Care Home: Cedar Gardens

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What the care home does well People live in a homely and friendly house which is in a good place on a main bus route near shops, pubs and facilities. People have good support with their personal care. Staff also help people to have routine health checks and manage their medicines safely for them. The home has a small, stable and caring staff team. This also means that people and staff know each other well and staff know what people like and dislike. What has improved since the last inspection? Recommendations from the last inspection were for the home to offer a more personalised and up to date service, where routines are not affected by staffing levels. There have not been any improvements in this area. What the care home could do better: The service should offer a more personalised service that meets current good practice guidance. This should include staff and the manager becoming more up to date with current good practice guidance, and the manager reviewing and planning for improved practice at the home. Staff and the manager should be offering innovative ways of communicating, helping people to make decisions, get involved in their health care, build on their personal interests, hobbies, and independent living skills, and personalise their house to reflect their own tastes. Improvements should be made so that records of the views and decisions made by people living at the home are clear. Recording of planning for health needs and personal interests should be improved so that goals are clear and everyone knows when a goal has been reached. Training on safeguarding and mandatory health and safety topics should be kept up to date, so people living at the home know staff will act in their best interests to keep them safe from harm or neglect. Key inspection report Care homes for adults (18-65 years) Name: Address: Cedar Gardens 122a Bromyard Road St John`s Worcester Worcestershire WR2 5DJ     The quality rating for this care home is:   one star adequate 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: Emily White     Date: 2 1 0 1 2 0 1 0 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 31 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 31 Information about the care home Name of care home: Address: Cedar Gardens 122a Bromyard Road St John`s Worcester Worcestershire WR2 5DJ 01905421358 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Phoenixhouse122abtconnect.com Mr Nigel Hooper care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 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 (LD) 6 Date of last inspection Brief description of the care home Cedar Gardens was first set up as a care home in 1992. Nigel Hooper is the sole registered provider and Carole Green is the registered care manager. Mr Hooper also operates another home next door called Phoenix House and many aspects of the two services are managed jointly. This home is registered to provide accommodation with personal care for six adults. People living there must require care due to learning disabilities, which are mild to moderate. The main aims of the service are stated as being to provide a permanent and homely environment and to encourage service users involvement in household tasks. Cedar Gardens is a large, detached house located on the west side of Worcester city. There are shops, pubs, churches and other Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 6 3 0 0 1 2 0 0 9 Brief description of the care home facilities nearby and the home is on a main bus route. The accommodation includes a sitting room, kitchen with dining area, laundry, bathroom, toilet and one single bedroom on the ground floor. The second floor has three single and one shared bedrooms, a staff sleeping in room and bathroom. Two rooms have en-suite facilities. Information about the service is provided in a statement of purpose and service guide. The guide can be obtained from the home and is available in a format that should be easier for people with learning disabilities to understand. The weekly charge for the service is as agreed between the provider and individuals funding authority. Each persons fee and any additional costs (such as transport, hairdressing, chiropody, phone calls, newspapers, personal items, clothing, social activities, college fees and holiday accommodation) should have been agreed by all parties and included in their written terms and conditions of residence and or contract. Care Homes for Adults (18-65 years) Page 5 of 31 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: one star adequate 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: We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. What other people have told us about the service. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? 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 7 of 31 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 8 of 31 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. The needs of people who are interested in the home would be assessed by the home to ensure they know their wishes and the support they require. This is because the assessment and admission processes include the people involved, their family and representatives. Evidence: No new people have moved into Cedar Gardens since 2003. Following the last key inspection three people completed surveys saying they were asked about moving in and had been given information about the home. Two people have previously confirmed they had visited the home to look around and for an overnight stay. One persons parents had visited with them. The AQAA tells us that: The majority of the residents have been in the home for over 10 years, some even longer; also most of the staff have been working at the home for over 10 years. This has been able to give a family orientated unit with a consistent family atmosphere. Care