Inspection on 15/03/06 for Cedar Gardens

This inspection was carried out on 15th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cedar Gardens 30/01/09

Cedar Gardens 16/01/08

Cedar Gardens 05/02/07

Cedar Gardens 25/10/05

Cedar Gardens 11/02/05

Cedar Gardens 04/10/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Cedar Gardens 122a Bromyard Road St John`s Worcester Worcestershire WR2 5DJ Lead Inspector P Wells Unannounced Inspection 15 & 16 March 2006 17:45 th th Cedar Gardens DS0000018639.V286433.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 Gardens DS0000018639.V286433.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 Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cedar Gardens Address 122a Bromyard Road St John`s Worcester Worcestershire WR2 5DJ 01905 421358 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) Mr Nigel Hooper Mrs Carole Ann Green Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2005 Brief Description of the Service: The home is a large detached house on the west side of Worcester. Locally there are shops, a pub and a bus route into Worcester city. There are four single bedrooms and one double bedroom with suitable communal rooms. The service users have mild to moderate learning disabilities, who require advice and support rather than assistance with personal care. Mr Nigel Hooper is the registered provider. The registered manager is Mrs Carole Green. The main purpose of the home is to provide a permanent, homely environment encouraging service users to be involved in household tasks. Mr Hooper also operates a second care home next-door and supported living accommodation in the area. The staffing for the supported living houses are on the Cedar Gardens roster. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection on the afternoon of 15th March 2006. On arrival at 3.00 pm there was no one in at Cedar Gardens. Therefore the inspector visited the home later. The manager was at Phoenix House. Time was spent with the manager, service users, the two members of staff on duty and reading documentation. The inspection was completed with the registered provider, Nigel Hooper and manager, Carole Green on the morning of 16th March 2006. Prior to the inspection the inspector read the pre inspection questionnaire completed by the manager. Cedar Gardens is the sister home to Phoenix House, which is next door. The services are managed similarly with many of the activities arranged jointly. This report to be read alongside the last report. The registered provider and managers were working together to develop the services to meet the National Minimum Standards. The inspector appreciated the co-operation and time of the service users, staff manager and provider. What the service does well: The service provides a permanent, secure, safe home for up to six adults. It is homely with a relaxed, friendly atmosphere. The service users are supported by a staff group that know their individual needs. Many of the staff have worked at the home for some years. The service users have the opportunity to attend regular activities out of the home, either as a group or individually. The service users all spoke positively about living at the home, the activities, the support from staff. A service user commented that it was homely and the staff nice. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cedar Gardens DS0000018639.V286433.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 Gardens DS0000018639.V286433.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): EVIDENCE: These standards were not assessed on this occasion because there had been no new admissions for the last two years. Cedar Gardens DS0000018639.V286433.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): 6,7,9 Service user plans and risk assessments are in place but need reviewing and updating. The service users are encouraged and supported to lead independent lifestyles. EVIDENCE: Service user plans and risk assessments were in place but still needed to be reviewed and updated with each service user (previous requirements). However the managers had been considering this and prepared a revised service user plan with risk assessments which is to be implemented for all the service users. A training session on risk assessing had been booked for 25.04.06, which should be beneficial to the staff. It was apparent through observations and discussions with the staff and service users that the service users’ individual needs, abilities and choices were well known and met. Service users were involved in making decisions about their daily routines and activities, with support from staff if needed. The provider is reviewing the arrangements for the service users’ monies (at present he is the appointee) and hoping to introduce a system so that service users will manager their own monies, with assistance. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 10 Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were previously met and at this visit it was apparent from observation, discussion with service users and staff that these standards were still being met. The service users continued to attend day placements during the week and various, regular social activities. The more able service users pursued their own interests. The service users advised that the new, lounge television had broken down but another television had been installed whilst the new one was being repaired. The provider had ensured the service users were not without a television in the lounge. The service users were looking forward to planning their annual holiday. Consideration should be given to service users choosing their own venues instead of (or as well as) a group holiday. It is hoped that outings and activities at weekends will increase as the weather improves. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 12 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): 20 There is a suitable system in place for the administration of service users’ medication. EVIDENCE: Standards 18 & 19 were assessed and met at the last inspection. At this visit it was apparent that the service users continued to be supported appropriately with personal and healthcare needs that arise. Health action plans were being introduced and completed with each service user for their use. The weighing of the service users was being reviewed. The pharmacist inspector viewed the medication system on 28th February 2006 and had sent a letter indicating her findings. Aspects of the medication system needed improvement and it was pleasing to hear, at this visit, that the six requirements had been implemented. The medication policy had been reviewed and a copy available for the inspectors to view. The storage of medication had been improved and medicines were now being kept in a suitable, locked medicine cupboard in the office/sleeping room. It was recommended that the cupboard is kept solely for the storage of medication and that valuables and monies are kept separately. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 13 Some of the staff had attended training relating to the medication system in February 2006. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 14 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): 22,23 The home has policies and procedures in place for raising concerns and the protection of vulnerable adults. The procedure for protecting vulnerable adults needs to be developed. The service users are listened to and any concerns acted upon. The new system for service users to manage their own monies, with support should be introduced. EVIDENCE: The home had a complaints procedure and it was in different formats for the service users. The manager advised that no complaints had been received. The home had a policy and procedure for the protection of vulnerable adults. However the procedure needed to be updated and make reference to ‘No Secrets’ (Department of Health guidance) and the Worcestershire Adult Protection procedure. Also the procedure needs to be personalised for the home. There was a copy of the Worcestershire guidance for staff on reporting abuse or mistreatment of vulnerable adults this needs to be referred to in the home’s procedure. The majority of staff had attended training in protecting vulnerable adults in February 2006. The provider who oversees the majority of service users finances was reviewing the system and proposing to introduce a system on 11.04.06 so that service users can manage their own monies. Each person has a lockable piece of furniture in their bedroom for the safekeeping of monies and valuables. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 15 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 The premises are suitable for their purpose. The location of the house is convenient to local services and facilities. The house is homely, clean and appropriately furnished. There is adequate communal space for the number of service users. The home needs to maintain a programme for decorating and refurbishment. Aspects relating to hygiene should be improved. EVIDENCE: This care home is situated on a main road on the west side of Worcester. There are shops nearby as well as a pub and bus route. The large, two storey, detached house is suitable for the number of service users. On the ground floor there is a lounge, kitchen/diner, laundry. Also bathing, toilet facilities and one single bedroom. On the second floor there are three single and one double bedroom, staff sleep-in room, bathing and toilet facilities. The house was homely and safe. Since the last visit the kitchen had been decorated, the dishwasher brought into use and the dining chairs replaced. A safety catch had been fitted on the cupboard containing the cleaning fluids. The fire doors had been adjusted and bedroom door locks repaired. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 16 However other areas of the home still needed decorating and refurbishment. A maintenance programme had been drawn up. Some of the service users showed the inspector their bedrooms, which were suitably furnished, personalized and kept tidy by themselves. Some of the bedrooms were cold (early evening) and the member of staff put the heating on. All the rooms used by service users need to be suitably heated to 21°C when there are service users are at home. It would be preferable for the heating to be set to come on prior to the service users arriving home from day placements. The home was viewed with regard hygiene and infection control. The separate laundry consisted of a washing machine, tumble dyer, washbasin and storage space. The laundry was cluttered and access to the washbasin was difficult. There were no sluicing facilities but staff advised that these facilities were not needed. There was a supply of protective clothing for staff. The communal facilities should have liquid soap and paper hand towel dispensers (as previously recommended). The use of communal bars of soap should cease. The service users should be encouraged to keep their own towels, flannels, sponges and toiletries in their bedrooms to prevent cross contamination. The majority of staff had attended training in infection control last year. The policy and procedure for infection control needed reviewing and updating. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 17 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): 32,34,35,36 Some of the staff team are experienced with skills and knowledge relevant to the work they are doing, which ensures that the needs of service users living at the home are effectively met. The staffing arrangements for the home during the weekdays should be reviewed. The recruitment process needs to be developed and recorded. Staff supervision needs to take place regularly and be recorded. EVIDENCE: The home has a small staff group of six (and the manager is on the roster), who also cover the three supported living houses in the St John’s area. There was one new member of staff and the managers were recruiting to fill vacancies. Agency and relief staff had not been used which was commendable. Existing staff and the manager had covered extra shifts. At this visit the two staff on duty had worked at the home for sometime, were experienced and knew the individual needs of the service users well. The staff spoken with were committed and enthusiastic about their work. The two staff on duty were aiming to complete NVQ in care, level 3 very soon. Another member of staff had an NVQ in care, level 2. It is hoped that within a few months 50 of the staff will have achieved an NVQ in care, which is the requirement. New staff should have the opportunity to undertake the LDAF Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 18 (Learning Disability Award Framework) induction training prior to progressing to NVQ’s. Staff had had the opportunity to attend training