Care Home: The Cedars

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What the care home does well Key workers and staff write monthly reviews of peoples needs in their service user plans. This means that they can see if anyones needs have changed and act on this. However, this regular review is not the case for personal goals. People have communal areas to relax in including the lounge and dining room. The garden is well kept. Relationships are supported so people can keep in touch with family and friends. The annual quality audit by the company is thorough. One person said staff help me with my money and medication. I do my own food shopping now. What has improved since the last inspection? Some people have been involved in developing their care plans. One person told us about their goals for the future that are now recorded with a plan of support in place so staff know how to support the person to achieve. Unfortunately there are no dates or timescales on plans to say when things should be done by. This means that service users do not know when things will happen and some goals may not be achieved. Information about the home is more user friendly in that pictures, symbols and photographs have been added. The manager has introduced a more formal handover sheet for staff to record information that needs handing over to other staff. This aids communication between staff. The company are in the process of updating the assessment tool so that it gathers more information about people. The AQAA says that the induction for new staff has been improved. Staff now attend a two week long induction as well as an in house induction. What the care home could do better: As found at the last inspection people with specific health needs do not always have this detailed in their support plans. This means that staff may not know what support they need to remain well, healthy and safe. There is no record of some of the medication that enters the home. This means that staff cannot be sure what stocks of what particular medicines they have on site. Staff hand write some medication administration records. These records are not currently recorded in line with good practice guidance and the Minimum Standards so may place people at risk of getting the wrong dose. For one person sampled, three personal goals are recorded but no target dates have been added. Progress towards the goals has not been reviewed for nearly six months. This means that staff do not know if the person is achieving or if the support they are giving is right or needs to be changed. We found that some people go out independently and others have to rely on staff. People who have to rely on staff are missing out on opportunities due to the lack of suitable transport arrangements. The manager said she plans to speak to a nearby home about sharing their transport and drivers. We found that when people cannot attend planned activities there is not much else on offer as an alternative. This means that people may be at home with not much to do leading to low levels of participation and engagement. Key inspection report Care homes for adults (18-65 years) Name: Address: The Cedars 10 Grimston Avenue Folkestone Kent CT20 2PS     The quality rating for this care home is:   one star adequate 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: Kim Rogers     Date: 1 1 1 1 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 33 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 33 Information about the care home Name of care home: Address: The Cedars 10 Grimston Avenue Folkestone Kent CT20 2PS 01303220820 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): cedars.folkestone@craegmoor.co.uk Lothlorien Community Ltd Name of registered manager (if applicable) Miss Natasha Lydia Jane Pryke Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 12. 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) Physical disability (PD) Date of last inspection Brief description of the care home The Cedars is registered to provide accommodation and personal care for up to 12 people who have a learning disability and/or a physical disability. The home is a large detached building in a residential street near the centre of Folkestone where there is a range of public transport, shops, churches and learning and recreational facilities. Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 12 12 3 1 0 3 2 0 0 9 Brief description of the care home There is a garden to the rear and parking in Grimston Avenue. The accommodation is provided on three floors. There is a lift to all floors. Fees range from about 825.00 pounds to 1514.55 pounds per week. Please contact the provider for current charges and information about what the fee includes. There is a new manager in post, Natasha Pryke. Care Homes for Adults (18-65 years) Page 5 of 33 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: one star adequate 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 was a key inspection of the service and included an unannounced site visit by one inspector. The site visit was carried out over about five hours. All of the key minimum standards were assessed. The previous key inspection was carried out over two days on 31/03/09 and 4/04/09. We spoke to service users, staff and the manager. There is a new manager in post since the last inspection. The new manager has been in post for about four months. We sampled records, made observations and had a look around the home. We looked at the Annual Quality Assurance Assessment or AQAA that the manager completed. This gives information about what the home does well and how they intend to improve. We looked at other information we have received about the home including any concerns, complaints and notifications about incidents and accidents. Care Homes for Adults (18-65 years) Page 6 of 33 There have been two safeguarding vulnerable adults referrals to the adult protection team at social services in the last twelve months. This means that abuse or harm to service users was suspected and reported. One of these alerts is now closed. The second alert remains open. For more information please contact the Provider. We sent surveys out to staff and service users to gain their views about the service. We only received one survey back, from a service user. This survey was positive. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: As found at the last inspection people with specific health needs do not always have this detailed in their support plans. This means that staff may not know what support they need to remain well, healthy and safe. There is no record of some of the medication that enters the home. This means that staff cannot be sure what stocks of what particular medicines they have on site. Staff hand write some medication administration records. These records are not currently recorded in line with good practice guidance and the Minimum Standards so may place people at risk of getting the wrong dose. For one person sampled, three personal goals are recorded but no target dates have been added. Progress towards the goals has not been reviewed for nearly six months. This means that staff do not know if the person is achieving or if the support they are Care Homes for Adults (18-65 years) Page 8 of 33 giving is right or needs to be changed. We found that some people go out independently and others have to rely on staff. People who have to rely on staff are missing out on opportunities due to the lack of suitable transport arrangements. The manager said she plans to speak to a nearby home about sharing their transport and drivers. We found that when people cannot attend planned activities there is not much else on offer as an alternative. This means that people may be at home with not much to do leading to low levels of participation and engagement. 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 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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. Assessments are carried out or obtained before a person moves in. There is some information about the home to help people decide about moving in. Evidence: No one has moved in since the last inspection. There are currently eight people living at the home. The AQAA shows that trial stays and visits are offered to prospective tenants. To help people decide about moving in there is some written information about the home. The manager has made this more user friendly by adding pictures, photographs and symbols. The information is displayed in the home. The company have updated the assessment tool they use to assess peoples needs. This means that the assessment process is more thorough and finds out about peoples personal goals as well as their needs. Care Homes for Adults (18-65 years) Page 11 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their needs and personal goals will be identified and recorded. Risks are assessed and communication is supported. Evidence: Each person has a service user plan or care plan. The manager said that they have been updating the information in the plans. We sampled one plan in detail and looked at a second plan. We found that updated information about the persons needs has been added to the plan since the last inspection. Staff have been talking to people about their personal goals and aspirations for the future. These have been recorded and steps towards goals have been recorded but there are no target dates. This means that staff do not know what has to be done by when and people will not know if they are achieving or not. The manager agreed to add target dates. For one person three personal goals have been identified and recorded on 8.04.09 and 15.04.09. Staff carried out a review during May 09. There is no further review so it is not clear if staff are giving the right support or if the person is achieving their goals. Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: Staff use a review sheet to evaluate peoples needs in care plans. This review sheet has sections relating to peoples needs. We found that care plans are reviewed on a regular basis. The last two reviews in the plan sampled are dated 20.08.09 and 29.09.09. People have three separate files with different parts of their care plan in each file. The manager agreed that it may be better to have the information in less files so things do not get overlooked. Some people or their representatives have been involved in developing plans. However, one plan showed the persons family were involved initially when the person moved in but there is no evidence of involvement since. This means that they may not have had the opportunity to have a say about the support the person wants and needs. Most plans are written and so are not individualised and may not be meaningful to people. The manager said that no one has had a person centred planning meeting and none are planned. Staff have not been trained on how to facilitate person centred planning meetings although most of the staff have attended a one day course on person centred thinking. This means that they may not have the skills to involve everyone in developing and reviewing plans and embedding person centred planning into the service. Some people have had formal review meetings or have one planned. The manager said she has introduced a more structured handover sheet. This means that staff can note any change in a person needs and hand it over to other staff. We asked staff how they would know about a change in anyones needs and they told us about the handover sheet and communication book. Potential risks are identified, recorded and assessed. Action that staff should take to reduce potential risks is also recorded. Some risk assessments have been updated and rewritten since the last inspection. The way people prefer to communicate is recorded and there are some systems in place to support communication. There is a picture menu board showing the meal choices of the day, however the choice displayed for the lunchtime meal was different to the meal served. There are laminated pictures of activity choices in the hallway. There is a board showing photographs of what staff are on duty. The manager said that one person has a communication book which is in their room as they do not use it. The manager and deputy said this person has a communication need but has not been referred for speech and language support since moving to the home. This means Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: that they may not have the support they need to communicate effectively with people. The manager said that some staff have had training in the Picture Exchange Communication System and in signs and symbols. This means that they will have better skills to support communication. The manager said that more training is planned. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for activities are currently limited due to the lack of planning around transport. Relationships are supported. People have the support they need to help plan and prepare meals. Evidence: Each person has an individual activity planner in his or her service user plan. This covers seven days and evenings and shows what people will be doing. However, opportunities for people who cannot go out independently are currently limited due to the lack of effective planning around transport. We sampled one persons care plan and found they should be going bowling then swimming on the day of our visit. The manager said neither activity will happen due to a lack of staff who drive. The day before our visit the person should have been on a train trip on a one to one basis with staff then line dancing. The manager said that Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: neither activity happened due to a lack of staff who drive. The daily notes showed the person refused the train trip activity. There was no record or evidence of any alternative activities being offered. We found no in house activities being offered on the day of our visit. We observed two people watching television in the lounge and one person standing in the hallway for much of the time. Some people went to the shops with staff and another person went out alone. This means that levels of participation and engagement for some people are low when at home, in that we saw no one participating in things like housework, cooking or meaningful activities. In a service plan sampled we found a record of monthly social activities. There are 36 entries for September 2009 and 19 entries record, in house, 5 walks, 3 times bowling and 5 drives. Out of 28 entries for October 2009, 23 entries say in house. All 5 entries for November 209 say in house. The manager said there is a shift plan in place showing what staff will be doing, however this was not completed until after 11am on the day of our visit and does not show alternative activities for activities that do not happen. This means that people may be left at home with not much to do. Relationships are supported with contact details of family and friends recorded so people have support to keep in touch. Family and friends come to review meetings, if service users wish them to be there. People are supported to be involved in planning and preparing meals. The meal choices of the day are displayed in colour pictures and large print so people can see what is on offer. However what was served for lunch on the day of our visit did not match what the picture menu showed. This means that people may not have known what they were having and therefore may not have the opportunity to make a choice. One person said they shop for their own food and do their own cooking. Others have more staff support with planning and preparing meals. For some access to the kitchen and the laundry is restricted unless staff are present. There is a cook during the week and at weekends staff take turns to cook. People needs relating to eating and drinking are recorded including any allergies and how to reduce the risk of choking. We saw that staff remain in the dining room while people are eating to give any necessary support. Some people would like to improve their cooking skills and we saw a plan of support Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: showing how staff will support this. We saw one persons plan of how staff are to support them develop more independent living skills like budgeting. For another person a goal of making snacks and getting a drink of water has been identified. However this has not been reviewed for six months and there are no target dates. This means that staff cannot know if the support they are offering is right and may not know what they should do and by when. There is no record of whether the person is making their own snack and drink yet. People told us about their recent holiday and said they enjoyed it. The manager said that everyone went on holiday together again and in the future more individual holidays will be supported so people have more of a choice. We received one survey back from a service user who said that they can choose what to do with their days and weekends. Care Homes for Adults (18-65 years) Page 17 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their personal needs will be supported. Some peoples health needs need clearer documentation to ensure they get the right support. Medication storage and control for people has improved but systems for recording receipt and administration of medication need to improve so people are protected from harm. Evidence: Each person has his or her personal care needs recorded in their service user plan. This means that staff know how people prefer to be supported. This information has been updated since the last inspection and where there is a potential risk, this is assessed so staff know what steps to take to reduce the risk. Bathrooms and toilets are close to peoples rooms. No bedroom has en suite facilities. Since the last inspection the manager has put blinds up in the bathrooms and pictures to try to make them look more homely and welcoming. The assisted bath chair is not working so some people cannot currently have the choice of a bath so are using the shower. The manager said they are in the process of replacing the bath chair. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Staff work with health professionals to ensure that peoples health needs are supported. One person said that they have the support they need to attend medical appointments. Staff have training relating to peoples particular health needs including diabetes. Health needs are recorded in individual plans with any risks to health assessed. Guidelines in place to support specific health needs like diabetes however, for one person there was no information or guidance about how to support a significant health need. For this person there is no clear guidance for staff to say what support the person needs as a booklet in the persons plan is incomplete. We found evidence that this health need is ongoing and still relevant. This shortfall was found at the last inspection. People have a booklet about their health but these are not all complete. The manager said she is in the process of completing these with people. There are systems in place to monitor peoples health like regular checks on weight. This means staff can act quickly if a change is noticed. People have their medication stored safely in their rooms. This means that everyone has some control over his or her medication. Staff give the necessary support to ensure that people get their medication at the right time etc. Staff have training before they can administer medication. The manager said she observes their practice and completes a competency assessment. This ensures that