Inspection on 05/01/07 for Cedar House

This inspection was carried out on 5th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cedar House 20/07/07

Cedar House 22/08/05

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/ Barnet Road Arkley Barnet Hertfordshire EN5 3LF Lead Inspector Stephen Boyd Key Unannounced Inspection 5 January 2007 11:30 Cedar House DS0000065432.V303608.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 House DS0000065432.V303608.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 House DS0000065432.V303608.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar House Address Rowley Lane/ Barnet Road Arkley Barnet Hertfordshire EN5 3LF 020 8440 4545 020 8440 3273 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) CareTech Community Services (No.2) Ltd Mary Purtill Care Home 12 Category(ies) of Learning disability (12), Physical disability (12) registration, with number of places Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2005 Brief Description of the Service: Cedar 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 disabilities. The home is operated by CareTech. 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. Fees charged at the home are £1824 per week. A copy of this Inspection report can be requested directly from the home or via the CSCI website (web address can be found on page 2 of this report.) Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in one day in January 2007. The inspector was pleased to meet the manager, Mary Purtill during the inspection. Three service users were seen during the inspection and three staff were spoken with. A tour of the premises was undertaken and various records and policies were reviewed. A number of relatives/ advocates for service users were spoken with by telephone after the inspection took place. What the service does well: What has improved since the last inspection? What they could do better: This inspection has highlighted five requirements, one of which is restated from the previous inspection regarding ensuring staff files contain information required by regulation. The four new requirements are in relation to medication, premises and staff training. With regard to medication stock issues need to be addressed and the room temperature of the medication storage room needs to be safeguarded. Settling cracks in the newer built areas of the home need to be remedied. Staff need to gain NVQ qualifications to increase the ratio of staff with qualifications. Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 6 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 DS0000065432.V303608.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 House DS0000065432.V303608.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. All new service users who would be admitted to the home would undergo a comprehensive assessment of their needs EVIDENCE: There had been no new service users admitted to the home since the previous inspection. Service users sampled showed that they had all received a comprehensive needs assessment prior to admission to the home. The manager or her deputies would assess any prospective new admissions of service users to the home. The home has an admission policy and procedure which includes good practice arrangements such as lunch and overnight visits prior to admission which would then be followed by a trial period. Cedar House DS0000065432.V303608.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users needs are reflected in individual plans of care. Service users are able to make decisions about their lives with assistance as necessary. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: Service users all have individual plans of care. These will be further enhanced by the planned introduction of a person centred care plan approach over the next two months. Care plans are based on activities of daily living and are regularly reviewed. The care plans now include a “life and leisure experiences” plan outlining planned activities on a month-by-month basis. A “social diary” records activities undertaken by each service user. This has met a requirement detailed at the previous inspection. Service users likes and dislikes are known and recorded to inform care given. Service users plans of care reflect that service users are encouraged and supported to make their own lifestyle choices where able. The inspector was advised of a service user who regularly likes to stay up late to watch television and therefore enjoys sleeping more in the daytime. Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 10 Service users records sampled showed that risk assessments were available, which had recorded strategies aimed at reducing risks. Risks identified included those associated with fall and epilepsy. Risk assessments had guidance outlined for staff and in discussion with staff it was clear they had a good knowledge of service users and their needs. Cedar House DS0000065432.V303608.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users are able to take part in a range of appropriate activities both within the home and wider community. Service users have appropriate relationships and their rights and responsibilities are promoted. Service users benefit from an interesting and healthy diet. EVIDENCE: On the day of inspection the majority of service users were attending local day centres. None of the current service users are able to participate in work opportunities. Service users were seen to participate in a range of leisure activities including shopping, trips out to pubs, cafes, parks etc. Service users attend discos and the inspector was informed of planned holidays that service users go on in the course of a year. The home has its’ own transport to facilitate outings in the local community and beyond. All of the current service user group except for two people have contact with family, friends or independent advocates. The manager informed the inspector that advocacy arrangements were being pursued for the two service users without any outside contacts. A relative spoken with after the inspection Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 12 confirmed they were treated well as visitors to the home and kept informed about their relatives care. Evidence on the day of the inspection suggested that service users are treated with respect. Staff were seen, for example, to knock on bedroom doors before entering. The rapport seen between service users in the home during the inspection and the staff on duty was good. Menus seen by the inspector indicated a varied diet was available to service users. As stated earlier service users likes and dislikes are known in respect of food and other issues and this informs menu planning. Stocks of food were seen to be ample during the inspection. The two kitchens were seen to be well equipped and appropriate records of individual food intake were seen to be kept as well as safety recording of fridge and freezer temperatures. Staff have received food hygiene training. Cedar House DS0000065432.V303608.