Inspection on 18/12/06 for The Cedars

This inspection was carried out on 18th December 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

The Cedars 21/10/08

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

CARE HOME ADULTS 18-65 Cedars, The 4 Chequer Street Bulkington Warwickshire CV12 9NH Lead Inspector Sheila Briddick Unannounced Inspection 18th December 2006 08:30 Cedars, The DS0000068554.V322034.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 Cedars, The DS0000068554.V322034.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. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars, The Address 4 Chequer Street Bulkington Warwickshire CV12 9NH 02476 310974 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) Coventry and Warwickshire Partnership Trust Mrs Angela Yearby Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can provide care and accommodation for 4 service users under 65 for reasons of learning disability. Date of last inspection Brief Description of the Service: The Cedars is a joint venture between Leicester Housing Association, which owns the property and Coventry and Warwickshire Partnership Trust, which provides the services and care. The Cedars provides 24-hour care to 4 service users with a learning disability. The Trust also provides Day Services for each service user. The Cedars is a domestic-style bungalow in the village of Bulkington. The bungalow has a communal living/dining area and four single bedrooms. There are no en-suite facilities. The home has been adapted to meet the service users needs including a good range of equipment to assist with daily routines. There is a large communal garden with flowerbeds. The property has secure fencing around the perimeter. There is a large minibus driven by staff members to enable service users to access the community. The current scale of charging is £273.00. Additional costs that have to be met by service users include toiletries, holidays and social expenses. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the inspection visit the manager had forwarded to the Commission a pre-inspection questionnaire, a staffing rota and menu records for the home. Service user and relative questionnaires were sent out and one relative responded. All pre-requested documentation was examined as part of the inspection process and the evaluation included in this report. The survey information from the relative concluded that lifestyle in the home was good, that people were safe and well cared for. The inspection visit was unannounced and took place on Monday, December 18, 2006. at 08.30 am and ended at 1.00pm. The inspection involved: • • • Discussions with the manager and five care workers. Observation of working practices and of the interaction between service users and staff. Two service users were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. A tour of the environment was undertaken, and home records were sampled, including staff training, health and safety, rotas, Quality Assurance records and fire records. • What the service does well: The people living in this home can be sure that their individual needs and choices are fully understood by the people supporting them. Care planning focuses on positive outcomes for the people living here and is enabling them to live ordinary and meaningful lives as they wish. Staff fully understand the individual communication needs of the people living here and have taken considerable time to ensure that care planning is about the individual rather than the collective needs of everyone living in the home. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 6 People are supported to enjoy a full and stimulating lifestyle with a variety of options to choose from. Daily routines are very flexible and service users were seen to be able to make choices about the days activities. Staff encourage and provide varied opportunities for service users so that they can develop their social, emotional and independent living skills and there is a strong ethos and focus on involving people in all areas of their life. One of the successes in being able to provide consistency to people in their lifestyle opportunities is the staff support offered which in many instances is 1:1. The staff team are accessible and approachable, good listeners and communicators and extremely interested and motivated in the work they do. They are to be particularly commended for the way they record the daily activities and life experiences of the people living in the home, this is enabling people who are not able to talk about their experiences but share photographic memories with people. 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. Cedars, The DS0000068554.V322034.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 Cedars, The DS0000068554.V322034.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): Standards 1 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about this home is amended as necessary to ensure that in the event of a vacancy occurring any prospective user would have up-to-date information about the service provision to enable them to make a choice about living there. EVIDENCE: The Coventry and Warwickshire Partnership Trust now own the service as a result of national configurations of Primary Care Trusts. The registration for new ownership was completed on 30/10/06 and a new certificate was forwarded to the home. The statement of purpose and service user guide for the home has been amended to reflect the change of ownership that has taken place and service user’s contracts have been renewed to reflect the new service provider. The four people living in this home are all younger adults and have been sharing the environment since the service was first opened. It is expected that they will continue to do so and that no new service user will be coming to live in the home. There is however an admissions process that would be implemented in the event of a vacancy occurring. Cedars, The DS0000068554.V322034.