Inspection on 16/01/08 for Cedar Gardens

This inspection was carried out on 16th January 2008.

CSCI found this care home to be providing an Adequate 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 2 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 05/02/07

Cedar Gardens 15/03/06

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 Christina Lavelle Key Unannounced Inspection 16th January 2008 2:30–6.30 Cedar Gardens DS0000018639.V352996.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 Gardens DS0000018639.V352996.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 Gardens DS0000018639.V352996.R01.S.doc Version 5.2 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) Phoenixhouse122abtconnect.com Mr Nigel Hooper Mrs Carole Ann Green Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: Cedar Gardens was set up as a care home in 1992. Mr Nigel Hooper is the sole registered provider and Mrs Carole Green is the registered care manager. Mr Hooper also operates another home, which is located next door. This home is called Phoenix House and many aspects of these services are managed jointly. This home is registered to provide accommodation with personal care for six adults. People living at the home must require care due to learning disabilities, although the home only offers care to people with mild to moderate learning disabilities. The main stated aims of the home are to provide a permanent and homely environment and to encourage service users’ involvement in household tasks. Currently there are five people living at the home who all moved in at least three years ago and three of them more than thirteen years ago. Cedar Gardens is a large detached house located on the west side of Worcester city. There are shops, pubs, churches and other facilities nearby and the home is also on a main bus route. The accommodation comprises of a sitting room, kitchen/diner, laundry, bathroom, toilet and a single bedroom on the ground floor. The second floor has three single and one shared bedrooms, a staff sleep-in room and bathroom. The bedrooms do not have en-suite facilities. Information about the home is provided in a statement of purpose and service users’ guide. The guide can be obtained from the home and is available in a format that should be easier for people with learning disabilities to understand. The weekly charge at the time of the last inspection varied from £319.38 up to £715.08 per week. Each person’s fee and any extra costs, such as transport, hairdressing, chiropody, phone calls, newspapers, personal items & clothing, social activities, college fees and holiday accommodation, should be specified and agreed in their written Terms & Conditions of Residence (and/or contract). Cedar Gardens DS0000018639.V352996.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 1 star. This means the people who use this service experience adequate quality outcomes. This is a key inspection of the service provided by Cedar Gardens. This means all the Standards that can be most important for adults living at care homes are assessed. No one at the home was told about this visit beforehand. Time was spent with some people living there and they were asked about their care and lifestyles. One care worker talked about the service and their role, training and support. The way the home is being run and any changes made and/or planned since the last inspection were also discussed with the manager. Surveys were left at the home for staff and people living there asking for their views of the home. Surveys were also sent to their families and to health and social care professionals involved with the care of people who are living there. Feedback from discussions and surveys returned is referred to in this report. An AQAA (Annual Quality Assurance Assessment) had been completed before this visit, as now required. This asks managers to say what they think their home does well, what it could be better and their plans to improve the service. It includes details of people living there, staff and other aspects of the home. Various records kept by the home were also checked and parts of the house looked at. All information received by the Commission about the home since the last inspection is considered including events affecting people living there. What the service does well: Cedar Gardens is homely and friendly. People living at this home say they are happy there and that they get on well with the managers and staff. The home is in a good place near to shops, pubs etc. and on a main bus route. This makes it easier for some people living there to go out into the community. People who live there have a comfortable home that is kept safe and clean. Each person living at the home has support they need with their personal care. Staff manage their medicines safely and arrange routine health care checks. There is a small, stable staff team who work well together and are committed to giving caring support to the people living at the home. Staff complete relevant training about how to keep the home environment safe and work in ways that promote the health and welfare of people living there. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 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.V352996.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. There are appropriate assessment and admission procedures in place to help to ensure the home could suitably meet the needs of prospective service users. Whilst each person living at the home has a written contract of residence they should be reviewed and updated to reflect their current fee and any costs not covered by fees. Their contracts to be agreed by them, with support if needed. EVIDENCE: The home provides a statement of purpose, service users’ guide and a contract of residence, as required. Relevant information documents are available in a suitable format including pictures and simpler language, so that people with learning disabilities should be able to understand them better. It was noted in the care records of two people living at the home however that their contracts of residence had been developed four years ago and do not specify the current fee charged and all costs not covered by this fee. It is expected that contracts should be regularly reviewed and amended to provide up-to-date information. They should also be agreed and signed by the person receiving the service and the registered manager (with support from a relative or advocate if necessary). There has not been a new person move into the home for over three years. Therefore the process that would be followed if a referral for a placement was Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 9 received was