Inspection on 11/06/07 for The Cedars

This inspection was carried out on 11th June 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cedars 28/03/09

The Cedars 04/04/08

The Cedars 05/06/06

The Cedars 29/11/05

The Cedars 19/07/05

The Cedars 05/10/04

The Cedars 10/06/04

The Cedars 27/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 The Cedars 10 Grimston Avenue Folkestone Kent CT20 2PS Lead Inspector Wendy Gabriel Key Unannounced Inspection 11th June 2007 09:45 The Cedars DS0000023688.V343299.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 The Cedars DS0000023688.V343299.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. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Address 10 Grimston Avenue Folkestone Kent CT20 2PS 01303 220820 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) Lothlorien Community Ltd Care Home 12 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd January 2007 Brief Description of the Service: The Cedars is registered to provide accommodation and personal care for up to 12 people between the ages of 18 years and 65 years who have a learning disability and a physical disability. The home is a large detached building in a residential street near the centre of Folkestone where there is a range of public transport, shops, churches and learning and recreational facilities. There is a garden to the rear and parking in Grimstone Avenue. The accommodation is provided on three floors. There is a lift to all floors. Fees are in the range of £974.00 per week. Please contact the provider for current charges. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Documents were viewed and an accompanied tour of the premises was undertaken during the unannounced inspection. The area manager and the acting manager were in the home at the time and both discussed different aspects of the service. Some members of staff spoke individually to the Inspector and one resident spent some time talking about life at the home. Other residents were introduced and one accompanied the inspector during the tour of the home. This unannounced inspection viewed ongoing issues of a random inspection carried out in January 2007. That inspection had been in response to concerns about a new resident being admitted outside of the registration category and who was a cause of distress to existing residents. The registration is found to be correct and the resident was placed within category; however, there is still concern that the service user is not appropriately placed for his needs and for the well being of the other residents. Staff have not received appropriate training to meet the psychological needs of the resident. Since the random inspection the Registered Manager has left for personal reasons and the acting manager has been in post since April 2007. Some of the eight requirements made at the January inspection have been met and some partially met. The acting manager has started updating records and although they are not complete they are well under way. Staff and several residents stated that the acting manager was ‘one of the good things about working in the home’ and that he was ‘supportive at all times’ and ‘brilliant’. One resident said he was her ‘favourite person’ in the home and added that she would always feel ‘good’ about telling him of any worries she may have. What the service does well: The warm and friendly atmosphere is enhanced by the good communication noted between staff and some residents. One resident said that they have lots of things to do and named a long list of places they visit. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Pre assessment for new residents has not identified the psychological needs of one resident. The resident is within the broad range of the learning disability registration but his needs have not been met by specialised staff training. Staff, although very sympathetic, expressed frustrations at not being able assist the resident integrate into the family atmosphere of the home. A requirement was made for this at the previous inspection and to make sure the new resident had been placed in the correct registration category at the last inspection. The registration category was found to be correct, therefore the requirement has not been fully met. The welfare of existing residents has not been taken into consideration. The staff spoke about how they tried different strategies to deal with any distress to both the new resident and the existing residents. The Registered Provider must promote the welfare of all residents. Some environmental issues were raised and the acting manager agreed to undertake requirement and recommendations made or put them forward to the company to resolve. The statement of purpose was altered in response to a previous recommendation but still needs further information added. A requirement has now been made for this to be undertaken. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cedars DS0000023688.V343299.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 The Cedars DS0000023688.V343299.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre assessment has not enabled the needs of one resident to be met. The statement of purpose will be improved by having clear information about how the home will meet the needs of categories of residents EVIDENCE: The home has a detailed pre assessment format but this, plus input from specialists, has not been used to identify and meet the particular needs of one resident. This is a shame, as other established residents have been integrated into a family environment. Two residents said they liked being with their friends in the home. One resident said she could not ‘cope with some people’ and named the resident. But that she otherwise had lots of friends in the home and that she loved the staff. The Registered Provider agreed to an action plan in February to have the resident reassessed by a suitably qualified person. No re-assessment of needs was available on the day of the inspection despite this being a requirement from the previous inspection. Guidelines had been provided from a representative of the company. The guidelines did not address the psychological issues of the individual. The care The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 10 manager of the placing authority re-assessed the resident in March but had not forwarded her findings to the home. The acting manager agreed to contact the care manager to obtain the assessment. The requirement is made again for assessments to identify psychological needs and for the home to act on findings to benefit the physical and psychological needs of residents. The statement of purpose was revised to indicate different categories of resident the home offers care to. But it still does not state how those will be met for example by environmental facilities and staff training. A requirement is made for the statement of purpose to include how the home will meet assessed needs within the registration category. The Cedars DS0000023688.V343299.