Inspection on 24/11/06 for Cedar Lodge

This inspection was carried out on 24th November 2006.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cedar Lodge 26/03/08

Cedar Lodge 06/10/05

Cedar Lodge 12/05/05

Cedar Lodge 20/09/04

Cedar Lodge 26/07/04

Cedar Lodge 05/01/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Cedar Lodge Cedar Lodge Chapel Road Charlwood Surrey RH6 0DA Lead Inspector Damian Griffiths Unannounced Inspection 24th November 2006 10:00 Cedar Lodge DS0000013586.V322570.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 Lodge DS0000013586.V322570.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 Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Address Cedar Lodge Chapel Road Charlwood Surrey RH6 0DA 01293 862050 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) Ashcroft Care Services Ltd Mr Dominic Charles Wayland Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2005 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 services, with local shops within walking distance. The home offers accommodation 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 transport. 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. Cost per: £ 1,626 to £2290.00 Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the Commission for Social Care Inspection (CSCI) year April 2006 to 2007 using the new ‘Inspecting for Better Lives’ (IBL) process. The Manager (yet to be registered) Godfrey Mushandu representing the establishment assisted Regulation Inspector Damian Griffiths throughout the inspection. The IBL process involves a pre-inspection assessment of service information from a variety of sources initially helping to prioritise the order of inspections and identify areas that require more attention during the inspection process. A new Inspection record is compiled from details received from a preinspection questionnaire and notifications of significant events known as Regulation 37’s compiled by the home. Any comments and complaints received and previous inspection reports are all considered for inclusion prior to the inspection visit. For more details of ‘IBL’ please visit the Commission for Social Care Website details can be found on the last page of this Inspection report. The inspector was with staff and service users at Cedar Lodge for a period of 6-½ hrs. The care needs of the service users at the home were complex and demanding. Staff were required to be competent communicators and to be able to use a variety of communication methods. The inspector ensured that time was spent sampling resident’s care need assessments, care plans, talking to service users and observing interaction between service users and staff. Staff files were inspected for evidence of good practice in the following areas: recruitment, training and the distribution of staff skills compiled in the daily rota. Completed CSCI surveys were received from one service user, two from relatives and three from social and health care practitioners. When asked whether they were satisfied with the overall care at the home the unanimous response was’ yes’. The inspector would like to extend thanks to service users, staff and management at Cedar Lodge for their assistance and hospitality. What the service does well: Service users received a comprehensive assessment prior to admission and specialist health and social care practitioners from the organisation and local teams made sure that assessment details were regularly reviewed. Staff helped ensure that each service user had the best opportunity to indicate their preferences by ensuring that their preferred communication method was Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 6 clearly recorded on their care plans. The uses of Makaton sign language, pointing or using pictorial prompt cards were used. Sections devoted to: likes, dislikes, activities and personal development helped service users to obtain a reasonable level of independence. The home had a sensory area contained coloured lights hi-fi and comfortable seating for the service users to relax or party. Other activities included: Bowling, personal shopping, cinema, local pub visits, swimming, walks in the local park, group music, board games and long drives in the country. Health and social care practitioners completing the CSCI survey were satisfied with the overall care demonstrated by staff as this statement concludes: ‘I am impressed with the high level of personal of care and personal commitment shown by staff’. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar Lodge DS0000013586.V322570.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 Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users received a comprehensive assessment prior to admission and specialist health and social care practitioners from the organisation and local teams made sure that this process was ongoing. EVIDENCE: Three service users files were sampled and all contained comprehensive assessments prior to admission. The assessments had been followed up over time to build up an impressive picture of each service users care needs. The ‘CSCI survey’ included confirmation from relatives and health and social care practitioners that the home always made them welcome. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 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 received specialised and individual care as identified in their comprehensive care assessment. Staff helped ensure that each service users had the best opportunity to indicate their preferences and care was taken to ensure the independence of services users was respected. EVIDENCE: The service users had complex care needs however their care plans were accurate and contained different sections devoted to a particular area of need such as: activities, personal care, protection, aromatherapy and a sample of health care needs included: prevention of dry skin, eating meals and weight loss. Each section contained signatory sheets for staff to sign confirming the section had been read by them. All the care plans sampled had been reviewed regularly and parents/representatives were supported to attend care review meetings. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 10 The distinct and individual need of each service user had been assessed and noted in the care plan providing information about the preferred communication method of the service user and included: the use of Makaton sign language, pointing or using the available pictorial prompt cards. The ABC* system of risk and behaviour analysis was one of the method in use to increase the level of communication and understanding between staff and service users. Staff and family support encouraged and promoted the opportunity of ordinary life-styles for service users to enjoy. *Antecedent, behaviour and consequences. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The service users enjoyed a varied and full lifestyle supported by the staff parents, representatives, social and health care practitioners. EVIDENCE: Service users were able to partake in the activities and facilities available in the local community. Care plans contained sections devoted to likes, dislikes, activities and personal development. Some of the activities listed included: bowling, personal shopping, cinema, local pub visits, swimming, walks in the local park, group music, board games and long drives in the country. Aromatherapy was available on a regular basis with a trained aroma therapist attending every week and the home had a sensory area containing a light and sound system and comfortable seating. Service users could relax or enjoy an opportunity to dance to their favourite music. The home had its own transport that enabled the service users to access the town and area daily and without fuss and enabled access to annual holiday destinations. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 12 Service users families were involved with the home and were welcomed to participate within the care planning process. Service users personal needs were handled sensitively and discreetly. Service users and staff were able to communicate their needs and requests using a mixture of Makaton and observational responses to body movement and behaviour. In this way the inspector was pleased to see staff responding to a service users request to go out for a drive on two occasions during the day. The inspector was invited to stay for dinner and observed the residents were able to have a choice of sandwiches and soft drinks, the main meal was served in the evening and staff were observed preparing this throughout the afternoon. The resident’s nutritional needs were catered for and service users were able to eat-out on occasion at the local restaurants. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users received health care treatment in a way that was suitable to meet their needs. EVIDENCE: Staff were observed managing a range of daily transactions that met the needs of the service users and reflected the needs recorded in the care plan. Evidence of frequent health care input could be found in service users care plans. Constant support from a range of health care practitioners included: GP, Dentistry, Chiropody and Community nurses. Health and social care practitioners completing the CSCI survey were satisfied with the overall care demonstrated by staff as this statement concludes: ‘I am impressed with the high level of personal care and commitment shown by staff’. The home had a good control of medicines policy in place and guidelines for the administration of individual service users medication, including guidelines for staff administering ‘occasional’ medication (PRN). Only senior care staff Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 14 administered medication. Medicine administration records (MAR) were checked. Photographs of service users identified their section of the MAR chart, which indicated that the correct medication had been given. Most medication was dispensed from blister packs, but some medication had been prescribed in packet form. It was recommended that the GP be approached to arrange for all medication to be ‘blister packed’ if appropriate. Please see that recommendation section of this report. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 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 their families had access to a complaints procedure and the Surrey safeguarding vulnerable adult policy and procedure was in place but in need of updating. EVIDENCE: The home had a complaints policy, setting out how the home will respond to a complaint and the timescales involved. The homes complaints and compliments book was inspected and there had been no complaints recorded or reported at the home. It was recommended that the home provide a new comments, compliments and complaints book. A restraint programme with clear guidelines was available to staff however staff consulted informed that inspector that avoidance behaviour and distraction techniques were always used avoiding the need to physically restrain. Staff had received training to ensure the safeguarding of vulnerable adults in their care and the Surrey multi-agency procedures were available but in need of updating. It was recommended that the current copy of procedures be updated. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users benefited from an environment that had been refurbished in selected areas however there was still some maintainence work to be completed and further refurbishment to be considered. EVIDENCE: A tour of the spacious and comfortable premises was conducted. The home had a large lounge, dining room and sensory room with unrestricted access. Repair and replacement requirements from the previous inspection had been actioned: a radiator cover had been replaced, the fireplace had been completely removed, a new carpet for the living room, the ground floor bathroom had been completely refurbished and now the service users could take advantage of the new Jacuzzi. The kitchen was clean and tidy but showing signs of wear and tear. The Kitchen heat sensor appeared to be water damaged due to following an Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 17 overflowing bath incident from upstairs. The ceiling was slightly water stained and the sensor had plastic wrapped around its base. The inspector was informed that this was in the process of being repaired by the homes maintenance team who proceeded to repair it during the inspection. It is recommended therefore that the home provide CSCI with confirmation of the repair. All service users had a single room, all of which were personalised with pictures and possessions. The doorframe and surrounding plasterwork to a service users bedroom situated at the right of the stairs required repair. The laundry area was in good order. Overall the home was clean and free of offensive odours and staff were doing their best to maintain a homely environment. It is recommended that the home consider a replacing the kitchen units. Please see the requirements and recommendations section of this report. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff were knowledgeable about their work and had a good understanding of the various needs presented by service users and staff training matched care needs however, it was unfortunate that the staff files did not contain all the recruitment documentation as required. EVIDENCE: There were three staff and the manager on duty at the time of the inspection. Two service users were receiving one to one attention and one other service user was attending a local day centre. Three staff files were sampled for details of recruitment procedures and to evidence documentation. All staff files sampled had received a criminal records check. The inspector was informed that one staff member’s details were still at the head office held there due to a recent transfer from one of the other homes run by the organisation, therefore one of the three files contained very little recruitment information. The Inspector was unable to locate staff employment histories and a job application form. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 19 It was recommended that the home review the content of staff files held at the home. Staff received training in the areas of need that reflected the service users care needs and core skills common to residential care homes. These skills included: Epilepsy awareness, autism, adult protection, challenging behaviour management, report writing, medication administration, first aid, fire safety and food hygiene and there was also a comprehensive induction programme for new staff. Please see the recommendation section of this report. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were working well with the new manager to support service users to express their views and access the local community there were however some minor concerns regarding health and safety at the home. EVIDENCE: The home has recently acquired a new manager, yet to be registered with CSCI. He has undertaken the RMA and NVQ level 4 and will be submitting an application for registration with CSCI in due course. Staff and manager were observed working well together however he is required to produce certifiable evidence of qualification and register with CSCI. Regular house meetings take place were everyone could air his or her view and minutes of the meetings were in evidence. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 21 Staff had received Health and safety training and in all areas checked there had been risk assessments and records were in good order: COSHH requirements were in place, water and refrigerator temperatures measured daily, fire extinguishers checked and fire drills recorded however the fire drills had all occurred during the day and there was no indication how the service users would cope with emergency evacuation at night. It was recommended that confirmation of the operational status of the heat/smoke sensor in the kitchen be confirmed and that a fire drill in the evening be arranged with particular regard to service users response if asleep. Please see the requirements and recommendations section of this report. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 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 3 X 3 X 3 X X 3 X Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 23 NO 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 YA24 Regulation 23 Requirement The registered person must ensure the premises are kept in a good state of repair and decoration, therefore, the repair work required to the service users door frame and replastering of the surrounding wall must be actioned. Timescale for action 24/01/07 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. Refer to Standard YA22 YA23 YA24 YA34 Good Practice Recommendations It was recommended that the home consults with the GP and seek to ensure that all medication is blister-packed. It was recommended that the Surrey multi-agency procedures for the protections of vulnerable adults be updated. It is recommended that the home should consider replacing the kitchen units and that confirmation of the kitchen heat/smoke sensors be confirmed. It was recommended that the home review the content of the staff files held within the home. DS0000013586.V322570.R01.S.doc Version 5.2 Page 24 Cedar Lodge 5. YA42 It was recommended that a fire drill in the evening is arranged. Cedar Lodge DS0000013586.V322570.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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