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users receive good personal support. Their health needs are given a high priority. The home needs to improve certain aspects in regard to the medicine system. EVIDENCE: Service user care plans outlined the way service users require and prefer care to be delivered. A key worker system helps to individualise the care given. Observations on the day of inspection suggested that care is given in a sensitive manner that respects the dignity and privacy of service users. Service users health needs are to the fore in respect of staff’s awareness. Their health is monitored via care plans and other records such as details of visits to health professionals such as G.P.s, dentists, opticians and consultants in learning disability issues. In respect of emotional health needs, a fellow service user had recently died and staff clearly understood the feelings and issues this could bring up for service users. The home operates a monitored dosage system of medicine administration. At the current time none of the service users are assessed as able to administer their own medication. The system needed some improvement to reduce overstocking of medication and achieve no more than twenty-eight days of medication in use at any one time. The inspector audited one service users Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 14 epilim medication and found that stocks did not tally with the amount that should have been available at the time of the medication cycle. The manager was advised to look at this issue. The medicine storage room was seen to hit temperatures in excess of twenty-five degrees Celsius. In order to alleviate this problem, it is suggested a portable air conditioning unit is introduced. All medication is administered by trained staff and is kept in a secure manner. Cedar House DS0000065432.V303608.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users and others can be confident their views will be listened to and acted upon. The home has suitable policies and procedures to protect service users from abuse. EVIDENCE: Since the last inspection the manager has amended the homes complaints policy to show how complainants can contact the CSCI directly. No complaints had been received since the last inspection. No one spoken with either during or after the inspection had any complaints or concerns to raise. The home has not made or been subject to any referrals since the last inspection in respect of protection of vulnerable adults issues. A suitable policy and procedure is in place and the policy and procedure of the London borough of Barnet was also available in the home. Staff have received training in respect of the protection of vulnerable adults. Cedar House DS0000065432.V303608.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. The home is clean, comfortable and homely in style. Some remedial work to newly built areas needs to be carried out. EVIDENCE: The home, which was extended to accommodate additional service users in 2005, was found to be homely in appearance and style. Service users benefit from ample sized accommodation. Decoration and furnishings were in a good state. Service users accommodation showed evidence of personalisation with pictures, photographs, ornaments etc. There were no obvious safety hazards seen during the inspection. The home was found to be clean, tidy and odour free during the inspection. Policies and procedures for the prevention of infection were seen to be in place. One area which needs to be addressed is the cracks in various walls that have appeared in the newer built areas of the home. The remedying of these will further enhance the quality of the environment. Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users are supported by competent staff who are trained to carry out their roles. Evidence to ascertain whether service users are fully protected by the home’s recruitment policies and practices was not available. EVIDENCE: AS well as trained nursing staff the home currently employs twelve full time and seven part time care staff. Of these, three have national vocational qualifications at level two. Three staff are currently undertaking this qualification and four more are due to start shortly. The manager advised that she hopes the home will have at least fifty percent of carers with nvq’s by the end of July 2007. Staff spoken with during the inspection presented as professional and caring in their manner. Staff as well as pursuing nationally recognised courses have received a range of training in the past months this has included courses on Epilepsy, food hygiene, protection of vulnerable adults, dementia awareness, Autism awareness, infection control and diabetes. Staff spoken with confirmed they had benefited from various training opportunities as detailed above. At the previous inspection, a requirement was made that all staff files must contain proof of identity and evidence that a satisfactory criminal records bureau check has been carried out. Unfortunately, due to a broken lock on the filing cabinet containing staff files, this requirement could not be assessed at Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 18 this inspection and the requirement is restated. The manager believed that all staff files were now up to date with all relevant information. Staff spoken to said they had undergone recruitment procedures such as completing application forms, attending interviews etc. Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. The home is well run and service users/significant others views inform the ongoing review and development in the home. The health, safety and welfare of service users is promoted and protected. EVIDENCE: The homes’ manager, Mary Purtill has been a qualified nurse for over twenty years, gaining lots of experience in that time. Ms Purtill is awaiting the result of the registered mangers award which is also being pursued by the two deputy managers. Staff spoken with during the inspection were complementary about the manager and her supportive style. The home undergoes two thorough internal quality audits each year. The home scored ninety eight percent in the last audit. Surveys of relatives are undertaken as well as meetings. The inspector received four comment cards prior to the inspection which were positive in their response. Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 20 The health, safety and welfare of service users was seen to be promoted and protected in a number of ways. Certificates were seen for electrical safety and for the maintenance of equipment used in the home. Certificates for fire equipment checks were available and tests on the alarm system and other fire fighting equipment were seen. COSSH assessments had taken place. Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 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 YA20 Regulation 13(2) Requirement The registered provider must ensure that supplies of medication are not kept in excess of one month to ensure better safety and security The registered provider must ensure the temperature of the medication room is kept at suitable level The registered provider must ensure the settling cracks noticeable in various parts of the building are remedied 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 received. This requirement is restated. Previous timescale of 1/10/05 not able to be determined. The registered provider must ensure that at least 50 of carers working in the home have National Vocational Qualifications at level 2 or above Timescale for action 28/02/07 2. YA20 13(2) 31/03/07 3. YA24 23(2) (b) 30/04/07 4. YA34 19 15/02/07 5. YA32 18 (1) (a) 31/08/07 Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cedar House DS0000065432.V303608.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office 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. 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