Inspection on 09/05/06 for Cedar House

This inspection was carried out on 9th May 2006.

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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cedar House 23/02/10

Cedar House 27/11/09

Cedar House 14/05/09

Cedar House 29/05/08

Cedar House 11/01/07

Cedar House 14/09/05

Cedar House 24/05/05

Cedar House 04/11/04

Cedar House 06/04/04

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

CARE HOME ADULTS 18-65 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA Cedar House 47 Smethurst Street Middleton Manchester M24 2BA Lead Inspector Key Unannounced Inspection 09 May 2006 09:30 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 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, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 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, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA Cedar House 47 Smethurst Street Middleton Manchester M24 2BA 0161 6553553 Address 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) Mrs Ann Merabi Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum number of 16 service users to include 16 service users in the category of MD (Mental disorder) and up to 3 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age) within the total number of 16. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 14th September 2005 2. Date of last inspection Brief Description of the Service: Cedar House is a care home providing personal care for 16 adults, who have been diagnosed with a mental disorder. Three places are registered for residents over the age of 65 years, although no-one of this age was living at Cedar House at the time of the inspection. The home provides 16 single bedrooms, a lounge, conservatory, dining room, communal toilets and bathing facilities. Cedar House is located at the end of a residential street, approximately 2 miles from the town centre of Middleton. A number of small local shops, post office, and pubs are near by. The home has a car park for residents and visitors. A grassed area is provided to the rear of the house and small garden areas to the front. The most recent Commission for Social Care Inspection (CSCI) report is available in the office. At the time of this inspection weekly fees were £375, £1625 per calendar month. Additional charges were made for hairdressing, chiropody, toiletries, activities, newspapers/magazines, clothing and transport. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written using information held on CSCI records and information provided by people who use the service, their relatives, the providers of the service (i.e. the owners), staff at the home, social workers, nurses and mental health consultants. A site visit to Cedar House on 09 May 2006 took place over 9¾ hours. The home had not been told beforehand that inspectors would visit. One inspector, who was at the home for 2½ hours, looked at care plans. The other inspector looked around the building and inspected paperwork that has to be kept to show that the home is being run properly. To find out more about the home this inspector spoke with seven residents, two carers, the registered manager and two joint owners. Comment cards asking residents, relatives and professional visitors what they thought about the care at Cedar House had been given out a few weeks before the inspection. Eleven residents, three relatives, two mental health consultants and eight care managers filled in the cards in and returned them to the CSCI. Telephone conversations took place with two care managers. The home has three owners, one of whom is registered with the CSCI. At the time of the inspection the registered owner planned to cancel their registration and the other two were planning to apply for registration. What the service does well: What has improved since the last inspection? What they could do better: Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 6 Whilst the manager had made all the above changes, there was further improvement to be made in each area in order to provide an adequate service. To achieve this, the manager needs the active and financial support of the owners. The registered owner must visit Cedar House regularly to see what changes need to be made to meet the regulations and to provide the money and support the manager needs to carry on improving the service. The manager cannot make all the required changes on her own. The owners must provide a competent deputy to assist the manager in the process and, where necessary, employ a consultant to advise. Whilst the majority of the staff group had worked at Cedar House for some time they have had little or no training in the care of people with mental health issues. They are therefore unable to always understand and act in the best interests of the people they care for. The owners must provide staff who can achieve this. They must also make sure that there are enough care and domestic staff at the home each day. Residents’ care plans must be completed more thoroughly to make sure they include each area of resident need and action to be taken to meet the need. Risk assessments must be written for every area of risk, along with plans to manage the risk. This particularly applies to residents at risk of self harm. Staff must always complete records when giving medication to residents. The manager and staff must continue to find suitable activities for residents both at Cedar House and in the community. Improvements to the building need to continue. A number are planned in response to CSCI requirements but the owners cannot continue to attend to the building only when CSCI require them to. They must introduce an ongoing plan of improvement for the building which they must send to CSCI and put into action within reasonable timescales. They must also make sure that equipment and services into the building are regularly checked by approved contractors. The owners must introduce a system to check with residents, relatives and professionals involved in their care what they think of the care provided and make changes at the home in response to their comments and suggestions. 