Care Home: 48 Cedar Road

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What the care home does well People can get information about what the service does, and who it is for, to help them decide if it provides what they are looking for. People`s needs and strengths are assessed, so that their care and support can be properly planned. This takes particular account of the specific needs of people with Acquired Brain Injuries. People have detailed care plans so that the staff looking after them have clear guidance about the ways in which they like to be supported. Regular meetings with key workers help to make sure that people are consulted often about what they want, so that important information is kept up to date. Staff encourage people to be as independent as they are able. They can do things they value and enjoy, go to places they like, and keep in touch with the people who are important to them. People can be directly involved in planning their menus, shopping for and preparing and cooking their food, if they wish. People are well looked after and get the support they need to keep important medical appointments, to keep them healthy and well. The service makes sure that specialist therapies are provided, to make sure their specific support needs are met. People can be confident that any complaints are listened to and taken seriously so that action can be taken to address their concerns. The home is well equipped, furnished and maintained, so that people can enjoy living in a house that is clean, comfortable and homely. People can be sure that important checks have been carried out to make sure that staff employed at the home are fit for their jobs. Staff are generally well qualified and trained, so that they have the knowledge and skills they need to do their jobs well. The home is well run. The Manager and staff show that they are committed to developing the service for the benefit of the people who use it. What has improved since the last inspection? Clear efforts have been made to meet requirements made at the time of the last inspection. Records to support robust recruitment practices are now complete. These include exploring any unexplained gaps in people`s work histories, and taking up references. This is so that people can be confident that proper action has been taken to make sure that staff employed are fit for the jobs they do. A detailed induction programme and a staff training and development plan are now in place. This is to make sure that staff have the knowledge and skills needed to do their jobs properly. The home has developed its quality assurance and monitoring systems. This makes sure that the opinions of people using the service are actively sought, so as to guide its future review and development. Full records are now kept of any concerns or complaints, so that it is possible to see what action has been taken to resolve any issues. Continued maintenance, redecoration and other improvements have been made to the home environment, to make sure that people carry on enjoying living in a clean and comfortable home. What the care home could do better: Written contracts should be fully completed, so that all parties are clear about what they have to pay, and any other responsibilities. Developing the use of person-centred approaches (and evaluating people`s goals more effectively) will help to ensure they get the support they need to achieve the things they say are important to them. Health Action Plans could be further developed to set clear goals more systematically. This could help to promote people`s health and wellbeing more proactively. (These two recommendations are made merely to build on existing good practice.) Arrangements to improve the frequency of formal staff supervision should be put into action, to make sure that staff get all the support they need to do their jobs well. Key inspection report Care homes for adults (18-65 years) Name: Address: 48 Cedar Road 48 Cedar Road Dudley West Midlands DY1 4HW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gerard Hammond     Date: 1 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 48 Cedar Road 48 Cedar Road Dudley West Midlands DY1 4HW 01384241877 01384241746 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Voyage Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Mental Disorder (MD) 9 Learning Disability (LD) 9 Physical Disability (PD) 9 Sensory Impairment (SI) 9 Date of last inspection Brief description of the care home 48 Cedar Road is registered to provide accommodation, care and support for up to nine adults, with acquired brain injury. The service provides 24-hour personal care and support. The aim of the home is to provide medium to long-term support to people, assisting them to develop an independent lifestyle, according to their individual abilities. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 0 0 9 9 9 9 Brief description of the care home The home was purpose-built. It is a two-storey detached property situated in a residential area of Dudley, close to local shops and amenities:the area is well served by public transport. The home has the use of two vehicles (one of which is wheelchair accessible) and off-road parking is available to visitors. There is ramped access for people with limited mobility. The first floor can be accessed by a passenger lift or the stairway. Communal facilities include lounge, kitchen with large dining area, activity room and private rear garden. There are nine single bedrooms: all are spacious, furnished to a high standard and have en-suite facilities. Additional toilets (all wheelchair accessible) are situated close to communal areas. There is also an assisted bathroom equipped with ceiling track hoist, on the ground floor. The service should be contacted directly for current information about fees and charges. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is the homes first key inspection in the current year 2009-10. We last inspected the home on 30th August 2007. We gathered information from a number of places to help us make the judgements shown in this report. The Manager sent us a completed Annual Quality Assurance Assessment (AQAA). This is a self assessment of how well the service is doing, and provides some numerical information about it. We sent written surveys to the people who use the service and their relatives. We made two visits to the home and spoke with people who use the service, the Manager and staff working there. We looked at personal records including assessments and care plans, staff files, safety records, previous inspection reports, and other documents. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? Clear efforts have been made to meet requirements made at the time of the last inspection. Records to support robust recruitment practices are now complete. These include exploring any unexplained gaps in peoples work histories, and taking up references. This is so that people can be confident that proper action has been taken to make sure that staff employed are fit for the jobs they do. A detailed induction programme and a staff training and development plan are now in place. This is to make sure that staff have the knowledge and skills needed to do their jobs properly. Care Homes for Adults (18-65 years) Page 7 of 30 The home has developed its quality assurance and monitoring systems. This makes sure that the opinions of people using the service are actively sought, so as to guide its future review and development. Full records are now kept of any concerns or complaints, so that it is possible to see what action has been taken to resolve any issues. Continued maintenance, redecoration and other improvements have been made to the home environment, to make sure that people carry on enjoying living in a clean and comfortable home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to help them decide if the service is right for them. Their strengths and needs are fully assessed, so that their care and support can be properly planned. Written contracts should be completed in full, to make sure all concerned are clear about their responsibilities. Evidence: We looked to see if the home had a Statement of Purpose and a Service Users Guide. These documents tell people who the service is for and what it provides. This is so that people have the information they need to help them decide if the home is right for them. We saw that these documents were available and included the required information. We saw copies on display in the home, and on individuals personal files. A DVD version is also available. We asked people about this in the surveys we sent them before we visited the home. Seven out of the nine current residents told us they received enough information about the home before they moved in. We looked at peoples personal records to check if their support needs had been assessed properly before they came to live in Cedar Road. The service uses an Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: assessment tool developed specifically for people who have an Acquired Brain Injury. We saw that this is comprehensive, highlighting important information needed to plan peoples care and support effectively. All of the files we looked at contained such an assessment, and we saw that these had been reviewed frequently. This is so that essential information can be kept up to date. The files we looked at also contained a written contract covering the terms and conditions of peoples residence at the home. We noticed that these did not all contain full details of the amounts payable, and by whom. We talked to the Manager about this, and recommended that these be completed as required. This is so that everyone is clear about their responsibilities. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the support they need in ways that suit them best and ensure that they can stay safe. Evidence: We looked at peoples personal records to see how their care and support is planned and managed. We saw that files are well presented and organised, so that important information can be found quickly and easily. Plans include detailed guidance for staff, to ensure that support is given in the way that best suits each individual. Records include preferred routines, and peoples likes and dislikes (e.g. food.)The care plans we looked at were comprehensive and clearly linked to assessments of individuals strengths and support needs. Plans were drawn up with the direct involvement of the person concerned, staff at the home and other professionals involved in peoples care. They are clearly cross-referenced with risk assessments: these include assessments of peoples capacity to make informed decisions (where appropriate)and the measures to be taken to ensure people get the support they need to stay safe. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Care plans are kept under regular review, through monthly discussions between individuals and their key workers. People told us that these happen regularly. We saw the reports that staff complete following these discussions. We noticed that peoples care plans include their agreed goals, and that these are considered in the daily records that staff complete, and the monthly report. This represents good practice, as a way of ensuring that people are getting the support they need to achieve the things that are important to them. We discussed this with the Manager and recommended some further developments. We suggested that extending the use of person-centred approaches could help identify more clearly the things that are really important to each individual. There are good tools in place already for evaluating the effectiveness of work done towards achieving agreed goals. However, it was noticeable that records relating to these often showed that people declined opportunities to do the things that are supposed to have agreed to (for example, tasks towards helping people prepare for moving on to more independent living). We recommended that evaluation of peoples goals should include a review of where things are clearly not working. This is to ensure that staff and people who use the service take responsibility for the things they have agreed to, where their abilities allow them to do so. These recommendations are made merely as a matter of good practice, seeking to build on the good work already being done in this area. People using the service also have opportunities to be involved in the day-to-day running of the home through regular house meetings. These include discussions about activities, budgeting and menu planning. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the support they need so they can do the things they value, go to places they like and keep in touch with the people who are important to them. They enjoy their meals and mealtimes. Evidence: We talked to people and looked at their records to find out about the activity opportunities they are able to enjoy. In the surveys we sent out we asked Do you make decisions about what you do each day? Three people replied always, four said usually and two said sometimes. Replying to the question can you do what you want (in the morning / evening / weekend) everyone replied yes to all the options. One person said he/she would like to go on more day trips. Another said I can do things when I want. Another person said I can spend time with my boyfriend and play my music. Someone else said Staff take me to the shops. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: The records we looked at show that people are able use a range of local amenities. These include going to college, out for meals, to the cinema and to the library. We saw staff supporting people to go to the park, on their way to a local community church facility for lunch. One individual has a personal trainer, goes to the gym and is now learning martial arts. At the home we saw people relaxing, watching television and films on DVD, playing computer games and pool. We saw a notice in the dining area informing people of the day trips planned in the near future, to Warwick Castle, the Black Country Museum and to Blackpool. These had been decided at the most recent house meeting. An important part of this services remit is working with people to help them regain their independence where this is possible. Some peoples records had care plans for managing a set budget. Others included goals for developing cooking and other domestic skills. Three of the current group of residents are actively working towards moving on to more independent living. Their activity plans include sessions to build up their skills in support of their aim to live as independently as possible. We saw that referrals had been made to Occupational Therapists to gain support in risk assessing these activities appropriately, and devising plans to help people achieve their goals. We spoke to two people who use the service about this. Both said they were looking forward to moving on to their new home as soon as they were ready. People are supported to keep in touch with their families and friends, where this is possible. It has to be acknowledged that the circumstances around individuals admission to the service sometimes make this difficult. Staff do their best to support people to maintain or repair their relationships, where the parties concerned are willing. We were able to meet with the relative of one person. He said that he was very pleased with the support his family member received and recognised the improvements and progress that had been made. We looked at the food stocks in the home and saw that these were plentiful. They included fresh fruit and vegetables. We saw people sitting in the dining room enjoying their evening meal with the staff on duty. People told us that they play an active part in planning the menus and in shopping for groceries, if they so choose. People who are actively working towards moving on have a cupboard in the training kitchen for storing their food. Staff support them to shop, plan and prepare meals as part of their training for more independent living. Records of meals show that people enjoy a balanced diet with a good range of variety and choice. People told us The food is lovely, we can have what we like. Another person said The food is good, I help to plan the menu, and go to the supermarket to do the shopping. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their personal health care needs are met, and that they get the support they need to be healthy and well. Evidence: When we visited the home, we saw that people were well dressed in good quality clothing, and it was clear that they had received any support they needed with their personal care and hygiene. We saw and heard interactions between the people who use the service and the staff supporting them. We saw staff knock on peoples doors before entering their rooms. People told us that there are no fixed times for getting up and going to bed, and that arrangements for meals are flexible. We heard staff speak to people respectfully and with warmth and friendliness. The responses we received to the surveys we sent were generally very positive. One person wrote that staff are always kind and friendly. When we asked people about this directly, another person told us I dont class them as staff, I think of them as my friends. If youve got a problem, they will sit and listen, you can go straight to them, they will help in any way they can. We looked at peoples personal records to see how their healthcare is planned and Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: managed. We saw that people had regular appointments with their doctors, dentist, optician, chiropodist and other health professionals as necessary. Their files had records of weight monitoring and we saw that one person had daily checks on blood glucose levels. There was clear guidance in the care plan about what to do if levels were outside agreed parameters. People had therapy programmes built into their care plans to increase / maintain their mobility and general fitness. The service purchases specialist therapy input from neuro-physiotherapists and psychologists, and speech and language and occupational therapy services. This is to ensure that the specific care and support people need because of their Acquired Brain Injuries is available