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): Standards 6, 7 and 9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are involved in decisions about their lives and are able to play an active role in planning the care and support they receive as a result of the effective communication skills of the staff team. EVIDENCE: Two care plans were looked at during the visit to the home and discussion took place with staff working in the home about the care planning process which is based on the principles of Person Centered Planning, referred to in the home as Essential Lifestyle Plans. The people living in this home have limited verbal communication skills and the staff have developed plans with them through observation and the use of object referencing and signing, (Makaton), the quality of information on the two plans looked at was to a good standard and key workers are to be commended for this. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 10 Each of the care plans began with an introduction about the service user, i.e. ‘The type of person I am’, ‘The type of person I would like to support me’, and ‘The people in my life’. This is followed by some descriptions of the service user’s personality by ‘The people who know and care about me’ and other information important to the service user. Care plans also inform staff about what is non-negotiable to the service user and the things that they must do, have and be included in. This includes contact with relatives, social activities and the one to one support needed by them to access their lifestyle choices. Examples of this information includes;I must have freedom to walk around the house. I am not a selfish person. Sometimes I like to have my meal late and not with others. I do not like being told you are going to take my photograph. The individual routines of each service user were clearly documented on their care plan and information about how they communicate their needs was clear and focused on positive outcomes. For example, When I am tired, I yawn and When it is really important that I have something quickly, my feet really thud . There is significant evidence to suggest that care plan reviews are thorough, regular and include all people involved in the care and support for the person. Invitations to attend six-month reviews are sent out to family members, GPs, consultants and key workers. An agenda is identified and the record of the review meeting includes a summary of goals achieved so far and identifies the people who are to be responsible for actions still necessary. Observation of care practices and discussion with staff demonstrated they have a strong belief in ensuring service users are involved in the planning of care about their lifestyle and quality of life. Service users were always included in discussion about them and it was apparent from observing their reactions to discussion that they were listening and responding to the conversation around them and this was recognised by staff who would respond appropriately to the service user. Individual risks to service users are clearly documented on their care plan and recorded in such a way to promote and respect the service user’s dignity. For example, when out in the community the support required for one service user is documented as, I do need you to link arms with me when I am out. Staff have clear guidelines to follow when managing risks and this includes information on care plans about how a service user manages their feelings. For example, the care plan has a specific section which records the things that a service user does not like and included, I do not like being told what to do”, Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 11 “I liked be asked, not rushed. and “When I do not want to interact, I will go to my room or sit in the corridor. Guidance for staff to follow with one service user when they become stressed included, The service user will enjoy a bubble bath at these times or a walk in the garden”. Service users do not manage their own financial affairs and the manager acts as appointee for handling their financial affairs. The financial status of individuals is included on the agenda during the monthly review and the impact in achieving goals is assessed against current finances. The record for one review informed key workers to be careful with the service users finances and to “increase, the Building Society bank balance whilst not impacting on the service users quality of life. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people living in this home have excellent support to live ordinary and meaningful lives and to participate in and contribute to the community in which they live. EVIDENCE: The activity diaries and lifestyle records of the two service users whose care was being looked at were examined. This determined that activities for service users are varied and regular and support a meaningful lifestyle. For example, in the two-week period prior to the visit to the home a service user had been shopping for household items, Christmas gifts and clothes and enrolled at the local college for courses in the coming term. They had lunch out on several occasions, had been horse riding and been to the Clothes Show at the NEC where they had met with celebrities and watched a fashion show. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 13 Diaries show that service users are encouraged to participate in domestic chores, for example, taking their clothes into the laundry, making a trifle, making lunch and going to the post box to post Christmas cards. A service user is actively involved in a drama group and has recently participated in a production of a show at the Bedworth Civic Suite. A photographic record of the activity, along with thank you cards from the production company, had been placed in the service users life story record. The staff team are to be commended for the excellent recording that is taking place of the life experiences and opportunities of service users. The record is photographic and is completed by the key worker with service users each month. As part of the quality assurance audit recently completed a psychologist had recorded, I was very impressed with the support to service users, especially the range of activities they are able to