Care Home: Welcome House - The Cedars

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What the care home does well The Cedars offers a homely environment for up to 26 people with enduring mental health problems. The service supports residents to live a relaxed and comfortable life whilst offering opportunities for some further development with regards to independent living skills. The staff liaise well with local health and social care professionals ensuring that the healthcare needs of residents are met. The registered manager is a stable influence on the home providing good leadership, direction and role modelling. The organisation has well developed quality assurance processes and the health, safety and welfare of service users is maintained. There have been no complaints or safeguarding vulnerable adults alert since the last inspection process. What has improved since the last inspection? The registered manager has addressed all the requirements and recommendations made at the previous inspection. The individual service user plans provide good evidence and guidance to ensure residents care and support needs are met. The organisation has developed an improved training programme sourcing external training providers. Work has been on-going with a number of residents to help re-establish family ties. The numbers of staff have improved with an extra 4 staffing hours provided per day to help support service users in and out of the home. What the care home could do better: 2 recommendations and no requirements have been made as a result of this inspection process. It is advised that the registered manager and organisation maintain a continuous review of staffing numbers especially with regard to increasing numbers and changing needs of service users. The organisation should also amend the staff application form requesting a full employment history. It was also noted that the registered manager might benefit from updating some of her own mandatory training needs in the near future. CARE HOME ADULTS 18-65 Welcome House - The Cedars The Cedars 2 Hartlip Hill Hartlip Sittingbourne Kent ME9 7PA Lead Inspector Joseph Harris Unannounced Inspection 30th April 2008 09:30 Welcome House - The Cedars DS0000024041.V361143.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 Welcome House - The Cedars DS0000024041.V361143.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. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Welcome House - The Cedars Address 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) The Cedars 2 Hartlip Hill Hartlip Sittingbourne Kent ME9 7PA 01795 843837 01795 842209 cedars@welcomehouse.co.uk Dr Toqeer Aslam Mrs Heidi Baum Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (26) of places Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th June 2007 Brief Description of the Service: The Cedars is a large detached property with accommodation on three floors, offering twenty single and three double rooms, which are all currently used as single rooms. There are three sitting rooms on the ground floor, one of which is a smoking room. There is also a large dining room and a domestic sized kitchen. The home is located on a busy arterial road between Rainham and Sittingbourne, with the village of Newington some 15-20 minutes walk away, where shops and a mainline railway station are situated. There is a bus stop 200 yards from the property, which offers an hourly service to Rainham and Sittingbourne. The home does not have dedicated transport. There are reasonably well-tended gardens to the front and rear of the building, and ample parking for cars. The current scale of charges at The Cedars is £580 per week. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection process culminated in a site visit to the home on 30th April 2008. The site visit commenced at approximately 9.30am and concluded at 2.30pm, lasting for around 5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the registered manager, staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: What has improved since the last inspection? Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 6 The registered manager has addressed all the requirements and recommendations made at the previous inspection. The individual service user plans provide good evidence and guidance to ensure residents care and support needs are met. The organisation has developed an improved training programme sourcing external training providers. Work has been on-going with a number of residents to help re-establish family ties. The numbers of staff have improved with an extra 4 staffing hours provided per day to help support service users in and out of the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 7 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 Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 8 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): 2 and 4. Quality in this outcome area is good. Prospective service user’s needs and aspirations are assessed. There is the opportunity to visit the home prior to moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service user files were examined, one of which related to someone who has recently moved into the home. In all cases the files contained relevant preadmission information including Care programme approach (CPA) documentation, care plans and risk assessments. The service also completes their own assessment covering all key areas of need and future plans. This information forms the basis of the initial plans of care and support. The registered manager invites the prospective service user to visit the home. During the site visit one individual visited the home with their care manager. They had opportunities to discuss worries and concerns and were shown around the home. The prospective service user said, “I like it here, everyone seems very friendly”. The option to spend a day and an overnight stay were also discussed. The registered manager stated that the aim is to be flexible in the admission and assessment process allowing prospective service users as Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 9 much time as they wish, whilst enabling staff and service users to get to know the individual. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 10 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 and 9. Quality in this outcome area is good. Service user’s needs are assessed and reflected in an individual plan of care. Risks are well managed and residents can make decisions affecting their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 3 individual service user files were examined during the course of the site visit. In each case a detailed and comprehensive support plan had been developed based on assessment information and the changing needs and aspirations of service users. Some minor omissions were noted and discussed with the registered manager. All of the service user plans have been reviewed and updated since the last inspection and the manager has invested a good deal of time and effort in improving this aspect of the home. The home aims to involve Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 11 residents as fully as possible in developing the plans of care, however this is dependent on the individual and their own preferences. A clear risk assessment process has been developed. All residents have a preliminary risk assessment completed and where a significant risk factor is identified a detailed risk management plan is then formulated. The risk assessments provide guidance to minimise risks and are based on promoting responsible risk taking rather than restriction. Service users are able to make decisions affecting their day-to-day lives. The home does not take an appointee role in relation to individual’s finances. This facility is provided by people independent of the home where necessary. The staff team have completed Mental Capacity Act training and the registered manager has become a trained trainer in this topic, showing a good level of awareness enabling service users to make decisions and assert their independence. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. Service users have opportunities to take part in activities. The involvement of family and friends is promoted. Residents have a choice of a balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are a range of activities available for service users. The home is in a relatively rural location between Rainham and Sittingbourne, however a regular bus service passes by the home and some residents choose to get taxis. The home has the facility of a volunteer driver who can be booked in advance to provide transport to appointments, etc. The home has recently had an increase in staffing hours providing an extra 4 hours per day to enable residents to be supported whilst in the community. This time is allocated flexibly according to the needs of the home. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 13 Some service users spend most of their time out of the home attending college courses, doing voluntary work and going to drop-in centres. Some other residents prefer to spend their time in and around the house, choosing a less active lifestyle. The staff in the home promote activities with all of the residents supporting residents where required. One resident said, “I like to go out and sometimes staff come with me.” Another person stated, “I’ve got enough to do, I like to help out in the house.” The home has worked closely with residents and their families to try and help re-establish contact with some very positive results. It was reported that one individual has recently regained contact with a sibling after 7 years. Visitors are welcomed into the home at all reasonable times. Residents are encouraged and supported to take an active role in the home where possible assisting with household chores and having responsibility for the tidiness of their own rooms. Service users are provided with a healthy and balanced diet. Service users are involved in the planning of menus and choices are offered at each mealtime. The home does not employ a cook. There is a domestic sized kitchen which is maintained to a reasonable standard of cleanliness. There are sufficient stocks of food available. Meals are taken in a suitable dining area. One person said, “The food is ok, I don’t like some meals, but I can choose something else.” Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 14 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 and 20. Quality in this outcome area is good. The health and personal care needs of service users are met. Medication systems are in place ensuring safety and accountability. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of service users require minimal support with regard to personal care needs. In the main, the support provided is in the form of encouragement and reminders to attend to personal care issues. Where more structured support is required this is appropriately documented in the service user plans. The majority of service users are also able to clearly verbalise the support that they do and do not require. The home retains clear and detailed healthcare records showing evidence of regular routine health checks both for general physical issues and mental health needs. All healthcare needs are addressed by appropriate practitioners and it was reported that the home receives good support from local community mental health services. Residents are encouraged and supported to take Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 15 control of their own healthcare needs as far as possible. Complimentary healthcare needs are addressed including annual physical check-ups and input from dentists, chiropodists and opticians. Medication systems are in place and well managed. Administration records were clear and well maintained. The home also keeps a record of all received, returned and destroyed medication. There are suitable policies and procedures in place in line with Royal Pharmaceutical Society guidance. The home does not currently have any controlled drugs prescribed and should be advised that if controlled drugs are prescribed appropriate storage facilities would need to be installed. A number of service users have been supported to become selfmedicating and the registered manager has developed clear competency and risk assessments in this regard. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 16 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 and 23. Quality in this outcome area is good. A complaints process is in place and service user’s views are listened to. Residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a well-established complaints process in place that encourages issues to be resolved at a local level, but does provide recourse for formal complaints to be investigated. Residents spoken to said that they felt comfortable raising issues with any member of the staff team in the home. No complaints have been received by the home or by the Commission for Social Care Inspection in relation to the service since the last inspection. Adult protection and safeguarding vulnerable adults protocols are in place and adhered to by staff in the home. Policies and procedures in relation to awareness, reporting and recording signs of abuse have been developed. All staff address abuse awareness issues through the induction programme and attend additional training in this regard within the first six months of employment. No adult protection alerts have been raised in relation to the service since the last inspection process. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is good. The premises are homely and comfortable. The home is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Cedars is located on a main link road between Sittingbourne and Rainham. It is approximately 1 mile from the nearest group of shops in the village of Newington. A bus route passes by the home providing links to the main conurbations of the area. The premises are located in a large detached building with parking to the front and gardens to the rear of the building. The home is set out over three floors with the communal accommodation located on the ground floor. This comprises of two lounges and a large dining area. There is a domestic style kitchen and a laundry area, which are suitable for the needs of the home. There are 20 single and three double bedrooms in the home and service users Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 18 stated that their private accommodation meets their individual needs. There are suitable toilet and bathing facilities located throughout the building. A recent Environmental Health Department visit highlighted some recommendations, which have been addressed by the home. It was reported that the home also meets fire safety regulations. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is good. Service users are supported by a well-trained and competent staff team who are recruited appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and organisation have made improvements with regard to staff numbers on duty and training issues. An extra 4 staffing hours have been allocated per day to allow greater flexibility for staff to support service users at home and in the community. The home operates with at least 2 staff members on duty, rising to three at times between the hours of 9am and 6pm. At all other times there is generally 1 member of staff on duty. At night 1 staff member sleeps-in; there is no waking night staff. The relatively low staffing levels, however, determine that the home does not have effective staffing cover for prospective service users with complex care and support needs. The staffing levels are suitable for the number and needs of the current service user group, although should remain Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 20 under constant review as the needs and amount of residents change. Refer to recommendation 1. There have been a number of staff changes since the last inspection with some care staff moving to other homes within the organisation. There is a small staff team and it would be beneficial for the service users to have a period of stability in this respect, however the registered manager remains a constant figure. Only 1 staff member currently has obtained a National Vocational Qualification (NVQ) 2 or above, but 2 other staff are close to completing their courses. In discussion with one member of staff it was apparent that he had a reasonable understanding of the needs of the service users despite being relatively new to the home. The organisation has improved the training programme sourcing all mandatory training from external training providers. The home is on track to ensure that all staff have completed the required training and induction programmes within the first 6 months of employment. It was noted that the registered manager should also endeavour to keep her own training needs up to date. 2 staff personnel files were examined both for newly appointed staff. All the required information was kept in an organised fashion on file including CRB and POVA checks, two written references and proof of identity. It was noted that the application form requests only the past 10 years of employment history and this should be amended to provide a full employment history. Refer to recommendation 2. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 21 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 and 42. Quality in this outcome area is good. The home is well run in the best interests of service users. The health, safety and welfare of service users is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post for a number of years and has overseen on-going improvements to the service over this time. She has evidently developed positive relationships with residents, staff, professionals and relatives. She brings a good deal of experience to the position and has completed all required managerial training, she would benefit from updating her own mandatory training. She demonstrates a positive attitude and has Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 22 improved aspects of the service through her own initiative and where previous requirements and recommendations have been made. The home receives regular visits from senior managers within the organisation and an effective quality assurance programme is in place, which includes monthly monitoring visits, in-house audits and feedback from service users and significant others. All health and safety documentation including accident and fire safety records were up to date. Service maintenance certificates were in date and in place including gas safety, electrical wiring and fire equipment. Staff are provided with induction and mandatory training and safe systems of work are underpinned through policies and procedures. Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 23 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 X 2 3 3 X 4 3 5 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X 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 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Welcome House - The Cedars DS0000024041.V361143.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA33 YA34 Good Practice Recommendations To ensure that staffing numbers remain under constant review meeting the needs of the service user group. To ensure that a full employment history is obtained for all applicants to work in the home. 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