Care Home: Cedar Avenue

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What the care home does well To make sure people`s care needs are met these are assessed and care plans written telling staff how people like to be supported. These are very detailed and include people`s likes, dislikes, preferences and choices. People`s plans are looked at regularly and changed to reflect any progress or changes. The records show people are supported to use ordinary community based leisure services including visiting local shops, and restaurants. Records also show people are assisted to attend local places of worship. People are supported to use ordinary community based healthcare services, however, some also receive support from the Community Learning Disability Team and hospital based Consultants. People living in the home have opportunities for personal development and attend various day time activities some of which are provided by the local authority. People`s own space is personalised and they have their rooms as they want. People`s needs are met by trained staff as records show over 50% have a National Vocational Qualification at Level 2 or above. People are protected by the way staff are recruited and selected as appropriate references and police checks are taken up before they are employed. What has improved since the last inspection? The way medicines are dealt with has been looked at and made safer. This includes all staff giving medicines now having training to do this properly and safely. The medicine system is checked regularly by the Pharmacist. People now have a brief summary of their care and support needs in their case files to show staff quickly and simply how they should be cared for.To make sure people remain safe the home`s Safeguarding Policies and Procedures have been looked at and now include the Local Authority Safeguarding Protocol. Records also show staff working in the home have now had Safeguarding training. Again to make sure people remain safe all staff has fire prevention training and attend fire drills. To make sure people are cared for and supported by people who know them more staff have been employed and there is now only one vacancy, which means agency workers do not have to be used as much. There is now a Service Development Plan showing what improvements need to be made as a result of asking people living in the home and their relatives about the quality of the services provided. To make sure the home is run in people`s best interests there have been improvements to the way the home is managed and the Registered Manager now has The Registered Managers Award. What the care home could do better: A tour of the premises found that people live in a well decorated and well maintained home that is comfortable and safe. However, the bathrooms and toilets have open pipe-work and some seals remain broken. The bathrooms and toilets are not decorated to the same standard of the rest of the home. It registered manager says the medicine administration system has not been checked by a Pharmacist in 2008. Although there have been improvements to the medicine administration system this needs to be checked regularly. Although there have been improvements to the Safeguarding Policies and Procedures to make sure people remain safe the Safeguarding practices should be monitored closely by the registered manager to make sure any incidents are reported properly. CARE HOME ADULTS 18-65 Cedar Avenue 5 Cedar Avenue Edgerton Huddersfield West Yorkshire HD1 5QH Lead Inspector Tony Railton Key Unannounced Inspection 18th December 2008 11:00 Cedar Avenue DS0000026335.V373545.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 Cedar Avenue DS0000026335.V373545.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. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Avenue Address 5 Cedar Avenue Edgerton Huddersfield West Yorkshire HD1 5QH 01484 530300 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) www.unitedresponse.org.uk United Response Ms Leanne Victoria Joseph Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Learning Disability - Code LD, maximum number of places 4 2. Physical Disability - Code PD, maximum number of places 4 The maximum number of service users who can be accommodated is: 4 20th May 2008 Date of last inspection Brief Description of the Service: Cedar Avenue is registered to provide personal care and accommodation for up to four people who have a learning disability and or physical disability. The registered provider is United Response. The purpose-built bungalow style accommodation is located in a residential setting close to Huddersfield town centre and all local amenities. There is car parking available to the front of the home and a garden to the rear. The support provided is based on living an ordinary lifestyle and people are encouraged and supported to use ordinary community based leisure and healthcare services. On the 7th January 2009 the registered manager confirmed the fees for living in the home are £1,744.80. Information about the home in the form of a Service User’s Guide and Statement of Purpose, together with the most recent Commission for Social Care Inspection report are available from the home. Inspection reports are also available at www.csci.org.uk Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Following this visit the service has been given a Two Star rating, which means people living in the home experience good quality outcomes. This visit started at 11:00 and ended at 14:00. During the visit there was the opportunity to speak to one person who lives in the home, their support worker and the Area Manager. A tour of the home was undertaken and some documents looked at, including peoples assessments, care plans, daily and medical records, and reviews. Other documents seen included the staff rota, some training records, the communication book, and dairy. Some people’s medicines were also checked. The Safeguarding policy and procedure were looked at, as were the health and safety maintenance records. Other information considered included the previous inspection visit report, the Improvement Plan sent to us by the service providers. A telephone conversation with the registered manager after the visit provided further information and a Service Development Plan was also provided by e-mail. This was a positive visit where a number of improvements were noted. The inspector would like to take the opportunity to thank those living in the home and their carers for their hospitality and cooperation throughout the visit. What the service does well: To make sure people’s care needs are met these are assessed and care plans written telling staff how people like to be supported. These are very detailed and include people’s likes, dislikes, preferences and choices. People’s plans are looked at regularly and changed to reflect any progress or changes. The records show people are supported to use ordinary community based leisure services including visiting local shops, and restaurants. Records also show people are assisted to attend local places of worship. People are supported to use ordinary community based healthcare services, however, some also receive support from the Community Learning Disability Team and hospital based Consultants. People living in the home have opportunities for personal development and attend various day time activities some of which are provided by the local authority. People’s own space is personalised and they have their rooms as they want. People’s needs are met by trained staff as records show over 50 have a National Vocational Qualification at Level 2 or above. People are protected by the way staff are recruited and selected as appropriate references and police checks are taken up before they are employed. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People living in the home experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit to the home. To make sure people’s care needs are met there are comprehensive assessments that include people’s likes, dislikes, choices and preferences. EVIDENCE: The assessments of everyone living in the home are very detailed and provide comprehensive information about how they need to be cared for and supported. To make sure people receive the care they need and require the assessments include how people communicate, behavioural assessments, cultural assessments, including religious beliefs and special dietary needs. The assessments are very detailed and include people’s choices, preferences, likes, dislikes and aspirations for the future. The good standard of people’s assessments and how they are maintained is to be commended. To make sure people’s support and changing care needs are reflected in their assessments these are looked at and agreed regularly by the people themselves, their relatives and others who may be involved in supporting them. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People living in the home experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit to the home. People have a say and influence what happens to them and they are supported to take risks as part of living an ordinary lifestyle. EVIDENCE: To make sure peoples care needs are met there is lots of information provided for staff, including, assessments, care plans, risk assessments, behavioural and communication details, and religious, cultural and dietary needs. To help staff there is now a brief summary provided for everyone in the home showing what is important to the people they are supporting. One Support Worker says they found these very helpful. The reviews show that the assessments and care plans are looked at regularly and changed to reflect people’s care and support needs. The daily records show that despite their communication difficulties, people influence what they do and what happens to them. The risk assessments show people have opportunities to do things for themselves and live as independent a lifestyle as possible. The Quality Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 10 Assurance Surveys in people’s case files show they have a say in the quality of care and support they receive. The minutes of the ‘multidisciplinary’ reviews show people and their relatives and other stakeholders are happy with the services provided and feel people’s care and support needs are met. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People living in the home experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit to the home. People have the opportunity for personal development and are supported to live as ordinary a lifestyle as possible. People are offered a varied and balance diet of their choosing. EVIDENCE: The assessments and care plans show people have the opportunity for personal development as they attend day service provided by the local authority. Records also show people are supported to be part of their local community with visits to the shops, city centre, and restaurants. One person attends a local Hydrotherapy pool and others are supported to attend local places of worship. The daily records and record of activities, menus and reviews show peoples individual Spiritual, Cultural and special dietary needs are also met. The support worker confirmed people have regular visits to the local Halal butchers. The reviews and daily records show people’s relatives are fully involved and have a say in how services are provided. The Service Development Plan shows people and their relatives influence how the home runs. The registered manager says people are supported to live as ordinary a lifestyle as possible and this is reflected in people’s care plans and programme of activities. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 12 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): People living in the home experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit to the home. Peoples healthcare needs are met by ordinary community based healthcare services, and they are protected by the way medicines are dealt with. EVIDENCE: People’s healthcare assessments are very comprehensive and records show most of these are met by ordinary community based healthcare services. However, records also show some people also have the support of the Community Learning Disability Team, and hospital based Consultants. To make sure people’s healthcare and emotional needs are fully met there are also Behavioural Assessments showing staff how they should support people. To aid communication there are also communication assessments and that includes information provided in the use of Makaton Signing. To make sure people remain safe the area manager and registered manager confirmed a review of the medication administration systems within the home. They also confirmed that all staff giving medication is now trained to do so safely. On the day of the visit two people’s medicines were checked and found to be correct. One support worker says they have been trained in how to give medicines safely. The registered manager said the medication system is checked by the local pharmacist but they have not been to do this in 2008. To make sure people remain protected by the way medicines are dealt with they need to be continually monitored by the registered manager. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 13 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): People living in the home experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit to the home. People have a say on the quality of the services provided and they are protected by the Safeguarding policies and practices. EVIDENCE: The service history shows that there have previously been problems in reporting Safeguarding issues to the local authority. To make sure people remain safe the improvement plan sent to the CSCI shows the Safeguarding policy and procedure has been improved and now includes the Local Authority Safeguarding Protocol. The registered manager confirmed this and also said to keep people safe all staff has now had Safeguarding training. The service history shows there have been no safeguarding issues relating to the home since the previous inspection visit. The service history also shows there have been no complaints received about the home or the service it provides. The complaints policy and procedure is accessible as everyone living in the home has a copy of an easy read complaints policy in their case notes. The minutes of the multidisciplinary reviews show people and their relatives and other stakeholders have the opportunity to comment on the services provided. The quality assurance surveys also show people and their relatives can comment on the quality of care provided. One support worker says they know the complaints policy as they went through this as part of their induction training. They also confirmed that they have recently had Safeguarding training. Although there have been improvements to the Safeguarding Policies and Procedures, the registered manager should monitor the Safeguarding practices to make sure any incidents are reported correctly. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 14 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): People living in the home experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit to the home. People live in a well decorated home that is comfortable and safe, however, the bathrooms are not maintained to the same standard as the rest of the home and could put people at risk. EVIDENCE: One person was observed relaxing in the lounge listening to music. They appeared to be comfortable and relaxed in a warm and homely setting. A tour of the home found it to be well decorated and well maintained with the exception of the bathrooms and toilets. It was noted the decoration of the bathrooms is not to the same standard of the rest of the home. In one bathroom there was exposed pipes and some of the floor seals were broken. This requirement is outstanding from the previous inspection. People’s bedrooms are personalised homely and comfortable. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 15 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): People living in the home experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit to the home. People’s needs are met by the numbers and skill mix of support workers available, and they are protected by the way staff are recruited and selected. EVIDENCE: The area manager said there are enough staff planned to be on duty to meet peoples care and support needs. The staffing rota confirmed this. They also said that new staff has been recruited and there is now only one staff vacancy. The registered manager confirmed this. They went on to say that the use of agency workers in the home is now minimal. The registered manager confirmed that over 50 of support workers have a National Vocational Qualification Level 2 or above. To keep people safe the registered manager confirmed that all staff giving medicines has been trained to do so safely. They also confirmed that all staff has had Safeguarding training. To protect people living in the home the registered manager and area manager confirmed references, police and POVA (Protection of Vulnerable Adult List) checks are taken up before staff are employed. One Support worker confirmed they had received induction training and other mandatory training, and there are regular staff meetings. The staff training records also show to make sure peoples support needs are met staff also have Epilepsy, Communication and Managing Challenging behaviour and First Aid training. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 16 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): People living in the home experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit to the home. People live in a home that is run in their best interests and where they and their family have a say in how care is provided. People’s health, safety and welfare is promoted and protected. EVIDENCE: The registered manager says they have completed the Registered Managers Award. The Area Manager confirmed this. The care management systems in the home have improved with a review of the way medicines are dealt with, including safe administration of medicine training for all staff. To keep people safe there has also been a review of the Safeguarding Policy and Procedure and practices, which now includes the Local Authority Safeguarding Protocol. This also included all staff having Safeguarding training. The Registered and Area Managers and support worker confirmed this. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 17 People living in the home now have a Brief Summary giving staff an outline of the important things in their lives. People’s assessments and care plans are good and are looked at regularly to make sure people’s progress and changing needs are recorded and reflected. To make sure people’s care and support needs are met there has been a review of the staffing of the home. The Area Manager and Registered Manager confirmed the home now has only one staff vacancy. The quality assurance surveys in people’s records show they and their relatives have the opportunity to comment on the running of the home and the quality of the services provided. The Service and Development Plan provided shows what people say is listened to and acted upon and influences the way the home runs. People’s health and safety are promoted and protected as the maintenance checks including fire alarm tests show these are carried out regularly. The records also show that staff has now undertaken a fire drill and there are plans for more in 2009. This visit confirmed that all of the work shown in the improvement plan sent earlier in 2008 has now been completed and people living in the home are safer. Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 18 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 3 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 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 YA30 Regulation 13(3) Requirement Appropriate repairs and redecoration should be made to bathroom and laundry areas to ensure infection can be controlled. This requirement has been brought forward. Original timescale of 31/05/07 and 30/09/08. Timescale for action 30/03/09 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 YA20 Good Practice Recommendations To make sure people living in the home remain safe the medication administration system should be monitored closely by the registered manager. The medicines should also be checked regularly by the Pharmacists and a record kept. To make sure people living in the home remain safe the implementation of the improved Safeguarding Policies and practices should be monitored closely to make sure any incidents are reported correctly. DS0000026335.V373545.R01.S.doc Version 5.2 Page 20 2 YA23 Cedar Avenue Cedar Avenue DS0000026335.V373545.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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