Care Home: The Cedars

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What the care home does well The financial arrangements for the people using the service are safe and robust. Receipts are obtained for all purchases and the staff and residents sign against each transaction. The people using the service are able to choose how they spend their day. One attends a day centre, whilst others attend local support groups. All of the people using the service are independent and able to access the community on their own. Most of the residents are able to use the local bus service and all have a bus pass. The people using the service also have access to two seven-seater people carriers. Regular meetings are held with the people using the service both in group and individual sessions. They discuss a variety of relevant topics, for example the new complaints procedure and fire safety. Care plans and risk assessments are developed for all of the people using the service, which are regularly reviewed. Information regarding complex needs is comprehensive and provides valuable guidance for staff. The people using the service are encouraged to be as independent as possible. Most have their own building society account and they can access them independently. One is supported by family. Each person has their own bedroom and they are encouraged to personalise them. Keys to the house and bedroom are available if people choose to have them. Health needs are closely monitored and the people using the service are supported to access the appropriate health professionals. Staff receive regular supervision and team meetings are held monthly. Regular mandatory training is provided on a regular basis and staff confirm that it is of a high standard. The staff are trained to support the people using the service with their mental health needs. Staff recruitment procedures are robust and protect the people using the service. Protection of Vulnerable Adults and Criminal Records Bureau checks are carried out for all prospective staff members. There have been no complaints made about the service at The Cedars, either to the Home or the Commission for Social Care Inspection. What has improved since the last inspection? The manager has obtained the National Vocational Qualification 4 and Registered Manager`s Award. The complaints procedure has been developed in pictorial format to help the people using the service better understand it. The organisation has recently introduced the Person Centred Plan approach to care planning, which should further ensure individual needs and wishes are established and addressed. The organisation is setting up a service user forum, which one of the residents is going to join.The manager has recently been trained to deliver courses in the Protection of Vulnerable Adults. One bedroom has been redecorated. Hot water is now available in the upstairs toilet. Staff have recently had infection control training. The number of staff with appropriate National Vocational Qualifications has increased. Caretech had developed and implemented an auditing system and two audits took place at The Cedars in 2006. However there have been none in 2007. CARE HOME ADULTS 18-65 The Cedars 2 Harding Road Hanley Stoke on Trent Staffordshire ST1 3BQ Lead Inspector Sue Jordan Key Unannounced Inspection 9th July 2007 09:45 The Cedars DS0000064029.V338635.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 The Cedars DS0000064029.V338635.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. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Address 2 Harding Road Hanley Stoke on Trent Staffordshire ST1 3BQ 01782 269739 01782 269187 stoke.enquiry@caretech-uk.com 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) Delam Care Ltd Miss Tracy Anne Baddeley Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2006 Brief Description of the Service: The Cedars is a long-term care home for six people with a learning disability and/or mental ill health. It is run by Delam Care, a company owned by Caretech. The property is a detached Victorian property in Hanley that is adjacent to two other care homes owned by the same company. The registered manager, Tracey Baddeley is also responsible for the two adjoining homes. The Home has a small back yard area and a small front garden and shares a laundry with the two adjacent care homes. The Home has six single bedrooms, four upstairs and two on the ground floor. The people using the service have the opportunity to attend college and they are all able to access the community independently. They also have the opportunity to go on holiday at their own cost. There is one care staff member on duty at all times and the aim is to provide service users with support, encouragement, supervision and monitoring in order to enable them to live as independent a life as possible. The home monitors, supports and encourages the people using the service to access appropriate health care facilities and to maintain their own personal care. They are also involved in a range of domestic and household tasks within the home. The current fees range from £298 to £350.84 per week. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four and three quarter hours. This was a ‘key inspection’ and the core standards were assessed. The methodologies used were: A day of preparation before the inspection, including scrutiny of the Commission for Social Care Inspection Annual Quality Assurance Assessment completed and returned by the manager. During the visit, the inspector met and spoke to five of the people living in the home and discussions were held with the manager and senior support worker. Observations were made of staff and service user interaction and non-personal care tasks and lunch was taken with some of the people living in the home. The medication systems were checked and a walk round the home taken. Two residents’ care records were checked. The service users financial records were also checked. Three staff recruitment files were examined and the training records. A random selection of the Health and Safety and maintenance records were examined. The last Key Inspection was in November 2006. Two requirements and eight recommendations have been made as a result of this inspection. What the service does well: The financial arrangements for the people using the service are safe and robust. Receipts are obtained for all purchases and the staff and residents sign against each transaction. The people using the service are able to choose how they spend their day. One attends a day centre, whilst others attend local support groups. All of the people using the service are independent and able to access the community on their own. Most of the residents are able to use the local bus service and all have a bus pass. The people using the service also have access to two seven-seater people carriers. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 6 Regular meetings are held with the people using the service both in group and individual sessions. They discuss a variety of relevant topics, for example the new complaints procedure and fire safety. Care plans and risk assessments are developed for all of the people using the service, which are regularly reviewed. Information regarding complex needs is comprehensive and provides valuable guidance for staff. The people using the service are encouraged to be as independent as possible. Most have their own building society account and they can access them independently. One is supported by family. Each person has their own bedroom and they are encouraged to personalise them. Keys to the house and bedroom are available if people choose to have them. Health needs are closely monitored and the people using the service are supported to access the appropriate health professionals. Staff receive regular supervision and team meetings are held monthly. Regular mandatory training is provided on a regular basis and staff confirm that it is of a high standard. The staff are trained to support the people using the service with their mental health needs. Staff recruitment procedures are robust and protect the people using the service. Protection of Vulnerable Adults and Criminal Records Bureau checks are carried out for all prospective staff members. There have been no complaints made about the service at The Cedars, either to the Home or the Commission for Social Care Inspection. What has improved since the last inspection? The manager has obtained the National Vocational Qualification 4 and Registered Managers Award. The complaints procedure has been developed in pictorial format to help the people using the service better understand it. The organisation has recently introduced the Person Centred Plan approach to care planning, which should further ensure individual needs and wishes are established and addressed. The organisation is setting up a service user forum, which one of the residents is going to join. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 7 The manager has recently been trained to deliver courses in the Protection of Vulnerable Adults. One bedroom has been redecorated. Hot water is now available in the upstairs toilet. Staff have recently had infection control training. The number of staff with appropriate National Vocational Qualifications has increased. Caretech had developed and implemented an auditing system and two audits took place at The Cedars in 2006. However there have been none in 2007. What they could do better: The manager must ensure that all items not included in the cost of fees are clearly listed in the contracts and Service Users Guide. This will ensure that the people using the service have the correct information about what they may be expected to pay. All of the staff must be trained in the Protection of Vulnerable Adults. The manager needs to obtain the new Local Authority Safeguarding Adults policy. The organisation must demonstrate that they regularly review the staffing levels to reflect the needs of the people using the service. There is only one member of staff on duty, which means that individual or impromptu excursions are difficult to facilitate. The organisation needs to formalise their Quality Assurance arrangements to ensure that the views of people using the service, staff and stakeholders are gathered, the results collated and a report as to any action required available. The Statement of Purpose and Service Users Guide should be developed in formats, which can be understood by the people using the service, to ensure that they have access to the information they may need. Up to date the people using the service have been very reluctant to discuss death and any after death wishes they may have. The organisation has commited to continue working in this area, to ensure that individual wishes are known and followed at this very difficult time. Work is still required to improve the environment and the management need to consider redecoration and refurbishment of the Home as outlined in this report, to ensure that the people using the service live in more pleasant surroundings. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 8 Systems should be in place to control the risk of infection and consideration given to providing paper towels in the communal bathrooms, toilets, kitchen and laundry and washable flooring in the bathrooms and toilets. The office and kitchen doors should be fitted with closures that are connected to the fire alarm system. This will better enable safe and free passage throughout the Home. 