Inspection on 12/08/05 for The Cedars

This inspection was carried out on 12th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Cedars 16/06/08

The Cedars 04/07/07

The Cedars 14/08/06

The Cedars 08/02/06

The Cedars 08/03/05

The Cedars 21/07/04

The Cedars 05/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Cedars 144 London Road Gloucester Glos GL2 0RS Lead Inspector Ms Tanya Harding Unannounced Inspection 12th August 2005 10:00 The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 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 DS0000016601.V255092.R01.S.doc Version 5.0 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 DS0000016601.V255092.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Cedars Address 144 London Road Gloucester Glos GL2 0RS 01452 500899 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) Cotswold Care Services Limited To be appointed Care Home 9 Category(ies) of Learning disability (9) registration, with number of places The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 08/03/05 Brief Description of the Service: The Cedars provides care and accommodation for up to nine adults with learning disabilities. The home is owned and run by Cotswold Care Services Limited, which is a subsidiary of the Craegmoor Healthcare group. It is a large three-storey detached Victorian house about a mile from the centre of Gloucester. All service users are provided with single bedrooms. Communal areas include the kitchen, dining room and lounge. There is also an enclosed rear garden and an annexe, which accommodates the day-centre. This is used by service users from the Cedars and by service users from other local Craegmoor homes. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 12th August 2005 starting at 10.00 and lasting about six hours. The inspection was supported by a second regulation inspector, Kath Houson. The home manager was also present. Most of the service users were met with and greeted during the inspection. Staff were observed supporting and interacting with the service users. Care records for three people were examined in detail as well as medication procedures and records. An inspection of the environment also took place. What the service does well: What has improved since the last inspection? Progress was evident in making the care plans more relevant to the needs of the individual service users and those seen were up to date. Systems for monitoring receipt and administration of medication in the home have been improved to prevent errors. Staff are accessing training required to carry out the work they do safely and competently. All staff have commenced NVQ courses. The new manager has applied for registration with the Commission as necessary. Reviews are being planned with the placing authorities to ensure that people’s needs can be re-assessed. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 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 DS0000016601.V255092.R01.S.doc Version 5.0 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 DS0000016601.V255092.R01.S.doc Version 5.0 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): 1 and 4 Prospective service users are given information about the home and opportunities to visit the home to help them in making a choice of whether they want to live there. EVIDENCE: The new manager has provided a copy of the updated Statement of Purpose for the home, which provides basic information about the service provided and the facilities in the home. This document could be improved to include more detailed information about aspects of the service and environment and be made more user-friendly. The manager hopes to develop the Statement of Purpose to reflect the service offered at The Cedars in greater detail. The home has been following an admissions process for a prospective service user who has visited the home three times to stay overnight. The manager felt that the person has been well supported to make an informed choice and that the person appears to like The Cedars. The manager explained that the pre-admission assessment was carried out in the person’s current placement by the previous manager. Other relevant information has been obtained and is in the process of being collated. The person hopes to move in next month. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 9 The person has additional specialist needs and staff will require training in this area. The manager has already obtained books about the condition in order to raise staff awareness and provide a point of reference. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 10 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 and 9 Care plans provide staff with good guidance on how to support individual service users with most aspects of care but can be further improved by demonstrating how each service user has contributed to the process. Guidance around communication is limited and this may mean that service users may not always be supported consistently to communicate their needs. Risks taken by service users may not always be appropriately assessed. EVIDENCE: Care files for two service users were examined. These contained a number of care plans and risk assessments, Essential lifestyle Plans and other information about the individuals. The new manager has developed the current care plans by using the available information and the care-planning format provided by Craegmoor. The care plans seen do provide good guidance to staff on how to support each individual. However, the current format does not provide evidence of how the service users were involved in the care planning process and whether the wishes and aspirations of each person have been taken into account when The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 11 writing the care plans. There was limited guidance about how service users communicate their needs and this needs to be developed. The manager expressed a commitment to using a person centred approach when developing care plans in the future. Risk assessments for people do not identify the level of assessed risk and this makes it difficult to establish whether the level of support provided is adequate, inadequate or excessive. Staff maintain daily records for service users which provide evidence of activities and daily routines. There was no evidence of current reviews with the placing authorities. The manager was already aware of the shortfall and has started to plan reviews for each person with the first one scheduled for December. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 and 16 Service users lead an active life and maintain relationships with their families, however, their right to make autonomous choices may not always be recognised and respected by the care staff. EVIDENCE: On the day of the visit, several service users were having breakfast out. One person was doing a crafts activity in the adjacent day centre and one person was out getting a haircut. Two more service users were planning to go out for a walk. During the day service users were also observed playing computer games, knitting and playing football in the garden. Records provided evidence of contact with families. An observation was made during the visit where a service user asked for a drink and was told that they would have to wait until the next time every one has one. The manager said that people can have drinks and snacks at flexible times and do not need to wait for the next round of drinks. It is possible that staff have The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 13 not fully taken this on board and may need reminding. Where limitations may be necessary in the best interest of that person, there must be a clear record of the decision making process which involves the person and other significant people who can advocate on their behalf. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 14 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): 18, 19 and 20 Service users receive support with personal care, health needs and medication in line with the assessed needs. There is guidance for staff to provide the necessary support safely and respectfully, although some aspects of this could be further improved. EVIDENCE: There are daily monitoring charts completed by care staff to record the support given with personal care (such as baths, dental care). Medical information is being recorded, and the manager is working on improving systems of how such records are maintained. One person has developed a new behaviour which is challenging to others in the home. Action has already been taken by the manager including a referral to the local Community Learning Disabilities Team and to the GP to look at possible medical reasons for the behaviour. There are systems for monitoring and recording epileptic seizures. Records where examined for one person where there is an additional protocol for ‘as required’ medication in case a seizure is long in duration or the person The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 15 experiences a series of fits. It was identified that improvements to the paperwork used to record the necessary detail are need so that no mistake can be made about when the additional medication should be / has been given. This was discussed with the manager during the visit. Medication storage has been relocated to a more suitable location. A designated senior staff member has the responsibility for monitoring medication administration systems. In addition, the deputy manager helps to check the medication in. There was a recent medication audit by the supplying chemist although no record of the visit and any resulting recommendations were left. The manager hopes to request any such records in the future. The home has compiled a list of staff who are competent to administer medication. This needs to be updated to include reference to those staff who have received training in administering a new ‘as required’ medication. The manager advised that medication is being reduced for three of the service users in the home and this is seen as a positive step for these individuals. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 16 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): Not assessed. EVIDENCE: These standards were not assessed on this occasion. The manager hopes to complete inventories of service users possessions by December. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 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, 27 and 30 Accommodation offered in the home is comfortable and spacious, however, some aspects of the environment do not promote service users’ independence; provide a less than welcoming environment and some are hazardous. EVIDENCE: Some improvements have been made to the home in the last year. The drive to the front entrance has been made more accessible and the kitchen has been made bigger. There is an issue about the location and suitability of the laundry room which has been outstanding for a considerable amount of time and has not been addressed to date. The laundry is located on the first floor next to the service users’ bedrooms. The flooring here does not comply with the infection control guidance and the noise from the machines limits when the laundry can be done. It was also noted that some clothes were being dried in the corridor outside of the laundry, creating a potential hazard in an emergency. The organisation has previously stated that it will look to relocate the laundry room to the ground floor, possibly to an outbuilding. The Commission requires that the necessary improvements are carried out. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 18 The shower on the first floor has no cubicle / surround. There is a high step to the base of the shower and a shower curtain to protect people’s dignity. The manager explained that service users find this facility difficult to use and need staff support. Some people could potentially have showers independently, but not with the shower as it is. The home needs to consider how this facility can be improved to ensure it promotes people’s independence and is suitable to their physical needs. The patio outside of the back door, which provides access to the main garden has many tripping hazards and must be repaired. A number of bedrooms were visited. These are spacious and are suitably decorated and furnished. Minor maintenance matters were noted and must be addressed: Room 4 – repair the chord on one sash window; Hallway by the second stairwell – investigate and rectify the sinking floorboards, which are causing a potential tripping hazard; Room 9 – provide an additional light (only one source of light in the room) Room 8 – remove the hazard from the sharp artex on sloping walls, which are within easy reach and could cause an injury (in particular above the bed and above the sink). The home lacks suitable storage and the hover was seen to be stored in a communal corridor posing a potential tripping hazard. Better storage solutions should be provided. The home employs a domestic for 25 hours a week who carries out cleaning of the communal areas. The home was clean on the day of the visit, although the carpet in the main corridor was heavily stained in several places and must be suitably cleaned or replaced. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 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): 33 and 34 Staff are deployed in sufficient numbers to provide the necessary levels of support for service users. Shortfalls in recruitment procedures could potentially compromise the wellbeing and safety of the service users. EVIDENCE: The manager advised that staff have received new job descriptions. There appeared to be sufficient staff on duty on the day of the visit to enable service users to take part in activities in house as well as in the community. There is a sleeping in person and a waking staff member on at night. The home has been using agency staff to cover a vacancy, which has now been filled (subject to employment checks). Two new staff have been employed since the last inspection. Files for both staff were examined. One person started in July 2005 but did not have a CRB disclosure, although a POVA First check was obtained. There was no recorded risk assessment in the absence of the CRB stating any limitations to the person’s role. Other checks and employment information were present on file. The manager must ensure that staff do not commence employment until all the necessary information has been obtained and is satisfactory. Where it is essential that staff commence employment whilst waiting for a CRB check The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 20 (because of staff shortages for example), the home must discuss this with the CSCI. It then may be possible for the person to start work on the basis of a risk assessment. Another person was employed from overseas, and was observed to have a good command of spoken English and a good rapport with the service users. The manager advised that the frequency of staff meetings and formal supervisions has slipped recently. She hopes to get these back on track. The inspectors accept that this has been mainly due to the change in management within the home and further assessment of this standard will be made at future visits. Staff are receiving mandatory training and are accessing NVQ’s. A detailed assessment of the training uptake was not carried out on this occasion. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 21 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): 37 and 42 Better consistency of management arrangements and a user-focused approach has meant that service users views are at the forefront of developing the service offered. The health and safety monitoring in the home is carried out regularly offering better protection for service users. EVIDENCE: The new manager was appointed after the departure of the previous manager in 2005. She is going through the registration process with the Commission and has commenced training relevant to her role in September 2005 (NVQ4 in care and the Registered Managers award.) The manager has demonstrated a caring but decisive approach to solving difficult situations and has sought advise from the relevant agencies. She has addressed a number of requirements from the last report in a competent way and with commitment to implementing further improvements and changes for the benefit of the service users at The Cedars. Her approach appears to be inclusive of service users, their advocates and staff. The new manager has The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 22 developed a good understanding of the company structures and should continue to be assertive in requesting support for her own role where necessary. The home has developed a fire evacuation procedure. The manager is responsible for carrying out regular health and safety audits in the home. PAT testing was being carried out on the day of the visit. An electrical assessment of the home was carried out in May 2005. Fire alarms are tested weekly. A visit by the fire officer took place in June 2005 and the report is still awaited. The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x 3 x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 2 x x 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score x x 3 2 x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Cedars Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 3 x DS0000016601.V255092.R01.S.doc Version 5.0 Page 24 YES 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 6 Regulation 12 (2)(4) Requirement Ensure there is clear guidance about people’s individual communication needs and abilities. Consider consulting CLDT professionals about best practice approaches. Ensure risk assessments clearly identify the level of assessed risk and state actions to be taken to eliminate / reduce the risk. Consider whether further risk assessments need to be developed to ensure all aspects of safety for individuals have been looked at. Staff must be given formal guidance about service users rights to make autonomous choices. Where limitations on choice and liberty are necessary, there must be documented evidence of who made the decision, which approach is to be used and how this is seen to be in the person’s best interest. Address environmental issues as follows: Timescale for action 31/01/06 2 9 13(4) 31/01/06 3 16 12/17(1), Sch 3 (q) 31/01/06 4 24 23(2) 31/01/06 The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 25 Improve first floor shower facility to make this safe for more independent use and to ensure this is suitable for the needs of service users who use it. Carry out repairs to the patio to make this safe for use. Repair sash window in Room 4. Repair sinking floorboards on first floor landing (small stairwell). Provide additional light in Room 9. Remove / cover sharp artex in Room 8 (as described in the text). Clean / replace soiled carpet in main hall/ corridor. Prevent spread of infection by 30/11/05 ensuring laundry floor is impermeable. Timescales of 31/12/04 and 31/05/05 not met. Consult with the Environmental 31/01/06 Health Department about the issues in the laundry room and other aspects of the environment to ensure the home is safe and suitable for its purpose. Provide a copy of the EHO report to the Commission for reference. Ensure staff are not employed in the home until all necessary and satisfactory information and employment checks have been obtained. Where staff are required to start employment before a CRB disclosure has been obtained, the home must discuss with the Commission and ensure that a The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 26 5 30 13(3) 6 30 23(5) 7 34 19 30/11/05 suitable and robust risk assessment is in place for that staff member. Obtain outstanding CRB checks for staff as discussed at the inspection. 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 Refer to Standard 1 6 Good Practice Recommendations Develop the Statement of Purpose document to provide greater detail about the facilities and environment at The Cedars. Care plans should show how service users were involved in the process and whether their goals and aspirations have been taken into account. Person centred approach should be considered when reviewing current care plans or developing new care plans. Needs reviews with the placing authorities should be arranged for all service users as soon as possible. Consider how the current systems for recording seizures can be improved to ensure better clarity when making a decision to administer ‘as required’ medication. Obtain and keep copies of pharmacy audits for reference and as evidence of following up any recommendations made. List of staff competent in administering medication should be updated. 3 4 5 6 6 20 20 20 The Cedars DS0000016601.V255092.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000016601.V255092.R01.S.doc Version 5.0 Page 28 - 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!