Inspection on 04/04/08 for The Cedars

This inspection was carried out on 4th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cedars 28/03/09

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 09/07/2008.

CARE HOME ADULTS 18-65 The Cedars 10 Grimston Avenue Folkestone Kent CT20 2PS Lead Inspector Kim Rogers Unannounced Inspection 4th April 2008 10:10 The Cedars DS0000023688.V361122.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 DS0000023688.V361122.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 DS0000023688.V361122.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Address 10 Grimston Avenue Folkestone Kent CT20 2PS 01303 220820 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) cedars.folkestone@craegmoor.co.uk Lothlorien Community Ltd Post vacant Care Home 12 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th June 2007 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/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. Fees range from £825.00 to £1514.55 per week. Please contact the provider for current charges and information about what the fee includes. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit, part of the key inspection, took place on 4th April 2008 between 10:10 am and 4:10 pm. The manager, people who live at the home and staff assisted with the process. One inspector carried out the site visit and was made welcome. The manager completed the Annual Quality Assurance Assessment (AQAA), which is now required. This gives information about the home and how it intends to improve. Some of the AQAA was not completed. The Inspector looked through the AQAA, had a look around and talked to people who live at the Cedars and staff. The inspection process also consisted of information collected before, during and in the few days after the visit to the home. Some of the information seen was assessments and care plans, medication records, duty rota, training information and staff records, including recruitment. The quality rating for this service is 1 star. This means people who use the service experience adequate outcomes. What the service does well: What has improved since the last inspection? The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 6 The AQAA showed a lack of evidence of how the home has improved in the last 12 months. The AQAA says that the home have introduced a new care planning format in the last 12 months. The requirements made at the last inspection have been met. Most of the requirements were made in relation to one service user. 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 The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience adequate outcomes. People know that their needs will be assessed before they move in so the home is sure they can meet those needs. People do not have the information they need in a way they can understand to make a decision about the home. Current residents do not get a say about who moves in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has reviewed the statement of purpose to meet the requirement made at the last inspection. This gives prospective and current service users information about what the home has to offer in the way of facilities and services. It is produced in a written format so not everyone can understand it. It is not written in plain English so is difficult to understand. This means that people may not have the information they need to make an informed choice about this home. There are vacancies at the home and someone has moved in since the last inspection. The move was planned to meet the individual’s needs and allowed for trial stays. The manager said that current service users do not have a say about who moves in. The manager said he considers compatibility issues. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 10 The manager said he carries out an assessment of a persons’ needs before they move in. This is done to ensure that the home has the staff and facilities etc to meet the persons’ needs. We saw the assessment for the last person to move in. The assessment covers lots of different areas including personal goals and significant life events. This means that the home has a complete picture of the person. Family members had been involved in the assessment that was sampled. There was also a copy of the assessment by care management. Although personal goals were assessed and recorded this did not always follow through to the service user plan. It was hard to see how staff are going to support and evaluate the person’s success towards their goals. The AQAA did not identify areas that could be improved mentioning that the home will continue to follow current admission and assessment procedures. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate outcomes. People’s needs are supported but any changes may not be identified. Current systems do not show if people are achieving their goals and whether risk is still an issue. Communication needs to be better supported to increase choice and help decision-making. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a service user plan. This should detail peoples’ needs and goals and show how staff are to support these needs and goals. Two service user plans were sampled. We found that both were written in a way that the people they are for might not understand. One showed involvement from the person’s family and gave detail about the person’s life and significant events. The other did not. The pages relating to life history in one plan were blank. A key worker system allows staff to work on a one to one basis and contribute to the care plan for the individual. Personal goals had been identified in both plans and a service user talked about one of their goals but there was no plan in place to support these goals. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 12 Without focus on developing skills and supporting aspirations people may not have the support they need to achieve and develop. One plan had the person’s specialist needs well detailed. One plan showed regular (monthly) review but the other had only been reviewed once on 20/2/08 since being written 20/11/07.This means that needs and goals might have changed but not been identified and without more regular evaluation staff can’t be sure they are giving the person the support they need. We found that risk assessments relate to areas of need in the service user plan. We found risk assessments have a focus on keeping people safe rather then enabling them to take risks as part of a more independent lifestyle. There is no record of when a risk last occurred so it is unclear if assessments are still relevant or need review. The current risk assessment form does not allow staff to consider and record the likelihood or severity of a risk, so some low risks are assessed and higher risks not. For example, the risk to a person on meeting new people was recorded as ‘I become anxious’ but a greater risk to the person regarding the way their