Inspection on 16/06/08 for The Cedars

This inspection was carried out on 16th June 2008.

CSCI found this care home to be providing an Adequate service.

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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cedars 04/07/07

The Cedars 14/08/06

The Cedars 08/02/06

The Cedars 12/08/05

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 28/09/2008.

CARE HOME ADULTS 18-65 The Cedars 144 London Road Gloucester Glos GL2 0RS Lead Inspector Ms Lynne Bennett Unannounced Inspection 16 , 17 and 20th June 2008 09:30 th th The Cedars DS0000016601.V366682.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 DS0000016601.V366682.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 DS0000016601.V366682.R01.S.doc Version 5.2 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) www.craegmoor.co.uk Cotswold Care Services Limited Manager post vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 9. Date of last inspection 4th July 2007 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 people living at the home have single bedrooms. Communal areas include the kitchen, dining room and lounge. There is also an enclosed rear garden with an outbuilding used for activities and as a sensory area. The home incorporates a day-centre which is used by people living at the Cedars and by some people living elsewhere in the community. The base fee was reported to be £1135 per week, although there is individual negotiation depending on people’s assessed needs. A summary of the Statement of Purpose is displayed in the hall. Prospective service users and others involved in their care are offered information about the home including copies of the Statement of Purpose and Service User Guide. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place in June 2008 and included two visits by two inspectors and an additional visit by one inspector. The manager had recently been appointed and was present throughout. The group manager was in attendance during the first visit. Time was spent observing the care provided to people and chatting to them. Staff were interviewed about their roles and responsibilities. Visiting relatives also gave feedback. Surveys were received from 3 people living in the home, 3 relatives and 1 healthcare professional. The deputy manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. A range of documents was examined including care plans and related records, staff files, incident and accident records, medication systems, health and safety documentation and quality assurance systems. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 6 Eleven requirements issued at the last inspection had been complied with including providing training for staff in diabetes, improving facilities in the first floor bathroom, replacing the carpets throughout the home and enabling people to go to church. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. By completing a full assessment of need the home will be able to make sure that they can meet the needs of people wishing to move into the home. Providing people with a copy of their statement of terms and conditions will make sure they have information about the cost of the service they are receiving. EVIDENCE: The home had a Statement of Purpose and Service User Guide in place that were last reviewed in September 2007. A copy of the Statement of Purpose was displayed in the hallway and people had an individual copy of the Service User Guide on their files. Information on the guide and complaints procedure about us was incorrect and this needs to be changed. Only one of the three people case tracked had a copy of their terms and conditions on their personal file. The last admission to the home was case tracked. There was considerable information on their file from their placing authority and other people involved in their care. The manager confirmed that a healthcare professional involved in their care had provided a handover to some staff about their care needs. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 9 Staff confirmed that they had visited the home once prior to moving in. There was no evidence of an assessment being completed by the home. The person had been transferred from another Craegmoor Home. The AQAA stated “Assessments are made of prospective service users in their current home and information is gathered to make their integration into the home as smooth as possible”. This was certainly the impression provided at the last inspection of the home. An enhanced care plan supplied by the placing authority stated that the person’s primary care needs were Schizophrenia and secondary care needs were borderline learning disability. After the inspection Craegmoor provided evidence that the person had a primary care diagnosis of learning disability and had been accepted to receive a service from the local Community Learning Disability Team. The manager explained that alternative accommodation was being arranged and that a meeting would be taking place the following week. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Basing person centred plans on each person’s assessment of need will ensure that they reflect the person’s wishes and aspirations. People are being supported to take risks whilst being safeguarded from possible harm. EVIDENCE: The care of three people was case tracked, which involved reading their care plans and associated documents, observing them and talking to staff about the care provided. Since the last inspection person centred plans had been put in place. Each person case tracked had a copy of this on their file, providing information about their physical, social, emotional and intellectual needs. One person had moved from another home and had a mixture of documents from that home with additional care plans from The Cedars. Another person had a current assessment of need from which care plans had been developed. There was no evidence that the others had an assessment in place. The home had a system of monthly key worker reviews but these could not be found and appeared not to be in use. Some people had signed their care plans and The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 11 others were signed and dated by staff. However this was inconsistent with some care plans having no signature or date. Files contained significant amounts of information that could be confusing to the reader. Information should be archived when no longer relevant. The deputy manager confirmed that annual reviews with representatives from placing authorities were taking place. Care plans provided guidance for staff that was specific about how needs were to be met. For instance several people needed support managing their diet and care plans indicated how this was to be implemented. Staff spoken with had a good understanding of their role in achieving this. Staff were also observed supporting people in line with their care plans and risk assessments. There was evidence that additional care plans were being put in place in response to accidents and incidents in the home. This information was being made available to staff in the handover book with evidence of a read and sign sheet. This is good practice. Previously concerns had been raised about communication profiles and the approach to communication within the home. Staff were observed using objects of reference with people offering them choice about what to have to drink and eat. For instance they were shown several different drinks and pointed to the one they wished to have. Staff were also observed using Makaton sign language. Communication profiles were in place in their plans. Care plans included some reference to restrictions and locked areas of the home, giving the rationale. A form titled “Infringement of service user’s rights” was also in place for one person. During one day of the visit the door in the lounge was locked whilst the people were attending the day care facility. Staff said this was to prevent a person at day care entering the home and causing damage to property rather than keeping people out. On the second visit to the home this door was unlocked and people were observed choosing whether to spend time in the home or at day care. Alternative ways of ensuring people’s privacy and safety within their own home need to be researched. (See also Standard 24) A notification to us about an incident indicated that sanctions had been put in place withdrawing the person’s access to a shopping trip. Staff spoken with said that this was not in the person’s care plan but that it had been their response to a situation they were attempting to deal with, although care plans provided guidance on this issue. The situation had escalated. Support and guidance for staff must be provided. Improved communication within the home such as regular staff meetings and supervision would help. (See also Standards 33 and 36) Financial records were examined and found to be satisfactory. People have bank accounts with Craegmoor and there was evidence that they were The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 12 accruing interest each month. Management were checking statements with expenditure records in the home. They should initial and date these when completed. Care plans indicated the support needed by people to manage their finances. Risk assessments had been reviewed alongside the introduction of person centred plans. Those examined provided detail about the hazards and how these could be minimised. Care plans could be clearly cross-referenced to risk assessments. Risk assessments highlighted at the last inspection involving the use of transport had been put in place. The Cedars DS0000016601.V366682.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): 12,13,14,15,16 and 17. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Opportunities to participate in social, educational, cultural and recreational activities may be affected by staffing levels. People are supported to maintain contact with families and friends. A nutritional and balanced diet must be provided. EVIDENCE: Each person had an activity schedule on their file reflecting their interests. There was some indication that these were not always followed due to staffing levels or people’s choice. Where an activity was refused this was logged on the daily activities sheet. Activities for three people over two weeks in May/June indicated that they had been to the cinema, swimming, bowling, shopping, out for lunch, on day trips, clubs and a disco. During the visits one person said they were looking forward to going bowling. Another person asked about payment for helping to clean around the home. Paid employment had The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 14 also been offered to another person to clean the local offices of Craegmoor. People were attending a local day centre and also have a day care facility within the home. Two people attend church on a regular basis. Part of the downstairs of the premises is used as day care facility, with two staff members employed to run this aspect of the care. These staff are generally supported by the other care staff on duty during the day. The area has a kitchen, a sensory room, a communal room for craft activities, and access to the rear garden. People were observed participating in activities and communicating with the staff in a relaxed atmosphere. However the inspectors had some concerns