CARE HOME ADULTS 18-65
The Cedars (8) Ashbrooke Sunderland SR2 7TW Lead Inspector
Hilary Stewart Key Unannounced Inspection 9 October and 20th November 2007 11:00
th The Cedars (8) DS0000015774.V354344.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 (8) DS0000015774.V354344.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 (8) DS0000015774.V354344.R01.S.doc Version 5.2 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 Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th October 2006 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 home charges from £48,715.15p to £77,001.69p per year. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 17th October 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service and the staff. The Visit: An unannounced visit was made on 9th October and 20th November 2007. During the visits we: • • • • • • Talked with people who use the service, staff and the manager. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well:
Each person who lives at the home has had their needs assessed to make sure the home can give them the care and support they need. All of the people have care plans which give information to staff about how to support them and meet their needs. Care is planned with the people in a way that they prefer and in a sensitive manner. The staff team at the home recognise the differing needs of the people who live there and make sure that they are aware of each person’s preferences. They treat the people as individuals and support them to live the life they choose as much as possible, so they will have new experiences and know that their opinions are valued. People who live at the home experience a variety of activities. This gives them choice, as well as building their self-esteem and confidence.
The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 6 The staff team make sure that the home is clean, warm and adequately furnished so the people who live at the home have a comfortable place to live. Staff support the people to use local services so they are part of the community. The staff make sure the people’s health care needs are met so they remain in good health. All of the people who live at the home have plans of care and risk assessments. This is so staff have the information they need to support each person and keep them safe. The home has procedures for staff for the administration and recording of medication, which is generally adhered to. This is to make sure the people who live at the home receive their medication when they need it and at the correct times. The home has procedures for dealing with complaints and protecting the people who live there from abuse. This means that the people who live at the home feel safe, know they can talk to the staff and that their views are listened to. What has improved since the last inspection?
Each person has a contract for the local authority which are kept at the organisations main office. The individual living plans are in a format, which is easier for the people who live at the home to understand. Menus are now in a pictorial format that is easier for the people who live at the home to understand so they can choose what they would like to eat. Risk assessments are up to date and have been reviewed so the staff have up to date information about how to keep people safe from harm. Ventilation has now been put into a downstairs bedroom. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cedars (8) DS0000015774.V354344.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 (8) DS0000015774.V354344.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): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The needs of each person who live at the home have been assessed so the staff know what care and support they require. EVIDENCE: The people who live at the home have had their needs assessed before and after they moved in. Both the manager and staff said that a person could only move into the home if they are certain that the persons needs can be met there. If a person decided to move into the home they would have visits before they moved in permanently so they could be gradually introduced to the other people who live there. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. All of the people who live at the home have individual care plans, although some had not been reviewed for some time, so it is not certain that their needs are being effectively met. People who live at the home are supported to become more independent at the same time staff try to reduce the risks so they are kept as safe as possible. EVIDENCE: The manager and staff confirmed that the people who live at the home have had their needs assessed. Parts of the care plans have pictures as well to make them easier to understand. Some people at the home do not use the spoken word so staff observe gesture and body language to communicate with them. The manager said that the home reviews the cared plans every year however some of the plans were dated April 2005. One person’s action plan had not been completed.
