Care Home: The Cedars

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What the care home does well The service provides a large and comfortable home which also has good access to local facilities. The home provides opportunities for individual and group activities within the home and in the community. There are good opportunities for staff training and people using the service are positive about the staff providing their care and support. There are good systems in place for support and scrutiny of the service from the registered Provider. What has improved since the last inspection? This inspection identified a number of improvements that have been made by the service that are resulting in better outcomes for people living in the home. It was observed by the Inspector that there appeared to be a more relaxed and settled atmosphere within the home and a positive approach to service provision from the staff team. Improvements have been identified in the care planning, including increased involvement of the people using the service in this process. There have been increased opportunities for activities and excursions into the community and increased promotion of choice. The service no longer runs a day centre within the home, which has promoted greater opportunities and the development of independence skills. There are improved arrangements in place around the access to the kitchen and the involvement of people in menu planning and food preparation. There have been improvements in the choice of information displayed in the home which is more appropriate. Staff have been provided with improved leadership and direction in terms of the philosophy and direction of care from the manager and senior staff. What the care home could do better: The care planning system could be developed further to increase the understanding and involvement of people living in the home. Care planning could also identify more specific goals and targets for some people and clearer evidence around the reviewing process. There is a need for all paperwork to be correctly signed and dated and some recording could be done more consistently to fully reflect the work, and initiative, of the care staff. Formal supervision and appraisals of care staff could be better recorded and also undertaken on a more regular basis. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Cedars 144 London Road Gloucester Glos GL2 0RS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynne Bennett     Date: 0 3 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home Name of care home: Address: The Cedars 144 London Road Gloucester Glos GL2 0RS 01452500899 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cotswold Care Services Limited Name of registered manager (if applicable) Mr Bradley Stewart Morse Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 9. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home The Cedars provides care and accommodation for up to nine adults with learning disabilities. The home is owned and run by Cotswold Care Services Limited, which is a subsidiary of the Craegmoor Healthcare group. It is a large three-storey detached Victorian house about a mile from the centre of Gloucester. All people living at the home have single bedrooms. Communal areas include the kitchen, dining room and lounge. There is also an enclosed rear garden with an outbuilding used for activities and as a sensory area. The home incorporates a dayCare Homes for Adults (18-65 years) Page 4 of 26 care home 9 Over 65 0 9 Brief description of the care home centre which is used by people living at the Cedars and by some people living elsewhere in the community. The base fee was reported to be #1135 per week, although there is individual negotiation depending on peoples assessed needs. A summary of the Statement of Purpose is displayed in the hall. Prospective service users and others involved in their care are offered information about the home including copies of the Statement of Purpose and Service User Guide. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was undertaken on 2/06/09 with an additional visit taking place on 3/06/09. The Inspector met with the registered manager, the senior staff and care staff and also the majority of the people living in the home. The Inspector also had contact with health professionals who are involved with the service. Records relating to care planning, staff recruitment and training, medication and health and safety were examined. An inspection of the environment was also carried out. Care Homes for Adults (18-65 years) Page 6 of 26 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 Care Homes for Adults (18-65 years) Page 8 of 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people are assessed before they are admitted to the home to ensure that their care and support needs can be met. Evidence: There have been no admissions to the home is the previous twelve months and the service currently has one vacancy. Assessments were being undertaken for one person who is considering moving into the home and they have recently visited and met staff and other people living in the home. The service is currently applying for a variation to ensure that it is registered correctly to meet the needs of this person. The service has a Statement of Purpose and Service User Guide in place and these documents contain the required information. These are not currently available in different formats including pictures and symbols but have been reviewed by the manager during the last twelve months Care Homes for Adults (18-65 years) Page 10 of 26 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. Peoples needs are met by person centered planning and the promotion of choice. Independent skills are developed and supported with the use of risk assessing Evidence: All care plans were in place and the home has further developed the process to be more person centered in style and process. Staff and people living in the home were positive about the new plans. Whilst there was a number of signatures to show parts of the plans had been reviewed and all were up to date there was little evidence of the actual reviewing process, or the involvement of the person in the process. Staff spoken with confirmed how they had involved the people in discussing and reviewing plans. A communication dictionary was seen in one file that provides guidance for staff on how to interpret behaviors and gestures and is designed to help staff improve communication and understanding. One staff member explained how this knowledge had improved their working relationship with the person concerned. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: There have been a number of service user meetings over the recent months. These meeting records show people being asked about a variety of issues within the home and provide evidence of people being involved in the running of the service they are using. One person also attends an area meeting organized by the Provider. People living in the home have also been involved in the recruitment of new staff Care Homes for Adults (18-65 years) Page 12 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to pursue their interests and are encouraged and supported to undertake activities in the community. People living in the home appear confident about their ability to make decisions about their lives. Evidence: People using the service are being encouraged and supported to have more involvement in domestic tasks such as cooking and cleaning and also be more involved in the cleaning of their rooms. People spoken to were positive about this. Since the previous inspection the service has closed the on site day centre and started organizing more individual programmes for people. All staff and people living in the home were very positive about this change and the better choices and increased variety that is now available. Each individual file contains a document called an activity Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: tracker which records what activities have been undertaken. Some files contained few entries and there was evidence of some activities that been completed that had not been recorded. All staff and people living in the home were positive about the increase in individually supported trips and activities. People spoken to said they had enough to do both during the day and in the evenings and weekends. One person described how they were now doing some work experience which had been a goal from their care plans. There has been an improvement in providing access to the kitchen whilst maintaining safety and meeting peoples needs. People are having increased opportunities to cook and plan meals and people were observing preparing their breakfasts, and snacks throughout the day. The kitchen was well stocked with fresh produce and the menus showed that increased healthy options are being promoted. Staff and people living in the home were positive about the food provided and all said that there had been an improvement in the quality, particularly the decreased amount of packaged and prepared meals that were now eaten. Care Homes for Adults (18-65 years) Page 14 of 26 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. Service users are supported to access the healthcare professional they require to ensure that physical and emotional health needs are met. Satisfactory arrangements are in place for the handling of medication, promoting service users wellbeing and encouraging their independence. Evidence: There was evidence that health needs are correctly monitored and issues recorded. Everyone has a Health Action Plan in place, though some of these are not dated and some contain more detail than others. People are receiving specialist health input where required. One person is being supported to move towards self medication and this is being done in a structured and well managed way. All people living in the home have had an health review completed by their doctor and there was evidence that all medication has been reviewed at the correct intervals. It is planned to have health reviews every six months. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: The medication and administration was examined and found to be satisfactory. There was an identified problem with the reordering of some medications when tablets within the monitored dosage system in place had been used out of sequence. Clarification was provided on this and evidence supplied that the issue had been addressed. The current location of the medication storage is not ideal and after discussion with the manager it is recommended that the service risk assess the situation and take what steps are required. Advice was also sought from the Commissions pharmacy Inspector. Care Homes for Adults (18-65 years) Page 16 of 26 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. The home provides a safe environment for service users in which they are respected and treated with dignity. Evidence: Staff have undertaken training in Protection issues and staff spoken with demonstrated an awareness of the relevance of this training to the roles they perform. All staff have undertaken training in the managing of challenging behavior and people said that this had been effective and improved their knowledge in how to manage behaviors and situations. It was observed during the inspection visit that there was a more relaxed atmosphere in the home and people appeared comfortable and confident in their environment. People living in the home spoken to said they felt safe and also that they knew how to make a complaint and who to talk to if there was something they were not happy about. Care Homes for Adults (18-65 years) Page 17 of 26 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 service provides homely and comfortable accommodation which is spacious and appropriate to their needs. Evidence: All parts of the home appeared well decorated and maintained and the home was clean and hygienic throughout. Part of the home was formally used as a day centre and it was explained how it is hoped to provide access to this room from the dining room