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans, although gradually improving, do not always contain full information to inform staff of individual specialised needs. Confidentiality is maintained and records kept secure. EVIDENCE: The existing care plans are being phased out and replaced with person centred documents provided by the company. Since the January inspection, the acting manager has done a lot of work in reviewing care plans and increasing information in risk assessments. A care plan seen for one resident does not contain information to detail the individuals’ psychological needs. The resident remains socially isolated and staff have not been given suitable training to significantly assist integration. A The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 12 requirement is made that the care plans clearly and fully identify needs and how these will be met. Another resident has a care plan plus a detailed document giving a full history of needs and how staff may understand and promote that persons wellbeing. This is good practice and the acting manager said it was currently only available for a few of the residents but that he hoped to be able to get more in place. The document had been provided with assistance from a learning disability team with input from key family members. The staff and acting manager have started to hold residents meetings but this is not always practical for some of the residents. A support worker had instead spent time individually with many of the residents to get and record their views on different issues in the home. The acting manager stated he wanted this to be a regular event as this is a useful way of getting opinions from people who have a wide range of communication abilities. Records are secured in locked offices. The Cedars DS0000023688.V343299.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some residents are able to undertake a variety of leisure and learning opportunities but others have fewer opportunities being more home based. Good community contact is encouraged through social events. People may make choices from menus and dietary requirements are catered for. EVIDENCE: Activity plans are up and running and several residents told the Inspector about the different opportunities they have for outings and holidays. There are different abilities among the residents and this has meant that whilst some residents are able to participate in a wide range of work, learning and leisure opportunities, others lead a slower and more home based routine. Staff have had difficulty in maintaining a suitable leisure and activity programme for the new resident and his care plan reflects this. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 14 The broad range of needs means staffing levels must be kept to maximum to ensure each resident receives input to fulfil their potential. This has recently been compromised by not having a full staff compliment. However, the area manager and the acting manager confirmed that a full time support worker is due to be employed. The acting manager and some of the staff said they thought that family contact was important to the family atmosphere of the home. Staff said they welcomed meeting and speaking to families. The home has vehicles for trips to the town and longer outings. One resident said she enjoyed all the trips they go to and listed many of her favourite places. Holidays are enjoyed annually. Staff were organising a passport for another person in the home at the time of the inspection. There is a full time cook working in the home. Menus are subject to individual choice. Two residents said they liked the food and one person confirmed that staff encourages the special diet she requires. There was evidence of a full fridge and fresh fruit and vegetables. A comments book for meals has recently been started but at the time of the inspection only one comment was seen. The cook and acting manager agreed to encourage residents to use this good resource. The Cedars DS0000023688.V343299.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Psychological needs have not been identified in the homes assessment, therefore, are not appropriately met. Professional advice has not been followed. Medication administration is sound. EVIDENCE: Personal support is reasonably described, but needs improvement to be more specific including psychological support. Professional advice about the individual recorded in a letter has not been followed. Some staff said that behavioural issues directed at them by the new resident distressed them. This also upset other residents in the home. One person named the new resident as someone she was upset by. A requirement is made for assessments to include how staff are to be supported with training to meet psychological needs. A resident said that the staff know how she prefers her personal support and that she is happy with the way staff care for her. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 16 Documented outcomes from health professionals are in place. Medication administration is sound and general storage is good. ‘As required medication advice records would benefit from being more informative regarding how individuals communicate when they want their medication. The acting manager agreed to this. The Cedars DS0000023688.V343299.