participate in. Staff scrap booking skills are impressive to, the use of photography for example”. A team of four staff is specifically designated to lead the daily activities for each service user and service users can expect 1:1, or when necessary, support from two staff. On the day of the visit to the home one service user was having their at home day which each service user has during the week when they are able to do their own known likes and enjoy their special ‘comforts’, which for this service user was to enjoy having the house to themselves. Two service users were going out for their Christmas lunch and some Christmas shopping. One service user, who has their own car, was going with staff to the garage for a repair to be done to the car followed by lunch out. The home also has its own minibus car which is used for supporting social and leisure activities in the community. The food provision in the home continues to be good with care plans clearly identifying any risks there may be for individual service users when eating, or drinking, or preparing food. Service users are involved in menu planning through use of object referencing and staff were observed to offer informed choices that would not confuse the decision-making, i.e. showing two tins of soup for a service user to choose which flavour they would like for their lunchtime snack. Service users sit together on a regular basis to look at a photo library of food when planning menus. A record of all meals taken by service users is maintained Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 14 The routine for the morning was very relaxed with service users getting up at the own pace and discussion with staff demonstrated that the individual needs of service users at this time are well known. Breakfast time was a leisurely occasion with service users having cereal or toast and a drink of tea. One or two service users had also had a cup of tea and toast in their bedroom and when staff observed that they would like some more to drink or eat after they were dressed and sitting in the lounge this was offered to them. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people living in this home can be sure that the health and personal care they receive is based on their individual needs and that the principles of respect, dignity and privacy are put into practice when care is offered to them . EVIDENCE: Examination of two care plans found that the personal care needs of individuals continues to be offered to them according to their needs and that the people providing care to them have a good knowledge of how service users wish their care to be met. Care practice observed during a visit was sensitive and respectful and service users appeared satisfied with their care received. For example, one service user does not like sitting for long periods and spends most of their time walking around their home however they were very content to sit on a chair as a staff member dried and styled their hair after it had been washed. The service user smiled when other staff members complimented her on her hairstyle. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 16 Service user’s clothes were clean and appropriate for the activities of the day for example, service users staying at home wore comfortable relaxing clothes whilst those going out for their Christmas lunch were wearing their best clothes. Health action plan is have been implemented and examination of the plans indicated that health-care needs are reviewed on a regular basis and that staff are taking appropriate actions to meet recommendations made by the learning disability nursing team who had completed the initial action plans. This included supporting service users to opticians and audiologists and opportunity to attend health screening clinics. When it had been decided, following discussion, with family members that a service users attendance at a healthscreening clinic would be too stressful this had been recorded on their health action plan. Care plans looked at continue to show that staff are responding appropriately to health-care emergencies and seeking advice from specialist consultants, and health-care services when necessary and this includes, psychology services, speech and language services and Community Learning Disability Nurses. Medicine management in this home is to a high standard with good evidence that competencies of staff when administering medicine to service users is regularly monitored. All records relating to medicine management seen on this occasion were up to date and care plans clearly identified the preferred way of the service user when taking their medicine. There is clear guidance on care plans for staff to follow in the event of service users choosing not to take their medicines at any time. There was evidence on the care plans seen that medical reviews with GPs and consultants were regular or as health needs changed. Staff monitor service users health-care, including epilepsy, and this information supports medical reviews with psychologists. Protocols for administration of diazepam during epilepsy seizures are very clear with instruction and guidance for staff to follow for the different types of seizures a service user may have. The service is currently reviewing its medication policies and procedures and is using guidance as recommended by the Royal Pharmaceutical Society. The training programme in the administration of medicine is also being reviewed and will include measures for competency through assessment and supervision. Competency monitoring will also include staffs views of their confidence when administering medicine. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in this home can be sure their views are listened to and acted upon. Adult protection policies and procedures in place for the protection of vulnerable people provides a safe environment for the people living in this home. EVIDENCE: There have been no complaints made about this service to the commission, or to the home manager, in the last 12 months. Comments that were the received from one relative as part of the Inspecting for Better Lives programme indicated that they were generally aware of the home complaints procedure, although not in great detail, but were confident that staff would let them know if necessary. The relative indicated that they were satisfied with the overall care provided. In discussion with staff they demonstrated that they would know if a service user was unhappy about their care saying that this would be demonstrated by the service users body language. Observation during the visit also confirmed that staff give service users time and opportunity to express their opinions when making or offering choices. There are well-established policies and procedures for the protection of people from harm and staff working in the home attend training in the Protection of Vulnerable Adults, (POVA), during induction and is mandatory training on a Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 18 regular basis. Staff spoken with had either attended POMOVA training or had identified a need for development in this area with the manager during supervision. The manager informed that she had recently attended the launch of a training programme for the Protection of Vulnerable Adults that has been developed by the Warwickshire Vulnerable Adult Protection Committee and the Warwickshire Quality Partnership Board. The training for staff will include working through a workbook, covering all vulnerable adult issues, and the manager will assess competency. Staff members will receive a certificate of competency at the conclusion of their assessment. There are policies and procedures in place for the protection of service user’s finances and staff spoken with had a full understanding of their role and responsibility of protecting service users money and of the safeguards in place for the management of risk of abuse of service user’s finances. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables the people who live there to be safe. The home is maintained and comfortable and the environment continues to encourage independence. Personal care facilities do not meet the collective needs of the people living in the home and this at times can impinge on the quality of personal care available to service users. EVIDENCE: There is a warm and welcoming atmosphere in the home and at the time of the visit it was homely, comfortable and safe. People living there are able to move around easily and freely and to go to their bedroom to rest if they wish. Where a service user feels more comfortable in the home is written on their care plan, for example, one service user enjoys sitting in the corridor and another service user likes to go to their room for relaxation. Each service user appeared comfortable and relaxed in their environment. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 20 All areas of the home were clean and there has been some recent decoration of one service user’s bedroom and this included replacing their carpet. Staff said that the service user had chosen the carpet themselves and that this had been done through a visit to the carpet shop and bringing home various samples of carpeting so that the service user had plenty of time to make their choice. Bedrooms reflected the individual lifestyle and interests of people and they had been provided with storage facilities sufficient to store their belongings. There is only one bathroom facility in this home and although the equipment in the bathroom is sufficient for the individual needs of service users the collective needs of people living in the home are not being met through the provision of only one bathroom facility. For example, staff said that on occasion the hydraulic bath chair has failed to operate and until it is repaired service users who require this equipment have no other bathing or shower facility to use in the interim period. There are continence issues in the home and without an alternative bathing or shower facility continence personal care would have to be met in the individuals bedroom and this is not satisfactory. Service users generally have an established routine when getting up for their personal care however one bathroom facility places limitations on this and individual service user’s daily routine, i.e. choosing to get up early or later and having to wait for the bathroom to be free. There is a separate toilet, which can be used, and there appears to be sufficient space in this room for a shower facility, which could also be used by a wheelchair user. The manager has discussed these issues with the Estate Manager for Leicester Housing Association but no definite plans are in place to improve the current facility. There are established policies and procedures in place for the control of the risk of infection in the home and staff practices during the visit were seen to be safe. Infection control training is included in mandatory training for all staff. There were sufficient supplies of gloves and aprons in areas where infection control is necessary and action has been taken to meet a recommendation made by environmental services at their last audit of the home about disposal of continence waste. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff working in this home have a very good understanding of the service user support needs, this is evident from the positive relationships, which have been formed between the staff and service users. The recruitment policy and procedure for this home ensures that service users are supported and protected from harm by the people caring for them. EVIDENCE: Five care staff were met during the visit to the home and through discussion with them and observation of their care practices it was determined that they were accessible to, approachable by, and comfortable with service users. They were good listeners, excellent communicators and demonstrated an interest, motivation and commitment to providing a lifestyle for service users that is meaningful and safe. All discussion in the house between staff was very much around the service users and the activities of the day and service users were included in the discussion with the use of signing, object referencing, with staff looking at Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 22 service users directly when talking about the individuals choices that day to other people. A staff member was asked, how do you know that what you are doing is what the people in this home want, and they replied, Through body language, we share successes and try new things. Pre-inspection information indicated that there is a well-established training and development programme in place for staff and includes training in, Learning Disability Award Framework, (LDAF), data protection, epilepsy and Makaton signing,. 