Homes for Adults (18-65 years) Page 9 of 31 Evidence: At the time of this inspection there was room for one person to move to Cedar Gardens. Two bedrooms have been recently renovated with en suite bathrooms. At the time of the inspection we saw from peoples care files that they were in the process of being re assessed by the local authority. The home also carries out its own annual review with staff from the day centre, the individual and their parents and advocates are invited. These reassessments and reviews ensure that peoples needs are being met by the home. The home has up to date documentation such as a statement of purpose and guide to the service to inform people who are thinking about moving there. Care Homes for Adults (18-65 years) Page 10 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a plan outlining their care needs. They could be better supported to achieve their personal goals through a more personalised way of planning for their support. People should be supported to make more choices, decisions and take risks in their daily lives. Evidence: The last key inspection report identified that the home should continue to implement a person centred approach. This means people should be more involved in planning and reviewing their support plans with more focus on achieving their personal goals. The report also identified that limits on staff time means that individual decisions and choices cannot always be supported. During our visit the manager confirmed that staff levels have not increased and this makes planning for individual time very difficult. Staff also tell us that there is little opportunity for one to one time. The AQAA tells us that: We could only improve on the service if we had more funding. Where there could be more changes and activities Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: on offer, however this would not be normal living, as people do not have all their choices met all day, every day seven days a week. During our visit we met people living at the home, spoke to staff and looked at care and support records to see how the home supports individual needs and choices. Everyone living at the home has a Person Centred Plan. These follow a standard format for everyone and are not fully completed. For all the areas identified by the plan, there is a section for Action Planning, which would help staff at the home to work on things that matter to people. None of the action plans we saw had been completed. For example, one persons plan states that client has limited reading/ writing skills, but does not elaborate on what can be achieved or how to assist with these skills. This persons Health Action Plan states they can read and write a little. During our visit we observed that this person had been supported to buy a magazine and was looking at it, but staff were not available to support as they were involved in cooking dinner. Peoples person centred plans have information such as Things I like, Things I dont like, Good things about me, a communication profile, hopes and dreams for the future, health and keeping safe, and a life story. We saw evidence from written records and speaking to staff and people living at the home that people are doing the things shown in the plans, such as going to day centres, going to the pub and watching TV soaps. The sections in the plans that deal with communication, hopes and dreams, health, and life story contain brief information. These sections have not been dated and did not show how frequently they had been reviewed or updated. The AQAA tells us that no one living at the home has specialist communication needs. However during our visit we met one person who has limited verbal communication skills and another person who has no verbal communication skills. Records in the home tell us that this person communicates by using gestures and signing. This person is also able to use Makaton at day services but doesnt at home. This persons Person Centred Plan has some limited information such as if i like or want something I will point; if i dont like something i will shake my head or hit out; I can communicate with you by using signs or body gestures. There is no action plan in place for how staff can help or improve communication with this person. Staff say they have done a total communication course, and can do some basic signs and use objects of reference. We saw that one person has a my life scrapbook which has not been started. We saw that there was a bundle of old photos kept loosely inside. We met this person and saw that they were very keen to show us photos in their room, and in the scrapbook. As part of person centred working it is important that people have opportunities to Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: talk about their lives through mediums such as photographs. It is also important that this information is kept up to date. Th last key inspection report identified that the home should ensure the necessary risk assessments are included as part of the care planning process. This should promote peoples independence and ensure that management strategies are in place that have been agreed with people and relevant specialists. We saw that people have risk assessments in place which focus on health and safety issues during planned activities, for example using the hot water during washing up. Care Homes for Adults (18-65 years) Page 13 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People take part in some activities in the local community, are able to keep in touch with their families and have a varied diet. A more personalised approach would mean that staff could be more responsive to peoples diverse needs, provide individual support and encourage independence in daily life skills. Evidence: The last key inspection report identified that the home should seek and provide support for people to take part in activities that meet