CARE HOME ADULTS 18-65
Cherrywood House 6 Eastfield Park Weston Super Mare North Somerset BS23 2PE Lead Inspector
Catherine Hill Unannounced Inspection 21st March 2007 10:15 Cherrywood House DS0000008117.V327400.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 Cherrywood House DS0000008117.V327400.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. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cherrywood House Address 6 Eastfield Park Weston Super Mare North Somerset BS23 2PE 01934 621438 01934 415143 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) www.craegmoor.co.uk Parkcare Homes Limited Mrs Margaret Eileen Fisher Care Home 12 Category(ies) of Learning disability (12), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. May accommodate up to 12 persons with learning disabilities, aged 18-64 years, requiring personal care only May accommodate up to 6 persons with additional mental health needs (MD). That the manager achieve the Registered Manager`s Award within one year of registration. Date of last inspection Brief Description of the Service: Cherrywood House is registered to provide personal care for up to 12 young adults aged between 18 and 64 with a learning disability, six of whom may have additional mental health issues. This service aims to support people with significant challenging behaviour in a homely setting. The home organizes a range of external activities for each resident, and offers intensive support - often one-to-one - to enable them to maintain close links with their families and to increase their independence. Cherrywood House is in a residential area of Weston-super-Mare, close to local amenities and public transport routes. The home is on three floors and has one ground floor bedroom with an ensuite. Each person has their own bedroom. The house is not accessible to wheelchair users due to the steps at the entrance. The home is operated by Parkcare No.2 Ltd, a subsidiary of Craegmoor Healthcare. The current level of fees is £908. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was done over the course of one day, between mid-morning and late afternoon. The inspector spoke with seven of the residents and also spent some time sitting in the lounges with them. The inspector spoke with eight of the staff, including the manager. The inspector also met a resident’s Social Worker during this inspection. Prior to this visit, the inspector contacted a number of health and social care professionals to get their views on the home. Four of these professionals returned questionnaires or responded by phone, and all of them felt very positive about the quality of care and the culture in the home. Professionals felt that the staff team works with them in a very open way and tries to provide person-centred care. Those professionals who have advised on how certain behaviours should be managed felt that the home carries out their suggested strategies effectively. One person commented that the manager has had a good influence on the service development. Two CSCI inspectors visited the home unannounced last autumn, following a concern raised by a relative. This was regarding the decor and state of repair of the home, and the untidy state of the garden. The house had recently been redecorated and a gardener had been appointed. The relative had also mentioned the level of activities, and inspectors made suggestions for how activities could be better recorded. What the service does well:
Cherrywood House caters for some highly dependent people, many of whom have behaviour that really challenges the service. Staffing levels are well above the minimum, allowing for the levels of support indicated as needed in residents care plans. The team approach strikes a good balance between being very flexible and immediately responsive, and providing clear structure to residents lives. Staff adopt an adult-to-adult approach to the residents. The success of this approach is reflected in the progress some residents have been able to make. Care plans are exceptionally clear and informative. A wealth of information is made easily accessible to staff. Care plans are written very much with the residents own wishes in mind, and people contribute to their own care planning as far as possible. Although the home scored highly for this at the last inspection, they have not rested on their laurels but redesigned the care plan format to be even clearer and more person-centred. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 6 Staff get a lot of training, and come across as a confident and competent team. Individual staff bring very different skills and qualities to the group, and there is evidently a strong mutual respect within the team. Each person has a good range of regular, interesting activities that suit their individual tastes and needs. Residents also have regular, planned one-to-one days with their key workers. What has improved since the last inspection? What they could do better:
Staff covering night-time duties must have fire refresher training at least every three months. Residents activities diaries would be improved by recording the one-to-one time they get with staff, and all the efforts staff make to engage them in activities. Each person should have a Health Action Plan, in line with the Valuing People guidance. The exterior of the house and the gardens would benefit from some repair and tidying. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 7 The kitchen cooker is very old, and staff have to get on the floor to light it. This has been pointed out at previous inspections but the cooker has not been replaced. There should be clear written policies on service users access to their files, on emergencies and crises, and on racial harassment. Key policies should be produced in formats that might be accessible to service users. 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. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 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 representatives get good information about the home before deciding to move in. The home gathers in-depth information about the person to ensure that their needs are likely to be met. EVIDENCE: The Statement of Purpose is regularly reviewed. This is a very concise document, which is posted in the hallway. It does not include the fire procedure and complaints procedure, but copies of each are posted in the hall nearby. Residents assessments are very in-depth, with lots of extra information added as staff get to know the person better. The home takes care to only admit new residents who seem likely to gel with the existing resident group, but their efforts are not always successful. Conflicts are managed with tact and creativity, and external professionals advice is promptly sought. When it has not proved possible to meet a persons needs in this setting, the home has liaised closely with external professionals to identify possible solutions. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 10 The inspector commented at the last inspection that the residents contract and statement of terms and conditions in current use are not very accessible to them. She recommended that alternative versions of these should be drawn up in formats more likely to be understandable to residents, with staff support as necessary. The contracts and statement of terms and conditions seen at todays visit were in the same format, but the manager said that all the information contained in them is covered in the Service Users Guide, which is in an accessible format. Prospective residents and their carers may visit the home as often as they need to before making a decision to move in. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A useful depth of information is kept on each persons needs and how these should be met. Staff are clear about what is required of them, and service users are involved in planning their care as fully as possible. EVIDENCE: Residents personal care records are exceptionally informative and detailed. There is a wealth of individual risk assessments that supplement the very detailed care plans, and many of these are cross-referenced with supplementary information on the best strategies to adopt. A front sheet has now been placed on each residents file, helping to ensure that staff are aware
Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 12 of all the detailed information available in various places within the file and can access it quickly. The inspector commented at the last inspection that the overall quality of care plans would be improved if the residents own aims were incorporated. The care plans sampled at todays visit showed that residents viewpoints underpin every goal. One of the residents had drawn up a list of the people she wanted to invite to her care plan review, and was ringing them herself to see what dates they were able to make. Two people have special communication needs. While different staff each gave the inspector very similar information about individual residents needs, this information was not reflected in the written care plans. When care plans are next reviewed, information on individual communication needs and styles could be expanded. Confidential information is kept securely, and staff discuss individuals needs discreetly. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each person has a full and individually tailored timetable, with plenty of staff support to participate in activities and to learn new skills. Residents lives are made more interesting and rewarding by this carefully focused support. EVIDENCE: Many of the residents are doing courses at the local college, either during the day or early evening. Each person has their own timetable of activities, and most people have one-to-one support from staff to access community-based activities. Staff doing one-to-ones with residents during this inspection were
Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 14 sensitive to the resident’s possible perceptions, and took care to communicate clearly. There is a good range of in-house and community activities, including cookery, keep fit, games, art, disco, girly nights, shopping, pub, bowling, theatre, swimming, walks, and minibus trips. The inspectors who visited last autumn made suggestions about how activities recording could be improved. Records seen at this inspection showed that these suggestions had largely been taken up. The person who has very changeable energy levels now has several options for activity listed on her timetable, so that staff have a range of possibilities, dependent on how active she is feeling. This is helping to ensure that the resident has regular opportunities, and is not simply left to her own devices if she does not wish to join in a more energetic pastime. Staff are also recording when they have offered activities that have been refused. However, this persons daily diary still tends to be very much about her mood and the personal care she has given. Over the past month, only a few entries gave clear information about how staff had tried to engage her in activities and given her one-to-one time. From the way this person’s engagement with her surroundings has increased, it is evident that she is getting a lot more input than her diaries reflect. The manager intends to discuss with staff what kinds of input should be recorded in these diaries. Craegmoor allocates each resident £200 a year towards holidays. Residents pay any additional holiday expenses on top of this. A qualified aromatherapist visits regularly. There is a small room set aside upstairs especially for the purpose of massage, and this has a proper table for residents who like body massage. Key workers support residents and their families to stay in touch. Residents are often taken to visit families, and staff will support residents to participate in social events with their families if necessary. Each of the professionals who responded to the pre-inspection questionnaire said that residents privacy and dignity are well promoted. Menus are based on residents known preferences and on the suggestions of those people who are able to express their ideas. The menus seen showed that people are offered a balanced and interesting diet. The food store revealed that vegetables and meat are almost all fresh, with very little tinned or frozen supplements. A good range of interesting meals and accompaniments are kept in store, likely to suit the tastes of this resident group. Cherrywood House DS0000008117.V327400.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): 18, 19, 20, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health care needs are generally well documented but people would benefit from having health action plans. Medications practice is safe. The culture within the home is in general respectful and empowering. EVIDENCE: The records sampled showed that each person has regular dental and opticians checks. However, none of the residents yet have a Health Action Plan, in line with the Valuing People guidance. While care plans address individuals particular health care needs, not all routine needs are covered. Routine health care checks such as cervical smears, breast checks and Well Man/Well Woman clinics need to be part of each persons care planning. Individual residents records showed the extent to which external professionals are involved in each persons care. Although there is a great deal of skill among the staff team, the home is prompt to request support from other experts. Each of the external professionals the inspector spoke to prior to this visit commented on how well the home works with them.
Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 16 Where a resident is unable to give or withhold consent to treatment themselves, the team of professionals involved in their care acts in their best interest. This is reviewed every few months. A staff member with delegated responsibility for overseeing medications practice talked the inspector through the routine and records. Records are thorough and promote safe practice. Records of medications administered show that good practice guidance has been followed. Each person who has PRN medication (medication given on an as-and-when basis) has clear written guidance on when this medicine should be administered. The supplying pharmacist provides refresher medication training for the whole staff team every few months. Clear records are kept of the effect of medications, particularly following any change in prescription, and each persons medications are reviewed every month. There are very high staffing levels, but staff interacted primarily with the residents rather than with each other. Staff coming on duty greeted residents as equals and were quick to initiate interactions with them. Staff responded immediately and positively to any approaches from residents. When residents need support with personal care, staff generally give this promptly and tactfully. One staff member made a negative comment about the state of a bathroom after a resident had used it. This staff member immediately realized their error and took steps to put matters right. Staff need to take care that any issues they have with each other are resolved privately and not allowed to spill over in front of residents, particularly when residents might feel that these issues reflect badly on them. Cherrywood House DS0000008117.V327400.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): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home actively tries to ascertain residents views and preferences, and takes constructive criticism seriously. Residents are well protected from abuse. EVIDENCE: There is a very clear complaints procedure for residents to use with support from staff. The homes staff have also produced an abuse awareness leaflet for residents. This is an excellent document for staff to work through with clients, providing clear information supported by relevant pictures. A relative raised a concern with the registered provider in autumn last year. This was regarding the poor state of décor and repair of the building, and the untidy state of the garden. The relative was dissatisfied with the providers response, which did not fully address the issues they had raised, and therefore took their concern to CSCI. The manager has worked closely with the relative to address other concerns raised. No other complaints have been received by the service or by CSCI. There is a comprehensive abuse policy that is in line with North Somersets No Secrets guidance. This gives clear guidance on such thorny issues as confidentiality and the need to avoid asking leading questions. A copy of the whistle-blowing procedure is posted in the hall. Staff the inspector spoke with were clear about their duty to report concerns and felt confident about doing
Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 18 so should the need ever arise. Staff described an atmosphere in which constructive criticism is encouraged. The home works closely with external professionals to ensure that individual residents well-being is promoted in all areas of their lives. Cherrywood House DS0000008117.V327400.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): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is generally very comfortable and well suited to residents needs. The outside the building and the gardens would benefit from some repair. The size of the resident group is not ideal for the level of service many residents require. EVIDENCE: Cherrywood House is a lovely building that is well decorated and furnished to a high standard, but the outside of the house is in need of redecoration and refurbishment. The gardens would also benefit from some general tidying. Many aspects of the environment are well-suited to residents needs but this is quite a large resident group for people with such a high degree of behavioural difficulties. The impact of the numbers of residents is becoming more pronounced as people with very challenging behaviours are increasingly admitted. Most of the professionals who responded to the pre-inspection
Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 20 survey commented that the home provides a very good service, considering the numbers of residents and the complexity of their needs. One professional commented that, although there is plenty of one-to-one time rostered, so many other people around in the environment allows lots of opportunities for this time to be disrupted by other residents. There are two spacious downstairs lounges, one of which has an art room leading off it. A small upstairs room has been converted into a massage room with a proper table for the visiting aromatherapist to use. There is a pleasant dining room opposite the downstairs lounges. The home also has a cafe, where residents can practise culinary skills with staff support. There is a move on kitchen, equipped for people wanting to learn a range of domestic skills. There is a secure area of the back garden where residents can go out unsupervised. Many areas of the home have been redecorated over the past year. Bedrooms are now all nicely decorated. The communal rooms have been repainted and recarpeted. Suitable ornaments and pictures have been provided in these rooms, some of which have been screwed down for safety. As the inspector was very easily able to lift some of these objects up, it is recommended that the security of the screwed-down ornaments is checked periodically. Lounge furniture is domestic-type soft furnishings, which is hard to clean thoroughly. The inspector suggested that specialist furniture suited to residents current level of need is considered. There are plenty of bathrooms and toilets around the home, all of which have had new flooring fitted. Attractive blinds and curtaining in these rooms makes them feel really welcoming. There is only one shower in the home, and this is in one residents ensuite. The manager said that this is not a problem at the moment because most residents prefer baths, but it should be kept under regular review as the groups needs change. The medications office carpet has been thoroughly cleaned, greatly improving the appearance of this room. The inspector commented at the last inspection that the cafe needs repainting and recarpeted on, and the furniture needed to be replaced. The manager confirmed at todays inspection that this had been completed, but the inspector did not visit the room as meetings were going on in there. A self-contained flat has been created out of the basement, allowing one resident to move into more independent accommodation. One-to-one staffing is provided at all times that the occupant is at home. The inspector commented at the last inspection that the wood of the step of the fire escape door near the sleeping-in room is rotting, and many windows and doors are starting to look in need of replacement. These have not been
Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 21 repaired. Many of the external windowsills are badly peeling and rotten in places. As at previous inspections, the kitchen remains in a poor state. The counters are very stained and worn, and some of the units are rotting or coming apart. The Environmental Health Officer visited last year and some remedial work has been carried out since. The Environmental Health Officer has also advised that new work surfaces, flooring, door and windows are required. The cooker is of an old-fashioned design, which staff need to get on the floor to light. This is not ideal for promoting health and safety, so is again recommended that the cooker is replaced. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 34, 35, 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staffing levels and practices promote quality care for residents. EVIDENCE: Rotas show that there is a minimum of 4 staff on duty but that staffing levels are usually much higher. Theyre often as many as 10 staff on duty at any one time. There are 3 staff on duty throughout the night. A blackboard near the back door is updated every day to show which staff are allocated to give residents one-to-one support. Each different role has a very thorough job description and a separate person specification. Each of the staff files sampled contained a contract, evidence of identity checks, references, and criminal record checks. New staff have a PoVA First criminal record check before they start work on the home. Craegmoor asks prospective employees for three references, above the minimum two required. A checklist on the front of each staff file helps to keep track of the date each document is sent for and received.
Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 23 Staff training records are particularly clear and it is easy to see at a glance who has had what training. A master record is kept that shows the dates each staff member last had statutory training, and copies of any certificates are kept on individuals files. Last year Craegmoor brought out a new induction and foundation training package, designed in consultation with BILD (British Institute for Learning Disabilities). Newer staff had found this training very useful. Staff have excellent training opportunities, and as well as statutory training have done courses on a range of other relevant subjects. Recent training includes manual handling, health and safety, control of substances hazardous to health, infection control, basic food hygiene, non-violent crisis prevention intervention, abuse awareness and equal opportunities. Staff mentioned recent training on autism from Social Services that they found really helpful and interesting. Senior staff and several other staff have NVQ3. In total, seventeen of the thirty-two care staff hold NVQ2 or above. Shift leaders do one-to-one supervision sessions every six weeks or so for the support workers, and the home manager does one-to-one supervision for the shift leaders. Staff found these sessions very supportive, and said they get plenty of praise for successes and good practice. Supervision sessions are also used as an opportunity to talk about future training needs and to discuss the philosophy of the service. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 24 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): Is it be its 37, 38, 39, 40, 41, 42, 43 Quality in this outcome area is good. Stop listening This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from a well-run service and a consultative management style. Effective staff support systems are in place and are being well used. There is a good system for monitoring health and safety issues but some aspects of this have slipped following the departure of a key member of staff. EVIDENCE: The manager, Maggie Fisher, has been in post for two years and was registered about a year ago. She has worked in a senior capacity at other homes for people with learning disabilities and is undertaking the Registered Managers Award. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 25 Staff described a friendly team whose members look out for each other. Support and communication are good. Seniors are seen as approachable, interested and supportive. Newer staff described being given clear information, a warm welcome and good support. Many of the staff commented that they feel encouraged to question practice. Each of the professionals who responded to the pre-inspection survey said that the team shows great commitment to working with external agencies for residents benefit. One professional told the inspector that the manager usually tries to get the entire staff team in to hear feedback, helping to ensure that residents benefit from a consistent approach. A professional said that the team is very responsive “from the top down”. The manager has increased budgetary responsibility and can now order most necessary items immediately. Three quality audits are done every year, two by line managers and one by the homes manager. The line manager visits unannounced every month and produces a written report on the service. The home has had the same line manager for more than a year, after a period of change, and this support mechanism is now working well. There is a lot of written guidance but it is not very easy to find in the home’s policy files at the moment. Craegmoor is currently reviewing all policies and procedures, and plans to re-issue guidance in a more accessible format. There are no policies at present on service users access to their files, on emergencies and crises, nor on racial harassment. It is advisable to have clear policies on these issues, and ideal to produce key policies in formats that might be accessible to service users. Relatives questionnaires are due to be sent out within the next month. The home has a very thorough system of carrying out and recording health and safety checks. Hot water temperatures, call bells, window restrictors, fire doors and fire escapes, locking mechanisms on washing machines, and other similar equipment is all checked very regularly. This is excellent practice, particularly for a group of residents who are at such high risk. The new maintenance man has set up a system for recording any minor problems or repairs that staff notice around the building. He signs the book when the repairs are completed, and dates each one. He carries out repairs in order of priority. New fire doors are planned throughout the building, as many of the current doors are lacking their intumescent strips and have keyholestyle locks. Each staff member has a regular one-to-one supervision session and yearly performance appraisal.
Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 26 There is a detailed fire risk assessment, and location lists of each type of fire precaution. Fire precautions testing records showed that these precautions are tested regularly and fire drills are held frequently. The inspector reminded the manager at the last inspection that staff covering night-time duties must have fire refresher training at least every three months. Fire training records show that this was immediately implemented. However, when the staff member with delegated responsibility for fire training left, this training stopped. Nineteen of the staff hold a current first aid certificate. While this is quite a high proportion of the staff, the inspector suggested that this is reviewed to ensure that staff doing one-to-one work with residents in the community are suitably qualified. The manager confirmed that at least one person per shift holds a first aid certificate, and said that more training is planned to increase the number of first aiders. Staff do the Appointed Persons first aid certificate, which is a more in-depth course than the basic first aid training. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 27 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 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 2 3 Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 28 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 YA42 Regulation 23 Requirement Staff covering night-time duties must have fire refresher training at least every three months. Timescale for action 21/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA11 YA19 YA24 Good Practice Recommendations Residents activities diaries should give clear information about how staff have tried to engage them in activities and what one-to-one time has been given. Each resident should have a Health Action Plan, in line with the Valuing People guidance. The kitchen cooker should be replaced. This recommendation was made at the last inspection but has not been actioned. The exterior of the house and the gardens would benefit from some repair and tidying. Ornaments that have been screwed down for safety should be periodically checked to ensure they are still secure. Policies should be drawn up on service users access to their files, on emergencies and crises, and on racial
DS0000008117.V327400.R01.S.doc Version 5.2 Page 29 4. YA24 5. YA40 Cherrywood House harassment. Cherrywood House DS0000008117.V327400.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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
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