50 of the staff team have in NVQ at Level 2 or above. Staff spoken with felt that the training programme was meeting their skill needs development saying, I have just done LDAF, although I had already achieved my NVQ Level 2 in Care, and I should be doing POMOVA training next, although we dont use it here it does show you how to get out of difficult situations. Staff also said, a lot of our training is mandatory but it is knowledgeable and it does help. All records looked at during a visit to the home of relating to recruitment were found to be in good order. Recruitment records included Criminal Records Bureau, (CRB) documentation that had been obtained prior to people coming to work in the home. There is an established induction procedure for new staff and includes the Learning Disability Award Framework induction programme. One relatives comment card was returned and this confirmed that the relative felt there was always sufficient numbers of staff on duty and that staff welcomed them into the home, which they could visit at any time. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in this home can be sure that the service is managed by a competent and skilled manager who has a strong belief of involving them in all aspects of life in the home. The policies and procedures for safe working practice in this home are ensuring that service user health, safety and welfare is being promoted and protected. EVIDENCE: Discussion with staff and the manager, examination of home records and observation of care practices demonstrated that the service is managed by a competent and skilled manager who fosters an atmosphere of openness and respect with service users, family and friends and staff feel valued and that their opinions matter. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 24 Staff spoke very highly of the manager and the support that they receive from her. They say that supervision is regular and it is two ways, saying I can ask for supervision and the manager is very approachable, I am happy to have supervision, its good for voicing your opinions and discussing problem. Another staff member said, we are a good team - we are not always perfect but because the manager is approachable possible problems can be nipped in the bud. Staff spoken with said that the manager dealt with difficult situations well saying, She doesnt single out individuals. There are affective quality assurance and quality monitoring systems in place based on seeking the views of relatives, professionals and staff working in the home. There is evidence to show that health and safety audits, food safety audits and surveys completed are evaluated and actions put in place to meet any shortfall or improvement of service suggested. For example, a recent health and safety audit identified that the first aid boxes needed renewing and food labelling had not been completed and records showed action took place immediately to meet the shortfalls. A food safety adviser recommended that staff wear protective clothing when working in the kitchen preparing meals, this was actioned immediately and staff now where domestic style aprons in the kitchen when preparing food. The wearing of domestic style rather than white plastic disposable aprons is more applicable in this home environment and supports the aims and objectives of the service. A home manager from another Coventry and Warwickshire Partnership services completes an audit of the service on an annual basis based on the National Minimum Standards for Care Homes for Younger Adults, this included the Environmental, Lifestyle and Safe Working standards. Health and safety management in this home is to a high standard and all records relating to this were up-to-date and in good order. Safe practices were observed in the home and records showed that this is further promoted through training for staff in manual handling, food hygiene, first aid, fire safety and infection control. Pre-inspection information received shows that maintenance of fire fighting equipment, electrical appliances and central heating systems takes place on a regular basis. Systems are in place for ensuring that food hygiene is maintained and monitored, this includes recording fridge and freezer temperatures and cooked meats. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 25 Risk assessment has been completed for safe working practices and these are reviewed regularly. The control of the risk of Legionella in the home and risks from excessive hot water temperatures have been assessed and monitoring checks of water temperatures are taking place routinely. Fire safety management includes regular testing of fire alarms and emergency lighting and all records relating to fire safety management were up-to-date and in good order. Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 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 3 2 N/A 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 3 25 X 26 X 27 2 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 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 27 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 YA27 Regulation 23.2(j) Requirement Sufficient bathing and showering facilities must be available at all times to meet the personal and healthcare needs of service users. Timescale for action 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. Extracts may not be used or reproduced without the express permission of CSCI Cedars, The DS0000068554.V322034.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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