their personal interests and give them more opportunities for meaningful activities and to participate in the community. Since the last key inspection staff tell us that there have been some improvement in daily life and activities, so that people are able to go to the local shops and do some shopping with a staff member. However there has been no increase in staffing since the last inspection which means that on days when people do not attend a day service Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: they still spend a large amount of their time next door at Phoenix House. For example when we arrived one person was watching television at Phoenix House as there were no staff at Cedar Gardens. The levels of staffing at present do not support people to have choices with regard to how they spend their days outside of day services. The AQAA tells us that: Again if we had more funding it would allow us to have more staff so that we could have more activities on offer at a one-one basis instead of group activities. How ever most of the residents enjoy the group activities We met people living at the home, spoke to staff and looked at records such as care plans and communications books which staff use to record daily activities. People living at the home each attend day centres three times a week, which they say they enjoy. People also have visits to town and the pub, go out to buy a paper, shopping, clubs in the evening, and weekend trips out if staffing permits. There is not always a member of staff who can drive, and records show that trips out at the weekend do not happen regularly. One person living at the home goes into town independently. He uses a bus pass and manages his own money. Staff support people to maintain links with their family and make their relatives welcome in the home. One resident has an advocate they go out with once a month, and the home is looking into other support to increase this persons social contacts. Records show that people have regular visits with families and friends outside the home. Minutes from staff meetings show that activities are regularly discussed and staff are aware they should be looking at improving this area. On the day of our visit we met people when they came home from their day centre, who spoke about what they had been doing and said they enjoyed it. One person said they had been gardening at the day centre which he very much enjoyed. When asked if he did gardening at home he said no. During the early evening people made their sandwiches for the next day, and watched TV or went to their bedrooms. Some people got ready to go to an evening club where there is a disco. Records show that people living at the home have a set routine which does not vary from week to week. People clean their rooms, wash up, make hot drinks and sandwiches. Records show that outside of the planned day services there is little opportunity for people to do different things on an individual basis or take part in unplanned activities. We saw that there had been a recent residents meeting. The minutes from this meeting showed that people had discussed discussed holidays. People usually go in big group with people from Phoenix House next door, but two people expressed that they would like to go away separately. People were also asked about their choices for Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: this year. People mentioned swimming, going out for meals, the cinema, pub and ten pin bowling. People were also asked if they would like anything changed - people said they would like more staff so they could do more. People tell us they like the food at the home. Menus are discussed with people. Staff know what each person likes and dislikes, which is reflected in menus, and people can choose an alternative if they wish. Menus include mostly traditional meals and staff say they try to promote healthy eating and use such as fresh vegetables. We observed that meal times are relaxed and friendly with everyone enjoying their food. The last key inspection report identified that two people had put on weight but there was little in the way of promotion of healthy eating and exercise. We note that little has been done to work on this area with people who are at risk of putting on weight. Care Homes for Adults (18-65 years) Page 16 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the personal support they need and their medicines are managed safely in the home by staff on their behalf. Where people have specific health needs plans should be put into place to monitor these. People would benefit from a more personalised way of approaching their health care. Evidence: People living at the home have care and support plans which outlines what support they need and their daily routine. People have a personal care assessment which has basic information but does state what what the person is able to do for themselves. Peoples daily living skills assessment also describes whether a person is able to manage tasks independently. However we also note that there is little further information for staff to help improve skills in maintaining health and personal support. Care plans have a brief statement which do not elaborate, give a history or plans for development by staff. For example, in one persons care plan the entry under Emotional Needs reads: needs reassurance she is accepted; under Behavioural Problems: can be verbally and physically aggressive towards residents and staff if distressed; under Communication Skills: has limited speech and can be quite Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: repetitive. Staff would benefit from further action plans or guidance for how to respond or support people under these circumstances. The last inspection report identified that people have Health Action Plans which include brief details of their condition and medical history but they are not being used in a