Care Home: Cedar Lodge

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What the care home does well Cedar Lodge is a relaxed, friendly and comfortable home which is managed well so that the people who live here have a good life. We arrived at Cedar Lodge as people were eating breakfast and preparing to go out. All four women had activities planned and were out for much of the day. The atmosphere in the home was very calm and relaxed, and staff and the people who live there showed great respect, care and fondness for each other. Two of the women who live at Cedar Lodge were able to talk to us about their lives. They told us that they, and the other two women, are happy at Cedar Lodge. One said "I have a good life, I enjoy myself". They praised the staff. The surveys which were returned to us from people who live at the home and their relatives/advocates were very positive. One person wrote, "My relative is very happy in this home"; another wrote "I would just like to say that I`m happy with the care my relative receives. This has given me great peace of mind knowing that I don`t have to worry how she is coping. I`m happy with the home". An advocate wrote "They`re very caring and nurturing towards (name). They actively encourage her to go on external outings and she is very happy and settled"; and another "Cedar Lodge provides a caring, homely environment". Staff, in their responses, were also very positive about the support they get, and the support they give to the people who live at the home. One wrote "It`s a very pleasant working environment". Two written compliments had recently been sent to Cedar Lodge. A solicitor wrote "....I was full of praise for Cedar Lodge and staff because I think you do an excellent job and I know that (name) is very settled and happy there". A relative of the person who died wrote "Thank you for all the care, love and understanding you gave to (name) whilst in your care".There is good information about the home available for people who are thinking about moving in, and thorough assessments of people`s needs are carried out. Support plans are detailed, person-centred and give staff good guidelines about how each person wants to be supported. People are able to make decisions about every part of their lives, and they are supported in the way they prefer. Each person does as much or as little as they want to do. A wide range of activities is available both inside and outside the house, and people enjoy their lives. Families and friends are encouraged to visit, and meals are chosen by the people who live here. People know their complaints will be listened to, and they will be kept safe. Enough staff are on duty to support people to do what they want to do. Staff are recruited well, and offered a lot of training opportunities, as well as supervision and staff meetings. Health and safety is taken seriously, and the home is run in the way the people who live here want it to be. What has improved since the last inspection? From everything we saw, we consider that the home has moved forwards since our last inspection, and we have confidence that it will continue to improve. In the AQAA the manager showed she is aware of areas the home can continue to get better. What the care home could do better: We have only made two recommendations and no requirements following this inspection. The acting manager should have a copy of Bedfordshire County Council`s safeguarding procedure, and she should make sure all staff are involved in a fire drill at least once a year. CARE HOME ADULTS 18-65 Cedar Lodge 9 Sundon Road Streatley Bedfordshire LU3 3PL Lead Inspector Nicky Hone Unannounced Inspection 1st October 2008 08:50 Cedar Lodge DS0000071797.V371635.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 Lodge DS0000071797.V371635.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 Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Address 9 Sundon Road Streatley Bedfordshire LU3 3PL 01582 883354 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.choicesupport.org.uk Choice Support Sharon Burns Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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 The maximum number of service users who can be accommodated is 5 This is the first inspection of Cedar Lodge since it transferred to Choice Support. The last key inspection was on 31/07/07. 2. Date of last inspection Brief Description of the Service: Cedar Lodge is a residential home for up to five female adults with learning disabilities. Management of the home passed from the Bedfordshire and Luton Mental Health and Social Care Partnership Trust (BLPT) to Choice Support in March 2008. The bungalow is owned by the Bedfordshire Pilgrims Housing Association (BPHA), which is responsible for the maintenance and upkeep of the building. The home is situated in the village of Streatley, near Luton, Bedfordshire and is close to local village facilities including a shop, pubs and a church. The building is a single storey bungalow, and provides five single bedrooms. Shared areas of the home include a large lounge/dining room, an activity room, kitchen, bathrooms, toilets, and laundry. There is also a large conservatory which leads onto a pleasantly landscaped back garden. There is parking for several cars at the front of the property. Fees for the service were not available at the time of the inspection. A copy of the last CSCI report is kept in the front entrance hall, in the back of the Service User Guide. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Choice Support took over as provider of the service at Cedar Lodge from the Bedfordshire and Luton Partnership Trust (BLPT) on 1st March 2008. The building is owned and maintained by the Bedfordshire Pilgrims Housing Association. The manager and staff team continued to work at the home, then the registered manager left in July 2008. At the time of this inspection there were four people living at Cedar Lodge, and the home was being managed by the previous deputy manager, Sandra Dykes. In this report, we refer to Sandra Dykes as the ‘acting manager’. About two years before the transfer to Choice Support, Cedar Lodge was reregistered by the Commission for Social Care Inspection (CSCI) as a home for older people, as the majority of people who lived there were over 65 years of age. However, everyone who lives at the home is there because they have a learning disability. When the home was registered to Choice Support, it reverted to being registered as a home for adults with learning disabilities. People of any age can be admitted to the home, provided they have a learning disability, the home can meet their needs, and they fall within the home’s aims as stated in its Statement of Purpose. For this inspection we looked at all the information that we have received, or asked for, since the last key inspection of Cedar Lodge. This included: • The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in May 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live here. The AQAA also gives us some numerical information about the service; Surveys which we sent to the home to give to people who live at Cedar Lodge, to their relatives/carers, and to staff. We received 13 replies: 4 from people who live at Cedar Lodge; 4 from their relatives/advocates; and five from staff. What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement; • • Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 6 • • Any safeguarding issues that have arisen; and Information we asked the home to send us following our visit. This inspection of Cedar Lodge included a visit to the home on 01/10/08. Noone knew we were going to visit on this day. We spent time talking to the manager and some of the staff, and talking to and observing the people who live at the home. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. What the service does well: Cedar Lodge is a relaxed, friendly and comfortable home which is managed well so that the people who live here have a good life. We arrived at Cedar Lodge as people were eating breakfast and preparing to go out. All four women had activities planned and were out for much of the day. The atmosphere in the home was very calm and relaxed, and staff and the people who live there showed great respect, care and fondness for each other. Two of the women who live at Cedar Lodge were able to talk to us about their lives. They told us that they, and the other two women, are happy at Cedar Lodge. One said “I have a good life, I enjoy myself”. They praised the staff. The surveys which were returned to us from people who live at the home and their relatives/advocates were very positive. One person wrote, “My relative is very happy in this home”; another wrote “I would just like to say that I’m happy with the care my relative receives. This has given me great peace of mind knowing that I don’t have to worry how she is coping. I’m happy with the home”. An advocate wrote “They’re very caring and nurturing towards (name). They actively encourage her to go on external outings and she is very happy and settled”; and another “Cedar Lodge provides a caring, homely environment”. Staff, in their responses, were also very positive about the support they get, and the support they give to the people who live at the home. One wrote “It’s a very pleasant working environment”. Two written compliments had recently been sent to Cedar Lodge. A solicitor wrote “….I was full of praise for Cedar Lodge and staff because I think you do an excellent job and I know that (name) is very settled and happy there”. A relative of the person who died wrote “Thank you for all the care, love and understanding you gave to (name) whilst in your care”. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 7 There is good information about the home available for people who are thinking about moving in, and thorough assessments of people’s needs are carried out. Support plans are detailed, person-centred and give staff good guidelines about how each person wants to be supported. People are able to make decisions about every part of their lives, and they are supported in the way they prefer. Each person does as much or as little as they want to do. A wide range of activities is available both inside and outside the house, and people enjoy their lives. Families and friends are encouraged to visit, and meals are chosen by the people who live here. People know their complaints will be listened to, and they will be kept safe. Enough staff are on duty to support people to do what they want to do. Staff are recruited well, and offered a lot of training opportunities, as well as supervision and staff meetings. Health and safety is taken seriously, and the home is run in the way the people who live here want it to be. 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 Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 People who use this service experience good quality outcomes in this area. Information is available about the service for people thinking about moving here, and assessments are carried out so that people know the home can meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has produced information so that people thinking of moving here will know what the home has to offer. The Service User Guide (SUG) we saw was up to date and included pictures, symbols and good information, as well as a copy of the report we wrote after our last inspection. The manager said a copy of the SUG has been given to the woman who hopes to move into Cedar Lodge. All four people living at Cedar Lodge have lived here for some years, so we were not able to check whether good assessments had been carried out before they moved in. However, on the files we looked at we found detailed assessments of people’s abilities and needs which were done in July 2007 in preparation for the change of provider. A care manager from the Primary Care Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 10 Trust had done an assessment of each person, and the home had done a second one. The acting manager told us that they have carried out a detailed assessment of the person who wants to move into the home, and are still assessing her needs when she visits. This person already knows the people who live here, and she has been to visit several times. She has told the acting manager “it’s not ‘if’ I move in, it’s ‘when’”. A Support Service Agreement has been drawn up which explains to people the service they are paying for, and what they can expect from the service. This uses pictures and very clear language. People also sign a licence agreement with the Housing Association: the one we saw stated that people’s rent is paid by the County Council. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 People who use this service experience good quality outcomes in this area. Support plans are clear and detailed, and give staff good guidance on the way each person wants to be supported. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked in detail at one person’s care plan. The plan contains full details about every aspect of the person’s life, with a ‘who will do what’ section to give staff guidance on the support this person needs. It is written in a very personcentred way, using “I”, just as the person would have said it. The person, and her advocate, have signed to say they agree with what has been written, and the plan has been reviewed at least every two months since it was written in February 2007. The plan includes pictures to explain what is written, and even has guidelines for staff to support this person to look after her budgie. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 12 Staff are in the process of writing detailed guidelines for each person’s individual ‘activities’, for example, personal care, outings, meals, at night and so on. Staff are working on these as a team so they all work consistently. Support plans are already being developed from the information the home has received about the lady who plans to move in, so that staff will know how to support her as soon as she arrives. People are encouraged and supported to make decisions about every aspect of their life. These decisions, and how the decision was made, are recorded. Staff also record why, in some instances, people have needed more support to make a decision. Risk assessments are carried out for any risks that have been identified for each person. On the file we looked at there were assessments for moving and handling, pressure sores, and falls, as well as a long list of risks that could affect the person in their daily life. There were clear, step-by-step guidelines for staff for all ‘movements’, such as transferring from the bed to the wheelchair, using the toilet and so on. In these notes we saw guidelines about how the monitor should be used for this person, including instructions to staff that the monitor must not be in the lounge if there are other people present. Daily support notes are written by staff at least twice a day, and give a good picture of the way each person leads their life, and what sort of day they have had. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 People who use this service experience excellent quality outcomes in this area. People are offered a wide range of opportunities to lead full, satisfying and interesting lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Three of the people who live at Cedar Lodge are over retirement age. One told us she does not want to do any jobs, and is happy going out and enjoying herself. She particularly enjoys going to the theatre, and was pleased to tell us about her holiday last year when she went to Yarmouth and staff took her to see a number of shows. She enjoyed her holiday this year in Blackpool, but has decided to go back to Yarmouth next year, for the shows. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 14 People told us they will be going to the “panto” at Christmas, and staff will take them out to dinner. A woman from the library visits the home every two weeks and brings a selection of talking books for one of the people at Cedar Lodge who prefers to listen to the radio and the talking books rather than watch the television. One of the women has a job. She works in the kitchen at a coffee morning held once a week in Dunstable. Two people are going to a conference, run by Choice Support, at Centre Parcs. Another person helped interview Choice Support’s new area manager. We looked at one person’s activity timetable which showed that she leads a very busy life, going out most days. She does several college courses, including art and craft, floristry, and a ‘cook and eat’ course. She plays carpet bowls, goes out for meals, and helps with the house shopping once every two weeks if she wants to. A second person’s activity plan showed that she too has a good balance of going out and doing things at home. From the records, and from talking to people, we learnt that in-house activities include ‘Bob the music man’ once a week, hand massages, aromatherapy, film choice evenings, and bingo on Sundays. One day a week each person is supported to hoover and dust their bedroom, change their bedding and do their laundry. People are encouraged to help in the kitchen if they want to. Friends and families are encouraged to visit Cedar Lodge and are always made welcome. Staff support people to keep in touch with their families and friends, by visiting, by using the telephone, or sending cards, giving gifts and so on. One person has a friend who lives in another home near by: the friend joins her at Cedar Lodge each Sunday for bingo. One of the women sees her relative weekly: staff provide the transport, either to take the woman to her relative’s home, or to bring the relative to Cedar Lodge. Each week the women who live at Cedar Lodge decide what they want on the menu the following week. The staff have put together a selection of pictures for people to choose from, and we saw that the menus include a variety of meals. Breakfast is a choice of cereals, with toast and so on. We saw that several boxes of cereal are put on the table for people to choose. The menus, including any changes, or alternatives if someone has decided they want something different, are kept as the record of food that has been provided. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 People who use this service experience good quality outcomes in this area. People are supported in their personal care in the way they prefer, their health needs are met and staff administer medicines correctly and safely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: One of the women who talked to us told us that she likes to go shopping for clothes. She told us about all the clothes she bought before she went on her holiday. She prefers to buy her shoes from a catalogue, because she knows they will fit her and that they will be comfortable. Staff support her to make sure she has the latest catalogue, and orders what she wants in the right size. On the file we looked at we saw that the person’s health is looked after. A nutrition plan has been completed, and a dietician contacted for advice. The person’s weight is recorded monthly, and the manager explained that the staff buy low fat and Weightwatchers foods so that this person, who loves her food, can still have the ‘treats’ she wants. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 16 In the file we looked at we saw that there is a plan in place for what to do in the event of the person’s death. The acting manager told us that 3 out of the 4 women have plans in place and staff are working towards getting the 4th plan completed. The acting manager said there was a plan in place for the person who died earlier in the year, which had been very supportive as everyone knew the person’s wishes were being carried out. Each person has their own medication folder which is kept in their bedroom, and each person’s medication is kept in a locked cupboard in their bedroom. The folder contained a consent form which the person had signed to say they would prefer staff to give them their medication. All Medication Administration Record (MAR) charts that we saw were completed well, showing that medication is receipted in and out and administered correctly. Guidelines for each person’s ‘when required’ medication were clear and had been signed by the doctor. Records showed that all staff have received thorough training in administering medication, as well as being observed several times doing the administration before being able to do it on their own. The medication policy includes ‘support to staff if unusual events occur’, for example, if the person refuses their medication, they are given the wrong medication, they have an unexpected reaction and so on. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use this service experience good quality outcomes in this area. People know that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People who live at Cedar Lodge know who to talk to if they are not happy about something. There is a clear, simple, complaints procedure. The manager keeps a complaints and compliments log. There were no complaints recorded, and two recent compliments. All staff have had Safeguarding of Vulnerable Adults (SOVA) training. One of the staff who spoke with us showed that she has a good understanding of safeguarding, what to look out for, and how to report any suspicions she might have. The acting manager showed us that Choice Support’s safeguarding policy is easily available to staff, who have all signed (other than the two new staff) to say they have read it. We recommended that the manager also print off the latest safeguarding policy written by Bedfordshire County Council, as the home must make sure they follow the procedures and protocols in that document. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 18 The women who spoke to us said they are happy for staff to keep their money for them in the office. Staff give them as much cash as they want when they go out. Records are kept of all transactions, and the cash balance is checked three times a day at each handover. The records we looked at were accurate. Each of the women who lives at Cedar Lodge also has a bank account, which they withdraw money from when they want to buy something more expensive, or go on holiday and so on. The acting manager has details of each person’s benefits, and it is clear that people only pay the weekly service charge to the Housing Association. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People who use this service experience excellent quality outcomes in this area. Cedar Lodge offers a comfortable, homely, clean and well-maintained home for the people who live here. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked round the bungalow and the people who live at Cedar Lodge were happy for us to look at their bedrooms. Apart from the empty bedroom, the whole bungalow was well decorated and well maintained. The acting manager told us that a lot of work had been done by the Housing Association before the home transferred to Choice Support. The lounge/dining room is bright and cheerful, each person has a comfortable chair in the lounge area and there is plenty of room at the large dining table Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 20 for everyone to eat together if they wish to. There were lots of fresh flower arrangements around the room. Two of the ladies explained that they had made these at their flower-arranging class at college. The conservatory has heating and blinds fitted, and comfortable seating, so can be used as a lounge area. It leads onto the large back garden, which has been attractively landscaped and is well maintained. There is a flower bed in the middle of the garden, with seats near it, which the women have dedicated to the person who lived with them who died earlier in the year. The people who live at Cedar Lodge chose the plants and helped to plant them, in memory of their friend. Each of the people who live here has chosen how they want their room to be decorated. They chose the paint colours, curtains and matching bedding, and have been supported by staff to buy things that they want in their room. So each room is personal and very different to the others. The spare room will be decorated in colours chosen by the person who is planning to move in, before she arrives. The Housing Association will be visiting the person at her current home so she can choose colours and what flooring she would like. One of the bedrooms has been fitted with overhead tracking as one person needs a hoist to transfer from her wheelchair to her bed. There is a small activity room with tables and chairs for people to do puzzles, arts and crafts, play games or do whatever they want to do. There is a good collection of things for activities, such as puzzles, games, books, paints and so on. The bathroom has a special (Parker) bath which includes a Jacuzzi, which the women all love. There is overhead tracking in the bathroom to make transfers for the person who uses a wheelchair more comfortable. One of the women told us that there is a monitor in her bedroom so that staff can hear her when she needs to call them. She has fits at night and likes to have staff support. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People who use this service experience good quality outcomes in this area. The people who live at Cedar Lodge benefit from staff that are recruited well, and who have sufficient training so that they can do their jobs properly. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Cedar Lodge has a very stable staff group, some of whom have worked at the home since it opened. Two ‘new’ staff recently joined the team from another Choice Support home. The acting manager said that the staff rota reflects what is going on for the people who live at the home, so there are more staff on duty if everyone is going out to different places. The home is fully staffed and agency staff have not been used since July 2008. Choice Support has a bank of staff who cover staff’s leave, sickness and so on, so these staff know the women well. In the surveys, a couple of the staff said there should be more drivers: the acting manager told us this has now improved. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 22 We looked at the files for two staff: all of the documents the home must have in place, to show the staff member is ‘fit’ to work with people were in the files, such as a Criminal Records Bureau (CRB) check, and two written references. Training records were detailed and clear. There is a record for each training topic, showing the date each staff member completed a course, and when they need to do that course again. Each staff member has a folder with the certificates from each course they have done. These records, and our discussions with the staff and the acting manager showed us that staff receive a lot of training. All staff have had first aid training, all except 4 have had a recent moving and handling and fire safety course, and after a course arranged for 09/10/08, all staff will have had food hygiene, health and safety, and infection control training. All staff have had SOVA training, and most staff have been on person centred planning, dementia, sensory awareness, and diabetes courses. One of the staff we spoke with, who has recently transferred to Cedar Lodge from another Choice home, told us she is pleased with the training opportunities available to staff at Cedar Lodge. She has been working through a detailed induction pack, and told us she has had supervision every month. She also said that staff meetings are held every month: she finds these useful because every staff member has the chance to give their views and to discuss any issues. Records showed that all staff have received monthly supervision, and that minutes are kept of the monthly team meetings. The acting manager said that out of the 14 staff who work at the home, 11 have been awarded a National Vocational Qualification (NVQ) in care, at level 2, 3 or 4. The other 3 staff are currently undertaking the award (with 2 “as good as finished”). So that when they have completed the courses, the home will have 100 of staff trained. This is excellent. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 People who use this service experience good quality outcomes in this area. Cedar Lodge is managed well so that the people who live here have a good quality of life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: One of the relatives who returned our survey wrote “We are very sorry about the manager leaving as we got on well with her. We hope that Sandra [the current acting manager] will be able to stay on in place of her”. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 24 The fact that we have not made any requirements following this inspection, and only two recommendations, shows that this home is run well, and in the best interests of the 4 women who live here. The acting manager is clearly part of the staff team, knows the people who live at the home well, and is passionate about her job. She has been awarded an NVQ level 4 in care, and hopes to start the Registered Manager Award soon. She intends to apply for the manager post when it is advertised. The acting manager showed us her ‘Quality folder’. It contained documents showing a number of different ways in which the quality of the service is monitored. These included: people’s responses to each activity they have undertaken; the results of questionnaires sent to families (which had very positive feedback); the reports of monthly visits done by the provider; inhouse audits on every aspect of the service; and charts, for example for all cleaning jobs, which are monitored. The manager completes a monthly report for Choice. To make sure that what the home is doing is what people want, and that it is doing it right, a number of meetings are held, and a record kept. For example, monthly meetings involving each person and their link worker, monthly meetings for all the women together if they want to attend, weekly menu planning meetings, annual care reviews by social services and so on. We saw the minutes of ‘residents’ meetings’: pictures are used and a wide agenda is covered. The fire log showed that weekly checks are done on the fire alarms and emergency lighting, as well as on other fire equipment, such as extinguishers, doors signs and fire blankets. A fire risk assessment has been completed, but we did not check this. Fire drills are held, and fire evacuation procedures are discussed at staff meetings, so that staff remember what to do should a fire break out. We recommended that the acting manager makes sure all staff are involved in a fire drill at least yearly. All specialist equipment needed by each person is cleaned and checked weekly, and things that need servicing, such as hoists, are serviced every six months. The home’s mini-bus, and the car belonging to one of the people who lives at the home, are checked weekly. Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 3 5 3 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 4 25 4 26 4 27 3 28 3 29 3 30 4 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 3 3 X 3 3 X Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA23 Good Practice Recommendations The acting manager should make sure a copy of Bedfordshire County Council’s Safeguarding policy is available in the home, and that staff are aware of its contents. All staff should be involved in a fire drill at least once a year. 2 YA42 Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Cedar Lodge DS0000071797.V371635.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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