266465.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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