person centred way. This would help people manage their own health care and focus on prevention and a healthy lifestyle. The AQAA tells us that: We are now working with a community nurse to improve the health and wellbeing for our residents. We plan to improve by arranging for all our residents to have annual heath checks with their own G.P. with the community nurse liaising with this as well. We looked at peoples Health Action Plans which are written in a format using words and pictures. The health action plans show that people are having regular reviews with relevant health specialists, as well as routine annual checks as necessary. The health action plans include basic information about communication, and mental health needs. The AQAA tells us that the home does not carry out nutritional screening for people who live at the home. One persons care plan states I need to watch my weight. No action plan is provided for this. This persons Health Action Plan states health is good, only thing X has to watch is their weight which has increased due to medications. Again there is no plan for this although this persons medication has been reduced following advice from the doctor. Staff meeting records show that staff are aware of two people, one who has had advice from the doctor to lose weight, and another whose weight gain was mentioned ten months earlier. We spoke to staff who are aware of these peoples needs, and were able to discuss goals such as smaller meals, walks, using a step exerciser at home and dancing at the disco. However it would be good practice for staff to generate an action plan to address specific health concerns which the person is involved with and can contribute to. Each person has a medication profile listing their current medication with an assessment of their ability to self administer and a consent form with their agreement for staff to manage and administer their medication. The home has suitably secure storage and administration records were seen to be maintained appropriately. Records show that the home has responded well to concerns about medications when they arise. Care Homes for Adults (18-65 years) Page 18 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. When people have concerns they feel able to raise them with staff. The home should show more clearly how peoples views are being listened to and acted on. People could be better protected if staff had more understanding of safeguarding procedures. Evidence: Since the last key inspection we have not received any complaints or concerns about the home. The AQAA tells us that the home has not received any complaints. The last key inspection report identified that records should be kept of the views, issues and any concerns raised by people living at the home. This would to demonstrate how staff encourage discussion and listen and act on their views and concerns. The AQAA tells us that the home has no plans for improvement in this area. The AQAA says that: We give every one the opportunity to speak out if there are any concerns or complaints. We have a good rapport between the residents and staff. The families are aware of any procedure for any matters that may arise. They know that they are able to communicate freely with all staff and are able to express their concerns. Regular training for staff is updated and are discussed at regular staff meetings. During our visit the manager told us that a record of minor views and concerns is not kept, but there is a residents meeting where views are recorded. We saw the minutes Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: from a meeting held in January 2010. There were no minutes from previous residents meetings so it was not clear how regularly peoples views are asked for by the home. The manager says that no complaints have been received, but peoples families get in touch if they need to. The manager has received one questionnaire back from several sent out to ask families about the quality of the service. The last inspection report identified that staff should receive specific instruction on local multi agency safeguarding procedures for vulnerable adults and this should be regularly reinforced. This is to ensure that all staff are clear about their responsibility and know where to report any suspicion or incidence of abuse or neglect of residents outside the service. Staff and the manager confirm that they have not had safeguarding training provided by the local authority in 2009. Staff are not clear on the local processes but are able to talk about different types of abuse and what they would do if they were aware of a concern affecting a person living at the home. Care Homes for Adults (18-65 years) Page 20 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Cedar Gardens have a home that is comfortable and kept safe and clean. Whilst the environment is homely people would benefit from their accommodation being updated and improved in ways they have chosen and are involved in. Evidence: The last key inspection report identified that the home should have a maintenance plan with timescales so so the accommodation continually improves for the benefit of people living there. The AQAA tells us that: We have had the hallway repainted, a new cooker and hob, new kitchen doors on the units and two upstairs bedrooms have had on suites put in, repainted & new carpets. The garden is having a make over so there is more space outside next year. We plan for the other rooms to be repainted and lounge furniture to be replaced. If we had more funding the residents could have all their rooms revamped. We discussed the improvements with the manager. Although a maintenance plan is not kept the upgrades to the environment are ongoing. We observed that the house is clean and homely but old fashioned in decoration. Peoples rooms are personalised but Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: there are few photos