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. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 9 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 The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 10 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, 3, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the Home, the service provided and the expectations and responsibilities of all parties is available to the people using the service in a standard format. Staff have the necessary specialist skills and ability to care for individuals who are admitted. EVIDENCE: The Home’s Statement of Purpose was reviewed and amended at the beginning of 2007. The organisation has plans to develop the Statement of Purpose and Service Users Guide into more accessible formats for the people using the service. This was agreed as being useful to ensure that all of the people using the service are able to understand their rights and responsibilities. However, regular meetings are held with the people using the service where they discuss issues such as the complaints procedure and the running of the Home. The Statement of Purpose lists the services included in the fees and those not covered. However, the manager needs to revisit these lists to ensure that all items are included. For example, the people using the service pay for their holidays and for the accommodation used by the accompanying staff. This is The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 11 not listed. This information should also be included in the contracts. The manager is aware that the present contracts also need amending to reflect the fact that Caretech now owns the Home. Before people are admitted into the Home, their needs are carefully assessed and the Home receives the required information from the referring agencies to ensure that they can meet the person’s needs. The present residents have lived at The Cedars for many years. The people using the service predominately have mental health needs. Organisational training is available in mental health awareness and all the present staff have received this training. The manager has a degree in psychology. The people using the service are also supported to attend outpatients’ specialist appointments with various mental health services. Some residents are in receipt of Community Care Approach reviews. The care plans contain comprehensive details about the individual mental health difficulties, including information for staff as to how the people using the service are to be assisted and supported. Many of the organisational and Home’s documentation could be adapted to be more easily understood by the people using the service, including the Statement of Purpose, Service Users Guide, menus and vital procedures. This could include pictures, photographs, symbols or written in a more easy to understand manner. The organisation has recently developed a more ‘user friendly’ complaints procedure. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 12 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, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are kept up to date and provide staff with the information required to meet the residents’ needs. The Home has systems in place that allow the people using the service the opportunity to make their views known and join in any decision-making. EVIDENCE: The care records for two of the people using the service were checked. Care plans and risk assessments are in place for all aspects of the person’s life and they are regularly reviewed. The organisation has just introduced Person Centred Planning. Following the completion of individual plans the people using the service will invite significant The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 13 people to meet with them to discuss their ideals and wishes and formulate an action plan. The residents of The Cedars are yet to embark on the Person Centred Plan process. Five of the people using the service are assisted with their finances, although they are encouraged to maintain their independence as far as is possible. A family member supports the other. Regular meetings are held with the people using the service at which they discuss a variety of topics, including the menus, activities and holidays. Each person using the service has a monthly one to one session with a member of staff, where they can discuss any concerns or just discuss day-today issues. It was evident during this visit that people using the service are able to choose how to spend their day; one was at a day centre, two went shopping, two went to the doctors and another stayed at home. The people using the service said that they got up and went to bed when they wanted. This was evident during the inspection. The menus are devised with the people using the service prior to the weekly shopping day. One of the residents said that alternatives to the menu are always available. None of the people living at The Cedars have been involved in staff interviews, although the organisation is planning to explore this. The organisation is setting up a service user forum to which, one of the people living at The Cedars has asked to attend. The Person Centred Plan process will further enable the people using the service to be involved in decision making. The introduction of ‘user friendly’ documentation will assist the people using the service to make more informed choices and decisions. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisational ethos promotes independence and the right to live in a flexible environment where the residents’ choice of routines are acknowledged and respected. The people using the service are able to enjoy a range of activities and access the community independently, if they choose to. EVIDENCE: The people living at The Cedars are able to access the community independently. They have concessionary bus passes which enable them to use public transport freely in the whole of the Staffordshire area and are looking forward to having national bus passes. The people using the service access the local community including Hanley Shopping Centre, local shops, supermarkets, markets and carboots. One resident attends a local Day Centre and a charitable mental health support The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 15 group. Both of these offer skills training and leisure and recreational activities, and mental health support. Another attends a Men’s Group, which promotes mental health well being and offers leisure activities. All have the opportunity to participate in meals out in local and country pubs, however there are some people living at The Cedars who do not like to be involved in trips out. Most of the people using the service choose not to attend college. Some residents also attend a local independent user-led and run group. This offers a wide variety of social, leisure and educational activities. Friendships have formed in the Home and with some of the residents in the other Homes. One of the residents has joined the local angling group. The organisation has the use of two 7 seater people carriers. All people using the service are on the electoral register and have the opportunity should they so wish, to cast their votes in local and national elections. Nearly all residents have regular contact with their family. One family is particularly supportive to the Home and all of the residents. Each person using the service has their own bedroom if they wish to spend time alone. People are able to get up and go to bed when they wish. The people using the service can have a key to the house or their bedroom. Annual holidays are organised, although these tend to be as a group. This also applies to outings and trips due to low staffing levels. All major excursions have to be planned in advance because there is only one member of staff on duty at a time, which limits the possibility of ‘inpromptu’ outings. The people using the service are encouraged to particpate in the Home’s domestic tasks, although the main responsibility for this lies on the staff. This also limits the time they are able to spend with the people using the service. Alternatives to the devised menu are available and staff are trained in food and hygiene practices. Some of the people using the service enjoy being involved in food preparation, particularly baking. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 16 The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services have access to healthcare and remedial services and staff assist them to attend appointments and visit local health care services. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. EVIDENCE: The people living at The Cedars do not require ‘hands on’ support with their personal care but some require encouragement and prompting. This is indicated within the care plans. There is ample recorded evidence that the health of people using the service is monitored and the appropriate medical, professional services accessed. All of the people using the service are registered with a general practitioner and are they supported in making appointments and if necessary attending those appointments. All have six monthly medication reviews. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 18 All of the people using the service are encouraged and supported to attend dental, chiropody and optician appointments for check ups and treatments. Some attend practice nurse appointments for vaccinations and one the diabetes clinic. The people using the service are supported to attend outpatients specialist appointments including psychiatry, psychology and mental health services. The medication systems and procedures were checked. Medication is appropriately stored in a new cabinet and stock control is monitored. Records are kept of all medication brought into the Home or returned to the pharmacist. The administration records are well maintained and no errors or gaps were seen during this inspection. Protocols have been developed for all PRN medication and explanations as to the reason and effects of medication are available for staff. Advice was given about the use of a homely remedies protocol for a vitamin suggested by the community pyschiatric nurse The staff at The Cedars have received ‘in-house’ medication training and their continuing competency will be checked every six months. The manager and assistant manager have undertaken the indepth ‘Safe Handling of Medicines’ course. It is hoped that all staff will receive this training. Two of the people using the service self administer their medication. Appropriate paperwork is in place and the staff check that the medication is being taken properly on a weekly basis. Up to date the people using the service have been very reluctant to discuss death and any after death wishes they may have. The organisation has commited to continue working in this area, to ensure that individual wishes are known and followed at this very difficult time. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been no complaints about this service and the people using the service have opportunities to express their concerns. The procedures followed in the Home protect the people using the service and training is being planned, which will show the staff how to recognise and respond to potentially abusive situations. EVIDENCE: There have been no complaints made about this service to the organisation or the Commission for Social Care Inspection. A new complaints procedure in pictorial format has been developed and this is on display in the hallway. The people using the service have opportunity to express their concerns during regular meetings or within their monthly one to one sessions with staff. The Home has access to the Local Authority Adult Protection policy but was asked to obtain the new ‘Safe Guarding’ policies. The organisation undertakes Protection of Vulnerable Adults and Criminal Records Bureau checks on all prospective staff. The financial procedures were checked and the records and monies tallied. The people using the service and the staff member sign all transactions and receipts are obtained. The manager has recently completed training, which will enable her to train staff in the safeguarding of adults. At the time of this inspection this training had not been provided to all of the staff working in the Home, although it was The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 20 believed that training has been requested. Staff undertaking Learning Disability Awards Framework and National Vocational Qualification training will cover the area of adult abuse. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable but some areas have not been decorated for many years and although there is a programme to improve the decoration, fixtures and fittings, maintenance tends to be reactive rather than proactive. The staff endeavour to keep the Home clean, however this is made difficult by the dated decoration and furnishings. EVIDENCE: The Cedars is a large Victorian house, close to Hanley city centre. All of the people using the service have their own bedroom, although none have en-suite facilities. Each has a wash hand basin. The people using the service are encouraged to personalise their rooms, all of which are lockable. There is an upstairs bathroom and separate toilet and a downstairs shower room. A small office/staff ‘sleeping in’ room is provided on the first floor. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 22 The people using the service have the use of a communal lounge, a dining room and there is a small ‘domestic’ kitchen. The Cedars share a laundry facility with two adjacent Homes belonging to the same organisation. The Home is comfortable and domestic in style but does need redecoration and refurbishment in most areas. Most of the bedrooms, the upstairs toilet, hallway, bathrooms and the lounge are outdated and the decoration ‘jaded’. In places the wallpaper is ripped and the carpets old. The kitchen needs refurbishment including the flooring, which harbours dirt and germs. The dining room was painted at the beginning of 2006 and one bedroom has been decorated. There are plans to paint the lounge and decorate one bedroom. Considering the state of the decoration the staff do a good job in maintaining cleanliness in the Home. It is recommended that together with the liquid soap, paper towels are provided in the communal bathrooms, kitchen and laundry to maintain infection control. Staff have recently received infection control training. The Fire Safety Officer visited the Home in April 2006 and the organisation was required to make a number of improvements. He visited again in November and confirmed that they had been completed. The environmental health officer has not visited the Home recently. The organisation recognises the improvements needed to the environment and have developed an action plan for 2007. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service benefit from being supported by staff that are well recruited and supervised and trained to meet their needs. The low staffing levels are adequate for group activities but would not allow for individual or spontaneous pursuits. EVIDENCE: There were two people on duty during this inspection, the manager and a senior support worker. The manager is rarely involved in providing hands-on support due to her managerial responsibilities, although she is available to offer assistance if required, for example if the staff member on duty has gone out with some of the people using the service she can support those people choosing to stay behind. The staff member is also expected to undertake all the domestic tasks, meal preparation and the laundry. This has been identified as being a hindrance to the provision of individual excursions and activities, although the people living at The Cedars are very independent and able to access the community on their own. They also regularly go out in pairs, as supportive friendships have been developed. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 24 The organisation will need to demonstrate that they review the staffing levels on a regular basis to ensure that they still meet the residents’ needs. Four staff are employed at the home, two of which have National Vocational Qualification 2 or above. The Home does not use agency staff and the staff attend monthly team meetings and receive monthly supervision from the assistant manager. The residents said that they liked the staff. As an organisation, Caretech provides a range of training courses and the staff also attend some arranged by the Local Authority. The training records of the staff employed at The Cedars were checked and mandatory training is mainly up to date. They have also been trained in mental health awareness. The staff member on duty said that the training is very good. The manager was able to evidence that she requests the required training, but that it is not always provided within the necessary time frame. The organisation has introduced the Learning Disability Awards Framework award as part of the staff induction and the manager is trained as an assessor. She is also trained to provide training in the Protection of Vulnerable Adults, although as yet she has not delivered any courses Three staff files were checked. The organisation obtains Protection of Vulnerable Adults checks before people work in the Home and Criminal Records Bureau checks are also undertaken. Two references are sought and the files contain all of the required elements. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 25 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, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisation is improving and developing systems that monitor practice and compliance, although more work is needed in this area. The manager is qualified and has the necessary experience to run the Home. Improvements have been made to fire safety arrangements. EVIDENCE: The manager, Tracey Baddeley has recently completed the National Vocational Qualification 4/Registered Managers Award. She is the registered manager of three homes in close proximity, although her office is based at The Cedars. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 26 The Fire Safety Officer visited the Home in April 2006 and the organisation was required to make a number of improvements. He visited again in November and confirmed that they had been completed. The environmental health officer has not visited the Home recently. Caretech has developed generic risk assessments. The manager has checked them and additional, specific information added if needed. A random selection of the maintenance records were checked, which confirmed that fire safety, electric and gas provision are afforded the appropriate priority. It was suggested that the residents’ names be added to the list of people involved in a fire drill, if applicable. The office door is still being propped open. The manager said that the fire safety officer had agreed this action as long as the office is occupied and that a risk assessment has been completed. The risk assessment was seen during this inspection and the door was not propped open when empty. However, to avoid any risks it is strongly recommended that the office door be fitted with a closure, which is connected to the fire alarm system. The area manager visits the Home on a monthly basis to monitor the quality of the service provided. The people using the service regularly meet as a group and in one-to-one sessions with the staff. It was not ascertained whether the organisation uses surveys or questionnaires to gather people’s views, which should include service users, staff, families and stakeholders, or if the results of these are formalised in any way. Daily checks are made to check the cleanliness of the Home. Staff receive regular supervision and attend monthly meetings. Caretech had implemented a quality audit system and The Cedars had two audits in 2006. They were given a score, which improved at the second visit. There has not been an audit in 2007. The manager completed the Commission for Social Care Inspection Annual Quality Assurance Assessment document prior to the inspection. The organisation is planning to implement a new Quality Assurance system in the next twelve months. There are plans to initiate a forum for the people using the services in Hanley. A resident of The Cedars has agreed to attend. Caretech has the Investors in People award. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 27 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 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 3 X 2 X X 3 X The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 (1b) Requirement Timescale for action 10/09/07 2. YA39 24 The manager must ensure that all items not included in the cost of fees are clearly listed in the contracts and Service Users Guide. This will ensure that the people using the service have the correct information about what they may be expected to pay. The organisation needs to 10/10/07 formalise their Quality Assurance arrangements to ensure that the views of people using the service, staff and stakeholders are gathered, the results collated and a report as to any action required available. 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 YA1 Good Practice Recommendations The Statement of Purpose and Service Users Guide should be developed in formats, which can be understood by the DS0000064029.V338635.R01.S.doc Version 5.2 Page 29 The Cedars 2. 3. YA14 YA21 4. 5. 6. YA23 YA24 YA30 7. 8. YA33 YA42 people using the service, to ensure that they have access to the information they may need. The people using the service should be offered the opportunity to enjoy spontaneous, individual activities. To consider the subject of ageing, death and dying and establish individual wishes. This will ensure that the people using the service and/or their families’ wishes are followed in this event. The manager must ensure that all staff are trained how to recognise and respond to potential abusive situations. To consider total redecoration and refurbishment of the Home to ensure that the people using the service live in more pleasant surroundings. Systems should be in place to control the risk of infection, including paper towels in the communal bathrooms, toilets, kitchen and laundry and washable flooring in the bathrooms and toilets. The organisation should demonstrate that they regularly review the staffing levels to reflect the needs of the people using the service. The office door should be fitted with a closure that is connected to the fire alarm system. The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Stafford Local Office Dyson Court Staffordshire Technology Park Beaconside STAFFORD ST18 0ES 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 The Cedars DS0000064029.V338635.R01.S.doc Version 5.2 Page 31 - 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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