Inspection on 13/01/06 for The Cedars (8)

This inspection was carried out on 13th January 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cedars (8) 09/10/07

The Cedars (8) 17/10/06

The Cedars (8) 02/08/05

The Cedars (8) 03/02/05

The Cedars (8) 25/08/04

The Cedars (8) 18/03/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 The Cedars (8) Ashbrooke Sunderland SR2 7TW Lead Inspector Mrs Katie Tucker Unannounced Inspection 13th January 2006 08:30 The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 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 (8) DS0000015774.V263204.R01.S.doc Version 5.0 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 (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Cedars (8) Address Ashbrooke Sunderland SR2 7TW 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) 0191 567 9753 0191 563 7711 lesley.lane@espa.org.uk European Services for People with Autism Limited Mr Francis Damian Evans Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: 8 the Cedars is a detached five-floor house that has been adapted to provide a care service. The home provides personal care for 8 adults who fall within the Autism Spectrum. This house has eight bedrooms and is divided into two units of four. In the downstairs unit the cellar has been converted to provide a bedroom, shower and office. A mezzanine landing contains the dining room and steps, which lead to the kitchen. Both units have their own entrance. Steps lead up to the main entrance for the first unit. The second units separate entrance has a level access but internally stairs lead up to the unit. Neither unit would be suitable for some one with a physical disability. The home is located in Ashbrooke and is walking distance from Villette Road shopping area. There is a range of shops on this busy parade, which include a post office, greengrocer, supermarket, chemist and newsagents. A pleasant park is easy to access. Bus stops can be found on the main road and have routes that go to the city centre and Durham. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 8 The Cedars inspection was carried out as part of the routine yearly programme. No one working for ESPA was told that the visit was to take place. An inspector visted and spent half a day at home. The inspector looked at the residents’ records, medication, staff training records and staff information. The staff were asked about the residents’ records, the guidelines for protecting residents, their training, staffing levels and changes to working practices. The residents were asked about their lives. 8 The Cedars cares for younger adults with an Autism Spectrum Disorder. The residents have difficulty understanding abstract thoughts. And, find changes in routine very difficult. Also they find it hard to understand other people’s needs and feelings difficult. Some residents find meeting strangers extremely challenging and if given the option would not like to spend time talking to new people. These people’s wishes were respected. Therefore staff practice, attitude and approach were also watched and judgements made on how well staff worked with people. During this inspection key standards were focused on but not all were checked. What the service does well: The manager, deputy manager and staff are very competent when working with people who have Autism spectrum Disorders. They understand the needs of the service and care a great deal about the resident’s. Staff constantly help residents’ to extend the range of activities they join in. Staff are skilled at working with people so they remain comfortable and willing to try something new. Thus residents have joined in a rowing competition, horse riding, conservation projects, performing arts and pottery as well as doing woodwork. Some people have previously experienced a great level of anxiety, which has led to people risking hurting themselves or others. Since the people have lived at 8 The Cedars this behaviour has markedly reduced and for some has disappeared. It has taken time but this type of change has not been achieved elsewhere. Staff never stop working towards changing behaviour and try ranges of approaches in order to find ones that work for each person. ESPA employs and has access to a range of specialists such as psychiatrists and psychologists. These specialists regularly visit residents and provide support in all aspects of people’s lives including sex education, managing anxiety, and social skills. Staff’s in depth knowledge of the difficulties that people with autism spectrum disorders face allows them to work successfully with people. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 6 ESPA has a range of services, which includes colleges and a day service (the Croft Centre). The centre has been designed to meet the needs of this client group. It features a café were people can serve and provide meals, performing art facilities as well as crafts and aromatherapy. Dedicated and appropriately qualified staff team work at the Croft Centre. Residents regularly use these facilities and staff accompany people to offer help if it is needed. 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 (8) DS0000015774.V263204.R01.S.doc Version 5.0 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 (8) DS0000015774.V263204.R01.S.doc Version 5.0 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 The various styles of service user guide makes it useful to all but the lack of information about fees flaws this record. EVIDENCE: The service user guide clearly shows what is available at 8 the Cedars and is available in a range of formats. Thus people have the full information needed to make a decision about whether they like the sound of the service. The generic contract, which is included in the service user guide, does provide space for the inclusion of the amount of fee. However the individual agreements do include this information or anything about special staffing arrangements. Also copies of the local authority placing agreement are not provided. These are not only required by regulation 5 of the Care Home Regulations 2001 but without them people cannot make informed decisions about whether the feel that the service they are getting is value for their money. ESPA has now worked with local authorities to develop these agreements. Blank copies of contracts that refer to the fees and staffing arrangements are now available but must be completed for each person. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 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 and 9 The available records and plans show how staff are meeting peoples needs. EVIDENCE: The care plans and risk assessment format have allowed staff to record full and detailed information about residents’ needs and the actions staff have to take to work with people. The plans identify the strengths people have and the common day risks that would be still acceptable for someone to take. Staff make sure they step out clearly each action that needs to be taken. Staff always record information about when they need to limit residents’ choices and wherever possible residents’ or their next of kin help to write the assessments and plans. The service users have the potential to challenge staff in many ways including passive challenge. The plans are being developed so they identify primary and secondary actions staff need to take prior to using physical interventions. Staff fully explore all of the triggers for challenging behaviour and make sure they put all measures in place to reduce this risk. Staff are aware that in order to meet Department of Health requirements they have to record all physical interventions in a hardback bound book with numbered pages. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 10 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): 13, 15, 16 and 17 The skilled work of staff and the range of experiences offered both by ESPA and 8 the Cedars have allowed residents to greatly widen their life and expectations. EVIDENCE: People with Autism Spectrum Disorders find it difficult to form meaningful relationships, understand other people’s needs and prefer fixed routines. However staff have not become fixed in the way they work with people. Therefore staff have worked with residents to increase their level of independence and have access to everyday activities. Also ESPA employs a psychologist who works with people around sex education and forming relationships. This work is designed to meet the needs of each person so is very helpful for all concerned. The cook is very competent and makes sure healthy, balanced diets are provided. Staff constantly involve family in designing how care will be given to residents. The residents regularly write and visit their relatives. The way staff and ESPA encourage relatives to be involved in people’s care helps residents and relatives feel valued. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 11 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 and 20 ESPA and staff have demonstrated an in depth knowledge of the difficulty that people within the autism spectrum experience and this means they can actively promote people’s wellbeing. EVIDENCE: Staff worked well with people. They were very respectful and valued people. Residents said ‘they were well’ and ‘staff were good’. Staff have worked with people to make sure the routines that are followed benefit the residents. Some residents have obsessive-compulsive disorders so work has been completed to make sure rituals people need to complete do not lead to them being unable to function. Staff have made sure the medication is stored and given out properly. The records were satisfactory. Also staff have had accredited medication training and the manager is very knowledgeable and provides regular up dates for staff. Residents do not have sufficient insight about the medication they receive, why they take or when to take it and would find it very difficult to learn these skills. Therefore, at present, no one self-administers their medication and the reason for this is recorded in people’s service user plans. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 12 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): 23 The manager follows the local authorities protection of vulnerable adults procedures. EVIDENCE: 8 The Cedars has an appropriate protection of vulnerable adults policy and follow Sunderland Social Services Department guidance. In this guidance ESPA has to put in a section about what they would do if an allegation of abuse were made. Staff have had training around protecting residents. The Social Service Department has a continuous programme of training for all the staff working in care. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 13 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): 24 and 30 On the whole the building meets the needs of the residents and visitors with a disability. However because of recent unforeseen events some of the parts of the home are not in good repair. EVIDENCE: The design and location of the home is a positive feature as it blends in well with the community. The home exceeds the current space requirements of the national minimum standards in all areas. However, not all of the bedrooms offer an en suite facility. 8 the Cedars is usually maintained to a high standard but recent issues with the maintenance team has meant delays in agreed refurbishment have been seen. Thus one bathroom and kitchen urgently need work completed to bring them up to a good standard of decorative repair and meet infection control requirements. The home is always kept clean and tidy. 8 The Cedars is not suitable for someone who has a physical disability because of the access to and throughout the home is via stairs. But ESPA has considered what has to be done should someone visit who has a disability. When the environmental standard changed the Government set certain requirements. One of these being the service user guide had to reflect where the home does not meet the requirements of the standards for new registrations. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 14 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 and 35 Staffing levels meet the needs of the residents. The staff team are effective and are completing appropriate NVQ Awards. The current physical intervention training leaves ESPA vulnerable, as it does not mean allow them to be fully insured. EVIDENCE: During the day at least 4 care staff inclusive of a senior care are at work and often 5 staff are on duty. At night 1 waking staff member plus a sleep-in senior staff member are on duty. Without the placing contracts being available it is uncertain whether 8 the Cedars is complying with any specific contractual arrangements that have been made. A part time cook and domestic are employed. Care staff with service users also complete domestic and catering tasks. The staff files are kept centrally and copies kept at the home. Training is delivered centrally and in-house. The person who completes physical intervention training has not received accredited training for some years. This means should any injury occur when staff are using an intervention ESPA is not covered by their public liability insurance and does not meet the requirements of Health and Safety legislation. The manager has been to a training course on physical intervention, which was provided by an accredited trainer as have a couple of the senior staff. However, the staff who are involved in most interventions have not been on accredited training. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 15 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 and 42 The management systems on the whole meet the needs of residents living at 8 The Cedars. But action needs to be taken to meet health and safety regulations. EVIDENCE: The manager is a very competent registered nurse. He is in the process of completing the registered managers award. He constantly makes sure his practices are line with recognised good practice. ESPA has developed a robust quality assurance system, which includes a service user board. Also the operational manager visit each home to conduct different audits of the service being offered and this information is provided to the local CSCI office. Recently some of the regulations were changed and the owners need to make sure their systems reflect these requirements. The lack of accredited physical interventions training poses potential health and safety risks for the residents and staff. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 16 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 4 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 4 14 4 15 4 16 4 17 Standard No 31 32 33 34 35 36 Score X 2 3 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Cedars (8) Score 3 X 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X 2 X DS0000015774.V263204.R01.S.doc Version 5.0 Page 17 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. Standard YA1 Regulation 5(3) Requirement The owners must ensure completed copies of the local authority placing contracts are provided to each service user guide and available in the home. The toilet must be repaired and re-commissioned. The downstairs kitchen must be refurbished and fixtures such as the fridge renewed. All staff providing physical interventions must have accredited training and this must be refreshed on a yearly basis. The manager must complete the registered managers award. Timescale for action 14/07/06 2. YA24 13(4) (a) 31/03/06 3. YA35 18(1) (c) 19/05/06 4 YA37 18 (1) (c) 01/12/06 The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 18 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 YA35 Good Practice Recommendations Consideration should be given as to how 50 of care staff will achieve a NVQ Level II by 2005. The Cedars (8) DS0000015774.V263204.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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. 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