medication is administered was not assessed. We found that there are no assessments to support some imposed restrictions on facilities and services. For example the front door is kept locked and gates prevent access to the first floor. Some people have communication needs and use lots of different ways to communicate. We found detailed communication guidelines in one plan written by the person’s family. This makes it clear to staff ‘when I do this it means this and you should do this’ Staff said that some people used to use Makaton (a sign language) but no longer do. Most of the staff are not trained in the use of Makaton, therefore the use of Makaton signs is not positively promoted. We found that the environment does not support communication. For example people do not know who is on duty, what is happening that day or what is for dinner etc unless staff tell them. Some signs like ‘do not use lift if there is a fire’ are written and not in a format that people can understand. Some staff underestimated the amount people can communicate by saying things like ‘He can’t talk so he can’t tell us’ and ‘it is difficult to get his views because he can’t talk’ - this impacts on choice and decision-making and means some people cannot affect change. Developing a range of individual communication tools and improving the way the environment supports communication will give people more control over their lives. The manager agreed that there is potential for people to have more control over their lives for example, some people could take more control of their money or medication. We found there are no plans in place to increase control and choices. Service user plans and other information are stored in files in a locked cupboard in the staff office respecting service user confidentiality. However The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 13 some sensitive information about individuals was seen displayed in the kitchen and in the managers office. The AQAA states that the company have introduced a new format for care planning over the past 12 months. There was no mention of how the home intends to improve in the above areas only that they intend to continue with current systems. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 14 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, 17 People who use the service experience good outcomes. People have the opportunity to take part in a range of activities and access the community regularly. People have the support they need to keep in contact with friends and family. Meals are healthy with people having a say about what they eat and helping to plan and prepare the food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that each person has an individual activity planner covering seven days and includes evenings. Activity planners showed that people take part in community and home based activities. These planners are written and kept on a wall in the staff office. This means people don’t know what they are doing from day to day unless staff tell them. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 15 People were observed going out and about on the day of the visit, shopping and to a club to play bingo. The daily reports by staff showed people go out and about regularly taking part in a range of activities. We saw people being supported to help prepare lunch and help with household chores including emptying the dishwasher. One person said that staff help them with their laundry and keeping their room clean and tidy. Although some people participate in the day-to-day running of the home there is potential for more participation for others. For example one person was observed sitting in the lounge for some time not being supported to take part at all. We found that for some people goals have been identified to develop skills. But with no plans in place of how staff are to support this it is unclear if people achieve these goals and develop their skills. Relationships with friends and family are supported. One person was supported to buy a family member a birthday card and present. Staff sat with the person to assist them to write the card. Records show that families are involved in the assessment and care planning process and are involved in people’s lives. We found that people do not have total control over their environment for example the front door remains locked and not everyone has a key. There is a gate restricting access to the first floor although no assessment has been carried out with service users to support this decision. We found that these restrictions have not been reviewed for some time. Some people have more choices than others based on how they make themselves understood. For people with more profound communication needs choices are more limited and are made on their behalf. As mentioned developing individual communication support will improve this. There is a full time cook working in the home and some service users help with preparing meals. Menus are subject to individual choice and planned at weekly meetings. Two residents said they liked the food and one person confirmed that staff encourages the special diet she requires. There was evidence of a full fridge and fresh fruit and vegetables. People have access to the kitchen when staff are around. The AQAA stated that the home plan to improve the way they support people to develop their skills and therefore take more control of their lives. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate outcomes People are supported to have her or his personal, health and medical needs met through documented support plans. Some procedures that take place need to be agreed with the person to make sure it upholds their dignity and rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that in the two service user plans sampled personal and health care needs are well documented. This means that people should get the support they need in the way they prefer. A service user told the inspector that staff help them with washing their hair. There is equipment in place to help people take baths and showers for example a chair was seen in the shower and one in a bathroom. Health care needs are well recorded with evidence that staff make referrals to health care professionals when people need the extra support. Some work has started on individual health action plans. One sampled was not completed, the other had information recorded but no action plan yet. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 17 One person takes control of their medication. For others staff have control. The manager said that there is potential for more people to have more control of their medication. The manager will consult with people and carry out the necessary assessments and support plans. Medication administration records were checked and were in order. Staff talked about one person refusing their medication. The staff member said they use different tactics and encouragement to get the person to take their medication. This, however, is not recorded anywhere so other staff may not be aware of the strategy. The site and security of the current storage is not in line with the standard. Medication is stored in a busy office that is difficult for some people to access due to stairs. The lock on the cupboard is not sufficient. Shortly after the site visit the manager contacted CSCI to say he plans to provide suitable lockable storage for people’s medication in their own rooms. Generally the stock of medication was organised and tidy however there were two strips of different tablets lose and not in a box and therefore had no name and administration details. Again the manager contacted the CSCI straight after the site visit to say he has made all staff aware this is poor practice and has taken steps to prevent it happening again. We saw evidence that some medication support may be carried out without the person’s assessed consent. There has not been any ‘Best Interests’ assessment using the Mental Capacity Act even though this serious situation was pointed out to the home by a community nurse on 3/3/08. This could be potentially serious for the person as staff are crushing and covertly administering medication. This is in contrary to the home’s own medication policy. Straight after the site visit the manager contacted CSCI to say that he is arranging a best interests meeting with the service user and their significant others to address these issues. The AQAA says that the home plans to improve by assessing people and enabling them to take more control of their medication and providing medication refresher training for staff. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate outcomes. Not everyone understands the existing written complaints procedure so his or her complaints may not be heard. People are protected from harm and abuse. There is potential for some people to have more control of their money. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure but it is not written in a way and produced in a format that everyone can understand. Communication could be better supported, as previously mentioned, so that staff know when people are not happy about something. We found a complaint made by a service user had been looked into by the manager who had also taken action to prevent it from happening again. This was fully recorded. One service user told the inspector he would speak to his key worker if he was not happy about something. He said his key worker would sort it out. The CSCI have received two complaints about the home since the last inspection. The Provider has investigated both complaints satisfactorily. All staff spoken to said that the manager is approachable and there are forums like staff meetings enabling them to raise any issues or concerns. Staff said they are confident the manager would address any issues raised. There were no staff meeting minutes available on the day of the visit but staff confirmed they have opportunity to attend regular staff meetings. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 19 Most staff are trained in safeguarding vulnerable adults. The manager could not find the policy relating to safeguarding vulnerable adults during the site visit so printed one from the computer. The manager agreed that the policy needs to be readily available to staff in case they need to look up what to do if they suspect someone is at risk of abuse or harm. The manager spoke with knowledge about the procedure when asked and has followed procedures when reporting suspected incidents. Staff control most people’s money. To safeguard people staff said they only keep about £20 petty cash for each person, get receipts and make regular checks of balances and records. Records seen were in order. One person controls their own money and another said they would like to look after their own money. They said they would like to have a safe in their room. This is another area where there is missed opportunity for the home to support people to be more independent. Staff are trained in supporting people who may have challenging behaviours. The AQAA says that the home could be better at supporting people to have more control over their money. They plan to improve by updating staff training in protecting vulnerable adults and supporting challenging behaviours. They plan to continue following the existing complaints policy and procedures. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good outcomes People live in a clean home but some redecoration and maintenance work is needed to ensure the home is safe and pleasant for people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a large building in a residential street in Folkestone quite close to shops etc. One service user said she likes to walk to the shops. The staff have use of a company vehicle so can access the wider community. As found at the last inspection some areas of the home need redecoration and maintenance. For example a service user showed the inspector their room which had a broken drawer front, cracked window pane and window frame that is worn with flaky paint. The person said the window does not open and close properly. The manager said there are plans to update and improve the home. As mentioned there are some restrictions imposed for example some people are The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 21 restricted from accessing the first floor and the front door is kept locked. An assessment should be carried out in consultation with people who live at the Cedars to ensure any restriction made is in people’s best interests. The home was clean on the day of the visit, a service user said staff help him to keep his room clean and help him to do his laundry. People have nice bedrooms, which are personalised making them their own. The garden is well kept and the Provider said a trip hazard to the front path has been repaired. The AQAA says they plan to continue with procedures for when new people move in and continue with the current assessment process. There was no mention of any planned improvements to the environment. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 People who use the service experience adequate outcomes There are enough staff to meet current service users needs but they do not all have the training they need. Recruitment checks are robust which protects service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently eighteen staff at the Cedars, some of the staff are long standing and know service users well. The manager said that there are five staff on duty in the morning and afternoon including a team leader. There is a deputy manager and manager who both work on shift if needed. At night there is one waking staff and one sleep in staff. There are currently 1.5 vacancies for support workers and the manager was interviewing on the day of the visit. Service users were not involved in the interviews. The manager said that service users are not involved in recruiting staff. This means they do not get a say about who will potentially support them. Recruitment checks are carried out by head office before a person starts in post, for example checking work permits and police checks. Two staff files The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 23 were sampled and both contained the required checks and documentation, which protects service users. Staff use a basic daily shift plan which allocates a member of staff to certain service users. There are female and male staff of a range of ages on shift at any one time giving people more choice about who supports them. Service users were observed having support to access the community in small groups and were coming and going throughout the day. Staff were observed talking to people with respect and empathy. Staff handled one incident with kindness and patience. The company organise training for staff. We found from the home’s records there are gaps in statutory training. For example the records showed that only 10 staff out of 18 have had fire awareness training, which included one of the waking night staff. Only 6 staff have had safe moving and handling training and 12 adult protection training. There were no records of ongoing competency assessments relating to these areas in the staff files sampled. The requirement made at the last inspection about specialist training has been met. The staff files showed that staff have regular supervision meetings with a line manager. This enables staff to air their views and discuss training needs and any other issues. The current induction for new staff is in line with the Minimum Standard. Just over 50 of staff have a National Vocational Qualification in care. We found that training relating to learning disabilities is limited including person centred planning and alternative communication. The AQAA says that they could be better at keeping up to date with mandatory and other training and that staff could be consistent in their approach with service users. The AQAA says the plans to improve are to carry on with existing training and recruitment procedures. Again there was no mention of how the home plans to improve, for example involving service users in recruitment procedures and more learning disability focused training. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People who use the service experience adequate outcomes Although service users views are sought they cannot be sure this will lead to improvements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked for the Provider organisation for about four years and previously managed another home. Although the manager has been in post for nine months he has not submitted his application to the Commission to be the Registered manager. This means he has not yet gone through the process to establish his fitness for managing The Cedars. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 25 The home has had some changes in management over the last few years; the manager feels the home is now more stable. The manager has a foundation qualification in care but has not yet completed the qualification required by the Minimum Standards. Qualifications and training relating to service user needs including person centred planning, active support and communication for staff and the manager are limited. Service users views are sought at regular service user meetings. Staff chair these meetings and take the minutes. Minutes were seen and we found that people make requests for things and make suggestions but no action is taken. For example at a meeting of 12/3/08 service users made different requests but the action taken and by whom and when part of the form was blank. Looking back through minutes requests had been made and not followed up at the next meeting and no action recorded. The manager said that head office send out yearly questionnaires to service users and their families. Any responses are returned to head office and issues are fed back to the manager for action. An area manager carries out monthly visits and audits practice. The company also carry out audits, including audits of training needs and heath and safety matters. The manager said that company audits have shown that there is lack of evidence of development at the home. The AQAA section covering management and administration was not completed to say what they could do better, what has improved in last 12 months and what are the plans to improve in the future. The second part of the AQAA requiring information about staff, service users and health and safety checks was not completed at all so it is not clear if health and safety checks are up to date. Some other parts of the AQAA were not completed including sections identifying barriers to improvement and equality and diversity. The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 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 2 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 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 27 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 YA37 Regulation 8,9 Requirement So service users know the manager is fit to run the home he should submit his application to be the Registered Manager and go through the registration process. Timescale for action 31/05/08 2. YA35 18 So service users know they are 30/09/08 in safe hands all staff must be up to date with mandatory training. The waking night staff must be competent in fire procedures. So service users are safe and their rights protected, staff must stop crushing and covertly administering medication until assessments including consent are completed and proper advice sought. To protect service users storage of medication must be safe and in line with the Minimum Standard. To support choice and decision making communication must be better supported individually and the environment. To support people to achieve DS0000023688.V361122.R01.S.doc 3. YA20 13 30/04/08 4. YA20 13 31/05/08 5. YA7 12 30/09/08 6. YA6 15 31/07/08 Page 28 The Cedars Version 5.2 their personal goals they must be identified and recorded in individual plans. There should be a plan for staff to follow to support peoples’ goals. Plans must be regularly reviewed to see if people are achieving their goals. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations So people have the information they need, the Statement of Purpose and other information including the complaints procedure should be produced in a way people can understand. Assessments should be carried out to increase the control people have over their lives including medication and money. So service users have more control over their lives, they should have a say about who moves in and what staff are employed. 2. 3. YA16 YA1 YA39 The Cedars DS0000023688.V361122.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000023688.V361122.R01.S.doc Version 5.2 Page 30 - 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!