Inspection on 05/02/07 for Cedar Gardens

This inspection was carried out on 5th February 2007.

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 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 3 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 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 Unannounced Inspection 5th February 2007 2.15–6.15pm Cedar Gardens DS0000018639.V328920.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.V328920.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.V328920.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.V328920.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 15th March 2006 Brief Description of the Service: Cedar Gardens was first 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 operates another home, which is next door to Cedar Gardens, called Phoenix House and also has supported living accommodation on the same site. Some aspects of these care services are run jointly. This home is registered to provide accommodation with personal care for six service users (men and women) who must be aged from eighteen up to sixtyfive. Current service users ages range between thirty-two and sixty and they have all lived at the home for at least three years and some of them since the home opened. Service users must require care due to learning disabilities and the home caters for people who have mild to moderate learning disabilities. The main stated purpose of the service is to provide a permanent and homely environment and to encourage service users to be involved 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 services and facilities close by and the home is on a main bus route. On the ground floor the accommodation comprises a sitting room, kitchen/diner, laundry, bathroom, toilet and a single bedroom. The second floor has three single and one shared bedrooms, a staff sleep-in room and a bathroom. None of the bedrooms have en-suite facilities. Information about the home is provided in a statement of purpose and service users’ guide. These documents can be obtained from the home and the guide is also available in a format that should be easier for people who have learning disabilities to understand. The current fee for the service ranges from £319.38 to £715.08 per week. Additional charges are made for transport, hairdressing, phone calls, chiropody, newspapers, personal items & clothing, social activities, college fees and for holiday accommodation. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of Cedar Gardens. This means the inspector checked all the Standards that can have most effect on people who live in care homes. This visit to the home was made on a Monday without telling staff beforehand. The inspector spent time with service users in the lounge and spoke to three of them in their bedrooms about living at Cedar Gardens. The way the home is run and changes since the last inspection were discussed with the manager. Two staff were spoken with about their experience, training, service users and their care and the support staff receive. Everyone was open and very helpful. Two service users and three of their relatives had sent in surveys with their views, and comments were received from Worcestershire Community Learning Disabilities Team about the home. Their feedback is mentioned in this report. Various records kept by staff were checked and most of the house looked at. There was helpful information in a questionnaire the manager had completed before this visit. All information received by the Commission about the home since the last inspection is also considered, such as notifications of events that had affected service users. There had not been any complaints made to the Commission about the home or concerns raised in respect of vulnerable adults. What the service does well: Cedar Gardens offers service users a secure and comfortable home. Service users say they are happy living at the home and that they get on well with each other and the manager and staff. Service users receive support they each need with their personal care. Staff make sure they have regular health checks and manage their medicines safely. Service users families feel they are made welcome in the home by staff. Most say they are told about and kept involved in their relatives care and overall that they are satisfied with the care provided by the home. The home is in a good place so service users can easily walk to shops, pubs, Church etc. This helps them mix with and become part of the local community. There is a small staff team who work closely together. Most have worked at the home for years and so they know service users needs and what they like, and service users also know staff, well. This is good for consistency of care. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 6 The provider arranges for staff to receive training to help them keep the home and service users safe. Necessary checks are made on new staff to make sure they are suitable to work in care, for service users’ protection. 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.V328920.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.V328920.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): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to this service. Written information is available about the home to help prospective service users (and/or with their representatives) decide if they would like to live there. There are appropriate assessment and admission procedures in place to make sure that the home could suitably meet the needs of new service users. EVIDENCE: The home provides a statement of purpose, service users’ guide and a contract of residence, as required. The relevant documents are also available in a more suitable format, which includes pictures and simpler language, so that people with learning disabilities are more likely to be able to understand them. There have not been any new service users for over three years. Referrals are normally made through Worcestershire Community Learning Disabilities Team and the home is sent a copy of any prospective service users’ community care assessments, made by a social worker. The statement of purpose describes how the home would arrange introductory visits to meet and assess that their needs could be met and to check their compatibility with other service users. A trial stay would follow, with reviews held after one and three months, when a decision is made about the suitability and so continuation of the placement. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 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. 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. To ensure that service users’ current needs and personal goals are known and reflected in their care plans, and that action is being taken to meet them, they must be more involved in drawing up and regularly reviewing their own plans. Although service users are able to make some choices in their daily lives and routines their plans and risk assessments should demonstrate this and how their independence and individuality are promoted, whilst risks are minimised. EVIDENCE: Two service users’ care records were checked. They include a personal profile, background information and their current medication. Staff also make daily reports in individual communication books about their behaviour, mood, visits and heath care appointments, so providing useful information about their lives. Each person has a care plan covering relevant areas of need. Plans are based on an assessment checklist of their daily living skills (including communication self-care, domestic & social skills, rights & freedom, psychological, leisure, exercise & physical needs), which had been completed in October 2004. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 10 Care records also contain information about service users likes & dislikes and a list called “My interests”. The manager said this was discussed with service users when their plans were drawn up. However, whilst staff clearly know service users well, it is now expected that care services should adopt a more “person centred” approach to care planning. This means that the wishes and goals of individual service users are sought and form the basis of their plans so that they are fully involved in planning their own care to the extent they are capable. If they are not their relatives and advocates should help to ensure their wishes are known. Plans should also specify any action needed to meet their identified personal goals, and be regularly reviewed to show any actions taken, with the outcomes recorded. The inspector gave the manager a DVD on person centred planning (PCP) and contact details of a local PCP facilitator. Plans not been updated recently and the manager explained they were trying to arrange review meetings with service users relatives and funding authorities and. However these annual placement reviews should not replace the reviews of plans that homes should carry out with service users at least six monthly. Support staff are allocated to particular service users as their keyworker and do such as arranging their health care check ups and taking part in annual reviews. They try to give service users more individual support, although their time is limited due to staffing levels. keyworkers should also take more of a role in drawing up and reviewing service users’ plans, especially if they can spend more time with them and so should know their needs and wishes better. A general risk assessment format is used by staff and had been completed for risks in the environment such as service users going out, bathing and opening windows. However, risk assessments should also be individualised and used as a means of promoting service users’ independence and life skills e.g. their ability to manage their own finances. Some risk assessments seen had also not been reviewed for some time and need to be updated and more detailed. Service users make some choices in their daily lives and routines and say they can usually make daily decisions. More so at weekends when they have no set activities, although the manager said that as staff are only on waking duty until 10.00pm service users needing support accept getting ready for bed and go to their bedrooms to watch TV before. The statement of purpose describes how service users will be encouraged to make everyday choices about such as clothing, and to keep their rooms and clothes tidy. Service user meetings are also held monthly when they discuss group activities, holidays and menus etc. The ethos of the home however is more of a traditional residential home, with an emphasis on family/group living. Whilst service users have accepted this approach (having lived there for years) some social/health care professionals consider it to be rather institutional. Current practice focuses on promoting service users individuality and independent lifestyle and the registered persons must consider this alongside a “person centred” approach to care planning. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 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. 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 these visits to this service. Service users pursue a variety of activities, some within the local community. However their plans should reflect their individual interests and social needs and how they are being met, with action taken to meet them and outcomes. Service users are supported by the home to maintain links with their families. Staff aim to promote healthy eating, but should ensure meals are varied and that service users individual choices are considered. Their involvement in meal preparation and cooking should also be facilitated to develop their life skills. EVIDENCE: Service users plans outline their interests and an activity checklist is kept showing what they have done and where they have been. Most attend day services or are on a life skills course at Worcester College on particular weekdays, although one person apparently refuses to be involved in planned activities. In respect of social/leisure activities two service users are able to go out locally on their own, one of whom often goes into Worcester city centre. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 12 Most go out weekly to a social club for people with learning disabilities and they regularly visit local pubs as a group. Whilst at home service users appear to spend most of their time with the television on or in their bedrooms. Whilst service users’ plans have a list of their interests they should also include an assessment of their social & developmental needs and how they will be met. This should then be reviewed periodically to check that action has been taken to meet their needs and to show if they have enjoyed and/or benefited from their activities (or not). Plans should also demonstrate how staff encourage service users to take up meaningful activities and how support needed for this is provided. It is apparent that activities requiring more individualised support (especially for those people not able to go out alone) could be limited due to staffing levels. Although staff say that service users enjoy group activities and holidays, consideration should be given to their individual needs and interests. This could be discussed in their annual placement review with their placing authority if there are implications for additional staffing and so for funding. Service users discussed family visits and how staff support them to keep in touch. Relatives say they are made welcome in the home and most that they are kept informed about and involved in their care. One service user doesn’t have family and it is good that the home are trying to find them an advocate. Regarding food provided by the home staff draw up a 6 week menu, based on what they know service users like & dislike. Although staff know service users preferences (and so they all usually have the same meal) they should feel able to request an alternative and also be more directly involved in menu planning. Menus show breakfast as being cereals and toast and weekday lunches as sandwiches & snacks such as stuff on toast. Main meals are mostly traditional including roasts, pies and stews followed by a pudding or fresh fruit. One week’s meals included about five red meat meals i.e. roast beef, beef burgers, beef stew, meat pie and diced pork. Attention should be paid to ensuring that a varied and balanced diet is offered, although staff say they do try to promote healthy eating with fresh fruit and vegetables. The home is advised to ask a Dietician to comment on their menus, which could be helpful. Tonight’s evening meal was observed to be salad, tinned pots and quiche. This meal was prepared totally by staff and homemade cake was even put out on side plates before the meal. Although some service users came into the kitchen when they got home and helped themselves to a cup of tea none were involved in the meal preparation. Whilst they may have chosen not to be one of the home’s stated aims is for service users to be involved in household tasks which should be encouraged by staff and help them become more independent Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 13 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. Service users receive support for their personal care and their medicines are managed safely in the home by staff. It should help to ensure that each service users’ physical and emotional health care needs are being monitored; preventative steps taken and their good health promoted when service users Health Action Plans are fully implemented. EVIDENCE: Service users’ plans indicate the support they each need with their personal care and individual records are kept of personal care received, such as baths. The inspector was informed that some toiletries are bought communally for the home and given out to service users, which is not considered acceptable as service users should have the opportunity to go out and choose their own. Care records show routine check ups e.g. to the Dentist and Optician are arranged and some service users have specialist health care input from a Psychiatrist. Records of weight are also kept and one person’s showed a substantial weight loss recently. Although the manager confirmed this is being investigated reports did not reflect staff concern about this loss and/or Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 14 what the home are doing about it. Some health care professionals also commented that their advice has not always been taken on board or followed through by the home, and sometimes they should have been approached for help sooner. The home must ensure that health related issues are closely monitored and is setting up Heath Action Plans for each service users, which the Department of health recommends for people with learning disabilities. These plans should help to confirm that service users’ health is being closely monitored and that any problems are identified and their good health promoted. This includes that any special needs are recognised and understood and service users are helped to stay healthy through preventative, as well as routine and specialist health care input. Regarding the home’s management of service users’ medicines a Commission pharmacist inspector inspected the medication system on February 28th 2006 and it was confirmed requirements made had since been implemented. They included an improvement in medicines storage, which are now kept in a suitable, locked cupboard in the staff sleeping-in room. There are also policies & procedures, including for homely remedies. Each service user has a written medication profile with a list of their current medication, a self-medication assessment and their consent to receiving prescribed medicines. Most staff attended training in respect of the safe handing of medicines in February 2006. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including this visit to the service. There are frameworks in place for service users to express their views and to raise concerns and for their protection. EVIDENCE: The home provides a suitable written complaints procedure. This is available in a service user-friendly format and is displayed on the home’s notice board. It is also in the service users’ guide, which all service users had been given a copy. Service users confirm they would feel able to talk to the manager and staff if they were worried about anything. There have been no complaints raised with the home or Commission about the service since the last inspection The home has a policy & procedures in relation to the protection of vulnerable adults and a copy of the Worcestershire multi-agency guidance on reporting any incidence or suspicion of abuse or neglect of service users. Most staff attended training in relation to protecting vulnerable adults in February 2006. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 16 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 is conveniently located and the accommodation suitably meets service users needs offering them a secure, safe, clean and comfortable home. EVIDENCE: Cedar Gardens is located on a busy road on the west side of Worcester on a main bus route. There are shops, Churches, pubs and other facilities within easy walking distance. The house is a large, two storey detached house, which is comfortable. Those areas visited are in a reasonable state of repair, décor and furnishings. Staff said they had done some redecorating since the last inspection and there are plans for new carpets in the sitting room, stairs & hallway. This will look nicer as the carpet is patterned and rather dated, as are the kitchen units, although the overall impression of the home is homely. Several service users kindly agreed to show the inspector their bedrooms. They are suitably furnished, well-personalised and kept tidy by themselves. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 17 One room seemed a bit chilly but service users said they didn’t find the room cold and the windows had been open during the day and the heating now on. The home was considered with regard to hygiene and infection control. Areas of the house seen were clean and tidy and there is a supply of protective clothing for staff. Most staff attended training in infection control last year and although it was noted in the last inspection that the home’s infection control policy & procedures needed reviewing and updating, this was not checked. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. Service users benefit from a stable staff team who know them and their needs well. However the team is small which can affect staff flexibility and so the time available to provide individual support. Staff deployment on weekdays also needs reviewing and appropriate arrangements made to cover the home. Although most staff are experienced and qualified they would have increased knowledge and understand how to meet service users special needs better if they receive other relevant training. This could also be achieved through staff having individual supervision and their own training and assessment profile. There are thorough recruitment procedures in place, which should ensure that only suitable people are employed at the home, for service users’ protection. EVIDENCE: The staff team is small comprising of six support workers and the manager. There had not been any new staff for nearly three years and two staff have worked at the home since 1992. This stability is good for consistency of care and staff clearly know service users’ needs, skills and preferences well. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 19 Although a small stable staff team can be positive for consistency of care and promoting good communication, there is limited scope for so few staff to work flexibly and provide individual support for service users with activities, going out in the community and their life skills development in the home. Staff rotas also show that the home is staffed throughout the day. However when the inspector arrived at the home the manager and two service users were next door at Phoenix House and the manager was supervising service users living at this home as well. Such joint deployment is apparently an ongoing arrangement in view that staffing levels are also minimal at Phoenix Staffing levels and deployment must therefore be reviewed by the provider and staffing arranged to cover the home when service users are there, if necessary in consultation with service users’ funding authorities. Regarding recruitment although there are no recently appointed staff it was confirmed that the home’s application form has been revised so that future applicants would now have to include their full job history. The manager is also aware that any gaps in their employment history must be explored and an explanation obtained and that one of their two written references must be from their most recent employer. The home has produced a basic induction checklist for new staff. However it is good that new staff in future will be expected by the home to complete the LDAF induction/foundation programme which is especially for staff caring with people who have learning disabilities. Four of the staff team have achieved an NVQ qualification in care and all staff are expected to undertake the mandatory health & safety training topics and had attended training sessions in safe working practices during the last year. However staff have not received much training in respect of service users special needs such as autism awareness and epilepsy and the opportunity for person centred planning training should be taken up. Staff say there is good communication within the team; that meetings are held and the manager and provider are always available and they can raise issues with them. However individual supervision is not arranged as often as the Standards specify, although the home has produced a checklist covering work related issues, training & development needs. There is a staff team training grid kept for health & safety topics, but staff should have an individual training & development assessment and profile. Records should also show that they each have received five paid days training a year and the source, type and duration of training sessions and courses undertaken. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 20 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 home is run by a suitably experienced & qualified manager. Consideration should be given to the home’s ethos to ensure it reflects the currently accepted philosophy and approach to supporting people with learning disabilities. Appropriate steps are taken to keep the home safe for service users and staff. A system has been implemented to monitor and review relevant aspects of the service. This should result in a plan for the home’s continual improvement, which involves service users and other interested parties in the way it develops EVIDENCE: The registered manager Mrs Carole Green has worked at the home for fourteen years. Mrs Green has an NVQ qualification in care & management and has also undertaken relevant training and refresher courses in safe working practices. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 21 Most of the management responsibilities are shared by the two care homes in respect of day-to-day oversight and such as record keeping and staff training. Some support staff also take responsibility for particular tasks e.g. drawing up menus & fire safety checks. Whilst there is clearly a caring approach in the home, which service users have accepted and are comfortable with, the ethos of the home is based on that of a family or group living environment. It therefore does not focus on providing individualised care and promoting an independent lifestyle, which is currently accepted to be good practice and is as outlined in the government’s plan called Valuing People. The registered persons should review the service in the light of this guidance and make plans to implement the principles, in consultation with relevant professionals and service users funding authorities. In relation to quality monitoring & assurance the provider has purchased a formal system that involves audits of all relevant aspects of the service. Questionnaires were also sent to service users, their relatives and significant other people others, asking for their views of the home. The results of audits and feedback obtained should now be analysed and result in a plan for the continual development of the service that is in line with what service users want. This plan should be made public and also available to the Commission. The pre-inspection questionnaire confirmed that most policies & procedures needed for care services had been reviewed last year to ensure they are in line with current legislation and accepted good practice guidelines. Regarding health & safety in the home, training is arranged for staff covering the mandatory health & safety topics i.e. fire, moving & handling, food hygiene and infection control. Most staff hold a current first aid certificate and have received training on managing medicines safely in care homes. The pre-inspection information states that fire safety checks & tests are being regularly checked and a fire risk assessment is in place. All staff attend an annual fire awareness course run by a professional trainer and a fire drill was arranged within the last few months. The home’s fire log showed checks and tests on the fire safety system and equipment were recorded as having been carried out at the specified intervals and the last service was in April 2006. The home has had a Legionella compliance check undertaken and the manager confirmed that water temperatures are now checked weekly and there are COSHH risk assessments in place. There were no safety hazards identified during this visit and overall it is indicated therefore that the home pays due attention to promoting the safety and welfare of service users and staff. Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 22 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 3 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X 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 2 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.V328920.R01.S.doc Version 5.2 Page 23 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 meets 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. YA6 Regulation 15 Requirement Service users must have an up to date care plan reflecting their needs and personal goals. (Previous timescales of 31/01/06 & 31/07/06 not met) 2. YA9 13,15 Risk assessments carried out in respect of service users’ must contain detailed information about how risks are to be managed by the home and how service users are supported to take risks as part of having an independent lifestyle (Previous timescales of 31/01/06 & 31/07/06 not met) 3. YA33 23 Staffing levels and deployment must be reviewed so the home is always staffed when service users are at home. Also to ensure that there are sufficient staff to facilitate flexible and individual support for service users. 30/06/07 30/06/07 Timescale for action 30/06/07 Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 24 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 YA6 Good Practice Recommendations The local Person Centred Planning (PCP) facilitator should be contacted to arrange PCP training for staff, so that service users’ care and plans can be reviewed and updated accordingly. Opportunities should be sought for staff to undertake training relevant to the special needs and care of service users. Staff should receive individual supervision sessions at least six times a year, which are recorded. Recommendation carried forward from previous inspection 4 YA39 The Quality Assurance & monitoring system implemented by the home should result in an action plan for the continual development of the service, based on the views of service users and other stakeholders. 2 YA35 3 YA36 Cedar Gardens DS0000018639.V328920.R01.S.doc Version 5.2 Page 25 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: 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. 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