of recent activities and events. There are no photos around the communal areas of the house. The communal areas of the house could be improved if people who live their were able to personalise the areas with their choice of decor and other personal items. The areas seen during our visit were clean and fresh and staff are clear about their responsibility for keeping the home environment clean and hygienic. Care Homes for Adults (18-65 years) Page 22 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive safe support from a stable staff team whose suitability has been checked. Their individual needs and goals could be met better with more staff on duty and from staff who are up to date with current good practice and personalisation. Evidence: The last key inspection report identified that the home should ensure that there are enough staff on duty to provide some individualised support for residents. This would mean that they would have more opportunities to pursue activities they choose, go out in the community and develop their daily living and social skills. The AQAA tells us that: If we had extra funding we could employ extra staff to support individuals to reach their goals. We have staff working in the home that have been here for over 10 years, which has given the residents continuity and trust. There are five staff employed in the home including the manager. This has not increased since the last key inspection. The staff rota shows that sometimes there is only one staff member at the weekend, and the maximum number of staff at any one time is two. While the people who live at Cedar Gardens are independent in many aspects of their lives, this level of staffing does not enable them to make choices about how they spend their time. Staff report that it is difficult to offer one to one Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: support but at home people can do baking or arts and crafts which means that staff spend some time with each person. We met staff during our visit and observed that they have a good rapport with people who live at the home. Staff show a good understanding of those they support. Staff say they have supervision and regular meetings. They say that as it is such a small team they pass information and catch up regularly about the needs of people they support. Staff tell us the home has a relaxed atmosphere which we saw. The staff say people let them know what they want or if they are unhappy. There have not been any new staff recently employed at the home. Staff say that they had necessary checks taken up and the manager reaffirmed that new staff would not be allowed to start working at the home without giving a full employment history and the home receiving satisfactory police checks and written references. The last key inspection report identified that staff should receive training, and or use their knowledge from training , to help them understand and meet peoples needs better. This is in relation to their specific conditions (such as autism), communication and understanding and dealing with verbal aggression and behaviours. The AQAA tells us that all five staff have NVQ level 2 or above. The AQAA does not mention training for staff over the previous year or plans for the coming year. Staff training records cover mandatory health and safety training and medication, epilepsy and autism. There were no records kept for safeguarding training. Some medications and moving and handling training had last been done in 2006. Care Homes for Adults (18-65 years) Page 24 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not made improvements to bring the home in line with current good practice and does not have plans for personalisation and modernisation in place. People do not benefit from a personalised service. The environment is safe because health and safety practices are carried out. Evidence: The last key inspection report identified that the manager is aware of the need to keep up to date with good practice for people who have learning disabilities but lack of funding is cited as being the main barrier to developing a more person centred service. The report identified that there is a friendly atmosphere in the home and the management and staff are caring, but there needed to be more focus on promoting independent lifestyles and not on group life and activities with a task based approach. This resulted in staff spending most of their time cooking, cleaning and on peoples personal care routines. We observed that the manager, staff and people living at the home have all lived and worked together for many years. While there is a stable, secure and homely Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: environment for people living at the home, there is very little in the way of innovative practice and developing new skills or interests. There has been very little development in the area of person centred working since the last key inspection. In the AQAA the manager does not identify many areas that have improved or where there are plans for improvement. The manager tells us there are plans for some staff recruitment which would in turn free the manager to develop her skills and keep up to date with current good practice. The last inspection report also identified that the home should continually review and make plans to ensure that the quality of the service improves and develops. This should also take into account the views of people living at the home and other stakeholders so that the improvements are what they want. The AQAA tells us that the home gains the views of people living at the home in the following ways: People have annual reviews either in house or at the day centre they attend, residents meetings, voicing their opinions on issues which are important to them and the home. For those residents that are unable to voice their opinions we encourage families, friends and advocates to