staff are still safe to administer medication. Medication administration records are kept. Staff or service users sign to say they have administered or taken the medication. Staff are hand writing some medication administration records or MAR and not all of the detail required is included in the hand transcriptions and some information was incorrect. For example one entry says the person has three capsules a day when they have only been given two a day. A dose of medication recorded in the person service user plan was incorrect when checked against the MAR. This means that staff may not have the information they need to safely administer the right amount of medication to people. For one person sampled there is no record of receipt of their medication into the home. The manager agreed that there are no records kept of the receipt of this persons medication into the home. This means that there is no record of how much stock they have of the medication and whether they received it or not. Current systems for checking and reporting medication issues may need to be reviewed and improved. For example checking any hand written entries are accurate and that there is a receipt for all medication into the home. This shortfall was found at Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: the last inspection. Care Homes for Adults (18-65 years) Page 20 of 33 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. People know their complaints will be listened to and acted on. Staff know what abuse is and who to report it to. Evidence: There is a complaints procedure displayed in the home with large print and some symbols. Currently this is not meaningful to everyone so not everyone can use it. The AQAA says they plan to make information like this more meaningful to people so it is more user friendly. Staff said they would listen to complaints and report them to the manager so she could investigate. The AQAA shows there have been no complaints since the last inspection. We received one survey back from a service user and it said that they know who to talk to if they have a problem. It said that staff would listen to them and act on what they said. The manager said that regular meetings between staff and service users enable concerns and complaints to be raised. Staff have training in how to safeguard people from harm and abuse. We found that staff know what abuse is and who to report suspected abuse to. There have been two safeguarding referrals in the last year. One made by the home and one made by a service users family to the adult protection coordinator at social services who investigates the suspected harm and abuse of vulnerable adults. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: One safeguarding alert is open and the other is closed. For more information about this please contact the Provider. Care Homes for Adults (18-65 years) Page 22 of 33 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 home is generally clean and well maintained. Evidence: The home is clean and generally well maintained. People have their own bedrooms, as they are all single rooms. People spoken to said they are happy with their rooms. Each room has a wash hand basin and no room has en suite facilities. We found that one persons bedroom window at the front of the house has flaking paint and does not open and close easily. We found that it does not close fully and one of the blinds is missing. There are no curtains. The AQAA says they have plans to improve the environment. There is a large lounge with lots of sofas and a large television so people have space to relax. There is a large dining room so people can eat together if they wish to. The communal areas like the lounge, dining room and hallway feel homely with pictures and photographs of people enjoying their holidays and other activities. The garden is well maintained so is a pleasant place to spend time. Access to the kitchen, laundry and outside space is restricted for some people. In one persons plan it said that this was because there was a risk of harm. The kitchen is open when staff are present and we observed this on the day of the visit. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The manager has put up a new blind in one of the bathrooms. We saw marks to the ceiling that look like stains from a water leak. A bath chair to assist people in and out of the bath is not working. The manager said this means people who cannot use the bath independently currently have to shower. The manager said the bath chair will be replaced so that everyone can have the choice of a bath or shower. We received one survey back from a service user and it said that the home is usually clean and smells fresh. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to meet peoples needs but at times there is a lack of opportunities due to lack of drivers and planning about transport arrangements. Staff attend mandatory training courses and have an induction. Recruitment checks are carried out before people start working at the home. The frequency of staff meetings and staff supervision is below the minimum standard. Evidence: There are usually four staff on duty and there is always a senior team leader on duty. At night there is one staff awake and one staff on call asleep. The manager said that she and the deputy usually work Monday to Friday but have covered some shifts recently. We found that there is usually enough staff to meet the service users needs. However due to the lack of effective planning around staffing and transport, some service users are missing out on opportunities to go out and attend activities. The manager said that the team leader prepares a shift plan so staff know what they will be doing and who they will be supporting. This means that there is some structure and organisation of the shift. However on the day of the visit the shift plan was not done until the manager realised and this was after 11am. The manager said this was because there was an inexperienced acting team leader on duty. The shift plan showed no alterative activities for activities that had been cancelled due to the lack of Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: drivers. Staff knew about peoples needs when we asked and this corresponded with what is recorded. Staff said they know about any changes to care plans because changes are handed over to them or are in the message book for them to read. The manager said she has introduced a more formal handover sheet to aid communication between the staff teams. Staff have had limited opportunity to attend staff