The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 11 The manager and staff said that the people who live at the home are supported to be as independent as they can be safely. Staff carry out risk assessments, and then use these to look at how they can reduce risk as much as possible for people, when they for example, take part in activities. The people are encouraged to make choices and decisions about what they want to do. One person said that they had been to a museum and likes to go fishing. They like to sit in the summerhouse in the garden. One person was about to go on a trip to an art gallery and then a meal out. The staff said that all of the people attend a centre run by the organisation where there is a club and a range of activities. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who live at the home lead healthy stimulating lifestyles, supported by staff that value them, while maintaining links with their families and friends. This means they can have new experiences and interests and do not become isolated. Mealtimes are flexible to suit individual preferences and lifestyles. People are given choice. EVIDENCE: The manager and staff said that the people who live at the home take part in various activities and are supported to make their own choices but they have to look at the risks at the same time. Staff said that they regularly look at the options open to the people in relation to leisure and social activities. Risk assessments are recorded in the care plans. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 13 On the day of the visit some of the people were out, one person was about to go out for lunch. The manager said that the people who live at the home go to the shops and the cinema. They have been on individual holidays one person went to Cornwall and another to London. The friends and family of the people who live at the home are encouraged to keep in contact with them. They can visit the home or staff will support the people to visit them. Staff said that they work with the people who live at the home around enabling them to have appropriate relationships and behave in ways that will help them get on with people. They also said that the privacy of the people who live at the home is always respected and they always ask before they enter people’s bedrooms. They said that the people could always have privacy if they want. Staff were observed asking before entering peoples rooms. Meals are based on the known likes and dislikes of the people who live at the home. The manager said that the menus have been changed so they include what the people have said that they like. Staff said that at least three meals are served to the people, which are varied and nutritious. One person said, “I like the food”. Fresh fruit and vegetables were in the kitchen. Records of food served were not recorded fully so it could not be confirmed what meals the people had each day. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who live at the home have personal support when they need it so they can be as independent as possible. Staff monitor and promote their health, to maintain their well-being and adequate medication systems are in place to make sure that residents are not put at risk. EVIDENCE: The health needs of the people at the home are written up in detail so the staff have accurate information and know how to care for the people. Staff said that the health and welfare of the people who live at the home is constantly being monitored. Their health and well-being is discussed with other healthcare professionals. If there are concerns about a person’s health appropriate action is taken. The manager and staff could describe and records showed how people are provided with personal support when they need it. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 15 The medication records were up to date. Medication is kept in suitable locked cabinets one in each flat. The manager said that most staff have been trained in how to administer medication safely. Staff who have not received training would not deal with medication. The manager said if it is thought to be safe following a risk assessment the people who live at the home could control their own medication. Details of health checks, visits to their GP and hospital appointments are recorded in each individuals file. One person said that they go to the doctors. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is in place. This means that complaints are dealt with effectively and to the satisfaction of the person who made the complaint. Protection procedures are in place to protect service users from risk of harm. Staff know about adult protection procedures, so the people who live at the home are kept safe. EVIDENCE: The home has a complaints procedure. Staff said that they would support the people who live at the home if they wanted to make a complaint. The manager said and records showed that this is now pictorial form so will be easier for the people at the home to understand. The manager said that there had not been any complaints about the home since the last visit. Staff said and records showed that they have had training in how to protect vulnerable people. The manager said that the home has an adult protection procedure and a copy of the Local Authorities protection procedure was available to staff in the office. Staff could describe the procedure to be followed if an allegation of abuse was made. One person who lives at the home when asked if they felt safe living there said, “yes”. Some of the people at the home do not communicate with spoken words but they looked comfortable and relaxed during the visit. Staff said that they observe gesture and facial expression to understand what they like and dislike.
The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 17 The manager said and records showed that staff have been trained in the management of challenging behaviour. At the present time the organisation are using a method called ‘Studio 111 Training Systems’. A record is kept in home of any physical interventions that take place. One of the recordings was not easy to read and did not give a clear detailed account of the incident. This had been drawn to the attention of the staff in the first visit and had still not been resolved on the second. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People live in a safe, comfortable and clean home, although some updating and repair are necessary. EVIDENCE: There are enough bathrooms and showers for the people who live at the home. The light pulls in some of the toilets and bathrooms were dirty so could be a risk of cross infection. In one bathroom an MDF radiator cover was damp and swollen with the paint peeling off. The wallpaper was coming off and the flooring was stained and damaged. Each person has their own bedroom and they looked comfortable and clean. They were all personalised reflecting peoples’ individual tastes and likes. One bedroom had a damaged radiator cover, which had sharp edges, which could cause injury to someone.
