Care Home: Cedar Grange Care Home

What the care home does well Staff would make sure that they collect detailed information from all professionals,the person and relatives before anyone is admitted to make sure their needs can be met. Care plans show what support people need to improve and maintain their health. Staff make sure people receive their medication safely. Meals are wholesome and choices are available. Visitors are welcomed and staff support people to maintain links with family and friends. Staff are sensitive and respectful to people when talking and supporting them. Staff have had Safeguarding Training and they would be confident in reporting any suspicion of abuse. The home is generally a clean and pleasant place to live. Appropriate checks are carried out before anyone is employed at the home so that people remain safe. Staff are receiving further training so that they can care for people`s changing needs. Individual records and personal monies are kept safe. Health and Safety systems are in place to make sure people are kept safe. What has improved since the last inspection? This is the first inspection with the new provider. What the care home could do better: The Provider should recruit a manager who is it become registered with the Commission. Continue to review the care plans so that they reflect a "person centred" approach to care delivery. Continue to improve the environment so that is remains a safe place to live. Make sure there are enough staff on duty so that people are able to access the local community and make sure they can choose from a wide range of social and leisure activities. Continue to review the service provided by completing quality assurance systems. Key inspection report Care homes for adults (18-65 years) Name: Address: Cedar Grange Care Home 2 Cedar Grange Ashbrooke Tyne and Wear SR2 7TR     The quality rating for this care home is:   two star good 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: Irene Bowater     Date: 2 6 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Cedar Grange Care Home 2 Cedar Grange Ashbrooke Tyne and Wear SR2 7TR 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.choicescare.com Choices Community Care Services Limited Name of registered manager (if applicable) Type of registration: Number of places registered: 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 - Code LD, maximum number of places 6 Date of last inspection Brief description of the care home Cedar Grange is a larger than average detached bungalow standing in its own grounds,which is approached by a private driveway. All bedrooms are single occupancy.There is one large communal lounge,a large dining room and separate sitting area and also a large breakfasting kitchen. Due to its design and layout it blends in well with other properties in the community therefore making it indistinguishable as a residential care home. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 6 Brief description of the care home It is situated in the Ashbrooke Range area of the city and is close to a busy shopping parade offering easy access to a good range of shops and health services. The home is on a recognised bus route,which offers easy access to the city centre and surrounding areas and close by is a local park. The home has its own transport in the form of a car and this is used to access community activities. None of the service users are capable of going out unaccompanied and are therefore dependent upon staff for support. The home is registered to provide personal care for 6 Adults aged 18 - 65 years who have a learning disability .At present the age of people living in the home is from 52 to 73 years of age. The range of disabilities within the home is varied and does include people who may have a physical disability, as well as a visual impairment. Care Homes for Adults (18-65 years) Page 5 of 29 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: two star good 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: Before the visit we looked at information we have received since the home was re registered. How the service dealt with any complaints and concerns. Any changes to how the home is run. The providers view of how well they care for people as highlighted in the Annual Quality Assurance Assessment (AQAA). The views of people who use the service,their relatives,staff and other professionals. The Visit. An unannounced visit was made on the 26 January 2010.This visit was carried out by one inspector and took four hours to complete. During the visit we: Talked with people who use the service,staff,and the visiting manager. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Care Homes for Adults (18-65 years) Page 6 of 29 Checked that staff have the knowledge,skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean,safe and comfortable. We told the visiting manager what we found. We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 29 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. Care Homes for Adults (18-65 years) Page 8 of 29 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 9 of 29 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 10 of 29 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. Pre admission assessments demonstrate that peoples needs and aspirations are identified so that they can be sure their needs can be met. Evidence: The home changed Provider in September 2009.The Statement of Purpose and Service User Guide are currently being up dated to reflect these changes. There have been no new admissions to the home since the change of Provider.Staff were able to discuss the admission process should there be any future admissions. This would include gaining a full assessment and care plan