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, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 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, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 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): 1,2 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although progress was being made with regard to empowering residents to make an informed choice prior to admission, the necessary procedures and paperwork were not in place to support this process. EVIDENCE: A Statement of Purpose and Service User Guide were written but were in need of updating to more clearly record the home’s function. Three of eleven residents returning comment cards said they had not been given enough information about the home before they moved in. In the past the Service User Guide had been issued to residents when they moved into the home, rather than before they moved in to help them decide whether they wished to live there. The newly registered manager had not admitted a new resident at the time of this inspection. Residents had not seen a copy of the terms and conditions of their stay before moving into Cedar House. Contracts held on file were unsigned and undated, residents spoken with didn’t recall having seen them. The registered manager was in the process of assessing a prospective resident and was considering whether staff had the skills to provide the required care. The home had no assessment format to gather information and check whether the home could meet assessed needs. The manager was planning to write one. She was working with the social worker and had requested a formal assessment from her to assist in the process. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 9 Feedback from one consultant psychiatrist indicated that one placement was inappropriate as the home was not equipped to meet the resident’s needs. Since taking up post the manager had reviewed all residents to reassess whether the home could meet their needs and plans were in place for this resident to move out. Discussions were taking place with regard to more suitable placements for four other residents to ensure the home only cared for those whose needs they could meet. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected 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 poor. This judgement has been made using available evidence including a visit to this service. Care plans did not clearly identify needs, goals and required action which could result in staff being inconsistent in their approach and not addressing residents’ uppermost needs. Residents were involved in making decisions about their lives, but had become de-motivated whilst living at Cedar House. Not all risk assessments and management strategies were clearly recorded and reviewed, leaving some residents at risk. EVIDENCE: Improvement was seen in the introduction of a new care plan format and staff had been given guidance on how to write them. Four were looked at in detail. The format included a personal profile, assessment of social, leisure, physical and mental health needs and related risk assessments. Staff had not completed the plans sufficiently well to clearly describe residents’ needs and how the home planned to meet them. Preferred daily routines and how much support the individual needed in these areas were not clearly identified. There was no evidence of individual goal planning with residents or use of recognised assessment/management tools. There were no recorded goals and action relating to residents’ involvement in making decisions, going into and becoming part of the local community, their leisure needs and development of Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 11 relationships. Although one file recorded reviews with the psychiatrist and Community Mental Health worker, others did not and there was no evidence that social workers had been involved in drawing up of care plans. Staff and residents said that if reviews had not been held with social workers or psychiatrists then they had been held with Cedar House staff. Internal reviews were not recorded on file however. Discussion with residents, staff and a care manager indicated that since the manager started work at the home there had been progress in each of these areas but care plans did not record or clearly monitor progress. These omissions indicated carers did not have the training, knowledge or skills to assess and understand residents’ need. This also limited the care they could provide. A scoring system was used for risk assessments but had been misunderstood by staff in one of the four plans inspected. Risks were not all assessed adequately therefore and when risk had been identified it was not supported by a plan to best manage the risk. Although two of the residents whose plans were inspected had a history of self-harm, there was no risk assessment related to this. Residents said they were able to make decisions but it was apparent from observation and discussion that some were not motivated to do so. Three of eleven residents returning comment cards said they didn’t always make decisions about what to do each day, although 2 of these 3 said they usually did. Decisions made on the day of