to them. We talked to the Manager about health action planning. We saw that records of medical appointments and therapy were generally well maintained. We also saw that these were discussed as part of the weekly meetings between individuals and their key workers. We suggested that health action planning could be developed so as to make practices more systematic. The focus of health action planning is proactive rather than reactive. That is, taking positive action to promote good health, rather than just reacting when problems arise. Having a health action plan that sets clear goals (in the same way as general care planning)helps to ensure that positive action is taken. For example, goals could include an annual well person check, six-monthly dental check-up and so on, with proposed dates. Clear goals might also show specific exercise programmes including frequency and duration. We did see examples of good practice in these areas, so the recommendation is to review this area of work so that it becomes more systematic. This could help to promote more positive action by helping individuals set their goals, and take greater responsibility for their own health and wellbeing. As previously, this recommendation is made merely as a matter of good practice, to build on existing strengths in this area. We looked at how medication is managed and administered in the home. We saw that the medication room has an air conditioning unit to ensure that a suitable temperature is maintained at all times. This is checked and recorded regularly each day. Each person in the home has an individual medication file. We saw that records are generally well maintained. They contain a photograph of the person, information about their prescribed medicines, and clear guidance about how this should be given. There is a protocol signed by the GP covering the use of homely remedies, and written protocols for any PRN (as required) medication. We saw that the Medication Administration Record (MAR) had been completed properly, with no gaps. Medication had been given as shown on the record. We saw that records also included photocopies of original prescriptions, and sample signatures of the staff authorised to administer medication. We sample checked stocks of medication not dispensed in Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: blister packs, and found that the number of tablets held tallied with the administration record. We saw that a daily audit is carried out to check the stocks of PRN pain relief medication. We also saw that an audit had been completed recently by the local pharmacist, and no problems identified. The medication store was clean and tidy. The medication cupboard and fridge were both secure, and the medication room was locked. These things show that the service takes positive action to ensure that medication is managed effectively and safely. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their concerns are listened to, taken seriously and acted upon. They get the support they need to help them stay safe. Evidence: We saw that the service has appropriate policies in place regarding complaints and safeguarding (adult protection). Summaries of these are included in the Service Users Guide: we saw copies of these on peoples personal files and on display in the home. A number of options are open to anyone who wishes to raise a concern or make a complaint. The Manager says she operates an open door policy: we witnessed this directly and saw that people who use the service are clearly comfortable in approaching her. People are also able to discuss any matters with their key workers in their regular meetings each week, or raise issues of general concern in the house meetings. People told us that they knew they could take up any matters they wished with the manager or the staff. If they wish to take up any matters outside of the home, they can contact senior managers in the organisation by sending them an I am worried card. These are available in communal areas, together with stamped preaddressed envelopes. Information about getting in touch with independent advocates is also available on the notice board. We looked at the homes complaints file, and saw that matters raised had been recorded properly. The record included action taken and the outcome of the complaint. We have not received any complaints about this service. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: We talked to staff about safeguarding. They were able to show us that they have a good understanding of the different forms that abuse can take. They also showed that they are sensitive to the ways in which people might react to abuse, for example through changes in regular behaviour or becoming withdrawn. They could say clearly what action they should take in the event of witnessing or suspecting abuse. We looked at staff records. These showed that important checks with the Criminal Records Bureau have been done before people are employed. Their records also showed that staff have received training in protecting vulnerable adults from abuse. The homes safeguarding policy is linked to local multi-agency guidelines. Action taken recently demonstrates clearly that the service follows these procedures correctly. We saw that the home keeps proper records of any money held on behalf of the people who use the service. These are supported with receipts to cover any expenditure. We sample checked the cash held and saw that it balanced with the written records in all the cases we looked at. These things show that the home takes positive action to make sure that people get the support they need to stay safe. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy the benefit of living in a comfortable, homely environment that is fully equipped to meet their needs. Evidence: We looked around the home in the company of the Manager. 