discussed with the manager. The home would first obtain a copy of the prospective service user’s community care assessment, made by their funding authority. As the statement of purpose also describes the manager would then arrange to visit and meet them to assess if their needs could be met and check their compatibility with people already living at the home. A trial stay would follow with reviews held after one and three months, before a decision would be made about the suitability of the placement. This would involve home staff, the potential service user, their family and social worker. Three people living at the home whose admission had been planned (rather than due to an emergency) confirmed in their surveys that they had been asked about moving in and given relevant information about the service. They had also visited the home to look around and meet people before deciding to try it out. One person said they also had an overnight stay and another that their parents had visited the home with them. The manager’s plan outlined in their AQAA to involve staff and people already living at the home more in the admission process in future would be a positive development Cedar Gardens DS0000018639.V352996.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 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. People living at the home all have a plan showing their current needs. Whilst progress has been made to involve them more in drawing up their own plans to focus more on their personal goals, this needs fully implementing to include actions needed to achieve them. Also to reflect how they are enabled to make decisions and choices and take risks to develop a more independent lifestyle. EVIDENCE: Two care records of people living at the home were checked and care planning discussed with the manager and a care worker. Staff also make daily reports in communication books for each person about such as their behaviours, mood, activities and health care appointments, so providing useful information about their lives. Since the last inspection all staff had received training on person centre planning (PCP). This is the approach now expected of care services and means the personal goals of people receiving care are sought and should form the basis of their plans. This should result in action plans supporting them to meet their goals, with timescales agreed and outcomes regularly reviewed. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 11 Action meetings had appropriately been set up to draw up plans on a new PCP format, with keyworkers involved (care staff allocated to certain people living at the home). The AQAA also states the manager plans to obtain more input from their families, day services and other professionals, which would be good. Plans of each person living at the home have been reviewed and updated (as required following the last inspection) but there is still scope for them to focus more on their personal goals. Whilst some goals are shown they relate just to social activities and not also to how they could develop their life skills and have a more independent lifestyle. Resulting action plans are also not very detailed and do not specify how staff will enable them to make decisions and pursue interests they like and how often etc. This to some extent depends on them being able to have more 1-to-1 staff support, which the manager recognises. Risk assessments are carried out as part of the care planning process using a generic format that includes risks in the environment and such as going out, bathing and opening windows. However risks should also focus on promoting independence and be linked to their plans. In this context one person’s daily reports show they are having difficulties that are adversely affecting another person living at the home. Clearly a review of their care is needed urgently and meanwhile a management plan should be put in place to manage their behaviours and ensure the safety of other people. It is of concern that detailed records of incidents are not being kept or consideration been given to making a referral under Protection of Vulnerable Adults procedures. The manager said a community nurse has been contacted but had not provided any input as yet. This matter must be followed up and the training planned in respect of the management of challenging behaviours be arranged as soon as possible. People living at the home say they make some choices in their daily lives and routines, although this can be restricted during weekdays particularly due to staff deployment. House meetings are also held regularly when they discuss such as group activities, menus and holidays. The ethos and approach of the home continues to be based on a family/group living arrangement however. This style of care service is not in line with currently accepted practice for people with learning disabilities, which promotes an emphasis on individuality and independent lifestyles. Issues of equality & diversity, such as age, gender and level of disability, should be considered and shown in plans and also any implications of the Mental Capacity when people are not able to give informed consent or present risks that mean some limitations are being placed on them. Cedar Gardens DS0000018639.V352996.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): 11, 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. People living at the home participate in various social, leisure and educational activities in the community. They would benefit further from the opportunity of more individualised support to go out and pursue activities of their choice. Staff support people living at the home to maintain links with their families. Whilst the home provides a healthy diet if staff encouraged people living at the home to be more involved in cooking and other household tasks they could take more responsibility in their daily lives and develop independent life skills. EVIDENCE: An activities checklist shows what people living at the home have taken part in and where they have been, although one checklist had not been completed for a while. Each person’s PC plan reflects their interests but should also show their social & developmental needs and goals and how they are being met and promote a more independent lifestyle. They also do not have individual activity schedules so any support needed is planned to enable them to lead fuller lives. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 13 Most people attend day services or college on a various number of weekdays. Those people able to go out alone have more choice and freedom to do what they like and go out in the community but those needing staff support have less opportunities. It is clear the home is accepted within the local community but staff time is limited for supporting individuals to go out shopping or use public transport etc. Staff comment “They have a good social life, although they go out in groups and not individually”. This includes going to social clubs for people with learning disabilities, a weekly night out at a local pub and an annual group holiday, which all include people living at Phoenix House. This group approach has already been discussed in this report, but any change would require more 1-to-1 staff support for activities, outings and to allocate time to enable them to develop their daily living skills. The person centred planning process should identify individual activities and support needed even though the manager and staff recognise that staffing levels are an issue. In view the AQAA states funding is the major barrier to increasing staffing levels this should be raised in placement reviews with the relevant funding authority. Staff say they help people living at the home maintain links with their families and keep them up to date about important matters. One person has no family but now has an advocate they see regularly. People living there confirm their relatives are made welcome in the home and are invited to parties etc. Some had regular visits and/or weekends and holidays with their families. Regarding food provided by the home efforts have been made since the last inspection to involve people living at the home more in menu planning. Meals they like are discussed in their meetings and the weekly menu is gone through with them. Menus show that main meals are mostly traditional, followed by a pudding or fresh fruit. Staff aim to promote healthier options such as porridge, wholemeal bread, fresh vegetables and salads. It is evident that people living at the home are still not very involved in food shopping and cooking albeit that one of the home’s stated aims is to involve service users in household tasks. They are encouraged to keep their bedrooms tidy, strip their beds and bring their laundry down and some people make their sandwiches to take on weekdays. However staff mostly cook meals and do the house cleaning and say they can help prepare meals if they wish, rather than expecting them to take responsibility and having the time available to support them to be involved and so develop their daily living skills. Cedar Gardens DS0000018639.V352996.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 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. People living at the home are supported to meet their personal care needs and medicines are managed safely on their behalf. Whilst staff ensure they have routine health care checks action must always be taken to manage behavioural and/or health related issues to promote their safety and welfare. When Health Action Plans are fully implemented they too would better ensure their health. EVIDENCE: Most people living at the home are relatively self-caring and so need guidance and oversight rather than direct support with their personal care. Individual plans show the support they need and that self-care should be encouraged. Regarding health care staff support people to access health care services and attend routine appointments. Records are kept of visits to GPs and health care specialists and there are body charts to complete for any injuries etc. observed and weight charts. Each person living at the home now has a Health Action Plan (HAP), as is recommended by the Department of Health for people with learning disabilities. HAPs seen outline the person’s health history, health care needs, medication prescribed and routine input needed. However they are still Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 15 not very detailed and, although the AQAA states staff plan to update the HAPs, they should be used more as a working tool and include all relevant records on health, rather than separate records being kept of visits to GPs etc. HAPs should help to ensure that all health care needs are recognised and are being managed appropriately. They should also promote good health through supporting a healthy lifestyle and preventative as well as routine and specialist health care input. People living at the home should be as involved as possible in managing their own health, but in the section called “Looking after myself” the sole entry is “making a cup of tea”, which does not relate to their health. Although one person’s weight chart clearly show they have an ongoing weight loss this is not recorded as a health problem and/or included in the dietary section of their HAP. The manager said that they are aware of this issue and medical input has been sought, but there were no records to show how staff are monitoring and/or dealing with it. Also this person had not been weighed for at least two months, according to their chart. It was previously discussed that another person has behavioural issues and was alleged to have injured someone else, but although a community nurse had been contacted this also needed to be followed up to ensure the welfare and safety of those involved. Regarding the home’s management of medication prescribed to people living there it was confirmed there are policies & procedures in place that the AQAA states had recently been reviewed. The home has suitably secure storage for medicines and administration records were being maintained appropriately. Each person has a written medication profile that includes a list of their current medication, an assessment of their ability to self-administer and a consent form with their agreement for staff to manage and administer when necessary. All staff have completed training relating to the safe handling of medicines. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 16 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 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. People living at the home can express their views and there are procedures in place to manage complaints and protection. To ensure they are kept safe any incidents affecting their welfare must always be fully investigated and action taken to safeguard them and/or be referred appropriately, with records kept. EVIDENCE: The home provides a complaints procedure that is available in a user-friendly format and displayed on the home’s notice board. People living at the home confirm they know about this procedure and feel able to talk to the manager or staff. They also have an opportunity to discuss their views about the home in meetings. Most people have family input and one person has an advocate who could take up issues on their behalf. There had been no complaints raised with to the Commission or reported as made to the home since the last inspection. Policies & procedures are provided to help staff know how to identify and refer suspicions or incidence of abuse or neglect of people living at the home that include inter-agency guidance on Protection of Vulnerable Adults (POVA). Staff attended a POVA training session in 2006 and the home plans to update their training this year and arrange training on managing challenging behaviours. Care records show an allegation had been made by a person living at the home about an injury they received. However this matter had not been investigated as a complaint or consideration given to referring it through POVA procedures. Steps must always be taken to investigate and/or take action and a plan put in place so the home ensures immediate and ongoing safety of people involved. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 17 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): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Cedar Gardens offers people living there a safe, clean and comfortable home that meets their needs. Whilst the environment is homely, and in a reasonable state of repair and décor, if a planned renewal programme was set up it should ensure the accommodation improves and in a way people living there choose. EVIDENCE: Cedar Gardens is located on a busy road on the west side of Worcester city on a main bus route. There are also shops, churches, pubs and other services and facilities within walking distance. The property is a large, two storey detached house that has a lawned area at the front and a small garden at the rear. The overall impression of the environment is “lived in” and homely. Although routine repairs and checks and/or servicing of such as electrical appliances and gas installations are being carried out there have been no improvements made to the fabric and decoration of the premises since the previous inspection. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 18 The manager’s plan to draw up an ongoing maintenance and redecoration programme does need to be implemented and actioned, as some aspects of the home do look somewhat dated, such as the patterned carpets, décor and kitchen units and they would benefit from being modernised and brightened up. People living at the home should be involved in choosing the décor etc., as they have been in their bedrooms, which are well personalised. Regarding good hygiene and infection control the home has a utility room with suitable laundry facilities. The AQAA also states that all staff have completed training relating to infection control and the home has infection control policy & procedures in place to guide their working practices. During this visit it was seen that the house was clean, tidy and fresh and staff accept that part of their role and responsibilities is to ensure a good standard of hygiene is maintained. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 19 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 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. People living at the home are supported by a stable, committed staff team who know them well and work together to offer consistent care. Although they would benefit from more staff and/or time to provide individualised support. Most staff have achieved a social care qualification, but their knowledge and skills to help them meet the special needs of people living at the home would be enhanced if they had more relevant training and regular formal supervision. Good recruitment procedures are in place to protect people living at the home. EVIDENCE: The staff team comprises of six care workers and the manager, some of whom also cover the provider’s home next door. One care worker left in the last year and not been replaced. Most staff have worked at the home for several years and two for longer than this. Whilst this stability is good for care consistency, and staff know people living at the home well, there is limited scope for them to work flexibly and provide individual support as part of their keyworker role and for activities in the community and to help people develop daily life skills. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 20 It is also apparent that staffing rotas and deployment continue to include both care homes. This means that at least one person living at Cedars Gardens spends time during weekdays at Phoenix House where they can be supervised by the manager or staff alongside people living at this other home. Whilst this person apparently likes the company this arrangement is not acceptable, as they should always have the choice and support available to be able to choose to stay in their own home or pursue other activities if they wish. As the AQAA reiterates that the home’s staffing is affected by funding levels this still needs reviewing, in consultation with the local authority responsible for placements. As there has not been any new staff appointed selection processes were not assessed in depth. The AQAA and previous inspection confirm their application form had been revised so it requires applicants full employment history, with gaps explained. The manager did also reaffirm that new staff would not be allowed to start work at the home before all necessary checks were taken up, including two written references (one from their last employer) and a criminal records check (CRB). The home has a basic induction checklist but would also expect new staff to undertake an accredited induction & foundation programme (LDAF), which is especially for staff caring for people with learning disabilities. Five care workers have achieved an NVQ qualification in social care and the home expects staff to complete all mandatory health & safety training topics. Limited progress had been made to access training in respect of the special needs of people living at the home as previously recommended. Recently some of the staff team attended a session on epilepsy but autism awareness and the positive management of challenging behaviours are still being planned. Staff are clearly committed to ensuring that people living at the home receive caring support. Staff confirm they all work well together and that being such a small team communication is generally good and the managers are accessible. Regular staff meetings are also held, which are minuted and allow them to express their views and discuss particular issues. Individual supervision is still not being arranged however and this is one of the manager’s improvement plans. Regular formal supervision should ensure their work performance is monitored and reviewed and that training & development needs are identified. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 21 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): 37, 38, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. The manager is suitably qualified and experienced. Management arrangement and the home’s approach need review however to provide more management time. Also to ensure the home is run in line with currently accepted practice for learning disability services so people living at the home may benefit from a better and more individualised service. The home’s quality assurance system still needs to result in an action plan for the continual development of the service, as people living there want and/or for their benefit. Appropriate steps are being taken to keep the home safe for people living and working there. EVIDENCE: The registered manager Carole Green has worked at Cedar Gardens for fifteen years. Mrs Green has an NVQ level 4 qualification in care & management and completed other relevant training and refreshers in safe working practices. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 22 Most of the management responsibilities for the provider’s two care homes are shared by both managers including day-to-day oversight, record keeping, staff training and support. They do however provide a lot of direct cover for the home, do provisions shopping and other “hands on” tasks, and work excessive hours. This is due to minimal care staffing levels and the manager and service would benefit from more dedicated time for the management task e.g. quality assurance, staff supervision and overseeing keyworkers’ care planning input. This inspection confirms there is a warm, friendly atmosphere at the home and people living there receive caring support. Whilst the manager is committed to the home, as a registered person she should be more proactive in the service’s development and with the provider ensure placement reviews are carried out, staffing is improved etc. to benefit people living at the home. Furthermore the ethos and approach still needs review to focus more on promoting independent lifestyles, with support from relevant professionals and funding authorities. Regarding quality monitoring & assurance a system has been implemented to audit relevant aspects of the service. Questionnaires are also sent to service users, relatives and significant others asking for their views of the home. The results of audits and feedback still need to be analysed and result in a plan for the home’s continual development. The AQAA is part of the process and should reflect how the service will be improved. The home’s AQAA does not provide enough detailed information to evidence what they feel the service does well or identify areas that need improvement and their plans to achieve them. Guidance is provided in KLORA (Key Lines of Regulatory Assessment) that are produced and recently updated by CSCI and will help the manager recognise areas that could be improved in each outcome areas of the Standards. In relation to health & safety within the home training is arranged for staff in all the mandatory topics i.e. fire safety, first aid, infection control, moving & handling and food hygiene. The information in the AQAA confirms that the fire safety system and equipment are checked/tested regularly as specified. Also that electrical circuit checks and portable electrical equipment tests are carried out, the gas installations serviced and COSHH risk assessments are in place. There were no safety hazards observed during this inspection visit. Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 23 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 2 2 X X 3 X Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 24 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 persons meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard 1 YA33 Regulation 23 Requirement Staffing levels and deployment must be reviewed. This is to ensure there are sufficient staff to provide more individualised support for people living at the home and for the manager to focus on the management task. To ensure that people living at the home are protected any incidents affecting their welfare ad safety must always be fully investigated and action taken to safeguard them if necessary and/or be referred appropriately, with records kept. Timescale for action 30/06/08 2 YA23 13 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1. Refer to Standard YA5 Good Practice Recommendations People living at the home should have their contracts of residence reviewed and updated. Contracts should detail their fee and extra costs so they know the current charges and the service they can expect and this has been agreed with them (or their representative if appropriate). DS0000018639.V352996.R01.S.doc Version 5.2 Page 25 Cedar Gardens 2. YA6 & YA19 Progress to implement person centred care plans and Health Action Plans should continue so that people living at the home are more involved in planning their own care. Also so that their plans focus more on their personal goals and how they can achieve them, develop their skills and take risks as part of an independent lifestyle. People living at the home should be encouraged and supported by staff to be able to make more choices in their daily routines and take greater responsibility for cooking etc to help to develop their independent living skills. There should be a planned maintenance and renewal programme drawn up so that the home environment is continually improved for the benefit of people living there. Opportunities should be sought for staff to undertake training relevant to the specialist needs of people living at the home and how to manage them. This should enhance their skills and knowledge so they could meet the needs of people living at the home better. Recommendation carried forward from last inspection. Staff should receive regular formal individual supervision, with sessions recorded. This should be part of monitoring their work performance and making sure their training & developmental needs are being identified and addressed. Recommendation carried forward from last 2 inspections The Quality Assurance & monitoring system implemented by the home should result in an action plan for the continual development of the service. This should be based on the views of people living at the home (and other stakeholders) so that the home improves as they would like it to and/or for their benefit. Recommendation carried forward from last inspection 3. YA16 4. YA24 5. YA35 6. YA36 7. YA39 Cedar Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Gardens DS0000018639.V352996.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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