Care Home: Cedar Oaks

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What the care home does well Cedar Oaks provides a homely, `family-style` atmosphere for up to three service users with learning disabilities. The home benefits from a stable and experienced staff team who are provided with a good training programme. The majority of staff have achieved National Vocational Qualifications in care at level 2 or above. Service users are supported to lead a active and fulfilling lifestyle and have the opportunity to participate in a good range of activities in and out of the home. The home has developed information and structured person-centred plans ensuring that staff are able to meet individual needs consistently. The manager has been in post for over 9 years and provides good leadership maintaining records and information to a good standard. The organisation has developed strong quality monitoring processes including annual satisfaction surveys and monthly monitoring reports. Service users are supported to take an active role in the running of the home and menus are planned around individual`s specific requirements and preferences. The resident`s bedrooms are personalised and well decorated providing comfortable individual space. No complaints or adult protection alerts have been raised in connection with the service over the last 12 months. What has improved since the last inspection? The service has maintained a high standard of care and support. The manager has continued to develop the service provision. The organisation has developed a day centre in the local area called the Cyber Club, which provides a good range of activities and skills courses for service users. Staff in the home work with service users to develop person-centred care plans and the scope of activities has increased further since the last key inspection. Staff training needs have been maintained and almost all staff have achieved National Vocational Qualifications in care. What the care home could do better: No requirements or recommendations have been made as a result of this inspection process. It was noted that some minor improvements could be made in relation to the environment such as the renewal of tiling in the kitchen and plastering around one of the bedroom doors. Key inspection report Care homes for adults (18-65 years) Name: Address: Cedar Oaks 68 Cavendish Road Herne Bay Kent CT6 5BB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joseph Harris     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 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 25 Information about the care home Name of care home: Address: Cedar Oaks 68 Cavendish Road Herne Bay Kent CT6 5BB 01227370158 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dyzack Ltd Name of registered manager (if applicable) Ms Rhonda Diana Grant Type of registration: Number of places registered: care home 3 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 accommmodated is: 3 The registered person may provide the following category/ies of service only: Care home only (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) Date of last inspection Brief description of the care home Cedar Oaks is a small three bedded home for people with learning disabilities. The home is located on a quiet residential road close to the town centre of Herne Bay with public transport links. The home provides single bedrooms for all of the service users and a good range of comfortable, communal space. Service users are supported to be as independent as possible in their day to day lifestyles. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 3 Brief description of the care home The organisation has a day centre nearby that provides a range of activities and courses. The current fees and other information about the home are summarised in the service user guide and are availalble from the service on request. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection process culminated in a site visit to the service on 8th December 2009. The site visit commenced at 10:00 hours and lasted for approximately 5 hours. The focus of the inspection was to assess the home in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Younger Adults. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Prior to the site visit a range of information was examined including the Annual Quality Assurance Assessment (AQAA) submitted by the service. The AQAA summarises the aspects of the service that have improved and are planned for improvement and focusses on outcomes for service users. It also provides us with some numerical and statistical information. We looked at information that we have received about the home from other people and any notifications from the home about things that have happened over the last 12 Care Homes for Adults (18-65 years) Page 6 of 25 months. During the site visit discussions were held with the manager, staff and service users. Interactions between service users and staff were observed. A tour of the premises was undertaken and a range of records were examined including information relating to service users, staff, health and safety and medication amongst other documents relating to the daily running of the service. The judgements have been made using the Key lines of Regulatory Assessment (KLORA) which are guidelines that enable CQC to be able to make an informed decision about outcome areas. Further information can be found on the CQC website with regards to information on KLORAs and AQAAs. Care Homes for Adults (18-65 years) Page 7 of 25 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 8 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 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 prospective service users are assessed prior to admission. Evidence: The home has a well established and robust pre-admission assessment process. One service user has moved into the home since the last inspection and there was evidence to demonstrate that a thorough assessment process had been followed including the receipt of information from the individuals care manager, time spent with the prospective service user and information from families/representatives. The home manager stated that she visits prospective service users prior to them visiting the service to ensure that the home will be able to meet their needs. There is an inhouse assessment form that had been completed in good detail and this information forms the basis of the initial care plan. The individual, family and representatives are consulted throughout this process. Care Homes for Adults (18-65 years) Page 10 of 25 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. Service users needs are planned for and they are able to make decisions affecting their day to day lives. Evidence: Two individual service user plans were examined both of which had been developed in very good detail. The home uses a person-centred planning process that describes clearly and in detail the care and support needs of service users reflecting personal choices and preferences. The plans ensure that staff have clear guidance to ensure that needs can be consistently met and additional tools have been developed including communication passports and listen to me documents. The organisation is in the process of introducing new documentation which should act to supplement rather than replace the original person-centred plans. The plans are reviewed at at least six monthly intervals. The service can demonstrate how service users make choices and decisions in their day-to-day lives regarding activities and how they spend their time. Staff were observed working positively with residents promoting choice and independence. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: Individual preferences are recorded in the service user plans. There is a positive risk management programme in place enabling service users to take responsible risks and providing staff with clear guidance to minimise perceived risks. The risk management plans are reviewed at least 6 monthly. Care Homes for Adults (18-65 years) Page 12 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported in achieving a diverse lifestyle that suits their individual needs. Evidence: Each service user has an activities planner in place and a range of activities are organised based on individual needs and wishes. All of the service users attend sessions at the nearby Cyber Club, which is a day centre developed by the organisation due to a lack of alternative facilities for people with learning difficulties in the immediate area. The Cyber Club offers a good range of activities promoting life skills and recreational activities. These include sessions such as Yoga, Music Therapy, Life Skills and Aerobics amongst other things. Other activities are also organised from the home including trips out, swimming, bowling and cinema trips. There are sufficient staff available at all times to enable service users to go out with one to one staffing if desired. Service user plans clearly demonstrate individual preferences and choices and Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: activity plans reflect these needs and wishes. Service users have available facilities in the home such as televisions, personal computers and music systems to enable them to enjoy a homely lifestyle. Staff were observed to interact positively and communicate well with service users promoting individual choices. Service users receive positive family support and regularly visit their family homes, visitors are also welcome into the home at all reasonable times. The manager reported that the home liaises with family members over issues of significance and good relationships have been developed in this regard. No visitors were present at the time of the site visit. Menu records are maintained demonstrating that service users have a healthy and balanced diet with available choices at each mealtime. Residents are supported to take an active part in the daily running of the service including involvement in meal preparation, cooking and cleaning. Two service users have religious and cultural needs and the service recognises this diversity, liaising with family members and promoting choices in this regard. These needs are clearly documented within the care planning process. Care Homes for Adults (18-65 years) Page 14 of 25 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. The health and personal care needs of the service users are met. Evidence: Individual service user plans clearly document the personal care needs of service users and any preferences in relation to this aspect of care and support. Staff demonstrated a good understanding of individual needs and methods in enabling service users to communicate their needs effectively. Staff were observed supporting service users in a respectful and dignified manner promoting their independence and choices. The home maintains healthcare records and is planning on introducing person centred health action plans over the coming year. All service users are registered with local GP surgeries and it was reported that the home receives good support from community health care professionals. All residents receive an annual well womens check up and complimentary healthcare needs such as chiropody and dentistry are met. The manager stated that good support is received from care managers and local community learning disability teams. One service user also regularly visits a Psychiatrist for medication reviews. Medication processes were examined and the home has policies and procedures in Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: place relating to all relevant aspects of the medication process. Storage facilities are secure and adequate for the needs of the service providing sufficient space at a suitable temperature. Medication records are well kept and up to date. Records are maintained of all received, returned and destroyed medication. The home liaises with medical practitioners for regular reviews of service users medication. None of the service user are currently self-medicating. Care Homes for Adults (18-65 years) Page 16 of 25 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. Service users are protected from abuse and their concerns and complaints are acted upon. Evidence: The home has a clear complaints process in place and this is summarised in the service user guide and displayed in the home. Some adaptations have been made to aid understanding of service users rights for those with communication difficulties. The manager stated that the vast majority of issues are managed on an informal basis, but service users would be supported through advocacy services should an issue need to be taken through the formal complaints process. A record of complaints, concerns and compliments is maintained. No complaints have been received by the home over the past 12 months. Policies and procedures are in place relating to safeguarding issues and staff have received training regarding the safeguarding of vulnerable adults, the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff spoken to demonstrated a good awareness of these issues. No safeguarding vulnerable adult alerts have been raised in connection with the service over the past 12 months. Care Homes for Adults (18-65 years) Page 17 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for the needs of the service users. Evidence: Cedar Oaks is a family-style home situated on a quiet, residential road close to the town centre of Herne Bay with public transport links street parking available outside the home. A tour of the premises was undertaken. There is sufficient communal space to meet the needs of the service users including a large open plan lounge/dining room. The kitchen is domestic in size and has a laundry area to the rear. It was reported that all equipment is in good working order. A new extractor hood has recently been fitted in the kitchen, but it was noted that some tiling now needs to be renewed as a result of this work. Two service user bedrooms were seen, both of which provide a spacious and personalised area for individuals to relax. There are sufficient toilets and bathrooms throughout the building. There is a small garden to the rear of the home, which is well used in the warmer months. It was reported that the home meets the requirements of the environmental health and fire safety departments. There is also a planned programme of renewal and redecoration. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a staff team that are skilled and trained to support service users. Evidence: There is a stable staff team all of whom have worked in the home for many years. There have been no staff changes since the last key inspection. Almost all of the care staff have achieved at least a National Vocational Qualification in care at level 2 and a number are now working towards their level 3 award. Staff spoken to demonstrated a good understanding of service users needs and were observed working positively with residents promoting choice and independence. Staff recruitment records are held securely at the local area office. These records were not examined during this visit due to the fact that there have been no staff changes since the last key inspection. At the last key inspection the recruitment processes were examined and all aspects of this standard were met. There is a positive staff training programme and care staff stated that they receive the training that they require to fulfill and supplement their duties. The staff training matrix was examined which demonstrated that all staff have received the required mandatory training and additional training including topics such as person-centred planning, epilepsy and Mental Capacity issues amongst other things. The organisation employs a training manager who is a trained trainer in a number of topics and ensures that all updates and refresher courses are provided as required. There is an induction Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: process in place for new staff. Care Homes for Adults (18-65 years) Page 20 of 25 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. The service is well managed, in the best interests of the service users. The health and safety of service users is maintained. Evidence: The manager has been in post for over 9 years and has had many years of prior experience in the care sector. She has achieved all required qualifications and is registered with Care Quality Commission. It was evident through observation and discussion that she has developed positive relationships with service users, the staff team and other stakeholders in the service. The organisation has developed strong quality monitoring processes that include robust monthly monitoring visits conducted by a senior manager in the organisation covering all aspects of the service. Action plans are developed to address any shortfalls identified from these visits. Satisfaction surveys are completed on an annual basis and provided to staff, service users, relatives and professionals. The results of these surveys are collated into an annual report and any issues of concern identified and addressed. Health and safety records were examined all of which had been kept up to date and Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: well maintained. Service safety checks are carried out routinely and certificates retained on file. Fire checks are completed and accident records are maintained. Policies and procedures are in place relating to safe working practices and environmental risk assessments completed and reviewed regularly. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 Care Homes for Adults (18-65 years) Page 24 of 25 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). 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