Inspection on 22/08/05 for Cedar House

This inspection was carried out on 22nd August 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Cedar House 20/07/07

Cedar House 05/01/07

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Cedar House Rowley Lane Arkley, Barnet Hertfordshire EN5 3LF Lead Inspector David Hastings Unannounced 22 August 2005 @ 09.30 am 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 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 Stationary 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 House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cedar House Address Rowley Lane, Barnet Road, Arkley, Barnet, Hertfordshire EN5 3LF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8440 4545 020 8440 3273 Stewart Wallace for CareTech Community Services (No 2) Ltd Mary Purtill N Care Home with Nursing 12 beds Category(ies) of LD Learning Disability 18-65 years registration, with number PD Physical Disability 18-65 years of places Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 6 April 2005 Brief Description of the Service: Ceder House is a care home registered to provide nursing care for a maximum of twelve service users between the ages of 18 to 64 who have learning disabilities and/or physical disabitlities. The home is operated by Care Tech. The CSCI has recently registered the home to increase the number of service users from six to twelve. The home is now divided into two units each with a kitchen, sitting room and dining room and bathroom. Staff and service users have moved from another unit near by into one of the units in Cedar House. The stated aim of the home is to enable service users to live as full a life as possible and to provide them with support in their daily activities. The home is a large detached bungalow. The home is situated in a residential area of Barnet and about half a mile from restaurants, shops, public transport and other community facilities. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday 22nd August 2005 and lasted six hours. The home has recently been registered for an additional six beds and extensive building work has been undertaken. Six service users have moved into Cedar House from another home operated by Care Tech. The staff at this home have also moved to Cedar House with the service users. The inspector was assisted throughout the inspection by the registered manager. A tour of the premises took place and staff and care records were inspected. The inspector was able to speak to a number of staff during the inspection. Everyone working at the home was very open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Three requirements have been restated from the last inspection relating to recreational needs being recorded on care plans, medication recording and the complaints procedure. The documentation, on the medicines administration charts, for the receipt of new medication and the medication carried forward from the previous month must be improved to ensure no mishandling. In order to facilitate the safe distribution of medicines a trolley must be provided to ensure that all medication required for service users is readily available. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 6 Newly admitted service users must have a care plan which is informed from the initial assessment. All care plans must record the service user’s preferred form of address. Staff files must contain all the information required by regulation. As a result of this inspection and an anonymous complaint received by the CSCI the registered provider must carry out a review of staffing levels at the home. Five new requirements have been issued as a result of this inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 All new service users to the home have a comprehensive assessment of their needs carried out by people trained to do so. EVIDENCE: As the number of service users has increased from six to twelve and major building work has been undertaken the statement of purpose and the service user guide will need to be revised. The registered manager informed the inspector that this was currently taking place. The care file of the most recent service user to be admitted to the home was examined. This had a detailed assessment of the needs of the service user as well as satisfactory risk assessments. The manager informed the inspector that from now on any new service user would be assessed by either herself or one of the deputy managers prior to admission. Lunch visits, overnight stays and the six-week trail period are detailed in the home’s admission policy and procedure. The manager confirmed that the new service user had visited the home a number of times prior to admission. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 In general service users assessed needs and personal goals are reflected in their individual plan of care and risk assessments are detailed and appropriate. Staff must make sure that recreational needs are recorded and that new service users have an up to date care plan. EVIDENCE: The inspector examined seven service user plans. These contained extensive information regarding how staff are to meet the physical and medical needs of service users. The minutes of regular care reviews examined indicated that service users and their relatives took part in their reviews and care planning. Staff interviewed had a good understanding of the needs of service users as described in their plan of care. The case records of service users contained risk assessments, which included strategies aimed at minimising risks. Appropriate and up to date risk assessments had been prepared in relation to falls, epilepsy, diabetes, and pressure care. These risk assessments included appropriate guidance to staff on how such risks can be reduced. Staff interviewed had a good understanding of these risk assessments. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 10 However the care plan of the most recently admitted service user was not satisfactory. The care plan did not describe how the assessed needs of this service user were to be met. Risk assessments identified clearly in the pre admission assessment were not recorded. This was disappointing as all the other care plans were very detailed. A requirement relating to this matter has been issued in the relevant section of this report. A requirement was issued at the last inspection that care plans must identify clearly how the recreational interests of service users are to be met. Most of the service users attend a day centre and staff were observed carrying out activities with the remaining service users. Records examined did not clearly outline the way all staff are to meet the recreational needs of service users. This is particularly important now that the two units have merged, as staff may not be as familiar with all the service users at the home. The requirement has been restated. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 16 and 17. The staff at the home are good at encouraging and enabling service users to take part in appropriate activities. Service user’s rights are respected. Staff provide service users at the home with a varied and healthy diet. EVIDENCE: Due to the severe learning difficulties of the current service users none have jobs at present. There was documented evidence in the case records of service users to indicate they had engaged in a range of activities, which included trips to the seaside, park, pubs, cafes, supermarket and attendance at local day centres. Nine service users went out to their day centre on the day of the inspection. There was evidence that service users’ rights are respected. Staff were observed knocking on bedroom doors before entering. The manager confirmed that service users’ mail is given to them or their representative unopened. The manager and staff were able to describe how observing service user’s facial expressions gave them a clear indication whether the service user wanted to join in an activity or not. Service user’s preferred form of address was not being recorded on their care plan. A requirement relating to this has been issued in the relevant section of this report. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 12 Both kitchens were clean and well equipped. A record of fridge and freezer temperatures had been kept. These were satisfactory. The menu examined appeared varied and well balanced. There was documented evidence that staff had been provided with food hygiene training. Meals seen on the day of the inspection looked appetising. Staff were observed providing discreet assistance to service users when needed. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 The service users are protected by the home’s medicines policies and procedures. The adherence by staff to these procedures is mainly satisfactory. EVIDENCE: On the day of the inspection the CSCI pharmacist inspector visited the home to inspect policies and procedures in connection with medication. The medicines policy is complete. The service users are unable to give informed consent to take their medication but from the records most appear to take it. In order to maintain their health a few service users are having their medication disguised with the consent of the service user’s doctors and their relatives. Currently no service users are self-administering their own medication. The records for the administration of medication were satisfactory. The recording of the receipt of medication was incomplete and medication carried forward from the previous month was not entered onto the current medicine administration chart. This was a requirement from the last inspection and is restated. The disposal of medication record was with the pharmacist at the time of the inspection. The medication is stored in a medication room, which is overcrowded and some of the medication cupboards could not be locked. The room temperature Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 14 was maintained at 25oC or below except in very hot weather. The refrigerator was not consistently being maintained between 2-8oC. The room is in the process of being updated. The home did not have Controlled Drugs prescribed for service users so there were no extra facilities for their storage. There was no trolley available to enable the medication to be taken round to service users. This resulted in staff returning to the medication room to obtain each service user’s medication or it being carried round on a tray. A requirement relating to this has been issued in the relevant section of this report. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. The complaints procedure is clear and easy to follow. Service users and their relatives must be given information about how to contact the CSCI. Service users are protected from abuse by a clear adult protection procedure. EVIDENCE: The home’s complaints procedure was clear but still does not make reference to the CSCI. This was a requirement from the last inspection and is restated. Service users spoken to indicated to the inspector that they had no complaints about the service. An anonymous complaint was received by the CSCI. This complaint alleged that due to insufficient staffing levels in the home, a service user’s holiday had to be cancelled, staff have no time to participate in activities with service users and that service users are left in bed in the morning for long periods. The manager informed the inspector that three staff had been allocated to go on holiday with a service user however the staff felt that four staff were needed. There did not appear to be a risk assessment available to identify the number of staff needed. However a risk assessment was supplied to the CSCI from the service manager. This indicated that three staff would be sufficient. It is a great shame that this issue could not have been resolved between the organisation and the staff at the home. The manager informed the inspector that another holiday has been organised. On the morning of the inspection all but one service user was up and nine service users were out attending day centres. There appeared to be enough staff to carry out activities with service users at the home. Both the manager and the six staff interviewed felt that there was a problem in the early part of the morning and that more staff were needed at this time. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 16 A requirement has been issued that the registered provider reassess the staffing levels at the home. The service manager informed the inspector that she would be carrying out a reassessment of staffing levels at the home. It does appear that the registered nurse on duty is not able to be as “hands on” due to the increased nursing workload. The home’s Adult Protection procedure is in line with the local authorities Adult Protection Unit policies and procedures, and includes sections on notifying police and medical professionals. There was evidence that the manager and staff have attended adult abuse awareness training. The manager was able to describe the actions she would take in the event of an allegation of abuse occurring at the home. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The premises are safe, clean, comfortable and well maintained. There are good procedures in place to control the spread of infection. EVIDENCE: Extensive building work has now been completed and the home has six additional bedrooms and separate kitchens, dining rooms and lounges. The standard of decoration and fittings is of a very high standard. The garden has been attractively landscaped. The manager informed the inspector that there is currently a storage problem at the home and a garden shed will be built as a result. The layout of the home feels like two distinct units and the inspector hopes that this separation of “sides” as some staff described it will be addressed by the manager and service manager. On the day of inspection, all areas of the home were clean and no offensive odours were detected. There are now two small laundry rooms located away from food activity areas. The home has a satisfactory infection control policy. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 Staff at the home are able to meet the individual and joint needs of service users and have a good understanding of service users’ needs. Training has now been organised in order to further enhance staff understanding of the needs of people with learning disabilities. EVIDENCE: Cedar House has increased the number of places for service users to twelve and two staff teams have merged together. At present there are eleven service users resident at the home. As detailed in standard 22 of this report, the CSCI received an anonymous complaint regarding staffing levels at the home. Six staff were interviewed during the inspection. The inspector was impressed by the commitment and dedication of the staff and it was clear that service users are well supported at the home. Both the manager and staff did comment that the staff team was stretched during the mornings, as most service users have to be up and ready for their day centres. As indicated previously the registered provider has agreed to review the staffing levels at the home. It was evident from discussion with staff that two distinct teams have developed which could be a problem in terms of communication and the smooth running of the home. The manager is aware of this issue and is taking positive steps to bring the two teams together for the benefit of the service users. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 19 A requirement was issued at the last inspection that staff undertake training in learning disability awareness. The registered manager informed the inspector that this was now planned and would be implemented shortly. The requirement has now been complied with. Five staff files were examined. Most contained the information required by Regulation 19 of the Care Homes Regulations 2001. However one file did not contain proof of identity and one file did not contain evidence that a satisfactory CRB disclosure had been received. A requirement relating to these matters has been issued in the relevant section of this report. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 There are good systems in place to monitor health and safety compliance at the home. Clear risk assessments enable service users’ health, safety and welfare to be promoted and protected. EVIDENCE: As the home has recently had extensive building work undertaken, a Fire Officer has recently inspected the premises. Records in relation to fire safety were examined. There was evidence that weekly checks are carried out. Staff were aware of the fire procedures and records indicated that regular fire drills have been taking place. Other records in relation to health and safety compliance that were examined were satisfactory. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x x 2 3 Standard No 31 32 33 34 35 36 Score x x 2 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cedar House Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 16(2) (n) Requirement The registered provider must ensure that individual service user plans detail how service users recreational needs are to be met by staff at the home. (Timescale of 10/06/05 not met. This requirement is restated). The registered manager must ensure that a detailed care plan is provided for all new service users. This plan must be informed by the initial assessment and contain relevant risk assessments. The registered manager must ensure that all service users prefered form of address is recorded in their individual care plan. The registered manager must ensure that all medication received for service users is signed for on the medicine administration record and any medication carried forward is also documented to ensure no mishandling. (Timescale of 01/05/05 not met. This requirement is restated). Timescale for action 01/11/05 2. 6 15 01/10/05 3. 16 12(2) 01/10/05 4. 20 13(2) 01/10/05 Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 23 5. 20 13(2) 6. 22 22(7) 7. 8. 33 34 18(1)(a) 19 The registered manager must ensure that medication is taken round to service users on a trolley to ensure that all medication for service users is readily available. The registered provider must ensure that the complaints policy clearly details how the complainant can contact the CSCI.(Timescale of 01/06/05 not met. This requirement is restated) The registered provider must review the staffing levels at the home. The registered manager must ensure that all staff files contain the information required by regulation. This includes proof of identity and evidence that a satisfactory CRB disclosure has been recieved. 01/10/05 01/10/05 01/11/05 01/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 20 Good Practice Recommendations The registered manager should ensure that a Controlled Drug register for the receipt, administration and disposal of Controlled Drugs, is available for use if necessary. If Controlled Drugs are to be kept in the home the CSCI North London pharmacy inspector should be contacted for advice. Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 24 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedar House 20050822 Cedar House X00023 UN Stage 4 S65432 V244246 G59.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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