meetings this year and one to one meetings with a line manager. The manager has held one staff meeting on 18.09.09 since starting work at the home in July this year. The other staff meeting minutes we saw were dated 29.04.09. The manager said she thought staff meetings were held in June and July this year by the previous manager but there are no minutes. The level of supervision for staff is below the minimum standard. This means that staff have not had formal opportunities to discuss training and service issues and have some coaching, support and mentoring. In one staff file sampled we found no record of supervision for a staff member who has been working at the home for three months. The manager said that supervision or one to one meetings need sorting out and she plans to train team leaders to take some of this responsibility. The manager said she is working through yearly staff appraisals at present. The manager said that staff are up to date with their mandatory training. This means staff have the skills and competencies required to keep service users safe. The AQAA shows that 9 out of 17 staff has a National Vocational Qualification in care at level 2 or above. Some staff have had training relating to peoples needs like alternative communication and diabetes. The manager said that staff have had training in the Picture Exchange Communication System to help improve communication. Most of the staff have attended a one day course in person centred thinking. Two staff are being trained in how to use intensive interaction techniques. We sampled two staff files and found that recruitment checks are carried out before people start work at the home. The manager said that prospective staff meet service users and have a look around the home before they start working at The Cedars. The AQAA says they are in the process of updating staff Criminal Records Bureau checks. This follows one staff members arrest for working illegally in this country. She had worked at the home for two years. The company had carried out the required checks on this staff member. For more information please contact the provider. The AQAA says that the induction for new staff has been improved. Staff now attend a two week long induction as well as an in house induction. We saw evidence of this in Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: the staff files we sampled. The manager said there are three new staff so there is a full staff team and one support staff has left the home since the last inspection. Care Homes for Adults (18-65 years) Page 27 of 33 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 home is adequately managed. Changes are made based on peoples views. Peoples health and safety is protected. Evidence: There is a new manager in post. The manager has been in post since mid July this year, so for about 4 months. The manager has 8 years experience in working with people with learning disabilities and has a National Vocational Qualification in care at level 4. She also has the Registered Managers Award qualification but has no accredited qualification relating to learning disabilities. She said she has attended one day courses in subjects including autism, challenging behaviour and person centred thinking. She has also completed a five week long course about intensive interaction techniques. The manager has gone through the process to be the registered manager. She has applied and has been interviewed by us and has been judged to be a fit person to manage the home. The manager completed the Annual Quality Assurance Assessment or AQAA. This gave us the information we need about the service, staffing and service users. The manager Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: says she has plans to improve the service. The AQAA shows they understand and support issues relating to equality and diversity. The manager has identified barriers to improvement including staff sickness and staff leaving. The manager has some ideas of how to overcome these barriers so that outcomes will still improve. There are systems in place to find out about what people think of the service. There are regular service user meetings, surveys are sent out to people to gain their views and there are area service user meetings called Your Voice meetings. The AQAA says that one service user from The Cedars attends the Your Voice meetings. The company carry out regular checks to see how the home is doing. An area manager caries out monthly visits to the home to audit practice and systems. The manager said she has regular one to one meetings with a line manager for support. The AQAA shows that they have made changes based on service users views in that they involve service users in recruiting potential staff. The Your Voice group have produced a DVD and people have been involved in the Special Olympics held in Ashford. The manager said that service users are involved in planning the weekly menus and she would like to give people more choices about their holiday destinations next year rather than all go together. She plans to get holidays organised earlier so people know where they are going and can choose who they go with. The AQAA shows that health and safety checks of the premises and equipment are carried out, as they should be. Staff have training related to area of health and safety including fire awareness and food safety. The manager said that all staff now have first aid training once a year. Fire drills have been held since the last inspection. The manager said she has gone through the fire procedures with the new staff and new and current staff also have training in fire awareness. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 12 The manager must ensure 31/12/2009 that people with specific health needs have a support plan in place. To ensure that staff know what to do to keep people safe and well. 2 20 13 There must be a record of 31/12/2009 receipt of all medication that comes into the home. Hand written entires on medication administration records must include all of the required information. To ensure that staff know the amounts of what drugs are stored at the home and to ensure that staff have the information they need to administer medication safely and correctly. Care Homes for Adults (18-65 years) Page 31 of 33 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 32 of 33 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). 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. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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