Inspection on 12/05/05 for Cedar Lodge

This inspection was carried out on 12th May 2005.

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

Other inspections for this house

Cedar Lodge 26/03/08

Cedar Lodge 24/11/06

Cedar Lodge 06/10/05

Cedar Lodge 20/09/04

Cedar Lodge 26/07/04

Cedar Lodge 05/01/04

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

CARE HOME ADULTS 18-65 Cedar Lodge Chapel Road Charlwood Surrey RH6 0DA Lead Inspector Mary Williamson Unannounced 12 May 2005 10.00 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 Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Address Chapel Road Charlwood Surrey RH6 0DA 01293 862050 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) Ashcroft Care Services Limited Caroline Howell Care Home 6 Category(ies) of LD Learning Disability (6) registration, with number of places Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The age/age range of the persons to be accommodated will be: 18-40 years. Date of last inspection 20 September 2004 Brief Description of the Service: Cedar Lodge is a large detached home in very pleasant well kept grounds, situated in a residential area in the village of Charlwood. It is close to all local facilities and main servies, with local shops within walking distance. The home offers accommodaton on two floors for up to six service users with learning disabilities. There are six large single rooms, dining room, kitchen, sensory room, two toilets and two bathrooms. There is ample parking and the home has its own vehicle. The service users have complex needs. All service users are placed by local authority and have regular reviews. Ashcroft Care Services owns and manages the home together with a number of other homes in the area. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and the first to be undertaken in the Commission for Social Care inspection programme year 2005 to 2006. Mary Williamson the lead inspector for the home undertook the inspection. Debbie Sparshot the Deputy Manager of the home was the representative for Ashcroft Care Services throughout the inspection. The team leader and five care staff were supporting three service users. One service user had returned from college with two members of staff. All five staff were spoken to and all three service users were communicated with either by the use of gestures for example hand shake or sign language with the help of the staff. There were no relatives or friends visiting the home during the inspection. The home is registered for six service users. There are currently three service users living in the home with a fourth person being admitted in the near future. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were inspected. The level of staff support was excellent with service users engaged in one to one or two to one activities and supported at all times. Despite the complex behaviour needs of the service users the atmosphere in the home was relaxed and homely. What the service does well: The home provides good quality care for service users. Competent and caring staff meets individual assessed needs. The high level of staff provided enables the service users to follow training programmes, and to attend activities on a one to one or two to one basis. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 6 The home has a robust assessment process for service users being admitted to the home. The home encourages family links and they are also encouraged to participate in the care planning process. The home provides a range of well-maintained communal areas as well as individual bedrooms, which are personalised to reflect individual personalities. What has improved since the last inspection? What they could do better: The lounge has a fireplace which is not in use. This has been identified as a potential trip hazard, and is covered with a mattress. Consideration should be given to removing the fireplace when the lounge is next decorated. Staff files must be maintained to include all the employments documents required in The Care Home Regulation to safeguard the welfare of service users. All medication must be signed for when given or explanatory information recorded if not given. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 7 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 Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 8 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 Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 9 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) 1,2,3, and 5 Information is available for relatives and designated representatives to support prospective service users in choosing where they wish to live. Robust assessment processes are in place to establish the suitability of the proposed placement. A staggered process of admission is followed. Written contracts are in place. EVIDENCE: The statement of purpose and service user guide is available to service users families, and care managers prior to admission. This is also available to service users and a copy kept in individual bedrooms. Staff make every effort to share the content of this with the service who have severe learning disabilities and find it difficult to understand. The organisation has a robust assessment process in place. Pre admission needs assessments are undertaken by the home manager, and a senior clinician from the organisation. This assessment also includes the impact the placement will have on fellow service users, neighbours, and the staffing levels Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 10 of the home. The deputy manager stated trial visits are offered which take place over several weeks prior to admission. Written contracts are in place between the service user, home and funding authorities. These were sampled and are signed by the relatives or designated representative. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 11 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) 6,7,9, and 10 Service users would not understand if their changing and assessed needs are reflected in the individual care plans in place. Every effort is made by staff to encourage service users to make decisions in their daily living skills. Risk assessments are in place for all identified needs. There is a confidentiality policy in place. EVIDENCE: Individual care plans are in place. These are based on input from service users whenever possible, service users families, and the multidisciplinary team. The care plans sampled were well documented, informative and reviewed regularly. The funding authorities organise yearly reviews. It was evident during the visit that service users were encouraged to make decisions through gestures and body language. For example staff were seen Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 12 communicating using gestures for the mini bus to take service users to a music session in a village hall. Various objects were used to communicate needs, and service users were able to point to a coat, a cup, and the door to express their needs. Risk assessments are in place and are not restrictive. They include risks associated with road safety, swimming, and indicate the number of staff required for individual activities. Service users are unable to access their records due to the nature of their disabilities. However their families and their care managers are able to do so on their behalf. There is a confidentiality policy in place and all information related to service users is stored safely in the homes office. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 13 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) 11,12,13,15,and 17. Plans are in place to develop personal goals and development. There is a good leisure activities programme available. Support is provided to assess local community facilities and to maintain family links. The catering arrangements suit the service users needs and lifestyle. EVIDENCE: The service has developed individual goal plans based on personal needs and targets. With staff support service users follow individual programmes for daily living skills and reviewed by the psychologist regularly. Leisure activities are also individual based. One service user attends college for rhythm and sound. Reflexology, aromatherapy, music therapy, and movement are also available. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 14 Community links are maintained and service users are supported to attend the local leisure centre for swimming. Shopping trips, horse riding, outings to the beach, and visits to the local pub and theatre are also organised. Family links are encouraged and maintained. Families are encouraged to take an active part in the care planning process and also attend reviews. The menus are planned weekly by staff, with the knowledge of service users likes and dislikes. The choice of meals suit the age and lifestyle of service users. The main meal is served in the evening. The deputy manager stated that service users like to eat out and this can be incorporated into the activities programme. The menus were sampled and the choice if food was wholesome and appetising. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 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 standard(s) 18, 19 and20 Service users healthcare needs are seen to be appropriately met, by the systems that were in place. EVIDENCE: Sensitive personal support is provided to service users, as outlined in individual care plans, in a caring manner. One service user is registered with a GP in Horley, and two service users are registered with a GP in Newdigate. Dental care is accessed at the special needs dental department at The East Surrey Hospital, and Chiropody treatment is accessed by home visits. There is also access to psychology and psychiatry treatment. There is a policy for the administration of medication in the home and all medicine is administered accordingly. Medication is supplied by Boots The Chemist and regular audits are carried out. There is currently no service user in the home who self medicates. All staff have been trained in medication procedures and currently undertaking a certificate in the safe handling of medicine at NESCOT College. There was a discrepancy in the recording charts when two gaps in signature were noted. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 16 Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 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 standard(s) 22,and23 The home has a satisfactory complaints system in place and relatives and designated representatives have a copy of this. Staff are also trained in abuse awareness and the organisation has a comprehensive policy relating to this in place. EVIDENCE: The complaints procedure is available to all service users who relay on staff or family to complain on their behalf. There have been no complaints since the last inspection. Abuse awareness training is provided to all staff in accordance with the homes policies and procedures. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 18 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) 24,26,27,28,and 30 The home is well maintained. Service users bedrooms are comfortable, safe and they are able to have their possessions around them. Communal areas are spacious. The home is clean, pleasant and hygienic. EVIDENCE: The premises are suitable to meet the service users individual and collective needs. The home is well maintained and accessible to all the service users. All service users bedrooms are decorated and furnished to good standard. The deputy manager stated one bedroom has been identified to be repainted, which was being addressed by the organisation. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 19 Two service users with complex behaviour needs will not keep curtains on their bedroom windows. Consideration should be given to an alternative means of shade to prevent service users from waking up too early during the summer months. The lounge and dining room are furnished to a good standard. The lounge has a fire- place and kerb- stone situated on the main wall. This is not in use and has been identified as a trip hazard for the service users, which is currently camouflaged by a mattress. Consideration should be given to removing this when the lounge is next being decorated to reduce the risk of accidents. The home is clean and free of odour. on both floors. The toilets and bathrooms are provided There is a large enclosed back garden with garden furniture and a swing. Two service users were observed sitting with staff enjoying these facilities. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 20 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) 31,34,and 34 Staff in the home have a good understanding of the assessed needs of the service users. The staff rota indicates a good skill mix of staff on duty at all times to support service users. Staff employment records did not contain all the required documentation as set out in The National Minimum Standards. EVIDENCE: On the day of the inspection there were three service users living in the home and there were five staff on duty. This ratio of staff was in place to support service users attend college on a two to one basis, and to enable all three service users to attend music in the village hall during the afternoon. The deputy manager stated that she is enrolled to undertake NVQ level 3 and a further 3 member staff were also undertaking this training. She also stated that the manager is undertaking NVQ level 4. All staff have induction training followed by foundation training. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 21 Employment records were sampled for two members of staff. There were no application forms in place and no evidence of a CRB reference number in place. The deputy manager stated that only copies of employment details are kept in the home with the originals retained in the HR department. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 22 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) 37, 38, and 42 The home manager was off duty during the inspection. The home was well managed by the deputy manager. The health and safety of the service users are promoted and protected. EVIDENCE: The home manager was off duty. He currently has an application in progress with The Commission for Social Care Inspection to become the registered manager of the home. The home was functioning efficiently and was well managed by the deputy manager. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 23 Health and safety policies and procedures were seen throughout the inspection and the staff confirmed that they are introduced to these during a period of induction training. Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 24 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 3 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score 3 x x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cedar Lodge Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 3 x h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 25 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 20 Regulation 13(2) Timescale for action The registered person shall make 30/06/05 arrangements for the safe recording of medicines administered. The registered person shall 30/06/05 retain in the home for inspection all employment documents as required in paragraph 1to 6 of Schedule 2 of the Care Homes Regulations The registered person shall 30/07/05 ensure all parts of the care home are kept reasonably decorated to include service users bedrooms. Requirement 2. 34 19(1)(b) 3. 26 23(2)(b) 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 24 Good Practice Recommendations It is recommended when the lounge is due for refurbishment that consideration shoule be given to the removal of the fire place which has been identified as a potential trip hazard for the service users. It is recommended that an alternative means of shade for bedroom windows is explored to prevent the service users from waking up too early in the summer months. h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 26 2. 26 Cedar Lodge Cedar Lodge h09-h58 s13586 Cedar Lodge v227005 120505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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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