Inspection on 05/06/06 for The Cedars

This inspection was carried out on 5th June 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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 04/04/08

The Cedars 11/06/07

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 Lois Tozer Unannounced Inspection 5th June 2006 11:50 The Cedars DS0000023688.V295988.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.V295988.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.V295988.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) Lothlorien Community Ltd Care Home 12 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: The Cedars is registered to provide accommodation and personal care for up to 12 people between the ages of 18 years and 65 years who have a learning disability and a physical disability. The premises consists of a large detached home with gardens at the back and around to the front with a walkway up to the front door and a drive way at the side. The accommodation is provided on three floors. Step free access is provided by a passenger lift. All of the service users have their own bedroom with furniture and equipment to suit individual requirement. An outbuilding provides space for recreational activities. The home is located in a residential street that is quite close to the centre of Folkestone. Charges currently start from £974.00 per week. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 5h June 2006 between 11.50 and 18.45, the newly appointed manager, Mrs Teresa McDonald and staff assisted with the process. Twelve people were living at the home, and four gave lots of feedback. Other people gave passing feedback, and care and support was observed. Several service users and the manager gave a tour of the home. All service users were proud of their rooms, and enjoyed the large, old style building. Two staff gave brief input during the visit. The inspection process consisted of information collected before and during the visit to the home, and care management feedback after the site visit finished. Other information seen included assessment and care plans, medication records, duty rota and staff employment paperwork. What the service does well: The pre admissions assessment draws out service user needs. The newest person to the home indicated that they were very happy with the service. Some people get a lot of opportunity to make decisions. One service user said ‘I have enough to do each day, I have a job. There is nothing I would change about the home’. Some service users get actively involved in the running of the home. Some risks are well managed and aim to give individuals more choice and freedom. Everyone is supported to get into the wider community on a regular basis. Medication management is generally good. There is a clear complaints procedure. Service user views are taken seriously and their best interests protected. Service users enjoy their rooms and like the building. The house is clean and hygienic. Recruitment follows good practice, keeping the service users safe. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Cedars DS0000023688.V295988.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 DS0000023688.V295988.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. The statement of purpose needs to be reviewed. The pre admissions assessments draw out service user needs. EVIDENCE: The new manager is reviewing the statement of purpose. It describes the range of facilities and support offered. A recent pre-admission assessment has drawn out individual support requirements and demonstrates the home can support the individual. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. Care plans are improving. Service users real life decision-making & participation opportunities need improvement. Risk assessment needs reviewing. EVIDENCE: Service user consultation has commenced regarding their individual care plans. Aspirations are being taken into consideration. There is a lot of work to do to make sure people who have greater support needs have equality in opportunities. Communication assessments need a greater level of information. Individuals personal communication needs documenting. Some service users were happy with their level of decision-making; others were not. Several service users said they want more involvement in the home. Some days could be boring. Management and staff were aware of service user choice, but more emphasis was placed on the right to not be involved in The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 10 decision-making. The manager is working to increase the level of involvement service users have in the running of the home. All risk assessments are being reviewed. Existing ones are of mixed quality. Environmental restrictions are in place, but have not been reviewed regularly to make sure they are still appropriate. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. For some, education and occupation needs to improve. Being part of the community is well supported. Family contact is improving. Relationships are discreetly supported. Daily routines need improvement. Menus are being revised. EVIDENCE: Some service users want to do more work-based activities, others have really full days. The more able people have much fuller lives. Quite a lot of ‘choice to watch TV’ was taking place. Staff were conducting chores without service user participation. General activities and opportunities need improvement. Staff organisation to offer meaningful opportunities throughout the day needs improvement. Community links are good, getting out into town and places happens regularly. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 12 Relationships are reasonably well supported, but regular family contact has only recently improved. Daily routines are specified in the care plans, but some personal details are displayed in communal areas. Greater involvement for service users in day-today routines is needed. Meal planning is being revised. Current menus don’t give the recommended 5 portions of fruit / veg a day. Service users want more say and involvement in this area. Individuals’ disability is currently excluding service users from participation. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. Personal care is provided mainly as per assessment, but there are some areas for improvement. Healthcare needs are kept under review; family involvement has not been well supported. Medication management is good, but cold storage needs reviewing. EVIDENCE: Personal support is reasonably described, but needs improvement to be more specific. Basic support, such as nail cutting, is not well managed. Notices in communal bathrooms about an individuals support needs were displayed, which is not dignified. Healthcare is reasonably well supported, but family involvement in important issues has been lacking. Families have expressed their wish to be fully involved, but this has been poorly supported. Documented outcomes from health professionals are in place. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 14 Medication is reasonably well managed. Administration and general storage is good. Some paperwork needed reviewing. ‘As required’ medicines advice sheet would benefit from being more informative. Cold storage was being used for items that did not require it, and were being applied to the person straight from the fridge. Staff were not questioning why they were doing this, just accepting that they had ‘always done it’. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. There is a clear complaints procedure. Service users know they will be listened to. Service user views are taken seriously and their best interests protected. EVIDENCE: Service users who were able said that they would feel happy making complaints. Staff said they knew signs of service user distress, and would make sure their problems were resolved. The majority of staff have had adult protection awareness training. Staff have built up good relationships with service users. Service users concerns are taken seriously and the adult protection protocol followed. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The house is comfortable, but some areas need risk assessing for safety. Service users enjoy their rooms and like the building. The house is clean and hygienic. EVIDENCE: The house is generally in good order, and service users bedrooms are highly personalised. A recent problem resulted in the heating failing for about 4 weeks. CSCI were not notified of this (under regulation 37). Service uses said that they had been quite cold. Small, portable storage heaters were installed. Now the boiler is working, uncovered radiators are very hot to touch. The safety of this must be assessed. Environmental restrictions (stair and bedroom gates) have not been reassessed for a long time. Some fire doors are wedged open at night. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 17 There is a dedicated laundry room, and all parts of the house were clean and free from offensive odour. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is good. Many staff have or are on NVQ qualification courses. Staffing levels need assessing against service user needs. Recruitment follows good practice, keeping the service users safe. A wide variety of training has been provided. EVIDENCE: Of 15 staff employed, 6 have NVQ Level 2, with 5 ongoing. Three have NVQ Level 3, with 1 ongoing. It is not clear if staffing levels are appropriate to the service users assessed needs. The shifts are not planned to maximise service user and staff contact. This should be reviewed. Recruitment follows the POVA and company policy, keeping service users safe. Staff have had a wide range of training. This is kept under regular review. As some service users have said they are bored, and occupation for less able people was poor, staffing skills in this area need attention. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. The manager appears competent to meet the homes aims and objectives. The implementation of quality assurance measures is improving. Some areas of health and safety need reassessment. EVIDENCE: The manager must chase her CRB disclosure to enable a registration interview to be organised. Improvements and changes to the way the home is run are filtering through. Notification of reportable events needs reviewing. Person centred planning has started; this is in line with the organisation quality assurance policy. Although there is lots of work to do to put the service users views as the driving force of the service, it is beginning to happen. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 20 Domestic appliance checks and fire checks are all in order. Staff have health and safety training. Environmentally, stair gates, fire doors and hot surfaces need reassessing. The majority of staff hold in date health and safety training and a rolling programme is in place to close gaps. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 21 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 3 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 2 X X 2 X The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA7 YA9YA42 Regulation 16 13, 23 Requirement Review activities and participation for service users. Take risk reduction / assessment action; stair & bedroom gates, staffing levels, hot surfaces, fire doors. Outstanding requirement, previous timescale 31/01/06; An assessment needs to be made on the occupational needs of each individual to determine how to make sure that everyone is being supported and provide the facilities needed. Ensure personal care needs are carried out and are discreet. External medication to be kept at suitable temperature. Using assessment tool (Residential Forum guidance), assess staffing provision and improve deployment though the day. Outstanding requirement, previous timescale 31/01/06; Develop the quality assurance system to include views and action plan from DS0000023688.V295988.R01.S.doc Timescale for action 01/08/06 01/07/06 3 YA12 13 01/08/06 4 5 6 YA18 YA20 YA33 12 13 18 01/07/06 06/06/06 01/08/06 7. YA39 24 01/08/06 The Cedars Version 5.2 Page 23 service users in the home. 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 YA1 YA20 YA23 YA28 Good Practice Recommendations Review and update statement of purpose. Review medication administration records folder for clarity and expand on the ‘as required’ protocols. Obtain up to date adult protection protocols. Need to consider options to provide an alternative quiet place and to discuss possibilities with service users and provide a written plan for action for the home. The Cedars DS0000023688.V295988.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V295988.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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