in the future which would improve the communal facilities for the people living in the home. The home has a large secure garden which was being enjoyed by the people living in the home at the time of the inspection. People living in the home were positive about their bedrooms and were encouraged and supported to personalize these. People are provided with keys to their rooms if they choose. People said that staff respected their privacy and did not enter rooms without permission. The kitchen access has been improved to promote independence and fully involve Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: people in cooking. This was seen by staff and service users as a positive development. Care Homes for Adults (18-65 years) Page 19 of 26 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. Service users are supported by a staff team that relates well to them and has a positive approach to their care and support. Formal supervision of staff, the reviewing of staffing levels and improved guidance in meeting needs has produced increased opportunities and improved outcomes for service users. Evidence: Service users spoken with were positive about the staff and the support and care they received. People said that they could talk to staff and they enjoyed undertaking activities with them, both in the home and in the community. Staff and people living in the home were observed interacting in a positive and relaxed manner and people were seen being encouraged to make choices and decisions about their daily routines and activities. People gave various examples of things they enjoyed doing with staff, including domestic chores and tasks. Staff spoken to demonstrated their knowledge of the needs of the service users and how to communicate effectively. The staffing structure has been changed since the last inspection with a manager and two seniors comprising the management team. Staff said they were positive about this change and they thought that it was working well. Staff thought they worked well as a Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: team and were positive about the support they provide to each other. The rota has been changed to ensure that staff are working shorter shifts and that the cover is more flexibly arranged. The rotas showed that sufficient staff levels are maintained. Some staff thought that at times more staffing could be provided at weekends and the manager explained that he was currently looking at ways of changing some weekend cover. Staff confirmed that when additional cover was required to support extra activities these requests had been agreed. People also said that the decrease in the use of agency or relief staff had had a beneficial effect on consistency of approach to the care and support. Training updates are coordinated centrally by the Provider and all staff were up to date with the required training. Five people have completed their NVQ s and another four were working to wards them. Staff have received good levels of informal supervision and there were records of formal sessions that had taken place, though these were not recorded in great detail and some staff had only had two formal sessions over the previous six months. The senior staff have now done training in supervision and will be taking over some of the supervision responsibilities. Care Homes for Adults (18-65 years) Page 21 of 26 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 being provided with leadership and direction to develop and improve the outcomes for people living in the home and promote a safe environment. Quality assurance systems and scrutiny and support from the Provider help to promote improvements within the home, ensuring that the needs of the people living in the home are met. Evidence: The manager has completed the registration process but is yet to receive their certificate from the Commission so this is therefore not yet displayed. They have also now completed their Registered Managers Award and NVQ training. The manager has received regular supervision from their line manager. The required regulation 26 inspections have been completed and copies of reports have been supplied to the home. There have also been visits from the Providers Clinical Governance Officer. The service has also had a financial audit completed by the Provider, something that is done every six months. The latest report was made Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: available for the inspection and provided evidence of sound procedures being implemented and the correct monitoring being undertaken. The service has also had a quality audit undertaken by the Providers and the copy of the report was supplied for the Commission. This was a positive report and also provided some action points for the service to respond to. The home has also circulated questionnaires to the people living in the home which they have completed on their own or with staff support. The manager is also undertaking training on the Mental Capacity Act and the Deprivation of Liberty Act. Staff and service users stated that they found the manager approachable and responsive to issues or concerns that were raised. Staff also said they felt well supported and that they were pleased with the leadership and direction that had been provided during a period of change and development in the service. All health and safety checks had been completed and recorded. The service employs a maintenance/driver worker to complete these tasks. The service has a fire risk assessment in place and this was reviewed and up to date. All fire safety checks and servicing of equipment completed had been completed. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service could produce its Statement of Purpose and Service User Guide in different formats to improve understanding for prospective service users and those already living in the home. The home should review and risk assess the location of the medication cabinet 2 20 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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