speak on their behalf. Their concerns can be of a variety of issues such as social, medical, menus, holidays, Christmas and day to day living. The AQAA does not list changes that have been made or planned changes as a result of listening to people living at the home. We saw a copy of the most recent residents meeting which was mentioned earlier in this report. Evidence from this one meeting shows that actions had been taken, for example one person had been supported to purchase a new television. It would be good practice for the home to keep records of all of these meetings so staff can review whether suggested changes are being made in the interests of people who live at the home. Training has been completed by most staff in the mandatory health and safety topics, although we note that some date back to 2006. Necessary health and safety procedures and risk assessments are in place and the AQAA confirms that the fire safety, gas and electrical systems and or equipment are serviced or tested regularly. There were no environmental safety hazards noted during our visit. Care Homes for Adults (18-65 years) Page 26 of 31 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 27 of 31 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 1 As part of personalising the service, the home should develop innovative ways of helping prospective individuals to choose a home that will meet their needs and preferences. This might include an information pack which includes photographs, the homes newsletter and an introductory letter written by people who live at the home. Staff who are key workers should actively contribute to person centred planning and ensure that care and support plans are live documents which people using the service are involved in. The home should improve how it personalised care and support planning, providing more detail which supports peoples individual needs and choices and regularly updating these. The way that staff support the individual decisions made by people using the service should be clearly documented and supported. More opportunity for people to affect change in their lives should be provided. Improvements should be made to the way staff understand and approach communication by people using the service. Page 28 of 31 2 6 3 6 4 7 5 7 Care Homes for Adults (18-65 years) 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 The home should consider using innovative and personalised communication methods. 6 12 People living at the home should be encouraged to develop their skills, including social, emotional, communication, and independent living skills. This may include building on the interests that people have developed through day services. The home should review the opportunities for people to become involved in the wider community outside of day services. More flexible routines and increased staffing would support this. The home should improve the way it monitors peoples independent living skills. More opportunities should be available for people to be involved in food shopping, the preparation of meals and daily tasks around the home. People using the service would benefit from more detailed and personalised information about their physical and mental health and personal care needs. This would help staff to use more innovative ways to respond to peoples needs. Where people have specific health needs identified, such as weight loss or gain, staff should work with that person to document how this is being addressed. This would help people to take control of their health care and ensure they lead the healthiest lifestyles they are able to. Records should be kept of the views, issues and any concerns raised by people using the service and others. This would to demonstrate how and that staff encourage discussion and listen and act on their views and concerns. Staff should receive specific instruction on local multiagency safeguarding procedures for vulnerable adults and this should be regularly reinforced. This is to ensure that all staff are clear about their responsibilty and know where to report any suspicion or incidence of abuse or neglect of residents outside the service. The home would benefit from being updated and the communal areas made more personal, to reflect the tastes and personalities of the people who live there. The home should ensure that there are enough staff on duty to provide individualised support for people using the service. People should have more opportunities to pursue Page 29 of 31 7 13 8 16 9 18 10 19 11 22 12 23 13 24 14 32 Care Homes for Adults (18-65 years) 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 activities they choose, go out in the community and develop their daily living and social skills. 15 35 Staff should have access to training which brings them up to date with current good practice in offering personalised care and support. The manager should develop her knowledge of person centred working and communicate this to staff so that the home can begin to offer support in more innovative ways. This will ensure that people receive support that is up to date and meets good practice guidance. It would be good practice for the home to keep records of all residents meetings and other ways peoples opinions are obtained. Staff should regularly review whether suggested changes are being made in the interests of people who live at the home. The manager should be able to clearly identify what improvements have been made to the home and what improvements are planned for the coming year. This will ensure that people receive support that is up to date and meets good practice guidance. The manager should ensure that all mandatory health and safety training for staff is updated. This will ensure people are kept safe using the most up to date practices. 16 37 17 39 18 39 19 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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