sessions in safe working practices during the last six months (see page 20). The house remains closed on weekdays and when service users are not attending day placements, they are expected to stay at the sister home, Phoenix House. This arrangement still needs reviewing so that service users have the choice of spending weekdays in their own home; in particular now that the service users do not all have day placements for five weekdays. The rota submitted indicated that the manager works on weekdays but is often not based at the house. A sample of staff files were viewed and it was apparent that there was a recruitment process including CRB (criminal record bureau) checks. However the recruitment process needed to be developed and more detailed. For example, the application form and questionnaire to referees. Also if in exceptional circumstances, staff are employed before an up to date, enhanced CRB check is obtained, the Department of Health & CSCI guidance must be followed. The use of set questions for interviews was good practice but notes also needed to be kept of the interview and responses. Staff records must be kept as per Schedules 2 & 4, Care Homes Regulations. Staff supervision sessions need to be at least six times a year (bi-monthly) and recorded – the last recorded supervision for some of the staff was October 2006. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 19 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): 39,40,42 The home has established management arrangements. A quality assurance system needs to be introduced, the policies and procedures reviewed and aspects of safe working practices developed. EVIDENCE: The registered manager has worked at the home for fourteen years. She commenced on the manager’s course in January 2005 and undertaken refresher courses in safe working practices. The provider has purchased a quality assurance programme so an audit of the home now needs to be carried out. The provider had circulated questionnaires to the service users, their families and friends and was pleased with the positive responses received. The results need to be analysed and made public. A sample of policies and procedures were viewed and it was apparent that these documents needed reviewing and personalizing for the home. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 20 The standard on safe working practices was assessed and it was apparent that there were systems in place to ensure the health and safety of the service users and staff. The gas, hot water and central heating system had been serviced. Also the portable appliances had been checked. The electrical wiring was about to be checked. Basic risk assessments for safe working practices and accident book were in place. The home had had a legionella assessment carried out. Water temperatures were being checked monthly and should be checked weekly or when baths are run. Staff had received training in safe working practices and this needs to be ongoing with priority given to moving and handling. Some staff had attended courses on administering medication, infection control and protecting vulnerable adults in the last six months. The manager was a first aider and 5 of the 7 staff had basic first aid certifcates. The fire precautions were being regularly checked and a fire risk assessment was in place. All staff attend an annual fire awareness course run by a professional trainer. The record of the daily checks was not evident and it was difficult to ascertain from the records whether each member of staff had received in-house fire awareness training quarterly. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 21 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 X 3 X X X 2 2 X 2 X Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 22 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 YA6 Regulation 15 Requirement Each service user must have an up to date plan indicating their lifestyle, goals, personal and health care needs. (timescale of 31/01/06 not met) All risk assessments carried out in respect of service users’ activities must be reviewed (timescale of 31/01/06 not met) The maintenance programme must implemented within the proposed timescales. A copy to be submitted to CSCI. (timescale of 31/01/06 partially met) The recruitment process must be developed and robust. A quality assurance system must be introduced in accordance with the requirements of regulation 24 and Standard 39. (timescale of 28.02.06 partially met) The policies and procedures must be reviewed and personalized for the home. Timescale for action 31/07/06 2. YA9 13,15 31/07/06 3. YA24 23 31/07/06 4. 5. YA34 YA39 19 24 31/07/06 31/07/06 6. YA40 17 30/09/06 Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 23 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. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12 Refer to Standard YA10 YA14 YA16 YA19 YA23 YA24 YA30 YA33 YA35 YA36 YA42 YA42 Good Practice Recommendations Statements on confidentiality should be given to partner agencies. Consideration should be given to service users choosing their own holiday venues. Service users should be given keys to their bedrooms and the front door unless it is assessed and recorded that there is a risk. The arrangements for weighing service users should be reviewed. Two signatures should be sought for financial transactions of service users money. The temperature in all the rooms used by service users should be kept at 21°C. Paper towels and liquid soap should be provided in toilets, bathrooms, kitchen and laundry. All these rooms should be uncluttered and the washbasin accessible in the laundry. The house should be staffed when service users are not attending day placements during the week. Staff should be encouraged to undertake LDAF and NVQ’s in care and other training should be on-going. Staff should receive individual supervision sessions at least six times a year, which are recorded. The temperature of the hot water should be checked weekly at all outlets. A record of the daily checks on the fire precautions should be kept as well as a clear record indicating that each member of staff has received in-house fire awareness training quarterly. Cedar Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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 Gardens DS0000018639.V286433.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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