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff and residents feel confident about raising concerns but one issue has not been appropriately considered. Staff training helps protect residents from abuse. EVIDENCE: A person living in the home said she would feel ‘good’ about talking to staff or the acting manager if she had a complaint. Staff also felt that the acting manager takes note of any concerns. One person in the home is causing concerns and distressing some residents and staff by behavioural issues. They have raised this issue with the acting manager. The area manager is aware of the issues. But no or little action has been taken. The concerns expressed by residents in relation to one specific resident must be fully explored to ensure all residents needs are met and all feel safe. The homes training matrix indicates that most staff have received adult abuse awareness and POVA training and all staff have received dealing with violence and aggression training. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean, hygienic and comfortable home. EVIDENCE: The home was clean and tidy and the acting manager said he and staff were planning to decorate in different areas. New waste pedal bins are being provided around the home and carpet has been ordered for a bedroom. Roof repair was being undertaken at the time of the inspection and two windows are being replaced. Some further painting is recommended for worn areas on outside window frames. The recent earthquake in Folkestone left some small cracks to a couple of interior walls and a professional was in the home on the day assessing them for safety and repair. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 19 The staff have made the garden attractive for residents to use in the fine weather. A recommendation is made for an old and disused oil tank to be removed from the rear garden. The garage to the rear of the garden could be used as an activity facility for people living in the home if made safe and suitable. One person living in the home accompanied the Inspector on the tour of the home. All the bedrooms seen were spacious and light and individual with different items indicating the occupants’ tastes and hobbies. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment practices are sound and staff receive induction and on going training. Staff levels have been low but this will be eased by the employment of a full time support worker in the next few weeks. Specialist training is needed to benefit staff meet individual needs. EVIDENCE: The company has a robust employment procedure that includes CRB checks. Induction is undertaken and supervision is now given on a regular basis. There was a pleasant atmosphere in the home that was due to friendly communication between staff and the people living in the home. Staff said they had been stretched at times recently due to not having enough staff on duty to meet the very differing needs of all the people living in the home. One newer resident had particular needs that staff had not received specialist training for. Staff were very sympathetic about that resident but expressed The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 21 frustration at not being able to integrate that person into the life of the home. Staff said that they had to make time to ensure behavioural issues of the newer resident did not distress other established residents. A requirement is made for staff to receive suitable training re acquired brain injury. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager but this will be resolved in the coming month. The acting manager has the confidence of staff and residents and was clearly aware of residents’ rights and best interests. EVIDENCE: The registered manager left for personal reasons early in the year and the acting manager has been in post since April. The area manager said a new manager will be in post in the following month. The company has a ‘Your Voice’ programme where residents from company owned homes are encouraged to meet and express their views about their lifestyle in the homes. This is good practice although it does not cover the day to day issues confronting residents. The acting manager said residents meetings had not been held regularly but he hoped would continue to be The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 23 monthly from now on. A member of staff had met with most of the residents in the home to obtain their views including choices. This had met the differing communication abilities of the people in the home and the acting manager said he would like this to continue as an effective way of ensuring all people have their say. The company also undertakes regular audits for medication, administration, infection control and clinical governance. The home has improved security for residents’ personal monies and records seen were in order. Risk assessments are being updated in care plans. Health and safety maintenance checks/certificates were in date. Several radiators require covers for safety and the acting manager agreed to get this done. The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 3 X 3 X 3 3 X 2 X The Cedars DS0000023688.V343299.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 YA12 YA6 Regulation 13 12. 1. (a) Requirement An assessment needs to be made on the occupational needs of each individual to determine that everyone is being supported and provide the facilities needed. Psychological needs are to be assessed by a suitably qualified person and training made available to staff to meet those assessments. Needs are to be reviewed and revised when necessary. Care plans are to clearly and fully identify needs and how these will be met. The statement of purpose is to state how the home will meet the assessed needs of residents. Concerns expressed by residents must be fully explored to ensure they feel protected and safe. Staff are to receive training for dealing with acquired brain injury. Radiators are to have covers for health and safety. DS0000023688.V343299.R01.S.doc Version 5.2 Page 26 Timescale for action 30/06/07 2. YA2 YA19 14. 1. 2. (a)(b) 30/06/07 3. 4. YA6 YA1 15. 4. (1) 30/06/07 30/06/07 5. 6. 7. YA22 YA32 YA42 13 18.(c) (1) 23. 2. (p) 30/06/07 30/06/07 09/07/07 The Cedars RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 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