Inspection on 20/05/08 for Cedar Avenue

This inspection was carried out on 20th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cedar Avenue 23/05/07

Cedar Avenue 11/10/06

Cedar Avenue 10/02/06

Cedar Avenue 18/07/05

Cedar Avenue 10/03/05

Cedar Avenue 29/06/04

Cedar Avenue 23/02/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

CARE HOME ADULTS 18-65 Cedar Avenue 5 Cedar Avenue Edgerton Huddersfield West Yorkshire HD1 5QH Lead Inspector Cathy Howarth Key Unannounced Inspection 20th and 24 June 2008 09:00 Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 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 Ms Leanne Victoria Joseph Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2007 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 purpose-built bungalow style accommodation is located in a residential setting within walking distance of Huddersfield town centre and local amenities. There is car parking available. 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. The Commission were informed that as at 18.08.08 the weekly fee was £1744.80 per week. Information about the home in the form of a Service User’s Guide and Statement of Purpose, together with the most recent Commission for Social Care Inspection report are available at the home. Inspection reports are also available at www.csci.org.uk Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was carried out by one inspector, over two visits to the home. We used information supplied by the manager in the form of an Annual Quality Assurance Assessment and a dataset of information. We also sent surveys to people who live there and staff working at the home. Two people returned their completed (supported by staff) surveys and no staff returned surveys. During the visit to the home we observed practice, talked with staff and the manager and carried out a tour of the home. We found that there have been several areas of improvement since the last inspection and some very good practice was seen for example good relationships between people who live there and staff were observed, However we found that in some very important areas people did not receive the high quality of service they should expect. The inspector would like to thank all the people living and working at Cedar Avenue for their welcome and cooperation during this inspection. What the service does well: There are positive relationships between people living at Cedar Avenue and the staff that work there permanently. People who live at Cedar Avenue have a good range of opportunities for social life and for leisure and holidays. Staff treat the individuals living there with respect and dignity. The environment is generally pleasant and homely. People’s individual rooms are personalised and equipped with appropriate aids and adaptations. People’s personal and health care needs are generally met in a way that respects their choices and preferences. Staff work hard to develop communication with people that live at Cedar Avenue. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 6 Staff recruitment systems are robust to make sure as far as possible, that people employed to work there are not unsuitable to work with vulnerable people. What has improved since the last inspection? What they could do better: The systems for managing medicines must be improved for the benefit of people who live there. People who live at Cedar Avenue need to be listened to very carefully including by observing them, and any concerns should be followed up without delay to make sure they are safe from harm. Bathroom and laundry areas need essential repairs to prevent spread of infection. All staff should have practiced what to do in the event of a fire so that they can keep people safe. Information about people ‘s needs should be more easily accessible to agency and new staff so that people can receive the care they need. Staff need to communicate better to make sure that people’s health needs are met. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 7 Staff training needs to be better managed so that all staff have the necessary knowledge and skills to care for the people living at Cedar Avenue. The staff team would benefit from a development plan for how they are to meet the aspirations of the people living there. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 8 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.V364915.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): No judgement has been made in respect of this area. The key standard could not be assessed at this visit, as there have been no new admissions to the home since the last inspection. EVIDENCE: There have been no new admissions since the last inspection. There are no plans for any new admissions in the future. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use services experience good quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People’s individual needs are met and they are supported to take appropriate risks. EVIDENCE: Documentation relating two people living at Cedar Ave was looked at in detail. There are detailed support plans to address people’s individual needs and these cover social and emotional needs as well as physical needs. There was evidence of some positive work to help develop communication with individuals who do not have verbal skills, for example staff have been noting down reactions in certain circumstances to help build a picture of a person’s way of expressing their views. The plans are detailed and guidance for each issue is filed separately within the personal files. This makes it quite difficult to access the information quickly. Given that agency staff are currently being used on a regular basis, it was Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 11 recommended that a short profile for each person is available so that these staff can quickly gain a picture of the important aspects of each person’s needs. The manager indicated that she was already working on this. Permanent staff, that were working during the visits, demonstrated a good understanding of individuals and their particular needs and preferences. Observations and records indicated that individuals receive sensitive and flexible personal support to maximise their privacy, dignity, independence and control over their lives. Daily records for each person follow a structure that is designed to help staff record the information that is important for each individual, relating to health needs for example, such as food intake and elimination, and also social development. Each person has risk assessments on file relating to issues that are relevant to them. These were generally found to be detailed, and geared towards enabling people to participate in activities they choose to do and to live their lives to the full. Some of the risk assessments appeared unnecessary as they repeat information which is in the support plans and are merely reflecting needs that people have, for example one person had a risk assessment around communication. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15,16 and 17 People who use services experience good quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People living at Cedar Avenue have good opportunities for personal development and to have good social relationships. EVIDENCE: Overall it was seen that there was a commitment to ensuring that people living at Cedar Ave have access to a good range of opportunities to engage with the local community and to follow their particular interests and meet their cultural needs. Each person has a weekly timetable of activities and staff are rostered daily to be responsible for meeting those goals. It was seen that staffing problems could interrupt this at times. On the first visit of this inspection, one person could not go to day centre and another could not go to meet their relative in town as planned because no staff were available to escort them. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 13 All people living at Cedar Ave have access to holidays. One person went Blackpool for the weekend while their room was redecorated. Last year another person went to Lanzarote supported by staff. Recent trips out have included a trip to the Chinese circus. There is a good range of in house activities and décor/sensory equipment available for people and the home has Sky TV so that people can have music channels on which some people like. Two people are Muslims and are supported to celebrate religious festivals and attend mosque if they wish to. One person has a CD with the Koran on to listen to. There was evidence of good relationships with families and promoting relationships outside the home. One person has re-established contact with a parent after many years with little contact. They now meet regularly. This is positive and a credit to staff. All the people living at Cedar Ave attend day centres several days a week. Staff indicated that they felt that sometimes they derived little benefit form this. One person certainly expresses a clear dissatisfaction with this according to staff by becoming distressed and self-harming when he goes there. People living at Cedar Ave are involved in the preparation of food and in shopping for food. Two people are Muslim and they have a halal diet. One person no longer has solid food but takes nourishment via a PEG tube. Staff handle this sensitively. One mealtime was observed and this was a relaxed affair with staff sitting around sharing food with people who live there. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use services experience poor quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People using the service are supported in ways they prefer, that respect their dignity. Health care support is generally good but there are some areas for improvement. The management of medicines is poor. EVIDENCE: The support plans for people indicate that there is great deal of concern to ensure that people get the support they need in a way they prefer and staff take the trouble to write small details about individuals so that others know how to support them with respect for their preferences and dignity. Support with health care is generally good. Daily notes system helps with this as demands people to make clear note of certain important aspects of health such as how much food people have had. Short-term care plans, were not found to be reflected in daily notes so that it is clear what progress or changes have occurred. For example, one person had soreness on the groin area, Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 15 which had been seen by the GP and a prescription for cream given but it was hard to discover if this had improved, as the daily notes did not refer to it. At the time of this visit one person was experiencing difficulties because of severe constipation. Although staff have generally recorded information relating to this, they failed to act quickly enough before the situation became very severe. District nurses had to intervene to provide relief for this person. Medication needs attention as a whole area. The home has had problems with ordering and maintaining stocks of medication for some people. One person went without Ibuprofen pain relief from 6 – 10 June because of stocks running out and not being replaced. In part this may be due to the fact that the role is shared amongst the whole team so no one person has an overview, and consistency in ordering becomes difficult. Also stock control systems were confusing and information hand written on Medication Administration Record (MAR) was misleading. For example for one person it was recorded that there were 18 sachets of Movicol at the start of the month. 9 sachets had been recorded as given but there were still 18 sachets in the box. Some medicines were found to be not given as directed. One person’s MAR for example directed that they should be given Senna if they did not have a bowel movement for 3 days, then Movicol if they had no movements for 4 days. The monthly chart indicated however that there was no movement from 31/5/08 to 8/6/08. No Senna was given after three days and staff did not start giving Movicol until 6/6/08. The home’s CD register was seen and was found to a source of confusion. Some medicines were logged in here that should not be recorded as controlled drugs, such as Epilim. Buccal Midazolam is prescribed for some individuals to control seizures in an emergency, but at the time of this visit it was not being taken out of the building, which means that if people have a seizure out of the home, they may need to be taken to hospital. Giving this medicine could prevent this. The issue was raised in previous team meetings and staff instructed to do this but this was still not happening. Staff indicated concerns about it being a controlled drug, but this is not relevant, as the regulations do not require safe custody of this particular medicine. The home does have a procedure for booking any medicines booked in and out and this would be appropriate to use. Although one person is designated on each shift to give medicines and this is shown on the rota. The keys were not being held by this person and were freely available to any staff in the key cupboard. Safe practice would be for the designated person to hold these keys separately and hand them over only Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 16 to the next designated person on shift. Meds cupboard keys need to be held by one person. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use services experience poor quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People living at Cedar Avenue are not adequately safeguarded from abuse. EVIDENCE: There is a complaints procedure and this is available in a pictorial format for people to understand better. It is a moot point whether the people currently living at Cedar Ave have the understanding of this. It is difficult to know exactly how they would be able to access this system without support. The use of advocates for some individuals was recommended at the last inspection but this has not been taken up. This is recommended once again in this report. No complaints have been made in the last year. There has been one safeguarding referral made in the last year, regarding some money, which went missing. This was responded to appropriately. The inspector did have some concerns however about the way in which some issues are responded to in the home. For example one person has continuously displayed self-harming behaviour at his day placement. This was noted and addressed at a meeting in Nov 07 and it was suggested that detailed observations were to be made and the issue addressed. However, the behaviour as still reported by staff as being of concern and consistently upsetting. Given that this person has limited means of expressing his views about things, this should have been addressed more urgently. The inspector Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 18 made a safeguarding referral following this inspection. Other areas of concern were about the follow up of reports by staff of bruising to individuals. One person recently had bruising that looked like finger marks to upper arms. Staff did a body map and reported the bruising, as they are required to. However the follow up to this and other similar incidents is unclear. Such reports must be followed up immediately and treated as a safeguarding issue. The people living at Cedar Avenue are extremely vulnerable and it is only non-verbal clues that can indicate that they may be being harmed. No copy of the local safeguarding procedures was available in the home, although staff that spoke with the inspector were clear about what they would do and indeed have reported issues initially. United Response has given training to all permanent staff around safeguarding individuals. At the last inspection it was required that the staffing complement was adequate to meet people’s needs because of the risk to individuals of having numerous individuals involved with personal care. Staff told the inspector that permanent staff always work with agency or relief staff to ensure that unknown people are not left alone with people who live at Cedar Ave. This is an improvement. Individuals who have behaviours that may put themselves or other at risk have support plans to guide staff in how to respond to this. This appears to be successful on the whole and there are relatively few incidents of aggression or self-harm. Finances for individuals were examined. Staff balance monies at each handover and receipts are obtained for all purchases where possible. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use services experience good quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The environment at Cedar Ave is homely and pleasant, reflecting people’s interests and needs. Improvements have been made since the last inspection. EVIDENCE: The environment at Cedar Ave is generally good. Bedrooms reflect the individuals’ personalities, and communal areas were found to be homely and clean. Several bedrooms have been redecorated; in fact one was decorated over the weekend between the inspector’s two visits. Since the last visit the garden has been tidied up and tubs planted up with tomatoes and strawberries so that people can enjoy produce from the garden. The garden shed is now also in use as a sensory area. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 20 Some repairs are still needed in bathrooms. There are repairs needed to fittings where there are exposed areas of wood, and broken seals that could harbour infection. This was identified as a priority at the last inspection and remains a risk to people living at Cedar Avenue. This requirement is outstanding. The corridor area is bland and the recent addition of a poster about the landlord services detracts from the overall homeliness in this area. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 35 and 36 People who use services experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The system for recruitment of staff is robust to make sure people are not unsuitable to work with vulnerable people. The core of the staff team is good but training needs to be better managed and the reliance on agency/relief workers has a negative impact on the quality of the service to people who live there. EVIDENCE: The home is still using agency staff. On both visits by the inspector, there were staff on duty that had not worked with people at Cedar Ave before. The staff rota shows that where possible consistent agency/relief staff are used. . On the first day of this inspection however, one person missed their usual day placement because of staff problems and another had to have a visit at home with their relative rather than going out to town with them, because staff were not available to accompany them. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 22 The manager said recruitment was being done and one person had started work that week. There is a good mix of female and male staff to support people living there, which is positive, as there are two male and two females living there. There are few Asian staff however, and as two people are from Asian backgrounds this could be an area to actively address through recruitment. Staff access to training is good generally and the home has now passed the 50 qualified NVQ staff. Staff also have access to United Response’s ongoing training for staff, which covers a wide range of relevant subject areas such as epilepsy, communication, challenging behaviour and First Aid. Some staff may need updates in certain areas and the systems to track this are not in place, for example about half the staff have not had training prevention from harm (safeguarding) since 2006. Also, training in handling medication needs updating for some staff, especially given the issues noted in the section of this report relating to this. Records show that only 4 staff have had training in this since 2006. One person appears not to have had this at all and several have not received training since 2003/4. The staff training profile needs to be reviewed to make sure training updates cover all staff. It was noted that training was identified on the staff rota so that staff would not forget this. Staff are paid to attend training. Recruitment of new staff is good. The process is robust with all checks being carried out before people start working with the people at Cedar Avenue. Since the last inspection the checks for agency staff have been verified. Agencies now submit a checklist to the manager in advance so that they know that checks have been done on anyone coming to the home. Criminal Records Bureau disclosures are not checked when agency workers come to the home however. It was recommended that these are checked when staff first attend and this is logged on the checklist sheet from the agency. Supervision is good, most staff get the opportunity on a monthly basis to discuss issues and have personal development sessions with the manager. Staff meetings are held 2 monthly so that all staff can meet and discuss relevant issues and plan ahead. Staff said they find these support sessions useful. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use services experience poor quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Management systems are not sufficiently robust in some key areas to ensure people are safely cared for by skilled and competent staff. EVIDENCE: The manager told us she has completed her NVQ4 in management since the last inspection. She is now awaiting confirmation that she has passed. As detailed in the previous section, the management of training for staff needs to be better, to track updates and to identify when staff have not done the required training. This is to make sure that the overall skills level within the team remains high to meet the needs of the people living there. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 24 The management systems also need to be better in relation to important areas identified within this report; the management of medication and of safeguarding issues at this time did not have a sufficiently robust approach to make sure that the welfare of people living at Cedar Avenue is protected. United Response has a corporate approach to quality monitoring and management visits take place regularly and actions are identified following these visits. United Response’s Huddersfield and Halifax Network, of which Cedar Ave is a part, has a clear plan for development of the service to meet the needs and aspirations of people using the services. This is very clear and identifies good indicators of how it will succeed. What is less clear is how this is distilled into a plan for Cedar Avenue. No specific team plan for achieving the goals within this setting is in place. From discussion with the manager, however, it is clear that there is commitment to improving the service to people who live there. . Health and safety issues are generally managed well within the service. Regular safety checks are carried out and routine maintenance checks had been completed for lifting equipment used by people living at Cedar Ave. Fire safety checks and drills have been carried out. However it was required at the last inspection that a record of staff participation was kept so that their training could be monitored to ensure all staff participate at least twice a year. This system has been put in place but staff have not achieved the twice a year target. It was seen that five staff have not yet participated in one drill. This requirement is repeated, as it is vital that all staff have practiced what to do to keep people safe should a fire break out. Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 25 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 N/A 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 3 32 X 33 2 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 2 X X 2 X Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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) • Timescale for action Adequate arrangements must 22/09/08 be made for the safe & secure handling, administration & recording of all medicines in the home, and in particular… 1. Ordering systems must be managed better to make sure that people always have stocks of prescribed medicines. 2. Stock control must be improved so that accurate balances of medicines can be identified and checked. 3. Medicines must always be given as directed by the GP to ensure that people receive the treatment they are supposed to receive. 4. There must be a safe procedure so that people can have access to Buccal Midazolam as directed by GPs, including when they are away from Cedar Ave, so that they can receive this if required, and possibly avoid an unnecessary hospital Version 5.2 Page 27 Requirement Cedar Avenue DS0000026335.V364915.R01.S.doc 2 YA23 13(6) 3 YA30 13(3) 4 YA42 23 (4) admission 5. The person on each shift who is designated to give medicines must be the only one to have access to the keys to ensure accountability and avoid mistakes being made with people’s medicines. Any concerns about individuals’ welfare must be responded to without delay following local safeguarding procedures without delay. Appropriate repairs and replacements should be made to bathroom and laundry areas to ensure infection can be controlled. This requirement has been brought forward. Original timescale of 31/05/07 The registered person must implement a system to ensure that all staff working at the home participate in a drill at least twice a year so that they are familiar with the procedure should a fire break out. This requirement has been brought forward. Original timescale of 30/06/07 24/06/08 30/09/08 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA19 Good Practice Recommendations There should be a short summary of people’s needs available to ensure that agency or new staff can become quickly familiar with people’s main areas of need. Short-term care plans should be tracked in daily records to make sure that people’s progress is communicated to all DS0000026335.V364915.R01.S.doc Version 5.2 Page 28 Cedar Avenue 3 4 5 6 YA20 YA22 YA23 YA33 staff. Any medicines logged in the Controlled Drugs register should be controlled drugs. People living at Cedar Avenue would benefit from the services of advocates to help give them an independent voice. The home should have a copy of local safeguarding procedures for staff reference. The management of staff training needs to improve to ensure that all staff are up to date with key skills and knowledge and have not missed any essential areas of training so that all staff have the skills to meet people’s needs. There should be a plan specific to the home, to address developing the service, in line with the stated aims of the wider organisation, to meet the aspirations of people living there. Management systems need to be improved to improve key areas of practice such as management of medication and responding to safeguarding. 7 YA39 8 YA37 Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedar Avenue DS0000026335.V364915.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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