Inspection on 17/01/06 for The Cedars (11)

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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 (11) 07/06/07

The Cedars (11) 05/01/05

The Cedars (11) 22/07/04

The Cedars (11) 12/02/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Cedars (11) Ashbrooke Sunderland SR2 7TW Lead Inspector Miss Andrea Goodall Unannounced Inspection 17th January 2006 1:30 The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Cedars (11) Address Ashbrooke Sunderland SR2 7TW 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) 0191 567 2886 0191 567 2886 Autism North Limited Michael Green Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th August 2005 Brief Description of the Service: The house at 11, The Cedars is a large detached Victorian building in a treelined road near the City centre. There are several other similar properties in the same road that provide care services. This home provides 6 places for young adults with Autism Spectrum Disorder and is operated by Autism North Limited, a private company. The house provides 6 bedrooms and a good range of sitting areas. There are 2 spacious lounges and a large dining room. The home has extensive rear gardens, and a small patio area at the front of the house. The home does not provide accommodation for people with significant mobility or physical disabilities. The Provider is mindful of the implications of the Disability Discrimination Act 1995, and employed consultants to assess the premises to consider ways in which the it can offer access to visitors who may have physical disabilities. Level access can be achieved by providing a portable ramp to the door to a rear lounge. There is good access around the ground floor and a communal toilet. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one afternoon in January 2006. Time was spent with 3 of the residents and some staff talking about the service, looking at residents bedrooms with them and at parts of the house. Some time was also spent with the Manager, looking at care records, medication records, and staff records. There have been no complaints, concerns or changes to the service since the last inspection. What the service does well: What has improved since the last inspection? One newer resident is now more settled and not so upset. This is because staff help that person to communicate and know how to support her. This has made the home a calmer place for everybody to live in. All of the people who live here are learning more about how to do things for themselves. This is because staff show them every day in the same way. All the people who live here have their own daytime activities now so that they do the things that they like to do. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 6 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 Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards have been assessed as met at previous inspections. EVIDENCE: The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 & 9. Residents needs and goals are reflected in an individual plan of care. Residents are supported to take acceptable risks as part of an independent lifestyle. EVIDENCE: There are comprehensive individual care plans in place for each of the 6 young people who live here. It was stated that residents do occasionally sit with a key worker who verbally explains the care plans to them. However due to the nature of their Autism residents do not have the capability to understand the concept of care planning. There is a dated, written record of how staff have tried to include and involve residents in their care plans and whether they appear to understand. However there is an enormous amount of information in the care plans and it would be difficult to explain all the elements of these records. There are currently no pictorial or photographic clues for residents to understand the more pertinent goals towards daily living skills. The people who live here are supported to take acceptable risks as part of an independent lifestyle, wherever this appropriate and manageable. There are The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 10 risk assessment records in place about activities that people carry out that might incur an element of risk, such as preparing food in the kitchen, and using a locked bathroom. In this way staff are clear about the support people need to minimise any risk to them. It is good practice that these records have been signed by parents. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17. Residents rights are respected and their responsibilities are promoted. Residents are choosing menus and enjoy their meals and mealtimes. EVIDENCE: All of the people who live here are involved in daily household task in their own home, such as cleaning their bedroom and doing their own laundry, with staff support. Despite some peoples occasional dislike of doing these things, this promotes their responsibility and ownership within the home. The people who live here have a range of different communication styles. Some people use speech or signs, other use noises and gestures. Staff have a good understanding of each persons communication needs. Staff encourage and promote conversations with the residents to help their language and communication skills, but also to involve and include them in discussions about the home. Staff were seen to be respectful and supportive when talking with residents. Residents can choose to use their own bedrooms for privacy whenever they wish. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 12 In discussions staff described their role as one of support and supervision to help the people here to learn their own skills. Staff were seen to respect residents choices. Residents were seen to be very involved in choosing their own styles and appearance. Residents also have their own daytime occupations that are purposeful as well as individual things that they enjoy. One person enjoys an art class at a college, which is significant as they could not previously tolerate crowds. One resident enjoys going to a cookery class, and brings the dishes home to eat. It is evident from observations at this and previous inspections that residents have really improved their independent living skills, communication and confidence over the time that they have lived here. All the residents are involved in shopping, preparing meals and clearing up after meals. Weekly menus are suggested, based on residents known preferences, although this is just used as a shopping guide and residents can choose alternatives to each meal. Most residents go to supermarkets with staff, one or two at a time, to get the weekly grocery shopping. A couple of residents find the noise and crowds in large supermarkets intolerable so choose not to go, but would still have opportunities to go shopping in smaller, quieter shops if they choose. Residents dine together with staff in the pleasant, large dining room. They also enjoy choosing a weekly take-away, and occasional meal out. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. Generally medication is well managed on behalf of the people who live here, but minor recording issues do not fully support the administration of medicines. EVIDENCE: None of the people who live here have been assessed as capable of managing their own medication. At this time, all medication is managed by trained, designated staff. Medication is delivered to the home by a local pharmacy in suitable containers. Medication is securely stored in a locked, alarmed metal medication cupboard away from residents accommodation. Records are kept of the administration of medication. However where medications have been discontinued or are only temporary, staff are continuing to mark the record with F, which is the wrong code for this situation. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 14 Also when medication is taken out of the home, e.g. by a resident going to stay at their parents house, the amounts are recorded. However the record does not allow for the dates of outgoing and incoming, so it is not possible to audit whether the correct amount of medication has been administered or is being returned. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Residents have information about how to make a complaint, and are supported by staff to understand this. The home has policies, practices and staff training in adult procedures to ensure that people living in the home are protected from abuse. EVIDENCE: Each resident has a copy of the complaints procedure which is in plain language and pictorial symbols to support the communication needs of the people who live here. The procedure is kept at the back of their personal files, which they regularly look at with their key worker. There is a written record to show when staff have explained their rights including complaints procedure to them. Due to the nature of their Autism some people find this information very difficult to comprehend. However it is clear that the home makes every effort to support residents with their rights. The residents do use signs, gestures and noises to express their dissatisfaction with immediate situations, and staff are very knowledgeable about the individual communication skills of each resident. Due to the nature of their Autism the people who live here need occasional staff intervention during episodes of behavioural needs to prevent them from harming themselves or others. Autism North Limited have comprehensive policies and procedures outlining the accepted sanctions that can be used to support people during such episodes. There are behavioural guidelines in place for each of the residents and these are shared with parents. There are also Intervention Records in place for each The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 16 resident that record any occasions where intervention techniques have been used. Some staff have had brief restraint training sessions. None of the staff have had training in physical intervention techniques from a BILD-accredited trainer (British Institute of Learning Disabilities). In this way staff may not be following current best practice guidance, as outlined by the Department of Health and BILD, in this area of care. The Manager stated the Regional Manager has now completed suitable training and that he is also to attend a BILD training course, which will accredit them as Trainers in Physical Intervention methods. In this way he will be able to train his own staff team in acceptable methods of physical intervention that will support the needs of the people who live here. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 25. Residents live in a homely, comfortable and safe environment. The home is well maintained and decorated. Residents bedrooms promote their privacy and independence. EVIDENCE: 11, The Cedars is a large 3 storey Victorian house that is indistinguishable from other desirable properties in this quiet area near the City centre. It is spacious and open and allows great freedom of movement for the young people who live here. As with all older buildings the house occasionally requires some minor repairs, redecoration and routine maintenance input. This is arranged as and when it is required. There were no significant premises issues noted during this visit. However the carpet to the risers on the main staircase is becoming worn, and in time could present a tripping hazard. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 18 The 6 bedrooms are all individual in style and character. Bedrooms reflect the personal interests and hobbies of the people who live here, and residents make good use of their own bedrooms whenever they wish. All of the bedroom doors are fitted with suitable locks, although at this time few people choose to use them, and risk assessments are in place about this. Bedrooms still do not have lockable facilities for residents to store personal items. However the Manager confirmed that different types of lockable facilities have been tried out to see which is the best type for the people who live here, and that these will be provided in the near future. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34. Residents are supported and protected by the homes recruitment procedures and practices. EVIDENCE: There have been 4 new staff to start work at this home since the last inspection. Autism North Limited operates very thorough recruitment and selection procedures. Staff are only considered after completing satisfactory application and interview, and only employed after references and police checks have been received. This process ensures the protection of the people who live here. Staff files are held confidentially at the home, and these demonstrate that all the checks and clearances have been carried out. Residents also have the chance to meet applicant staff during a trial visit to the home to see if they have suitable personalities and values to support young people with Autism Spectrum Disorder. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42. Residents benefit from a well managed home. The health, safety and welfare of the residents is promoted and protected. EVIDENCE: The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 21 The Registered Manager is responsible for the day-to-day management of the home. He has several years experience of working with younger adults with Autism Spectrum Disorder. He has attained care and management qualifications that are suitable for his role. He is supported by a Regional Manager of Autism North Limited. A representative of the organisation visits the home at least monthly and reports on its operations. In this way the home is well run for the people who live here. All staff receive mandatory training in health & safety matters, including first aid, food hygiene, and Infection Control. The building is well maintained and repairs are carried out wherever necessary. At the time of this visit there were no health & safety issues to those parts of the building that were viewed. Staff receive fire training at the right intervals and this is recorded. In this way the health and welfare of residents the people who live here are promoted, and the home is a safe place for the people who live here. The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 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 X 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 X X X X 3 X The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 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 YA20 Regulation 13(2) Requirement Records of discontinued medication should not be marked with the F code; and records must include the date of when medication was taken out and returned to the home. Timescale for action 01/03/06 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 YA6 YA23 YA24 YA26 Good Practice Recommendations Consideration could be given to the use of photographs or pictures of the activity next to a small number of pertinent goals within support plans as a visual clue for residents. All staff should receive training in physical intervention methods that is BILD-accredited. Plans should be put into place for the replacement of the stair carpet to ensure that this does not become a tripping hazard. Bedrooms should be provided with a lockable facility for residents to store personal items, or a risk assessment should be in place that demonstrates why this is not suitable for individual residents. DS0000015786.V265695.R01.S.doc Version 5.1 Page 24 The Cedars (11) Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Cedars (11) DS0000015786.V265695.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!