The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 19 Plaster was coming off the wall in the hallway and the living room wallpaper was peeling. The dining room carpet was stained and the door handle was missing. In a kitchen upstairs the cupboard doors were missing, the flooring is damaged and stuck down with tape. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 20 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): 32,34,35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff are sufficient in numbers and have opportunities for training so they know how to give the people who live at the home good care and meet their needs. They are not receiving individual or group supervision as often as they should, to further enhance the care provided. The home has a recruitment procedure to make sure that only suitable people come to work there. EVIDENCE: Records showed and staff said that they receive training, which helps them with their work. All have mandatory training such as first aid and food hygiene. The manager said that 50 of the staff have vocational qualifications. The manager said that due to staff having to cover additional shifts at the home, this had taken up a lot of their time. This has meant that staff had not had individual supervision as often as they should or regular staff meetings to support them to do their job. They hope to address this in the following months.
The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 21 Sufficient staff were on duty at the time of the visit and the manager and staff said that enough staff work at the home. Records showed that on other days enough staff had been on duty. On the second visit a member of staff had been injured the previous day. They had been a member of staff short due to sickness anyway so another staff member had to be called out to cover the shift while they went to hospital. The manager said that all staff have been CRB (Criminal Records Bureau) checked at an enhanced level to make sure they are suitable people to work at the home. However they do not see the original check, their line manager informs them and a record is kept on their file. Original CRB checks are not kept by the organisation therefore were not available to be inspected. Some staff records were looked at and they showed that they had gone through the organisations recruitment process to make sure they are suitable people to work for the agency. Records showed that gaps in employment history had not been explored with some staff during the recruitment process to look. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home, supported by an experienced manager and a quality assurance system, which shapes and improves the service. Ultimately service users are kept safe and well. The manager is not yet registered. EVIDENCE: The manager said that they have the relevant experience to run the home and have a recognised vocational qualification. Although the manager has worked at the home since October 2006 they have not applied for registration and Commission did not until recently have any record of being informed that the The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 23 registered manager had left their post. The manager has not received individual supervision from their manager. Safety checks have been carried out on the equipment in the home; such as testing electrical equipment and the servicing the central heating boiler. Fire safety risk assessments had been completed. The fire logbook showed that regular fire drills and checks take place. Records did not show that staff received fire instruction when they should. Staff said that they have fire drills. The people who live at the home find the fire drills to disruptive so do not have them frequently. The manager said and records showed that regular monitoring visits take place at the home and copies of the reports are sent to them. The manager said that the home has a quality assurance system and people at the home are asked their views about the running of the home as much as possible and they also have a yearly improvement plan. One person said when asked if they felt safe at the home said “yes” and “I like my room ”. Staff said that they have a good relationship with the manager at the home. The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X X 2 x The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 25 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. 4. Standard YA6 YA17 Regulation 15 17 Requirement Individual care plans must be up to date, accurate and complete. Records must be kept of food served in sufficient detail so any person inspecting the record can tell if the diet is satisfactory. The registered manager must make sure that any physical restraint is recorded clearly and in sufficient detail. Radiator guards must be in good order. (Timescale of 31/12/06 not met) All parts of the home must be kept in good state of repair (Bathroom and Toilet) (Timescale of the 30/06/07 not met) Anti topple devices must be fitted to freestanding furniture in the home. (Timescale of 31/12/06 not met) Staff must have individual and group supervision at the required intervals. The manager must be registered with the Commission. Staff must receive fire instruction at the required intervals.
DS0000015774.V354344.R01.S.doc Timescale for action 31/03/08 31/03/08 5. YA23 13 31/12/08 6. 7. YA24 YA24 23 23 31/12/08 31/03/08 8. YA24 13 (4) (a) 31/12/08 9. 10. 11. YA36 YA37 YA42 18 9 23 31/12/08 02/01/08 31/12/08 The Cedars (8) Version 5.2 Page 26 12. YA34 19 The registered person must make sure that all staff have any gaps in their work history explored and a record kept of this information. 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Cedars (8) DS0000015774.V354344.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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
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