inspection were with regard to meals, going out and what to do during the day. Residents said they were asked for their opinions at meetings as well as at reviews and the manager was acting on their suggestions for change e.g. arranging a holiday, helping residents to find work. Two residents managed their own finances, six were subject to Power of Attorney arrangements. Residents interviewed were happy with arrangements regarding personal monies. Where the home were involved with residents monies, appropriate records and receipts were held. Financial records for two residents were inspected, and seen to be well kept and up to date, showing incomings and outgoings. However, when monies were checked against the record, one person’s was incorrect. This was rectified during the inspection. Financial records were not regularly audited by someone other than the manager. One resident had a financial advocate but advocacy arrangements weren’t in place for other residents. The manager had, and was still, actively seeking care management support for those residents who had been unsupported for some considerable time. Risk assessments were in place to ensure residents safety in the building. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst improvement was noted in each of these areas, more work was needed to ensure all residents were involved in appropriate activities both in-house and in the community, that personal relationships were encouraged and developed and basic rights assessed in order to provide residents with fuller, more enriching lives. A healthy diet was enjoyed by residents. EVIDENCE: Activities and community contact had increased since the manager took up post. However, in-house activities were limited to board games, completing household tasks and watching TV. On the day of the inspection, although some residents went out and others did their washing/cleaning, the majority stayed in watching TV. The inspector was informed that it had been agreed that some residents would help to do the garden which had been very neglected, but no action had been taken in this area. Gardening was recorded as an interest on one care plan inspected but it had not been transferred onto the activity planner or actioned by staff to enable the resident to regain gardening skills. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 13 Residents said that the manager was helping everyone to apply for bus passes, those who had got them were getting out more to the shops, the hairdressers and to a local day centre. The manager had arranged a trip out at the residents request and another was planned. One staff member commented on improvement in this area as staff had never gone out with residents before the manager started work at Cedar House. For the first time since the home had opened the manager had arranged a 5 day holiday for residents. All but one were planning to go and those spoken with were looking forward to it. One care manager commented this was an activity her client had been requesting for some considerable time. As well as making arrangements for leisure activities the manager had helped two residents to make contact with a local employment agency. One had been offered part time employment and was looking forward to starting the job. Resident contact with family and friends was encouraged and the manager was actively promoting family involvement in residents’ care by inviting them to care plan reviews. All but one comment card completed by three relatives expressed satisfaction with their level of contact with the home. Residents’ choice of faith and their wishes regarding religious activities were recorded on the new care plan format and known by staff interviewed. Three residents chose to go to church occasionally. Staff said that should a resident wish to be accompanied to church arrangements would be made, although weekend staffing levels may be restrictive. Residents rights were respected in that they were asked for their opinions and involvement in day to day running of the home. They were consulted when care plans were written and reviewed. When restrictions to lifestyle were introduced they were discussed and agreed with residents, but not always recorded. Residents had not received voting cards for their local election, indicating that they were not registered on the electoral roll. This basic right was not available to them therefore. A more healthy, balanced diet had been provided since the last inspection. Residents spoken with were satisfied with the food provided and made only a few suggestions for change, some of which were less healthy options than those provided. They particularly enjoyed Sunday brunch. A cook had been appointed a week prior to the inspection and she agreed to review menus with residents whilst continuing to encourage healthy eating. Residents said they were offered a choice of food and recent records supported this with regard to main courses. However, choices were not displayed for residents’ information and a full record of their daily choices were not made. No special diets were required, the cook provided a soft diet for someone who had problems chewing. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 14 The manager and the cook did the food shopping. In order to release the manage to undertake pressing management duties, and to facilitate more community involvement for residents the cook may wish to take a resident with her to do the shopping in place of the manager. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Improvement was noted in each of the areas but none of the outcomes were fully achieved to ensure residents’ needs were constantly and consistently met. EVIDENCE: As staff had recently been involved in writing care plans with residents their knowledge of individual needs had increased. Residents’ involvement helped staff to identify how they wished their support needs to be met. However, as identified above, staff did not have the necessary knowledge and skill to identify all needs and always work independently and appropriately with residents. Staff on duty wished to act in the residents’ best interests and when directed by the manager they worked to meet identified needs. Staff were observed encouraging residents to take responsibility for personal hygiene and assisting when necessary. Staff said they accompanied residents on health and social appointments, and encouraged them to participate in activities both in and outside Cedar House. Feedback from care managers’ comment cards and telephone discussion indicated staff could be more pro-active in meeting needs. Residents were happy with the approach staff took and observation indicated they enjoyed good relationships with staff. Whilst all the residents were of white-British origin, three of the nine staff were of other ethnic origin. Two of Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 16 these staff spoke English well, the third was attending an English as a second language course. The majority of staff were female whilst over half of the residents were male. The manager was seeking to recruit male staff but few applied. These ethnic and gender differences restricted residents if they wished to choose staff to work with them who were from the same ethnic background or of the same gender. However, none of those spoken with considered there was a problem in this area. Residents physical and healthcare needs had been reassessed since the manager took up post. Residents had been Improvement was noted with regard to staff reminding, encouraging and enabling residents to attend health appointments, although one care manager commented that this was still not always achieved. The manager had actively supported residents in accessing healthcare checks e.g. opticians, physicians, and she had asked for number of medication reviews to reduce medication. This was said to be having positive effect on some residents who were becoming more alert and interested in activities. Medication storage, administration and recording were checked. Storage of all medication including controlled drugs was seen to be secure in a locked trolley bolted to the wall and a double locked cabinet in a locked room. Staff administering medication all had recent training and a list of signatures/initials was held with medication administration records in order to identify who had completed the record. Hand written entries on the administration sheets had been signed by the staff member who had written them and by another staff member who had checked them. However, records were not always filled in fully by staff giving out the tablets, a number of gaps were seen on one of the three records inspected. A controlled drugs book was not in use. All medication was counted and recorded when it was brought into the home. In some cases, two records were kept but in one instance these did not match each other. All medication returned to the chemist was recorded and returned on a monthly basis. The person collecting the medication signed for it before taking it back to the chemists. The manager had begun to encourage residents who were able to go to the community clinic for injections rather than professionals visiting them at Cedar House. In these instances there were no entries on administration records to show the person had had their injection. Two Community Psychiatric Nurses reported instances where injections were not available when they visited. The manager was aware of the matter and said she had addressed it. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. Whilst residents were satisfied their views were listened to and acted upon, care managers were not. Necessary employment checks, training and risk assessments were not in place, putting residents at risk. EVIDENCE: The home’s complaint procedure is included in the Service User Guide but was not displayed at the home. The majority of residents knew how to make a complaint, 2 residents and 1 relative did not, although all residents had received a copy of the procedure in the Service User Guide. The manager may wish to consider providing relatives with a copy of the procedure also. Residents spoken with said that if they raised issues with the manager they were addressed The CSCI had received no complaints about the service since the last inspection, neither did the home have any recorded. Three care managers said they had complaints about the home in the past and matters had not been addressed although one care manager said there had been recent improvement and issues appeared to be being addressed. There was no record of care manager complaints at the home. The manager had written a new policy and procedure with regard to Protection of Vulnerable Adults. A copy of Rochdale Interagency Policy was not held at the home however. Although not familiar with the term ‘whistleblowing’ staff spoken with during the inspection were clear that they would report any abuse they witnessed. They were also familiar with the different types of abuse. Three staff and the manager had attended Protection of Vulnerable Adults training. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 18 A procedure for the management of residents’ monies was in place and staff interviewed said that they were not involved in shopping for residents. Risk assessments with regard to self-harm were not written and reviewed, and the most recent staff member had been started work before the home had received a satisfactory Criminal Record Bureau (CRB) or Protection of Vulnerable Adult (POVA) check. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Improvements have been recently made to make the home more comfortable and secure but further action is needed to ensure a safe, secure and adequate environment is provided for residents to live in. Small improvements were needed with regard to cleanliness and infection control. EVIDENCE: A homely environment was provided and all residents had single rooms. They had all chosen their own bedrooms and negotiated changes if they wished to change rooms. A maintenance worker was not employed and a maintenance book not kept to record areas needing attention. The owners employed tradesman to do small jobs in the home as necessary. Improvement was noted in the environment in that the majority of bedrooms had been redecorated and re-carpeted. New bedding and, where necessary, mattresses and had also been replaced. A number of rooms remained in need of refurbishment. Plans were in place to undertake a number of further environmental improvements whilst residents were on holiday i.e. decorate/refurbish bedrooms, refurbish the kitchen, address the damp problem in the shower and Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 20 retile, and relocate the dining room to where the quiet room is. Observation during inspection showed that the following also needed addressing: worn corridor carpet needed replacing, lounge unit and some bedside units had worn surfaces and needed replacing, bath panel on 1st floor bath needed replacing. The lounge carpets were in good condition but in need of cleaning by the dining room. Externally the house was poorly maintained. Although two new security doors had been fitted, external woodwork needed painting and PVC window ledges etc cleaning; guttering needed cleaning out; a broken downspout needed replacing; the fence needed repairing; and a loose flag needed to be made safe. Security had improved in that locks and alarms had been fitted to the front door but ground floor windows needed restrictors fitting. The garden and flower beds were neglected, they were full of dandelions and needed to be weeded. Radiators were not covered and this presented no risk to residents in the main. However, one resident had recently begun to fall. Her bed had been moved away from the radiator but risk of burning from other radiators had not been assessed. There was no control of infection policy at the home and staff had not had training in this area, although staff spoken with during the inspection described good practice. Communal soap was in use in bathrooms but was removed on the day of inspection. Due to compassionate leave the cleaner had not worked at the home for 5 days and although carers had tried to maintain cleanliness it was noted that liquid soap had run out in one bathroom, and the insides of bathroom/toilet bins had been not been replaced. Residents returning comment cards a few weeks before the inspection considered that the home was kept fresh and clean. The laundry was seen to be in good order. It was clean, tidy and sufficient equipment was provided. Residents said the machines were easy to use. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 21 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, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Sufficient staff with adequate experience and training were not provided to meet residents’ needs. The home’s recruitment practices were not safe, putting residents at risk. Recent provision of regular staff supervision benefited residents. EVIDENCE: Rotas for the week of inspection and 2 previous weeks were inspected. Whilst sufficient staff were provided on weekdays and nights, provision dropped to only 2 carers at weekend. Neither the cook nor the domestic worked at weekends either. Staff said that as two people needed to be at the house with residents, this arrangement stopped residents from going out if they needed a staff member to go with them. The domestic was on short term compassionate leave at the time of the inspection, she had not been replaced. A training programme had been introduced following requirement at the last inspection. Some staff had undertaken courses in food handling, health and safety and 1st Aid. With the exception of the bank worker all staff had completed medication administration and fire awareness training. Staff were booked on basic mental health awareness and Protection of Vulnerable Adult courses. In order to achieve a knowledgeable and skilled workforce to work competently with residents, all staff must attend statutory health and safety training and more detailed mental health training. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 22 Four staff had an NVQ level 2 and two were undertaking NVQ level 3. Whilst these qualifications provide a good care base to work from, they are general care qualifications and do not have a mental health focus. The manager had introduced a training file relating to mental health issues which was available for staff and included information regarding manicdepression, schizophrenia, dementia, anxieties, phobias and Parkinson’s disease. Staff said they found the content interesting. Eleven residents who filled in questionnaires said that staff treated them well. One said that they found the staff supportive regarding health and safety, personal hygiene, financial and family affairs. Two care managers spoken with said residents they visited were happy living at Cedar House and had positive relationships with staff. Their observations supported those of the inspector – that staff needed