about the organisation and effectiveness of the day care facility. There appeared to be little individualised planned structure to the day care, though some activities did happen on a regular basis, and there was no direct link to the “person centred planning” system that the home has put into place. There are no formal or structured reviews of the individual programmes followed by the service users, and the care plans seen did not actually have written plans of the day-care activities undertaken. Individual planning and reviewing of day care activities, co-ordinated through the care planning system would help ensure greater choice and a more structured approach to developing skills and promoting social inclusion. Greater clarity could also be provided around the line management of the staff involved in day care, which would provide more clarity as to who has the responsibility for developing and improving this aspect of the service. Comments in surveys from relatives and staff indicated concerns about access to regular and appropriate activities. One relative said, “there is not always a member of staff available to accompany him” and “concerns about stimulation/going out”, although another relative stated, “at the moment there are some good day trips arranged”. Staff said that activities needed to be more person centred reflecting what the individual wanted to do and “not just our day centre, as its not appropriate for some of our clients” and “better staffing levels to enable clients to complete their individual programmes of activities”. The AQAA recognised these concerns, “More opportunities could be sought to allow the service users to have better access to a wider range of community facilities. More emphasis could be put on working towards independence” and staff shortages and “limited staff that are able to drive, restricts the places that service users can visit.” People were being supported to maintain contact with friends and family. Comments from visitors indicated that they were made to feel welcome. Contact records were being kept noting visits or use of the telephone to keep in touch. Some people were involved in helping around the home. One person was helping with the cleaning as well as preparing and cooking of meals. However for others this appeared to be very limited. Staff said that they were not The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 15 involved in cleaning their rooms or helping with their laundry. As the AQAA indicated, this is an area for further development. House meetings did not appear to have been held this year. An outcome sheet from the last meeting was being completed as issues were dealt with. The AQAA identified future goals as “ensure that our service users are encouraged to ask for change so that we continually move forward, and promote a modern service that is led by them.” Examples of actions met included supporting people to go to church, day trips and more involvement in putting together menus. Menus had been reviewed with people living in the home and although a choice of meals was not being offered, two people had menus separate to other people reflecting their dietary needs. Staff said if people did not like the main meal an alternative could be provided. Some daily notes indicated what people had eaten but this was not being consistently recorded. Concerns were noted in surveys from staff about the nutritional content of meals. Although the menu appeared to provide a well-balanced and nutritional diet, there was evidence in the kitchen that some pre-cooked and packaged foods were being provided which can be high in salt and sugar content. People had access to fresh fruit. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 16 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 and 20. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home needs to be responsive and sensitive to changes in people’s personal care needs enabling staff to support them with dignity and respect. Improvements in the safe handling of medication will protect people from possible harm. EVIDENCE: The way in which people would like to be supported with their personal and healthcare needs was clearly set out in their person centred plans. Staff spoken with demonstrated a good understanding of this and of the importance of promoting people’s privacy and dignity. They were observed treating people with dignity and respect. Plans however did not appear to identify the preferred gender of staff providing personal care for people. Concerns were identified at the last inspection about a person who had sun burn. During the visits staff were observed applying sun cream to people and some were wearing hats. A policy and procedure was in place for supporting people in hot weather. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 17 A number of monitoring sheets were in use such as body maps and fluid and epilepsy charts. Clear protocols around the response to seizures and to the use of monitoring devices were seen. Guidelines for the amount of fluids for one person were also displayed on a white board in the kitchen. Staff were using this in preference to the fluid monitoring charts on their file but this was then wiped clean every day. The fluid charts should be used so that a clear picture of their fluid intake is kept. Discussions, incident records and daily notes suggested that several people were developing intimate personal relationships. There was no evidence in their care plans of any support or guidance they may need or information for staff on how to enable them to develop relationships whilst respecting their privacy and dignity. Since the last inspection Health Action Plans have been put in