CARE HOME ADULTS 18-65
The Cedars 10 Grimston Avenue Folkestone Kent CT20 2PS Lead Inspector
Julie Sumner Unannounced 19th July 2005 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 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 Stationary 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 H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The Cedars Address 10 Grimston Avenue, Folkestone Kent CT20 2PS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 230131 Lothlorien Community Ltd Registered Care Home 12 Category(ies) of Physical Disability/Mental Disability registration, with number of places The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th October 2004 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 premises consists of a large detached home with gardens at the back and around to the front with a walkway up to the front door and a drive way at the side. The home is located in a residential street that is quite close to the centre of Folkestone. The accommodation is provided on three floors. Step free access is provided by a passenger lift. All of the service users have their own bedroom with furniture and equipment to suit individual requirement. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the afternoon and early evening on Tuesday 19th July, commencing at 12:30 and finishing just after 6 o’clock. The home was clean and welcoming. Service users were pursuing planned activities both in and out of the house. Some staff including the manager were attending training away from the home. The manager returned later in the afternoon. Service users were very positive about their lifestyle and behaved confidently in discussions whilst participating in the inspection. The following methods of inspection and information gathering were used: One-to-one discussion and group discussion at different times with service users and staff, observing activity in the home, touring the home and reading and discussing policies, plans and records including individual service user plans, medication charts, some staff records including training records and duty rota. What the service does well:
Staff said they had a “good working relationship with the service users, knowing when to interact and when to give space to support”. This was later confirmed by what service users said individually. Positive and encouraging interactions were observed in the home between service users and staff and there was a good understanding of when to give direct and indirect support. There is a close working relationship with parents and relatives, who have participated in inspections before. One relative said that she always felt welcomed when visiting and could visit without notice. Service users talked about the different activities and hobbies they pursued and were very happy with their lifestyle. One service user talked about a college course that included being taught different daily living skills like cooking and gardening. One service user said “ I go to karate and am going for my red belt tomorrow” along with two staff. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better:
Service users said they would like a quiet room. They have their own bedroom to be alone and like to socialise in the lounge but sometimes they would like to be able to go somewhere else in the house where it is a little less central and busy. This would be particularly useful when other service users become agitated. A conservatory/summer house was discussed. A recommendation has been made to discuss with service users, consider options and plan to provide this facility.
The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 7 The building is old and needs a lot of maintenance. One service user pointed out the cracks and damaged paintwork including a bulging area around the window and ceiling of her bedroom. The roof needs repairing, as there were visible signs of water damage and damp in the upper floor ceilings. A recommendation has been made for this. The manager had requested additional support rails to be fitted to enable service users to get in and out of the bath safely and this was being arranged. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Not inspected at this time. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 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 standard(s) 6, 7, 8, 9, Service users know that their views are listened to and that their personal goals are reflected in their individual plans and potential risks are managed. Service users receive good support to develop and overcome communication difficulties. EVIDENCE: Service user plans have been updated. The files all have photos of each individual. Service users know what information is in theirs and have been involved in compiling it, depending on their ability. All irrelevant information has been removed. The manager is guiding and teaching staff about care planning and risk assessment to ensure that they are useful tools to aid continuity of support and provide an accurate reflection of how service users are being supported. One of the staff is key worker to a service user who has communication difficulties. She has been taking photos when out to compile a supporting communication aid and for the home generally. The member of staff is going to make a wallet of laminated photo cards for use on the daily activity planner board.
The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 11 Risk assessments were included in the service user plan folder. One service user said she enjoyed the support for her to develop her independence. She was able to go out unescorted to specific locations within agreed limitations and this was documented on a risk assessment. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 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 standard(s) 12, 13, 15 Service users are able to pursue a variety of activities to develop their skills and education and for leisure. Service users benefit from the support of a good working relationship between parents, relatives and staff. EVIDENCE: Service users talked about their interests and hobbies. All discussions around interests reflected that each person had chosen different activities that were being supported and encouraged. Educational activities were also included with service users being able to choose from a range of options and try new things as well as further develop skills in a particular area. Activities included: going to the gym, college courses in IT and cooking, shopping, karate, going to functions at Gateway, horse riding and swimming. Service users are also supported to make a decision to stop pursuing an activity if they decide they are no longer interested in it. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 13 One service user has just returned from holiday abroad with his parents. Some service users had been out to Lyminge forest or for a walk along the Leas and for a coffee during the morning and returned for lunch. Many of the service users’ relatives are in close contact with them and the home as a whole and have a significant and supportive role. Service users are assisted to visit home. Relatives are encouraged to visit and invited to functions held in the home as well as the more formal individual reviews. Relatives assisted with the purchase of the lounge furniture. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 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 standard(s) 19 Service users are supported to maintain their healthcare. EVIDENCE: One service user was recovering from some dental treatment that had been given under general anaesthetic and said that he did not feel very well. Regular health care checks are arranged and attended and records are kept in the individual service user plan. Staff are receiving training in specific health conditions to support their care. One service user talked about the support for her health and her recent weight loss which she was pleased about. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Staff have a sound knowledge and understanding of adult protection issues which protects service users from abuse. EVIDENCE: The registered manager is a trainer for adult protection. Four team leaders had attended adult protection training. The financial procedures have been reviewed so that service users are paid directly into their bank accounts. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 16 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 standard(s) EVIDENCE: After almost a year of periodic breakdown the lift has had a major refurbishment and is now in working order. The gas boilers have been replaced and the central heating and water heating are now working efficiently. Maintenance is ongoing in the home with repairs identified by the manager and at the previous inspection having been carried out. The roof remains a problem with visible damage outside and interior damage due to water leakage and damp in the upper floor rooms in the home. A recommendation has been made to repair this as a matter of priority. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Staff morale is getting higher and service users are benefiting from the support of confident and competent staff. EVIDENCE: The training matrix and a selection of training certificates were viewed. Training in techniques for managing challenging behaviour had been updated. Staff had been learning about autism and how to recognise its characteristics. Training in diabetes was being updated to enable appropriate support for the individuals in the home who have the disease and this was booked for August. Staff were being guided by the manager and training to increase their awareness of challenging behaviour and how to manage it with a view to reducing negative impact behaviours. Staff discussed recent training. NVQ training is ongoing and encouraged. 2 Team leaders are studying NVQ 3, 2 team leaders are finishing studying NVQ 2, 7 support workers are studying NVQ 2 with 2 different companies and started at different times. The manager is an NVQ assessor and is able to assist staff to complete their courses. The NVQs will be verified externally. All statutory training has been attended and is ongoing. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 18 The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Not inspected at this time. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x x x x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x 2 x x Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Cedars Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x x x H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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 24 28 Good Practice Recommendations Need to include repair to roof as priority in the maintenance and renewal of the building. Need to consider options to provide an alternative quiet place and to discuss possibilities with service users and provide a written plan for action for the home. The Cedars H56-H05 S23688 The Cedars V226725 190705 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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