Inspection on 28/03/09 for The Cedars

This inspection was carried out on 28th March 2009.

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

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

Other inspections for this house

The Cedars 04/04/08

The Cedars 11/06/07

The Cedars 05/06/06

The Cedars 29/11/05

The Cedars 19/07/05

The Cedars 05/10/04

The Cedars 10/06/04

The Cedars 27/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Cedars 10 Grimston Avenue Folkestone Kent CT20 2PS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Rogers     Date: 3 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Cedars 10 Grimston Avenue Folkestone Kent CT20 2PS 01303220820 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : cedars.folkestone@craegmoor.co.uk Lothlorien Community Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 12 12 The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Date of last inspection Brief description of the care home 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/or a physical disability. The home is a large detached building in a residential street near the centre of Folkestone where there is a range of public transport, shops, churches and learning and recreational facilities. There is a garden to the rear and parking in Grimston Avenue. The accommodation is provided on three floors. There is a lift to all floors. Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home Fees range from about 825.00 pounds to 1514.55 pounds per week. Please contact the provider for current charges and information about what the fee includes. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of the service and included an unannounced site visit over two days by one inspector. The site visits were carried out over about seven and a half hours on 28.3.09 and 31.03.09. All of the key minimum standards were assessed. The previous key inspection was carried out on 4.04.08. We spoke to service users, staff and the manager. The manager is now registered with us as required at the last inspection. This means that he has passed the fit person process and people know he is a fit person to manage the home. We sampled records, made observations and had a look around the home. Care Homes for Adults (18-65 years) Page 6 of 32 We found that they have made improvements and addressed some of the requirements made at the last inspection. One requirement was not met relating to staff training. As this requirement has not been met we may now take enforcement action. We looked at the Annual Quality Assurance Assessment or AQAA that the manager completed. This gives information about what the home does well and how they intend to improve. We looked at other information we have received about the home including any concerns, complaints and notifications about incidents and accidents. There have been two safeguarding vulnerable adults referrals to the adult protection team at social services since the last inspection. One of these alerts is now closed. The adult protection team and the police are investigating the second alert. For more information please contact the Provider. There has been one complaint about the service since the last inspection. This was about staffing levels and was passed to the Provider to investigate. For more information please contact the Provider. Following this inspection we issued a Code B notice. This informs the the recipient that we believe, under the Care Standards Act 2000, an offence has been committed, that we have taken evidence that demonstrates this breach and makes clear what the rights of the individual receiving the notice are. What the care home does well: What has improved since the last inspection? What they could do better: Service user plans are bulky and not easy to use every day. The manager agreed to sort these files so they contain the right information for staff to give the right support and make them user friendly. Everyone should have their personal goals and aspirations recorded and supported. Imposed restrictions should be reviewed like access to the kitchen and laundry to ensure they are still necessary. There should be better monitoring of medication to make sure people have the right medication at the right time. People with health needs should have them clearly recorded so staff know what to do to support them. The bathroom on the first floor needs improving to make it more homely and Care Homes for Adults (18-65 years) Page 8 of 32 welcoming. Mandatory training must be planned in advance so that there are no gaps and people maintain their knowledge and skills. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments are carried out or obtained before a person moves in. There is some written information about the home. Evidence: We found that no one has moved in since the last inspection. Therefore the assessment process could not be tested. The AQAA says the company have plans to improve the assessment tool. We found there is some written information about the home. We found that people are given contracts detailing the terms and conditions of their stay. These are produced in text and are in service user plans. The AQAA says they plan to improve information so that it is meaningful to more people. We found that the manager has met with service users to talk about improving the information about the home including the Service User Guide. The manager said he plans to support service users to be involved as much as possible Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: in this. This means that service users can have a say about what is included. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their needs will be supported but not everyone can be sure their aspirations will be supported. People have the support they need to make choices. Evidence: We found that each person has a service user plan. Most are currently in large files with other information that may not be needed on a day to day basis. For example one plan sampled included information about the fee breakdown and a contract of residency. Staff said the files are bulky and therefore difficult to use on a day to day basis. Staff said they do not get much time to look at and read the service user plans as there is too much information. The manager said that they have been updating the information in the plans and so some information has been superseded and may need removing. The manager agreed that the plans could be streamlined so staff have the information they need to support people on a day to day basis and make plans more user friendly. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Most plans are written and so are not individualised and may not be meaningful to people. We found that people and their representatives are involved in developing plans. This means that they have a say about the support they want and need. We made a requirement at the last inspection for everyones personal goals and aspirations to be identified and recorded by 31.07.08. We found that work on this has only started recently and is limited to the more able people. We found that not everyones personal goals have been identified and recorded. This means that there are no plans in place to support the achievement of individual goals for everyone and people with more complex, profound needs are missing out. The manager said that there are plans for key workers to work with individuals to identify and record aspirations and goals. The manager said that no one has had a person centred planning meeting and none are planned. Some people have formal reviews planned. Three staff are due to attend a one day course about person centred planning and some have attended a one day course on person centred thinking. This means that staff may not yet have the competencies needed to develop and fully implement individual person centred plans. We found that potential risks are recorded and assessed. Action that staff should take to reduce potential risks is also recorded. The manager said that they have been updating risk assessments lately. We found that some risk assessments do not enable people but restrict them. For example, in one plan sampled we found that the person does not have free access to the kitchen because of a serious risk of harm. The assessment does not say what this serious risk of harm is and whether it could be reduced enabling more access and a reduced risk. The manager agreed to review risk assessments relating to imposed restrictions, like access to the kitchen, to ensure that peoples rights and freedoms under the Deprivation of Liberties Safeguards are protected. We found that key workers carry out a detailed written review of plans and risk assessments regularly. We found that the way people prefer to communicate is recorded. We found that they have improved the way the environment supports communication in that there is a picture menu board showing the choices of the day. There are laminated pictures of activity choices in the hallway. This means that people can find out for themselves what is on offer rather than rely on staff telling them. We found there is a board showing photographs of what staff are on duty. The photographs on display did not Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: correspond with who was actually on duty. Two people asked who was on shift later as they had no other way of finding out. Staff said there are plans to update staff photographs so people now who will be supporting them without having to ask. We observed staff offering people choices including what they would like to eat and drink and what they would like to do with their day. We found individual choice making could be better supported. For example, people are used to going on holiday en mass and have limited experience of different locations. Staff said they offer the choice of somewhere new but people tend to stick to where they know. With the use of different tools like brochures, pictures, film, staff agreed that people would have the support they need to help them make a more informed choice. This means people may have the opportunity to experience different locations and destinations. There are plans for staff to have training in the Picture Exchange Communication System. This means that they will have better skills to support communication. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a range of activities including furthering their education. Relationships are supported. People have the support they need to help plan and prepare meals. Evidence: We found that people have the support they need to access a range of activities. People say they enjoy going to local colleges, clubs and shops. We found that people are given a choice about what to do like going out for a drive, a walk or to a local garden centre. There are two company vehicles that staff drive to support people to access the wider community. Each person has an individual activity planner in his or her service user plan. This covers seven days and evenings and shows what people will be doing. Staff said there Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: are plans to individualise these further, and make them more meaningful to people and display them in peoples rooms. We found that hobbies are supported. On the day of the visit we found that people were going out shopping and out with family and friends. We found that relationships are supported with contact details of family and friends recorded so people have support to keep in touch. We found that family and friends are involved in developing care plans and coming to review meetings, if service users wish them to be there. We found that people are supported to be involved in planning and preparing meals. We found that the meal choices of the day are displayed in colour pictures and large print so people can see what is on offer. Some people shop for their own food and do their own cooking. Others have more staff support. For some the kitchen and the laundry are restricted and the manager agreed to review the restrictions to ensure that it is still the least restrictive option and still in everyones best interest. Some people would like to improve their cooking skills and we saw a plan of support showing how staff will support this. We saw one persons plan of how staff are to support them develop more independent living skills like budgeting. This is new to the home and not everyone has had the opportunity to look at what skills they may like to increase or learn. The manager said this is at an early stage and they plan for everyone to have the opportunity to increase and learn new skills. We found that people needs relating to eating and drinking are recorded including any allergies and how to reduce the risk of choking. We found that staff remain in the dining room while people are eating to give any necessary support. As mentioned, we found that people usually go on holiday en mass. At a recent service user meeting one person said they would like to go abroad to Spain. The manager said individual holidays would be supported. We received three surveys back from service users and all said that they could chose what to do with their days and weekends. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their personal needs will be supported. Some peoples health needs need clearer documentation to ensure they get the right support. Medication storage and control for people has improved but systems for checking practice need to be tighter. Evidence: We found that each person has his or her personal care needs recorded in their service user plan. This means that staff know how people prefer to be supported. Where there is a potential risk we found that this is assessed so staff know what steps to take to reduce the risk. Bathrooms and toilets are close to peoples rooms. We found that one bathroom does not feel homely as some of the tiles on the window sill are chipped and cracked, there are stains on the floor around the toilet, some stains and cracks to the ceiling and the bath panel has an edging strip missing exposing bare wood. This means that it may not be a relaxing, appealing place to have a bath. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: We found that staff work closely with health professionals to ensure that peoples health needs are supported. One person said that they have the support they need to attend medical appointments. We found that staff have knowledge of peoples health needs and have used the internet to fill gaps in their knowledge. This means that they can understand people needs and give better support. We found that health needs are recorded in individual plans with any risks to health assessed. We found guidelines in place to support specific health needs like Diabetes however, for one person there was no detailed information or guidance about a health need. The team leader said this might be because there is no formal diagnosis. Currently there is no clear guidance for staff to say what support the person needs as a booklet in the person plan is incomplete. The manager said he would address this to ensure that there is clear guidance for staff on what to do to support the persons health need. We found that there are systems in place to monitor peoples health like regular checks on weight. This means staff can act quickly if a change is noticed. We found that people have their medication stored safely in their rooms. This means that everyone has some control over his or her medication. Staff give the necessary support to ensure that people get their medication at the right time etc. One person said they prefer having their medication in their room rather than in the office as it was previously. The requirements made at the last inspection about storage of medication and the way medication is administered have been met. We found that staff have training before they can administer medication. The manager observes their practice occasionally and completes a competency assessment. This ensures that staff are still safe to administer medication. One person said they want to learn how to take more control of their medication and there is a plan in place to support this. They said staff give them the support they need. This keeps the person safe. We found that medication administration records are kept. Staff or service users sign to say they have administered or taken the medication. We found on 28.03.09 that one record had two gaps for 26.03.09. The person was not sure if they had taken the medication or not but thought they probably had. They were not sure why there was a gap on the record. The manager said staff would be present to support the person to sign the record and would therefore know about any gaps but it had not been reported to him by Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: 31.03.09. This means that current systems for checking and reporting may need to be reviewed and improved. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not everyone can use the complaints procedure as it is. Staff know what abuse is and who to report it to. Evidence: We found that there is a complaints procedure displayed in the home with large print and some symbols. Currently this is not meaningful to everyone so not everyone can use it. The AQAA says they plan to make information like this more meaningful to people so it is more user friendly. Staff said they would listen to complaints and report them to the manager so he could investigate. The manager said there have been no complaints since the last inspection. The Commission have had one complaint about the service since the last inspection. This complaint was from an anonymous source that complained about staffing levels in that people were not getting the one to one support paid for and that some staff were working excessive amounts of hours. This complaint was passed to the Provider to investigate. For more information please contact the Provider. We received three surveys back from service users and all said that they know who to talk to if they have a problem. They all said that staff would listen and act on what they said. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Staff have training in how to safeguard people from harm and abuse. We found that staff know what abuse is and who to report suspected abuse to. There have been two safeguarding referrals since the last inspection. One made by the home and one made by a service users family to the adult protection coordinator at social services who investigates the suspected harm and abuse of vulnerable adults. One safeguarding alert is still open and this relates to the death of a service user. Social services and the police have made investigations and their findings are currently with the Crown Prosecution Service awaiting a decision. The manager and staff have cooperated with the investigation. For more information about this please contact the Provider. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally clean and well maintained. Evidence: We found that the home is clean and generally well maintained. People have their own bedrooms, as they are all single rooms. People spoken to say they are happy with their rooms. There is a large lounge with lots of sofas and a large television so people have space to relax. There is a large dining room so people can eat together if they wish to. We found that access to the kitchen, laundry and outside space is restricted for some people. In one persons plan it said that this was because there was a serious risk of harm. However it did not note what the serious risk is and whether steps could be taken to reduce the risk giving the person more access. This means that some people may not get a drink when they want one and get fresh air when they need to, they have to rely on staff. The manager agreed to review the restrictions to see if people can have more access with the right support. We found that the communal areas like the lounge, dining room and hallway feel homely with pictures and photographs of people enjoying their holidays and other activities. The garden is well maintained so is a pleasant place to spend time. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: We found one of the bathrooms unwelcoming in that some tiles on the windowsill are chipped and cracked, there are stains on the floor around the WC and some stains and cracks to the ceiling. The AQAA says that they plan to update and improve the environment. We received three surveys back from service users and all said that the home is usually clean and smells fresh. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to meet peoples needs. The manager must ensure that staff are suitably inducted and trained so that service users are safe. Evidence: We found that there are usually four staff on duty and there is a always a senior team leader on duty. At night there is one staff awake and one staff on call asleep. We found that there is enough staff to meet the service users needs. The team leader says he prepares a shift plan so staff know what they will be doing and who they will be supporting. This means that there is some structure and organisation of the shift. Neither the manager nor the deputy manager was at the home on the first day of the visit, a Saturday. The team leader on duty assisted with the inspection. We met with the manager and deputy manager a couple of days later on the second day of the inspection, to ask questions and give feed back. Staff knew about peoples needs when we asked and this corresponded with what is recorded. We observed staff offering choices of activities to people and talking to Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: people and each other with respect. Staff said that they have the opportunity to attend staff meetings and one to one meetings with the manager. This means that staff have the opportunity to discuss training and service issues and have some coaching and mentoring. We found that not all staff are up to date with their mandatory training. The deputy manager said that first aid certificates have expired for five staff, two staff need to have fire training, one staff needs to attend food safety training and five staff need to have safe moving and handling training. This means that not all staff have the skills and competencies required to keep service users safe. This is especially concerning as one of the staff that needs training in first aid is a team leader who we observed working alone and therefore could not call on anyone for help. Another staff who needs first aid training is a waking night staff. Although they could call on the sleep in staff this could cause delay and place service users at potential risk. A recent serious incident at the home meant that staff really needed up to date first aid skills and knowledge. Staff support during a particular mealtime was not sufficient for an individuals support needs and one of the three staff on dutys first aid certificate had expired. We made a requirement at the last inspection that all staff must be up to date with mandatory training by 30.09.08 to ensure that service users are in safe hands. This includes first aid, fire safety, food safety, infection control and safe moving and handling. We found that not all staff are up to date with some of this training and therefore we may take enforcement action. The day after the visit the manager told us that he had booked some training so that all staff will be up to date. This will protect service users however this should have been done by 30.09.08 as previously required. We made a requirement at the last inspection that all staff, especially the waking night staff as they work alone, should be competent in the fire evacuations procedures to ensure service users are safe. We found that there is a new waking night staff who started work at the home on 12.3.09. We found that there is no record of any induction for this new staff. The manager said she has not taken part in a fire drill. Following the inspection the manager told us he has arranged for this waking night staff to take part in a fire drill. The AQAA shows that nearly all staff have a National Vocational Qualification and that Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: the staff team are stable. This means that people get consistent support from people they know. We found that some staff have had training relating to peoples needs like alternative communication and epilepsy. Staff said they are due to have training in the Picture Exchange Communication System to help improve communication. Some staff have had training in Person Centred Planning, PCP, although said this was some time ago and some are due to attend this training. This means that staff should have the skills to develop individual PCPs with people. We sampled staff files and found that recruitment checks are carried out before people start work at the home. The AQAA says they plan to involve more service users in the interview process so people can have a say about who may potentially support them. The AQAA says that the induction for new staff has been improved. Staff now attend a week long induction. There is a new night staff at the home who has transferred from another company home. As mentioned we found no record of any induction for this staff. The manager said that the staff member worked three nine to five shifts and read the care plans. Although the staff transferred from another company home so may be aware of company policies and procedures they need an induction specific to The Cedars to ensure service users are in safe hands. One person said staff are kind. We received three surveys back from service users and all said that staff treat them well and listen and act on what they say. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately managed. Changes are made based on peoples views. Peoples health and safety should be better protected with up to date staff training. Evidence: We found that the manager is now registered with us as previously required. This means that he has passed the fit person process so people know that he is a fit person to manage the home. We found that a requirement made at the last inspection has not been met relating to staff training. Although the manager took steps to address this after our inspection this should have been done by 30.09.08. Of the other four requirements made previously we found that three have been met and they have just started working towards the fourth. This relates to finding out about, recording and supporting peoples personal goals and aspirations. We found that work has not started on this for some of the people with more complex needs. This Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: could be an equality issue so should be prioritised so that the requirement is met and everyone has the support they need to lead the life they want. We found that there are systems in place to find out about what people think of the service. There are regular service user meetings and staff told us how they find out what people with communication needs think and how they try to involve everyone. Staff said that feedback is also sought from people at review meetings. The AQAA shows that they have made changes based on service users views in that they have improved communication techniques and involve service users in interviewing potential staff. The company carry out regular checks to see how the home is doing. An audit was carried out recently showing the home has improved. The AQAA shows that health and safety checks of the premises and equipment are carried out, as they should be. We found shortfalls in staff training relating to health and safety namely, first aid, fire safety, safe moving and handling and food safety. This was a previous requirement that all staff should be up to date with this training and as it is not met we may take enforcement action. The manager took action after the inception to address this and booked staff into training. As mentioned we found that not all staff have attended a fire drill and training. This includes a waking night staff for whom there is no record of any induction. This means that staff may not know what to do in the event of an emergency situation. Again, after the inspection the manager took steps to address this. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 35 18 So service users know they 30/09/2008 are in safe hands all staff must be up to date with mandatory training. The waking night staff must be competent in fire procedures. Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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