48 Cedar Road is furnished, equipped and decorated to a very high standard. It is fully wheelchair accessible and has been designed to meet the needs of people who may have significant mobility problems. There is ramped access to the building, and passageways and doors are wide. Access to the first floor is via a full passenger lift or the stairway. On the ground floor there is a comfortably furnished lounge: the carpet in this room has been renewed recently. There is a spacious open plan kitchen / dining area. This includes adjustable height surfaces to accommodate the needs of people who use wheelchairs. There are pictorial aides to help people relearn tasks such as making a pot of tea. The orientation board is in this area. This displays the time, day and date, and has photographs of the staff on duty. There is an assisted bathroom on the ground floor, with height adjustable bath and ceiling track hoist. The Manager told us that this is not currently in use. People currently using the service prefer to use their private facilities in their bedrooms. However, we saw that this equipment has been Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: maintained and serviced and is available for use should the need arise. There are ample toilets available on the ground floor, and these are also wheel chair accessible. New non-slip flooring has been fitted in the main hallway, and this space has also been redecorated. A new carpet has been fitted in the activity room. We saw people enjoying watching television and playing computer games in this room. There is also a pool table, bar football game, exercise bicycle, and arts and crafts store for people to use if they wish. Communal areas are decorated with pictures and art work completed by current and former residents of the home. The Manager said that these works had won prizes in competitions and been displayed in local galleries. There is a small training kitchen which some of the residents use to develop their skills in preparation for moving onto more independent living. Occupational Therapists and members of the staff team support people using this facility, to risk assess and provide opportunities to practice. We were able to see some of the bedrooms. All of the rooms are singly occupied, and include en-suite shower and toilet facilities (level access / wet room). Three of the bedrooms are on the ground floor, the remaining six on the first floor. Some rooms have capacity for ceiling track hoists, and these are available to be fitted if required. Similarly, some rooms have kitchenette facilities: these can be isolated independently so that they do not present a danger if they are not required, as is currently the case. Rooms are spacious and individual. We saw peoples personal belongings and effects in place, including TV, DVD player, music players, CDs, books, pictures, ornaments and family photographs. A staff call system is also installed. There is a staff sleep-in room, the laundry and COSHH store also situated on this floor. There is parking to the front of the building, and a private walled garden at the back. This has ramped access for wheelchair users, raised flower beds, patio, garden furniture and barbeque. The Manager said that she is seeking to improve the access to the garden for people using wheelchairs by reducing the slope on the path, and installing hard standing around the rotary washing line. We noticed that the walls in the main lounge are in need of repainting, and the carpet on the stairway and first floor landing is coming up to needing replacement. However, it is clear that redecoration, repair and maintenance around the home is carried out regularly, and the Manager told us that these matters have already been raised for attention. We saw that the home was clean and fresh when we visited, and that good standards of hygiene were maintained throughout. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know they will get the support they need from a generally well qualified and trained staff team. They can be confident that action has been taken to make sure that staff employed at the home are fit for their jobs. Arrangements must be made to ensure that staff get all the support they need to do their jobs well. Evidence: We looked at staff records to find out if people had been recruited properly. At the time of the last inspection it was noted that some information about this was incomplete. The files we looked at all had completed application forms. We saw that where there were gaps in employment histories, that this had been highlighted, and there was written evidence that this had been explored appropriately. All of the files we saw contained two written references and evidence that checks had been carried out with the Criminal Records Bureau (CRB). Files also contained written job descriptions and declarations of physical fitness. These things show that the service takes positive action to make sure that people employed to work at the home are fit for the job. In the Annual Quality Assurance Assessment (AQAA)the Manager told us that 56 of the current staff team hold qualifications at NVQ level 2 or above. She told us that others are currently working towards this. She provided a copy of the teams training Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: and development plan. This shows that statutory training is generally complete, or that training is booked or being arranged to address any shortfalls. Seven out of eight staff responding to surveys told us that they received regular training that is relevant to their role (the other person left the answer blank). Staff we spoke to told us that they have regular opportunities for learning. Staff rosters show that there are generally four or five staff on duty per shift. We saw that there were sufficient staff on duty to meet peoples assessed needs. At night there are two staff on duty, one awake, one on sleep-in. People using the service told us that they get on well with the staff that support them.. One person said I feel at home here, staff will help me in any way they can. Another said Staff are great. We looked at the minutes of staff group meetings and saw that these generally take place on a regular basis as required. However, available records of formal supervision of staff show that this is not currently up to the required standard ( six meetings in any twelve-month period, pro-rata for part-time staff). The Manager acknowledged this, but was able to show that she has taken action designed to address this shortfall. We saw the schedule of supervision appointments that had already been posted on the office notice board. It has to be acknowledged that staff told us that they feel generally well supported and that they are able to deal with most issues on a day to day basis. It was suggested that consideration be given to delegating some responsibility to senior staff. This could provide them with additional opportunities for learning and development. Some staff told us that they frequently take up matters with the senior staff as a first port of call, as things stand. It is important that this matter be addressed appropriately, to ensure that staff get all the support they need to do their jobs well. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well run for the benefit of people who use the service. Peoples views are sought and taken into account, to develop the service in their interests. Positive action is taken to ensure that people living and working at the home can stay safe. Evidence: The homes Manager is suitably experienced for her post and well qualified. She holds the Registered Managers Award (RMA) and NVQ level 4. She also has a BA (honours) degree in Special Needs and Inclusion. She continues to update her knowledge through further training and told us that she is studying for a diploma in cognitive rehabilitation. She has also recently attended a seminar in working with Acquired Brain Injuries and aggressive behaviour. She demonstrated a good understanding of the specialised nature of Acquired Brain Injury, and the diverse effects on the support needs of the people in the services care. As mentioned elsewhere in this report, the Manager says that she seeks to operate an open door policy with regard to the way in which the home is run. Both residents and staff told us that she is approachable, and that her style of management is open and inclusive. We witnessed this directly during our visits to the home. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: The Manager told us that she enjoys good support from the organisations Operational Manager, to whom she is directly accountable. We saw that reports required under Regulation 26 (Care Homes Regulations 2001) have been completed regularly. We saw that the service makes clear efforts to consult directly with the people that use it. We have already referred to the regular meetings individuals have with their key workers, and house meetings to discuss matters of common interest. We also saw a copy of the services annual quality assurance report and development plan that arises from this. We saw that the Operational Manager took an active part in this exercise, so that people using the service were able to speak with her directly. The Manager sent us a completed Annual Quality Assurance Assessment before we visited the home. This was clear and gave us all the information we asked for, and was returned within the time requested. The manager also told us that the organisation currently hold the Investors in People Award. Comments we received about the service included: The home is nice and clean, the food is good, and I can do things when I want Responding to a question what does the service do well one person told us Everything. Another person told us that the things he/she liked about the home were the nice staff, always kind and friendly and good choice of food. An independent professional, who took part in the homes annual service review wrote I have always been made to feel welcome at Cedar Road, staff are always available to discuss...and ensure that any guidelines are put into place. Service users appear settled and well cared for. The staff do a good job under sometimes difficult circumstances. One persons relative wrote I think the service offered at Cedar road is excellent. We looked at records relating to health and safety in the home, to see how these things are managed. There is a record of a monthly audit of health and safety, completed as part of the homes ongoing quality assurance and monitoring. We saw that regular checks had been made on the fire alarm and emergency lighting systems, and fire-fighting equipment. Checks on the temperatures of water, the fridge and freezer, and the medication store are carried out and recorded appropriately. We saw that the assisted bath and hoist equipment had been serviced. Also that the COSHH Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: store (where cleaning materials and other potentially hazardous substances are kept) was locked and kept secure. We saw that packages of food stored in the fridge had been labelled with the dates of opening, in keeping with accepted good practice. These things show that the service takes positive action to help make sure that people are supported to stay safe. We saw that records are well maintained and kept up to date, and that they are stored securely to protect peoples confidentiality. Policies and procedures are in place as required, and these are reviewed regularly. Systems to ensure that essential tasks are completed when they should be are in place, or are being developed as needed. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 5 6 Ensure that written contracts are completed in full, so that all parties are clear about their responsibilities. Develop the use of person centred approaches and review the evaluation of peoples goals. This will help to ensure that people get the support they need to achieve the things they say are important to them. Develop health action planning to make it more systematic, with clearly measurable goals. This will help to further develop positive action to actively promote peoples health and wellbeing. Make arrangements for staff to receive regular formal supervision, to ensure that they get all the support they need to do their jobs well. 3 19 4 36 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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