place which clearly evidenced a range of health care appointments including the outcome of the appointment. People were having regular access to healthcare professionals including dental treatment and a chiropodist. Systems for the administration of medication were examined and found to be mostly satisfactory. Staff attend an introduction to monitored dosage systems training with a local pharmacy who according to the AQAA “also internally audit the home on its medication practices. Internal audits are also carried out by the home manager and clinical governance team to check that the company’s policies and procedures are being followed.” Staff administering medication need to have accredited training in the safe handling of medication. There was some inconsistency on the medication administration record recording stock levels for medication dispensed in boxes. The home need to make sure that a stock record for this medication is kept and carried over each month. Some handwritten entries had been correctly countersigned on new administration records but this had not been completed on the previous month’s records. A copy of the most recent British National Formula was in place. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 18 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): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff need to have confidence that any concerns about the wellbeing and safety of people living in the home will be listened to and acted upon ensuring people are safeguarded from possible abuse. EVIDENCE: The home has a complaints policy and procedure in place. Some people living at the home indicated that they would talk through concerns with staff. One person said in their survey that they did not know how to make a complaint. A complaints procedure was displayed in the hallway. Our details need to be amended to reflect contact information for Bristol. The AQAA indicated that two complaints had been received by the home. The complaints folder had copies of these with evidence of the response to one complainant. It was not evident what the outcome had been of the other complaint. However a Regulation 26 report for this period stated that a telephone response had been provided. This information must be recorded on the complaints file. Staff confirmed that they had attended safeguarding training in the past year and that they would identify and respond to any concerns they may have. Not all staff had confidence in the systems in place within the organisation for the monitoring and management of safeguarding concerns. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 19 Care plans for one person indicated that at times they might be inappropriate verbally and physically to people of the opposite sex. It did not define what the inappropriate behaviour might be. Guidelines were given for 1:1 support at all times when in the presence of the opposite sex and to prompt the person that this was not acceptable. An alleged incident had occurred, although accounts from staff were inconsistent. The deputy manager said that she had investigated and spoken with the person and was satisfied that no further action was needed. A critical incident form verified this although some staff were still clearly stating a different version of events. These inconsistencies are concerning and need to be investigated further by Craegmoor Healthcare Group to ensure a system is in place that generates confidence amongst the staff team and ensures residents are protected by robust procedures. Another incident also happened and again people were interviewed and other healthcare professionals involved. A critical incident form had been completed. Management said that they provided support where needed, care plans and risk assessments had clearly been reviewed and staff were made aware of changes to their practice via the communication book. We had not been informed of these incidents. A copy of our most recent notification form was given to the deputy manager and guidance on its use. Recording of accidents or incidents appeared to be inconsistent. Some entries were found in the communication book, others in daily notes or accident records. Occasionally incidents had been recorded in all three places which is good practice. We had not been informed of all incidents, including assaults by one person on other people living in the home or on members of staff. There had also been a medication error which we were not informed about. Critical incident forms were also in use in the home that were then forwarded to Craegmoor for monitoring, these have a space for indicating whether a Regulation 37 notification had been sent to us. Staff confirmed that they receive training in Crisis Prevention Intervention, a low arousal approach to the management of challenging behaviour. Staff were observed using this effectively during the visits and those spoken with confirmed that physical intervention was not used in the home. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 20 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 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides spacious and comfortable accommodation but the re-siting of displayed information could improve the homely quality of the service. EVIDENCE: The home is generally well maintained and decorated throughout. On the day following the inspection extensive work was planned for the outside of the building and the grounds. A selection of bedrooms were seen and these were personalised and comfortable and several had been recently decorated. In one bedroom (bedroom 2) there was detected a strong odour and this was brought to the attention of the manager, who explained that consideration was being given to the provision of different flooring. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 21 In the downstairs hallway there was a lot of information being displayed on the walls, including roles of the key-worker, memos and details of a whistle blowing policy. These notices distracted from the homely feel of the accommodation and many could be better located elsewhere. Some of the notices in the rear hall were also over a year out of date. Some staff comments, and feedback from surveys, suggested that the process and procedure for ongoing internal maintenance could be improved. The logging of faults or required repairs was not always being done correctly or clearly and the supervision of the maintenance programme was a little disorganised. For example, the staff in the home were unable to explain what work was due to be undertaken on the exterior of the building during the rest of the week. The staff responsible for maintenance also appeared to have additional responsibilities for driving, including collecting and delivering service users. The Cedars DS0000016601.V366682.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): 32,33,34,35 and 36. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are caring and competent, and have opportunities for professional development, promoting the quality and consistency of care. The ability of the team to meet people’s needs has been compromised at times by short staffing. Recruitment procedures are not safeguarding people from possible harm. EVIDENCE: The AQAA stated, “More staff need to gain NVQ Level 2 qualifications. Carry on with NVQ training and more specialized training to suit the needs of the service users. There are several members of staff currently waiting to start their NVQ Level 2 and 3.” The DataSet indicated that 33 of staff had a NVQ Award. Some staff spoken with said that they had been waiting a considerable time to register for a NVQ. New staff confirmed that they completed an induction programme. A copy of this was examined confirming it meets with the Skills for Care Foundation Standards. Staff were observed to interact with service users in a caring, skilled and responsive manner. The people living in the home appeared comfortable with The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 23 the staff. They gave positive feedback about the team. Comments included that staff were ‘all right’ and ‘I like staff’. Concerns were raised by relatives about the “quick turnover of staff” in the home and the levels of staffing. The AQAA acknowledged the impact of “Staff shortages due to maternity leave especially when service users become ill, or require 1-1 support” and that they need to “Recruit more staff that are suitable to the requirements of the home”. Rotas for two weeks in June indicated that at times there were four staff on shift during the day that could fall to two staff in the afternoon/evening. During the day there was management cover and support from two or three day care staff. An additional agency person was being employed to work with one person living at the home but there were occasionally periods when staff on shift had to cover this. During the first visit the cleaner was providing this additional cover and on the second visit the maintenance person was covering. Both had received mandatory training and training in CPI. However this was not an ideal situation. Where staffing levels fall below three staff on shift we must be notified. Recruitment and selection information was examined for three new members of staff. A front checklist was in place providing evidence of documents received, although the receipt of a Criminal Records Bureau check (CRB) had not been evidenced on two checklists. All people had had a PovaFirst check with a copy of this on their file. The following shortfalls were also identified: • References did not provide the reason for leaving previous employment (the wrong reference request form had been used, the new version requests this information) • there were gaps in employment history for two people • one person gave a private address for an employer’s reference and there were some discrepancies about the authenticity of this reference • there was no evidence that a risk assessment had been put in place for new staff starting work without a CRB in place, although the deputy manager said that these were normally in place. There was a copy of a risk assessment for a person under 21 outlining her duties and each file had evidence of staff identity with a current photograph. Copies of CRB checks were examined. There were a significant number of these dating back to 2004. These can now be destroyed. A record was in place containing information of when CRB’s had been obtained for all staff working in the home. Training records were examined. A current training matrix was available and copies of training certificates on staff files. These provided evidence that the staff team were accessing a variety of mandatory and specialist training relevant to their roles and responsibilities. This included training about The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 24 diabetes, epilepsy, equality & diversity, adult protection and the management of challenging behaviour. Staff said that communication within the home could be improved. Staff meetings were not being held on a regular basis. There had been three since November last year. Likewise all staff had received supervision sessions in January 2008 but there was no evidence of any other sessions being held this year. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 25 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): 37,39 and 42. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A number of areas identified throughout this inspection would benefit from more leadership, direction and consistency of approach from the management team. People living at the home will benefit from a manager who has a dynamic and creative approach, and who will provide clearer direction and leadership. Effective quality assurance systems are in place involving people. The health, safety and welfare of people are being put at risk by unsafe practices in the monitoring of fire systems. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager had recently been appointed prior to the inspection. He has considerable experience in the field of learning disability having managed services for an NHS Trust in Oxfordshire. He has a NVQ Level 3 in Health and Social Care and had completed a First Line Management Diploma in Management. He was registering to complete a NVQ Level 4 in Care and the Registered Managers Award. He was applying to us for registration. Staff spoken with were positive about his appointment. Craegmoor have a comprehensive quality assurance system in place. They conduct regular audits of the service. The last clinical governance audit identified a number of action points that were being implemented. Regular unannounced Regulation 26 visits were taking place and copies of written reports were available for inspection. People living in the home had just completed a “Your Voice” questionnaire to be returned to Craegmoor. The AQAA indicated, “We aim to listen, to involve and be influenced by the people who use our service. We are involved in the “Your Voice” project and we have representatives from the group who attend monthly meetings and yearly conferences and this is a company initiative that we “Ask, Listen and Do”. All fire safety checks hade been completed and recorded and fire safety equipment has been serviced and maintained. Regular health and safety checks are also completed and recorded in relation to the environment. The home has a fire risk assessment in place but this had no review date and appeared to be a fairy basic document. There is a need for this to be reviewed and advice taken as to whether a more comprehensive fire risk assessment would be appropriate. The Cedars DS0000016601.V366682.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 2 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X X 2 X The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 14(1) Requirement New people must be fully assessed prior to admission to make sure that the home is able to meet their identified needs. Each person living in the home must have a copy of a statement of terms and conditions providing them with information about the service they receive and the costs of this service. Assessments of each person’s needs must be kept under review so that their changing needs may be identified and met. People must have a nutritious, wholesome and healthy diet which promotes their health and well being. Guidance must be provided in care plans which addresses how to support people in personal intimate relationships. This is to promote dignity and respect within the home. Staff must have training in the safe handling of medication to provide them with the knowledge to administer medication safely. Complaint procedures must DS0000016601.V366682.R01.S.doc Timescale for action 30/06/08 2. YA5 5(1) 30/08/08 3. YA6 14(2) 30/08/08 4. YA17 16(2)(i) 30/07/08 5. YA18 12(4)(a) 30/07/08 6. YA20 13(2) 30/08/08 7. YA22 22(7) 30/07/08 Page 29 The Cedars Version 5.2 8. 9. 10. YA22 YA23 YA33 22(8) 13(6) 18(1)(a) include the correct contact details of CSCI. Outcomes of complaints must be recorded and made available for us when requested. Systems must be in place which staff feel confident to use in the reporting of suspected abuse. There must be sufficient numbers of staff on shift to meet the needs of the people living in the home at all times. (This requirement has been repeated from the last inspection). 30/07/08 30/07/08 30/07/08 11. YA34 19 Ensure staff are not employed in 30/07/08 the home until all necessary and satisfactory information and employment checks have been obtained (timescales of 30/11/05 and 31/03/06 not met. Timescale of 30/11/06 and 06/08/07 also not met in respect of employment history). Staff must be appropriately supervised. The home must review its fire risk assessment 30/07/08 30/07/08 12. 13. YA36 YA42 18(2)(a) 23 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. Refer to Standard YA6 Good Practice Recommendations Aim to review care plans monthly as per the home’s policy. Sign and date care plans and financial records Archive information no longer relevant. Reframe care plans about consent to medical treatment in terms of the Mental Capacity Act 2005. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 30 2. 3. 4. YA14 YA17 YA18 Day-care activities should be individually reviewed as part of the care planning system Keep a comprehensive record of meals eaten by people. Provide information about people’s preferences for the gender of care staff providing personal care. Use fluid monitoring charts. Maintain a stock control record for medication dispensed in boxes. Countersign all handwritten entries on the medication administration chart. 5. YA20 6. 7. 78. YA33 YA34 YA36 Aim for staff meetings to be regular (at least every two months). References should always be professional rather than personal as far as possible. Aim for at least 6 supervision sessions per year. The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Cedars DS0000016601.V366682.R01.S.doc Version 5.2 Page 32 - 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. 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