from other agencies, arranging visits to the home at different times including overnight and at weekends, and making sure that the admission was as flexible as possible for the person. This is to make sure that detailed plans are in place so the person can be properly supported when they move into the home. Care Homes for Adults (18-65 years) Page 11 of 29 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. Support plans reflect the assessed needs of the people therefore promoting their welfare and wellbeing. Evidence: Care plans are being changed as there is a new provider.Both the previous and new style showed that plans are developed with the person,care manager,other professionals,staff and advocates. The information records aspects of individual social,personal and health care needs within a risk management framework. Plans are in place so people can lead a lifestyle according to their wishes whilst there are guidelines in place to make sure they are being supported and protected. Although there is clear information available staff are aware that the plans need to be reviewed and updated to show a more person centred approach to daily living. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: People living in the home are involved in the running of the home and show one person would like a job and another wants to go bowling and everyone is involved in choosing food and deciding daily menus. Care Homes for Adults (18-65 years) Page 13 of 29 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. Although staff support people to maintain relationships and independence, further support is needed to make sure peoples changing lifestyle is being met. Evidence: People are supported to maintain links with families and friends.Relatives are welcomed and people are supported to keep in touch by telephone and letters. Information is available to show that where possible there are visits to local pubs,theatres and cinemas.As every one needs support of staff this is difficult to achieve all of the time. As people are becoming older it is becoming more difficult to plan and make sure individuals are able to choose from a range of activities outside of the home. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: Staffing levels and the lack of drivers for the homes own transport have also prevented some activities from taking place.The staff are aware that they need to source events and activities in the local community that meet the changing needs of those living in the home. On the day of the visit one person assisted a member of staff do the weekly shopping,a member of staff joined in playing cards and dominoes and another person enjoyed watching television. One person has been supported to become more independent and now can assist with personal laundry and making of some meals. Routines are generally flexible but comments in staff meetings about everyone being bathed, showered and dressed at an appropriate time does not reflect individual choices being respected. There are choice of all meals on daily basis and meals are planned with peoples food preferences are taken into account when planning meals. Menus show that the home continues to provide nutritious, home made and balanced meals. There are good arrangements in place to enable residents to have snacks and drinks throughout the day. Care Homes for Adults (18-65 years) Page 15 of 29 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. Care is being planned and delivered in a respectful and individual manner. This enables people to fully access health care and other services and ensures their needs are supported. Evidence: The support plans that are being introduced are accompanied by risk assessment and risk management plans for all staff to follow. These risk assessments and plans are very detailed so that staff can continue to give care and support appropriately and safely. Care plans show that staff support people access all health care services.Should someone have a health problem staff make sure referrals are made to the appropriate specialist. Discussion with the staff showed that they had a good understanding of individuals health care needs and recognised any short and long term changes. As there is a new Provider new medication policies are being introduced.Medication Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: was being safely stored and a random check found no discrepancies. Care Homes for Adults (18-65 years) Page 17 of 29 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. Good complaints and protection procedures are in place and effectively followed to ensure that people are listened to and protected from harm. Evidence: Clear complaints and safeguarding policies are available.In addition, staff are trained and know what steps to take should there be any suspicion or allegation of abuse. Also procedures and risk assessments are available should anyone become very anxious and distressed. There are clear policies and procedures in place to make sure peoples money is kept safe. Staff have completed training which links into Sunderland Local Authority procedures and they have had further training regarding Mental Capacity and Deprivation of Liberty training is to be arranged. There are monthly meetings with the people who live in the home and how to make a complaint or raise a concern is always discussed. Care Homes for Adults (18-65 years) Page 18 of 29 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. Further investment is needed to make sure the home remains a safe,comfortable place to live. Evidence: The home is a large bungalow set in its own grounds, within easy access to local amenities including bus routes. The communal areas are spacious,the kitchen,lounge and dining area and are domestic in style and bedrooms are large and for individual use. Bedroom doors have been fitted with self closing devices and individuals have be able to choose their own furniture and have a say in the decoration of their own rooms. The decoration is looking worn but the home is to be re wired in the near future and redecoration will take place afterward. There is damage to the shower flooring with staining around the shower base.Information is available to say that the flooring becomes very slippy when wet and is not to be used until the flooring is replaced.This has not happened.Also the the light cord and call bell need to be replaced as they are grimy and damaged. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: On the day of the visit the home was generally clean and tidy. Care Homes for Adults (18-65 years) Page 20 of 29 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. Systems around recruitment,selection and training are satisfactory,however there are not always sufficient staff on duty to meet the needs of people living in the home. Evidence: The home does not have a registered manager.Management of the home has been allocated to the assistant team leader. On the day of the visit there were two staff on duty.Given the dependency of some of the people this means that no one can go out until further staff support are provided. This was discussed on the day of the visit and it was confirmed that extra hours have been allocated but this had not been implemented. Staff files are kept centrally so were not seen on this visit.It was confirmed that appropriate references, Criminal Record Bureau checks,(CRB)proof of identity, and employment history are checked before employment . During the changes in provider some training has not taken place,however there are plans in place for further training and development during the coming year. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Staff have a mixture of National Vocational Qualifications to level two and three and staff have completed medication and Infection Control Training through Sunderland College. Training in Dementia and Palliative care has been sourced and is due to start in February 2010. There are regular staff meetings and have regular supervisions as well as an annual appraisal. Care Homes for Adults (18-65 years) Page 22 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are satisfactory arrangements in the general management of the home which safeguards the health, safety and welfare of people living in the home. Evidence: There is no registered manager in post and the assistant team leader is currently managing the service whilst carrying out her own role. She has a Certificate in Supervisory Management and holds a National Vocational Qualification to Level 3. As there is a new Provider staff are having to adopt some different ways of working and become familiar with all the policies and procedures. All sections of the AQAA were completed and the information gave a reasonable picture of the current situation within the service.More detail of how the service is planning to develop and improve during the coming year would have been useful. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: There are regular visits to the home by senior managers and they complete Regulation 26 forms to show how the service is progressing. Accidents and incidents are recorded with any action taken recorded. All service certificates and in house maintenance records are available and are up to date. Care Homes for Adults (18-65 years) Page 24 of 29 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 25 of 29 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 1 12 12 Make sure that that people 07/06/2010 are supported to take part in activities according to their changing needs. This will make sure individuals are continually supported to live fulfilling lives. 2 13 18 Ensure that there are sufficient staff on duty to support people at weekends and in the evenings. This will make sure that people are able to fully become part of the local community. 05/04/2010 3 24 23 Ensure risk assessments are 07/06/2010 in place when the home is re wired and that it is redecorated afterward. This will ensure the home remains a safe,comfortable place for people to live. Care Homes for Adults (18-65 years) Page 26 of 29 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 4 27 23 Ensure the shower room floor is replaced. This is to make sure that people are kept safe. 03/05/2010 5 30 13 Ensure that the light cord and call cord in the shower/bathing areas are replaced. This is to make sure that risk of infections are minimised. 05/04/2010 6 33 18 Ensure there are sufficient staff on duty at all times. This will make sure peoples needs will be met. 05/04/2010 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 The current Statement of Purpose and Service User Guide should be updated to reflect the change in Provider and be made available in alternative styles. Once the fee rates have been agreed,people living in the home need to be provided with new contracts. It is recommended that the care plans are reviewed and up dated to show a more person centredapproach to care delivery. It is recommended that generic comments about daily routines are not used in records. It is recommended that a permanent manager is allocated to the service. 2 3 5 6 4 5 16 37 Care Homes for Adults (18-65 years) Page 27 of 29 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 6 40 It is recommended that all staff continue to update themselves on the new policies and procedures. Care Homes for Adults (18-65 years) Page 28 of 29 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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