Inspection on 30/01/09 for Cedar Gardens

This inspection was carried out on 30th January 2009.

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

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

Other inspections for this house

Cedar Gardens 16/01/08

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cedar Gardens 122a Bromyard Road St John`s Worcester Worcestershire WR2 5DJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christina Lavelle     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Cedar Gardens 122a Bromyard Road St John`s Worcester Worcestershire WR2 5DJ 01905421358 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Nigel Hooper Name of registered manager (if applicable) Mrs Carole Ann Green Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Cedar Gardens was first set up as a care home in 1992. Nigel Hooper is the sole registered provider and Carole Green is the registered care manager. Mr Hooper also operates another home next door called Phoenix House and many aspects of the two services are managed jointly. This home is registered to provide accommodation with personal care for six adults. People living there must require care due to learning disabilities, which are mild to moderate. The main aims of the service are stated as being to provide a permanent and homely environment and to encourage service users involvement in household tasks. 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 on a main bus route. The accommodation includes a sitting room, kitchen with dining area, laundry, bathroom, toilet and one single bedroom on the ground floor. The second floor has three single and one shared Care Homes for Adults (18-65 years) Page 4 of 30 care home 6 Over 65 0 6 Brief description of the care home bedrooms, a staff sleeping in room and bathroom. Residents bedrooms do not have en-suite facilities. Information about the service 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 for the service is as agreed between the provider and individuals funding authority. Each persons fee and any additional costs (such as transport, hairdressing, chiropody, phone calls, newspapers, personal items, clothing, social activities, college fees and holiday accommodation) should have been agreed by all parties and included in their written terms and conditions of residence and or contract. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of the service provided by Cedar Gardens was completed on 16th January 2008. A key inspection means that all the standards that can be most important to people using care services are assessed. As part of this key inspection we visited the home without telling staff or people using the service beforehand. It was agreed that people living at the home should be called residents in this report. Time was spent with three residents and their support and lifestyle were observed and discussed. It is difficult to ask them direct questions about the service because of their limited communication. The way the home is run and changes made or planned since the last inspection were discussed with the manager. One care worker was spoken with about their role and training and surveys about the home were completed by three Care Homes for Adults (18-65 years) Page 6 of 30 staff and three residents. Their feedback is referred to in this report. An annual quality assurance assessment (AQAA) was completed before our visit. The AQAA asks managers to say what they think their service does well, could do better, has improved and their plans to improve in the next 12 months. It also gives some numerical information about residents, staff and other aspects of the service. Some records kept by the home were checked and parts of the house seen. Any other information we have received about the home since the last inspection is also considered, such as events that had affected residents (these are called notifications). What the care home does well: What has improved since the last inspection? What they could do better: If efforts to develop a more person centred approach to care continues residents could be better supported to identify and achieve their personal goals. With more staff and so staff time residents could have more individualised support. This would better ensure they could take part in activities they choose and go out more. If the homes routines were more flexible and residents took more responsibility for its day to day running they could develop more life skills and promote their independence. If risk assessments related to residents behaviours are carried out with plans based on them staff would know how to manage them better. Some aspects of residents health care could be met better if relevant professionals are consulted and give staff advice about how best to deal with them. Make sure that all staff know how to report any incidence or suspicion of abuse or neglect outside the home. This would better ensure the protection of residents. Update the decoration, furnishings and equipment in the home with the involvement of residents so that the accomodation improves for them and as they want it to. Care Homes for Adults (18-65 years) Page 8 of 30 If staff used their knowledge from training and had other training on the specific needs of residents they should be able to understand and meet their needs better. Have ways of making sure that the quality of the service is reviewed and plans made to improve it. This should also ensure that the home keeps getting better as people involved want it to and for the benefit of residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of prospective residents would be assessed by the home to ensure they know their wishes and the support they require. This is because the assessment and admission processes include the people involved, their family and representatives. Evidence: Nobody has moved into Cedar Gardens since 2003. Three residents indicate in their surveys that they were asked about moving in and given information about the home. Two of them previously confirmed they had visited the home to look around and for an overnight stay. One persons parents had visited with them. The AQAA states that no admissions would be made until a full needs assessment of prospective residents had been carried out and introductory visits to the home arranged. A copy of their community care assessment would also be obtained, completed by their social worker. They would be given a copy of the homes service users guide, which is available in a user friendly format. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: Reviews would be held during and after prospective residents have had a trial stay at the home so that a decision could be made about their suitability. This would involve the prospective resident, their family, social worker and the home. Compatibility with the homes existing residents would also be checked. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a plan outlining their care needs. They could be better supported to achieve their personal goals if they were enabled to make more choices and decisions and to take risks as part of developing a more independent lifestyle. Evidence: We looked at a sample of residents care records and discussed care planning with the manager and staff. Each resident now has a care plan that is in a person centred format, although a person centred approach has not really been implemented. This means the focus would be to identify and meet each residents personal goals. Although residents were apparently involved in setting up their own plans they are not very detailed and include few goals. One persons goal is to go out more but where to and how this could be achieved with support needed is not specified. Whilst the manager recognises the rights of residents to make their own decisions and choices this does not always happen in practice because staff have very limited time to Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: support people in a way that promotes their individuality. The homes routines are consequently task based, rather than being flexibly led by residents preferences. Plans also do not show how residents diverse needs are being met. Two staff had attended a training session on equality and diversity in the last year and the AQAA says that the home fully considers equality and diversity issues. However there is no evidence in the AQAA or plans as to if and how residents needs in respect of such as their gender, age and level of disability have been considered in the support they receive and or their lifestyle. At least one resident has communication difficulties but staff do not use such as signs or pictures to help them express choices and say that they know what this person likes or they will lead them to show what they want. Staff write daily about residents behaviours, moods, events and activities in individual communication books and use a diary for appointments etc. Staff report that they use these records rather than care plans to obtain information and direct their practice. Plans have been reviewed, apparently with residents and their families invited to be involved in this process, but their input is not evident. Care staff are also allocated to particular residents as their keyworker but their role in providing one to one support and in developing and reviewing their care plans is very limited. Risk assessments have been completed but these are basic and focus mostly on keeping people safe. One resident is said to be verbally agressive and have a personal problem that is behavioural. However there are still no management plans in place in respect of these that are based on any incidents that should have been recorded and analysed with specialist advice and input sought. Risk assessments should also be linked to plans and be part of how residents independence is promoted. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents take part in some activities in the local community. If staff were more responsive to their diverse needs, provided individual support and encouraged their daily life skills they could be enabled to have a more independent lifestyle and to follow their personal interests. Residents are able to keep in touch with their families and have a healthy diet. Evidence: The AQAA states the home is committed to helping service users develop social, emotional and independent living skills. However residents participation in daily life and social activities is limited. They have few opportunities to follow their personal interests and do not receive individual staff support to enable them to do so. The home is well established in the community but this is mostly those people able to Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: go out without staff support and from their weekly group visit to the nearby pub. Most residents weekday activities comprise just of day services. During evenings and weekends trips out include two social clubs for people with learning disabilities and the pub, which Cedar Gardens and Phoenix House residents go to together in the homes minibus. There is also an annual group holiday arranged. Staff confirm that none of the residents go out regularly with their keyworkers to do their own shopping or an activity or outing they have chosen. On days when some people do not attend a day service they spend their time next door at Phoenix House, as the home is not staffed from 10am until around 3pm most weekdays. One persons plan says they would like to go out more but does not show how this may be achieved. The AQAA does not include plans, other than recruiting more staff, to help staff seek more varied lifestyle opportunities or activities for residents based on what they like or specify any life or social skills they could be supported to develop. Staff describe their role mostly in terms of the household tasks, cooking and personal care. It was also observed that there are set daily routines. Staff cook meals for residents and although some people help to lay and clear up they are not actively involved in meal preparation. After tea the table was laid out with bowls and cereals for next days breakfast. Whilst residents keep their rooms tidy and bring their laundry down staff do not spend time helping them learn or expect them to take much responsibility for household tasks, as their statement of purpose says. Staff support people to maintain links with their family and make their relatives welcome in the home. One resident has an advocate they go out with once a month. Regarding food provided menus are apparently discussed with residents. Staff know what each person likes and dislikes, which menus reflect and they can choose an alternative to meals if they wish. Menus include mostly traditional meals and staff say they try to promote healthy eating and use such as fresh vegetables. Fresh fruit was seen to be freely available but although two residents had clearly put on weight this did not seem to be monitored and a more active lifestyle encouraged. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the personal support they need and their medicines are managed safely in the home by staff on their behalf. It would better ensure that their physical and emotional health needs are met if the home consulted relevant specialists and if there were appropriate procedures in place for staff to follow. Evidence: Residents are relatively self caring and so mostly need guidance and oversight rather than direct assistance with their personal care. Plans show the support that each person needs and state that their self care should be encouraged. Staff support residents to access GPs and attend routine health care appointments such as dentists in the community. Records are kept of these visits and check ups. Each resident now has a health action plan (HAP), as recommended for people with learning disabilities. HAPs include brief details of their condition and medical history but they are not being used in a person centred way to help residents manage their own health care and focus on prevention and a healthy lifestyle. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: One persons HAP says they have learning disabilities with autistic effects but there is no indication of what these effects are and how they should be dealt with. Staff discussed how one person has continence issues, which they feel has a behavioural cause. Their daily reports include will wet for no reason and wets bed frequently but this has still not been followed up with specialist input and there is not a behaviour management plan in place. This needs to be investigated by health care specialists so that procedures can be set up for staff to help this resident. Comments made in their reports also do not reflect an understanding and respectful approach to the individual. Regarding residents medicines it was previously confirmed that the home has policies and procedures in place. Each resident has a medication profile listing their current medication with an assessment of their ability to self administer and a consent form with their agreement for staff to manage and administer their medication. The home has suitably secure storage and administration records were seen to be maintained appropriately. All staff have completed a formal training process relating to the safe handling of medicines and a community pharmacist regularly checks the system. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If residents have concerns they feel able to raise them with staff, although the home should show how peoples views are being listened to and acted on. Residents could be better protected if staff had more understanding of safeguarding procedures and how to manage aggression. Evidence: The service has a complaints procedure that is available in a user friendly format and is displayed on the homes notice board. Residents surveys indicate that they know who to speak to if they are not happy, how to make a complaint and that staff listen and act on what they say. There had been no complaints made to the home or commission about the service since the last inspection. The AQAA states that the home has an open approach, welcomes complaints or concerns and allows them to be raised without any conflict. Residents appear to have an open rapport with the manager and staff, but due to their disabilities it is apparent that three of them would not be able, or need a lot of support, to use a formal complaints procedure. The AQAA desribes how residents can express their views in meetings and had been given questionnaires about the service. However there is little evidence about how they influence decisions or the day to day running of the home. If records were kept of issues they have raised and of any actions taken to address this would demonstrate how residents, their families or advocates views are obtained and acted on. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: It was previously confirmed that the home has policies and procedures about abuse and for protecting vulnerable adults. The staff team had attended a training session but staff were not aware of local multi-agency safeguarding procedures and their responsibilty to report any suspicion or incidence of abuse or neglect outside the home. In addition staff understanding of verbal aggression by residents and how this should be dealt with indicates they would benefit from training and specialist input. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents of Cedar Gardens have a home that is comfortable and kept safe and clean. Whilst the environment is homely residents would benefit from their accommodation being updated and improved and in ways they have chosen and are involved in. Evidence: Cedar Gardens is situated on a busy road to the west of Worcester city, which is also a main bus route. There are shops, churches and other facilities within walking distance of the home. The property comprises of a relatively modern detached house, which has a lawned area at the front and a small garden at the back. Residents accommodation is suitable for their needs and it fits in well with the local community. The overall impression of the environment is homely, although it appears to be well lived in and the decor, carpets, furnishings and kitchen units are rather dated. There have been few improvements made for years and since the last inspection only the stairs and landing have been redecorated. However an action plan seen at the home states that a programme is in place for ongoing redecoration and replacement of fixtures and fittings from January 2008 to June 2009. Upgrading is needed with improvements identified, timescales for completion met and residents should be involved in how this is implemented. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: Regarding the promoting of good hygiene and infection control the AQAA and previous inspection confirm that the home has relevant procedures in place. Staff have or are currently completing a distance learning training programme on infection control. The areas seen during our visits were found to be clean and fresh and staff are clear about their responsibility for keeping the home environment clean. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive safe support from a stable staff team whose suitability has been checked. Their individual needs and goals could be met better with more staff on duty and from staff who have received or use their training knowledge more effectively. Evidence: The staff team now comprises of only four care workers and the manager, all of whom have worked at the home for years. This stability is good in respect of consistency, as staff and residents know each other well, but there is little scope for this small team to work flexibly. Staff and their surveys indicate that they have sufficient time just to undertake household tasks and ensure the general welfare of residents. As there are four residents there is now regularly one staff member on duty, especially day time on weekdays and weekends. Staff rotas and deployment also still include both care homes. This means that some residents have to spend time during weekdays at Phoenix House so they can be supervised by staff with the people living there. However they should always have the choice and support available to stay at Cedar Gardens, their own home, if they wish. Staff are consequently not able to give residents one to one input. This is needed for Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: their keyworker role and so they can offer support to enable people to develop their life and social skills and pursue their individual interests out in the community. Although there has been no new staff appointed for years it was previously confirmed that the home has thorough recruitment procedures in place. Staff say in their surveys that they had necessary checks taken up and the manager reaffirmed that new staff would not be allowed to start working at the home without giving a full employment history and the home receiving satisfactory police checks and written references. Three care staff have achieved a social care qualification and the home endeavours to ensure all staff complete mandatory health and safety training. Most staff had attended training sessions on topics relating to the specific conditions of residents, such as autism and epilepsy. Whilst staff are clearly well motivated they have a limited understanding of person centred care and how to use their knowledge about such as autism. They would also benefit from training in relation to behaviours, aggression and their management so that residents are understood and could be supported better. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being run in a way that doesnt meet currently accepted good practice and so residents do not benefit from an individualised service. Ways of reviewing the service are not being used effectively to ensure the service develops, and as people want. The environment is safe because health and safety practices are carried out. Evidence: The manager Carole Green has worked at Cedar Gardens for 16 years. Mrs Green has a social care and management qualification and has completed other relevant training. The day to day responsibility for this home and Phoenix house next door are shared by their two managers. However both managers provide mostly direct care input, including transporting residents to day services and provisions shopping, because care staffing levels are minimal. This impacts on time available for the management task. Mrs Green is aware of the need to keep up to date with practice for people who have learning disabilities but lack of funding is cited as being the main barrier to developing a more person centred service. Whilst there is a friendly atmosphere in the home Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: and the management and staff seem caring there needs to be more focus on promoting independent lifestyles for residents and not primarily on group life and activities with a task based approach. This results in staff spending most of their time cooking, cleaning and on residents personal care routines. The evidence from this and previous inspections shows the home needs to have more staff. Staff would then have the time and be able to use their training to focus more on care planning, the specific needs of individuals and take more account of equality and diversity issues. Furthermore thsi could help to ensure that the statement in the AQAA that they are committed to helping service users develop social, emotional and independent living skills is being met. In respect of reviewing and assuring the quality of the service the AQAA had not been completed in much detail. It provides limited evidence to support how what the service is stated to do well has resulted in good outcomes for residents. The AQAA describes only two improvements made since the last inspection and the only improvements planned for the next 12 months include to recruit more staff and provide more 1 to 1 support. However it also says this is unlikely to be addressed due to funding. Although questionnaires had been given to residents, their families and other people the AQAA or an annual improvement plan does not show how their feedback has been used to inform the developments people want for the service. Regarding health and safety in the home training has been completed by most staff in the mandatory topics, although one staff had not completed food hygiene. Necessary health and safety procedures and risk assessments are in place and the AQAA confirms that the fire safety, gas and electrical systems and or equipment are serviced or tested regularly. There were no environmental safety hazards noted during our visit. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The home should continue to implement a person centred approach to care. This means residents would be more involved in planning and reviewing their plans with more focus on their personal goals to ensure action is taken and support given to help them achieve their goals. The home should ensure that necessary risk assessments are included as part of the care planning process. This should promote residents independence and ensure that management strategies are in place that have been agreed with residents (if possible) and relevant specialists. The home should seek and provide support for residents to take part in activities that meet their personal interests and give them more opprtunities for meaningful activities and to participate in the community. The homes daily routines should be more flexible and residents rights and responsibilities for their own lives recognised and enabled. This would help residents develop their daily life skills and promote their independence. The home should seek advice and input from appropriate health care specialists so that any health care related issues are properly assessed and procedures put in place for staff to follow if necessary. This would ensure that Page 28 of 30 2 9 3 12 4 16 5 19 Care Homes for Adults (18-65 years) residents health care needs are being addressed and that staff know how best to manage any issues appropriately and consistently. 6 22 Records should be kept of the views, issues and any concerns raised by residents and others. This would to demonstrate how and that staff encourage discussion and listen and act on their views and concerns. Staff should receive specific instruction on local multiagency safeguarding procedures for vulnerable adults and this should be regularly reinforced. This is to ensure that all staff are clear about their responsibilty and know where to report any suspicion or incidence of abuse or neglect of residents outside the service. The homes programme to improve the decoration, fixtures and fittings should include timescales so that maintenance and upgrading is ongoing. This is so the accommodation continually improves for the benefit of residents. Staff should receive training, and or use their knowledge from training , to help them understand and meet residents needs better. This includes in relation to their specific conditions (such as autism), communication and understanding and dealing with verbal aggression and behaviours. The home should ensure that there are enough staff on duty to provide some individualised support for residents. This would mean that they would have more opportunities to pursue activities they choose, go out in the community and develop their daily living and social skills. The home should continually review and make plans to ensure that the quality of the service improves and develops. This should also take into account the views of residents and other stakeholders so that the improvements are what they want and or benefit them. 7 23 8 24 9 32 10 33 11 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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