both training and direction to improve their performance. Their lack of understanding and knowledge was further evidenced in the inappropriate language they used when describing interactions with residents. The home had a satisfactory recruitment and selection process but this was not always followed. Of particular concern was the employment of the most recent recruit who had begun work at the home prior to receipt of the Criminal Records Bureau (CRB) check the home had applied for. At the time of the inspection the manager had still not seen the CRB to check whether or not it was satisfactory. Requirement has been made in the past that Protection of Vulnerable Adult (POVA) or CRB checks must be received before employment begins. This poor practice must cease. The recruitment and selection process included completion of an application form, a recorded and scored interview, and provision of two satisfactory written references. Staff records held at the home were incomplete however as a number had been stolen from the home a few weeks before the inspection. Those that had been retrieved were inspected and seen to be in order but full judgement could not be made. An in-house induction had been introduced by the manager. The most recent employee had not completed the programme despite being employed at the home for over 6 weeks. Foundation training was not provided as staff were expected to undertake NVQ level 2. Not all had however. Inspection of records, and discussion with the manager and staff provided evidence that staff received regular, formal supervision which was recorded, agreed and signed. Staff said the manager was supportive and understanding in these sessions but didn’t hesitate to identify poor practice and offer guidance for improvement. Supervision from an experienced mental health worker was not available to the manager. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 23 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, 40 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A competent manager is in post and has made positive changes at Cedar House but further action and support is needed to ensure residents live in a safe, well-run home which is run in their best interests. EVIDENCE: The manager was registered with CSCI in April 2006. She has a BTEC in Care Management and had attended NVQ level 2 and level 3 courses. She was undertaking NVQ level 4 and the Registered Manager’s Award at the time of the inspection. Information provided on comment cards and through talking to residents and staff was very positive as to the changes she had made since her appointment. One resident said ‘the house is in very good hands since she became manager’, staff commented that residents got out a lot more and one care manager said that the cleanliness, furnishings, staffing levels and opportunities for client activities had improved. She had also reviewed residents care plans, suitability of placements and medication, and had been actively seeking care management support for those residents who had no care management contact. She had arranged staff training and was providing Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 24 regular supervision for staff. Staff and residents all said that she was available when needed and would listen and act upon points raised with her. CSCI were kept informed of important incidents at the home – although care managers were not always routinely informed. Discussion with the manager and two care managers indicated a break down in communication with some of the Community Mental Health Team (CMHT) who visited by the side door and did not seek out the manager during their visits. The manager planned to introduce a signing in system for official visitors on arrival. She was also advised to be more pro-active in informing all members of the CMHT of her recent registration as manager and plans for improvement at the home in order to encourage 2 way communication and improve joint working for the benefit of residents. The home did not have a formal quality assurance system although there were a number of quality monitoring practices i.e. residents were involved in the writing of care plans and reviews, residents meetings were held, staff meetings were held and staff received regular supervision. The manager was in the process of writing resident questionnaires. However, whilst these initiatives were used to address issues as they arose, they were not used to make an annual plan to develop the service. The manager was unable to monitor the home’s performance against National Minimum Standards as she had not seen a copy of the standards. The registered owner had not visited the home since October 2005 to write a report for the manager and CSCI about the standard of care. These visits should be monthly and would advise the owner of improvements still needed. The manager needs the active and financial support of the owners in order to continue to raise standards to reach an acceptable level. In addition, her role should be clearly defined in a job description which allows her to concentrate on management and care issues rather than daily mundane tasks e.g. food shopping. She would also benefit from the support of a competent deputy manager with mental health training and experience. The manager had reviewed and rewritten a number of policies and procedures but 20 procedures recommended in the National Minimum Standards were not in place, some of which were necessary to safeguard residents’ rights and best interests e.g. missing resident, bullying, infection control, 1st Aid, recruitment and employment. Provision of health and safety training had improved but insufficient staff had attended First Aid and health and safety training. None had attended infection control training. The majority of maintenance tests to equipment and services (e.g. gas and electric) were carried out within recommended timescales. However, the annual gas inspection was overdue and evidence of a legionella inspection could not be located. A retest was undertaken shortly after the inspection. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 25 Fire equipment were tested annually by the supplier, but internal checks were not undertaken as often as required. Fire records showed that monthly fire drills were held for residents and staff on duty, but it was not clear which staff had attended. Accidents were recorded internally but RIDDOR reporting was not followed. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 26 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 1 2 2 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 2 34 1 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000041209.V288758.R01.S.doc 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 2 1 X 1 X Version 5.1 Page 27 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA 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 YA6 Regulation 15 Requirement Care plans must clearly address residents’ needs, goals and action required to achieve them. Any agreed lifestyle restrictions must also be recorded. Risk assessments and management strategies must be written to protect residents, especially with regard to selfharm. The provider must ensure that all medication records are complete and consistent. (not met from 28/07/05) All staff must have Protection of Vulnerable Adult training. A maintenance and renewal plan must be written and forwarded to the CSCI, to include all items recorded in the report and a projected plan for the continued replacement of worn furnishings and fittings. Additional ongoing mental health training must be provided for all staff including the manager. Staffing levels must be increased at weekends to enable residents who wish to go out accompanied DS0000041209.V288758.R01.S.doc Timescale for action 01/08/06 2 YA9 13 01/07/06 3 YA20 13(2) 09/06/06 4 5 YA23 YA24 18 23 01/08/06 01/07/06 6 7 YA32 YA33 18 18 01/10/06 01/07/06 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA Version 5.1 Page 28 to do so. 8 YA33 18 Replacement staff must be provided whenever caring or domestic staff are on leave or sickness leave. Staff must not be employed without a satisfactory POVA 1st or CRB check. SkillsforCare induction and foundation training or common induction training must be completed within recommended timescales. Provision must be made to support the manager in raising standards at the home, this to include recruitment of a competent deputy, active and financial support of the owners and access to good quality consultant advice. A quality assurance system based on service user feedback must be introduced. The registered provider must undertake monthly visits to Cedar House and send a copy of the visit report to the manager and CSCI. Risk assessment must be undertaken with regard to radiator covers and any other requirement with regard to the resident who falls and any immediate action taken to make the premises safe. All staff must attend health and safety and infection control training, and sufficient staff must complete 1st Aid training to ensure one per shift is trained. to attend All staff must attend at least one fire drill per year. Annual gas and legionella inspections must be undertaken. 09/06/06 9 10 YA34 YA35 19 18 10/05/06 01/08/06 11 YA37 18 01/08/06 12 13 YA39 YA39 24 26 01/08/06 09/06/06 14 YA42 13 09/06/06 15 YA42 18 01/08/06 16 17 YA42 YA42 18 23 01/08/06 01/07/06 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 29 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 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Refer to Standard YA1 YA1 YA2 YA5 YA7 YA13 YA17 YA20 YA22 YA23 YA20 YA36 YA37 YA37 YA39 YA39 YA42 Good Practice Recommendations That the Statement of Purpose and Service User Guide are amended and copies provided to residents and the CSCI. A copy of the Service User Guide should be given to each prospective resident. The manager’s assessments for admission should be recorded on a suitable format which addresses areas listed in Standard 2.3. Residents should sign and date their individually written contract or terms and conditions. Residents monies should be regularly audited by the provider. Application should be made for residents to be registered on the electoral register so they can exercise their right to vote of they wish. A daily menu should be displayed and a record kept of desserts as well as main courses. A controlled drugs book should be used. All complaints should be recorded along with the action taken to address them. A copy of Rochdale’s Interagency Procedure for the Protection of Vulnerable Adults should be held at the home. A controlled drugs book should be used. The manager should receive regular, formal supervision from an experienced mental health worker. A job description should be provided for the manager. The owners should provide the manager with a copy of the National Minimum Standards for Adults (18-65). An annual development plan should be written. Policies and procedures listed in Appendix 3 of the National Minimum Standards for Young adults (18 – 65) should be written. Accident reporting procedures should be followed. DS0000041209.V288758.R01.S.doc Version 5.1 Page 30 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V288758.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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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