Inspection on 22/03/07 for The Cedars

This inspection was carried out on 22nd March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Cedars 30/06/09

The Cedars 16/05/06

The Cedars 03/11/05

The Cedars 30/06/05

The Cedars 05/01/05

The Cedars 01/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 The Cedars The Cedars (2 - 4) The Old Grove Surrey GU26 6BW Lead Inspector Vera Bulbeck Unannounced Inspection 22nd March 2007 10:30 The Cedars DS0000013588.V330039.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 DS0000013588.V330039.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 DS0000013588.V330039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Address The Cedars (2 - 4) The Old Grove Surrey GU26 6BW 01428 608726 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) Robinia Care South Limited Karen Wilmott Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 18-50 years Four Service users to be aged between 18 - 65 Years Date of last inspection 16th May 2006 Brief Description of the Service: The Cedars consist of three bungalows, numbered 2, 3 and 4, that provide care and accommodation for fourteen adults with a learning disability and physical disability. Each of the bungalows provides single service user bedrooms and offers a communal lounge, two bathrooms or shower rooms, a large kitchen. Bungalow 2 provides accommodation for four service users, and also accommodates the office facility for the service. Bungalows 3 and 4 each provide accommodation for five service users. All bungalows are suitably equipped for wheelchair users. The laundry/utility room has been situated in the grounds of the home and the laundry is undertaken by the staff, from the three bungalows at different times of the day. The garden area has been landscaped and surrounds the three bungalows. A fence surrounds the garden area and this provides a safe environment for service users. The fees range from £1,159.87 per week depending on the assessment of the individual service user. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit formed part of the key inspection process and took place over seven hours commencing at 10.30 am and ending at 17.30pm. Mrs V Bulbeck, Regulation Inspector carried out the visit. A full tour of the premises was undertaken. Three care plans were sampled and the care observed for the three service users. The majority of service users were spoken too and a number of staff was spoken with during the visit. The registered manager was present throughout the inspection. There were fourteen service users living in the home on the day of the site visit and there were no vacancies. The inspector would like to thank the service users and staff for their cooperation and hospitality during the inspection. The service users living in the home wish to be called service users, therefore service users will be referred to as service users throughout the report. What the service does well: What has improved since the last inspection? A number of areas have been improved since the last inspection these include new dining room furniture, new blinds and curtains are currently being made for the lounge and dining area, a new washing machine and coffee table has been purchased. New colour boards for the kitchen and four bed protectors have been purchased. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 6 The registered manager is constantly improving the home; by a number of methods these include furnishing and fitments, and general maintenance. 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 DS0000013588.V330039.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 DS0000013588.V330039.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): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs and aspirations are fully assessed and documented prior to admission and on an ongoing basis in regular reviews. EVIDENCE: Service users are admitted to the home following a full needs assessment, which is undertaken by the registered manager. The registered manager explained that she has a format for assessing service users to ensure the home can meet service users needs. This was evidenced by sampling, written records and discussion with the staff on duty. There have not been any new service users placed in the home since 2006. There are currently no vacancies in the home but the placing of a new resident needs careful consideration as the majority of service users have lived in the home for some time. It was noted in service users files that a number of risk assessments have been undertaken on all the service users. Three care managers are very much involved with the care provided in the home. On the day of inspection an annual review was undertaken with the deputy and care manager. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 9 The registered manager informed the inspector the statement of purpose has recently been updated. The Cedars DS0000013588.V330039.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, 7and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ individual plans are clear and comprehensive including details of needs and goals. They also incorporate known or indicated preferences and choices, and include risk assessments. EVIDENCE: Staff stated that service users are supported to make decisions affecting their lives in a number of ways. Each service user has an allocated key worker, who is trained to offer one to one support and who knows the service user well and understands his or her needs. The service users confirmed this during discussions. A number of service users are unable to communicate therefore staff have the experience to enable service users to make decisions and choices, for holidays, menu planning and outings. For example one service user stated he is able to speak with the staff and make his views and suggestions known, and also informed the inspector if he is not happy about anything in the home he speaks with the manager who always listens and takes appropriate action. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 11 Service users individual choices of meals were recorded on their weekly menu plan. Staff advised that information is provided to service users to assist with decision- making and this is in a format to suit their individual needs. All service users are involved with their care planning and where possible indicate they agree with their care plan. The manager informed the inspector that care plans are currently being updated to person centred plans. Service users care plan should indicate service users who are unable to hold a key to their bedroom; care plans must be documented to include the reasons for not holding a key. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users have opportunities for personal development and to take part in appropriate activities within the home and in the local community. They are supported and enabled to maintain and develop appropriate personal and family relationships. Systems are in place to ensure that service users’ rights are respected. EVIDENCE: Service users are supported to make choices in their everyday lives as far as they are able. Families of service users are consulted and encouraged to be involved in the decision making process. A member of staff informed the inspector that an advocate is involved with a service user. It was good to hear that the advocate will see any service user when necessary. There are eleven service users who have contact with family and friends and the three service users without any family have the support of the care managers. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 13 The majority of service users attend various outings; these include visiting the London eye, Hampton Court, going to the pub, meals out, pop concerts and a visit to the BBC studios. One service user has a brother who plays in a band and was playing during Guildford 2006 weekend. The service users mother sent twenty tee shirts to the home for all the service users. Six service users went to a gig in Islington over two evenings during the summer of 2006. One service user goes to college in Portsmouth four days a week. The inspector was informed during the summer months the service users enjoy going on a picnic. Service users have a busy social life. Seven service users go home to their relatives at the weekend. During 2006 the majority of service users went on various holidays these include an activity week in Devon, Haven Holiday Park. Holidays have already been arranged for 2007 with a trip to Disneyland Paris, and an activity week in Devon once again as the service users enjoyed last years holiday in the same place. The meals observed were nutritional and well balanced. Staff was seen to be feeding service users in a respectful way staff informed the inspector that service users are involved with the menu planning and eat healthily. Food intake and nutritional content is monitored and all service users are weighed monthly. Comments from service users regarding food were very positive and those able to communicate indicated they enjoy the food. The home has a quality assurance system in place to gain feedback from service users and their families. All members of staff receive training at induction on respecting and promoting the rights of service users. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care and healthcare support and assistance is planned and was seen in care notes, to be provided, where needed, in a respectful and sensitive manner. Policies and practices are in place for the administration and management of medication. EVIDENCE: The inspector was informed by a service user they are able to choose when to go to bed and when to get up and are supported to choose their own clothes, hairstyles and other aspects of personal grooming. There are regular visits by the local G.P and service users have an annual health check. All service users have good support from the medical team as well as other professional health care people, including the dentist, optician, chiropodist and physiotherapist. The system for medication administration was seen and was generally carried out to a high standard. The Medication Administration Record (MAR) sheets were seen and no gaps in the recording were noted. Staff stated key workers, who report in turn to the registered manager, monitor the MAR sheets. Any The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 15 recurring gaps or errors would be referred to the manager, and this would be discussed at a supervision meeting. It was pleasing to see that guidelines are in place for medication that is given “as required”. A photograph of each resident is provided with the MAR sheets to guide staff to the correct service user and a medication information sheet gives details of the medications for each service user. Staff stated that any additional entries to the MAR sheet, which have been handwritten on, are signed by the member of staff making the entry and by a second member of staff who checks that it is correct. This had been carried out. Two staff signs the MAR sheet for all medication given and for the receipt of medication into the home. Sample signatures of all staff that administer medication were held with the MAR sheets for ease of reference. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All required policies, procedures and practices are in place to ensure that service users are safeguarded, as far as reasonably possible, from harm or abuse. EVIDENCE: There were one recorded complaint; which had been handled appropriately the registered manager informed the inspector there were no external complaints received. Records seen indicated that complaints would be responded to within the guidelines. The homes complaints procedure for service users is in pictorial form and some service users would be able to use it when necessary. The complaints form is written with widget symbols and easy for service users to understand and a copy is held in each service users bedroom. All relatives have also received a copy of the complaints procedure. Two new members of staff have to complete the training for vulnerable adults. The registered manager confirmed that she would undertake the training for the two new members of staff. Staff spoken to, stated that they had undertaken training in the protection of vulnerable adults and would report any concerns they had to the manager. Staff said they would be willing and able to report any concerns and “would go to any level to protect service users”. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 17 Service users finances are paid directly into their bank and fees for their placement is deducted by direct debit. The manager manages any personal allowance money and relatives are involved. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in the home are continuous in order to ensure a safe and wellmaintained environment for service users. The home was observed to be clean and hygiene. EVIDENCE: The environment is homely and welcoming all bedrooms were personalised with items purchased by the service users, observation by the inspector service users have a good rapport with the staff and enjoy living in the home. A contractor maintains the garden on a regular basis, the garden is accessible to the service users and clearly the service users enjoy sitting in the garden when the weather permits. There is ample room and the garden is nicely laid out. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive staff recruitment procedure, which is designed to ensure, as far as reasonably possible, that service users are supported and protected. The number of staff on duty was adequate to meet the needs of service users. Staff that is trained and competent supports Service users. EVIDENCE: The management of the home constantly review the staffing arrangements. At present there are two members of staff on duty in each bungalow. Sleeping in duty consists of two staff members in each bungalow. Three staff files were inspected and it was noted that staff files were in order and relevant documents were in place. All staff had completed induction training over a two-week period A Staff training plan was seen and training was up to date apart from some staff require some updates. The home would benefit from all staff undertaking equality and diversity training. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 20 Two members of staff spoken to confirm they are aware of the different needs of the service users and staff work with service users in this area to ensure their needs are being met. Interaction between staff and service users was observed to be good. Ten members of staff have completed NVQ Level 2, 3 and 4. Two members of staff are undertaking NVQ Level 2 and 3. The home has provided all staff with a copy of the General Social Council and Care document. All staff working in the home should be familiar with the National Minimum Standards document and all staff to read, understand and comply it is advised that this document could be used as a working tool. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The systems for service users consultation are varied and have been devised specifically to enable the service users to make their views known and management of the home ensure that the health, safety and welfare of service users is promoted and protected from harm and abuse. EVIDENCE: The registered manager has completed the Registered Managers award and is experienced and competent to manage the home. Staff confirmed the manager is supportive and has an open door policy. Systems are in place to ensure a regular audit profile the last one undertaken was January 2007. A quality assurance audit was undertaken November 2006 and the comments made by relatives were complimentary. The monthly monitoring visits by the responsible person were found to be well documented The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 22 and covered a wide area of care practice in the home. Timescales and action was included. The home operates a number of good practices with regard to health and safety. For example, risk assessments are in place for all service users, the hazardous substances cupboard was securely locked, and a member of staff has been given responsibility for overseeing the health and safety of the home. A variety of safety certificates were seen and found to be satisfactory. The relevant policies and procedures have to be read by each staff member and then signed by them. It was noted that maintenance records were clear and dated when work completed. The registered manager informed the inspector that she emails the works dept as well as keeping a hard copy to enable the work required to be undertaken is carried out as soon as possible. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X 4 X X 3 x The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 24 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. 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 3 4 Refer to Standard YA20 YA24 YA24 YA35 Good Practice Recommendations All medication creams and lotions need to be stored in a locked facility include creams stored in the fridge. The kitchens in two of the bungalows need updating. The parking area outside the log cabin needs to be cleared of rubbish. Up dates to staff training needs to be kept up to date and staff require equality and diversity training. The Cedars DS0000013588.V330039.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Burgner House, 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 DS0000013588.V330039.R01.S.doc Version 5.2 Page 26 - 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!