CARE HOME ADULTS 18-65 Cherries Residential Home Cherries 25 Green Trees Avenue Cold Norton Maldon Essex CM3 6JA Lead Inspector Diana Green Unannounced Inspection 18th March 2009 10:30 Cherries Residential Home DS0000072841.V374638.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 Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright 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 Internet address www.csci.org.uk Cherries Residential Home DS0000072841.V374638.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. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 3
SERVICE INFORMATION Name of service Cherries Residential Home Address Cherries 25 Green Trees Avenue Cold Norton Maldon Essex CM3 6JA Telephone number 01621 828 141 Fax number 01621 828 141 Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration T McTaggart Ltd Mrs Theresa McTaggart Care Home No. of places registered (if applicable) Category(ies) of registration, with number of places 2 Learning disability (2) Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 4
SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care Home Only - Code 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 - Code LD 2. The maximum number of service users who can be accommodated is: 2 Date of last inspection This is the first inspection of the service. Brief Description of the Service: Cherries is a fully detached domestic style property situated in a wholly residential area close to the centre of Cold Norton village. The home was initially registered in 1994 with Essex County Council as a small home (accommodating up to two service users) for adults who have a learning disability. A recent change in Provider has prompted the need for a new registration of the service. Accommodation is provided in single rooms, the lounge/dining room on the ground floor and the bathroom and wc on the first floor are shared with the registered provider and family. At the rear of the property there is a large garden, which is fully accessible to residents. Visitor car parking is available at the side and front of the property. Additional street parking is also available. Cherries is situated in a semi rural location. Limited public transport facilities are available locally but community access is mainly achieved by the use of two cars provided by the registered providers/manager. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 5
At the time of this inspection the rate of fees was between 496.86 and 993.79 per week. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 6
SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced inspection took place on 18 th March 2009. All of the Key National Minimum Standards (NMS) for Young Adults, and the intended outcomes, were assessed in relation to this service during the inspection. The report has been written using accumulated evidence gathered prior to and during the site visit, including the homes (AQAA) Annual Quality Self Assessment. The Annual Quality Assurance Assessment (AQAA), a self-assessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the self-assessment provided us with some detail to assist us in understanding how the registered persons understand the service s strengths and weaknesses and where they will address these. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, management qualifications and training, the premises and policies and procedures. Time was spent talking to the manager/owner and residents. Telephone contact was made with two relatives and two health and social care professionals to seek their views on the care home. The management/owners were welcoming and helpful throughout the inspection. What the service does well: Cherries provides a very friendly, relaxed homely environment for the two people living there. Residents, relatives and health and social care professionals who made comment all confirmed that they were happy with the level of care and support provide. One relative commented on the excellent service and both residents confirmed that they were very happy living in the home. Residents are supported and encouraged to pursue age and peer appropriate activities outside of the home and to make new friends and develop relationships. Both residents are encouraged to participate in activities of Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 7
interest and to actively participate in their local community. One resident is a local people parliament representative and the other continues to take part in local amateur dramatic productions, including Shakespeare production. Where it is appropriate residents are supported in taking paid or voluntary employment. Residents have good access to healthcare services and are supported to manage their medication where they are safe to do so. What has improved since the last inspection? This was the first inspection of the service. What they could do better: Care plans for each individual person should be developed by the home rather than rely on the review documentation provided by the care manager. Care plans should be person centred, agreed and owned by the person receiving the service and be an up to date working tool used by them and people who support them. 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. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 8
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 Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 9
Choice of Home The intended outcomes for Standards 1 5 are: 1. Prospective service users have the information they need to make an informed choice about where to live. 2. Prospective users individual aspirations and needs are assessed. 3. Prospective service users know that the home that they will choose will meet their needs and aspirations. 4. Prospective service users have an opportunity to visit and to test drive the home. 5. 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): Quality in this outcome area is good based on inspected standards 1 & 2. People planning to live at Cherries can be assured their needs are fully assessed prior to admission to ensure these can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a Statement of Purpose and Service User Guide that were comprehensive documents. Copies of both documents were viewed during the site visit and had been recently reviewed (September 2008). There had been no admissions since the previous inspection. However from discussion with the manager it was evident that these would be made available to potential residents and their representatives. There had been no admissions since the previous key inspection. One resident had lived at the home for four years and one for five years. It was therefore not possible to verify admission procedures from the care files. However from discussion with the manager it was evident that potential residents would receive a full assessment with support of the multi-disciplinary team and the pre-admission assessment would be undertaken to obtain full information and ensure needs could be met. For example one resident, in order to determine if their needs could be met, was taken out for meals and various activities. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 10
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Individual Needs and Choices The intended outcomes for Standards 6 10 are: 6. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. 7. Service users make decisions about their lives with assistance as needed. 8. Service users are consulted on, and participate in, all aspects of life in the home. 9. Service users are supported to take risks as part of an independent lifestyle. 10. 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): Quality in this outcome area is good based on sampled inspected standards 6, 7 & 9. People living at Cherries can expect to have their care needs met and to be fully supported to make independent decisions about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA informed us that both residents are consulted and involved throughout assessments for future plans and that no work is completed without their consent. Both residents living at Cherries were independent in respect of their personal care needs. All care support was provided by the manager and her husband (owners of the care home) and no other staff were employed. The manager explained the care planning process. Professional reviews are received in writing from each resident s social worker/care manager. These are used as the care plan. This was viewed for one resident and was seen to include their current needs, for example lifestyle, employment etc. and had been reviewed on 21/05/08. However there were no current Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 12
review care notes available for the second resident, the latest review having been recorded on 16/10/06. The social worker was spoken with during the site visit and they confirmed that a review had been undertaken during December 2008. They also stated that the service provided was structured enough to keep the resident safe but flexible to take account of their needs. The manager confirmed that both residents had a family member that was involved in their care and assisted in making decisions on their behalf. The service user guide has information on advocacy services. One resident had an independent advocate who had been accessed for their support. The AQAA informed us that the home supports residents to be as independent as possible within a risk management framework. Risk assessments (i.e. risks to self and risks to others) for different types of behaviours were seen, for example, aggressive behaviour, manual handling, spending time with others and anger management, demonstrating that risks were assessed and minimised. Policies and procedures in place demonstrated the home s commitment to minimising identified risks and hazards and promoting the health and safety of residents. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 13
Lifestyle The intended outcomes for Standards 11-17 are: 11. Service users have opportunities for personal development. 12. Service users are able to take part in age, peer and culturally appropriate activities. 13. Service users are part of the local community. 14. Service users engage in appropriate leisure activities. 15. Service users have appropriate personal, family and sexual relationships. 16. Service users rights are respected and responsibilities recognised in their daily lives. 17. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT we looked at outcomes for the following standard(s): Quality in this outcome area is excellent based upon sampled inspected standards 12, 13, 15, 16 & 17. People living at Cherries can expect to have a planned programme of individual social activities and to receive a well-balanced and nutritional diet that is provided in a family type environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit both residents spoke of their life at the home and the various activities they were involved in. One resident worked for Barnardos one morning per week and assisted with Riding for the Disabled one afternoon. They also had paid employment helping Access Champion for Maldon and is a part chair for a local action group, the Essex Peoples Parliament. The other resident had a full programme of activities arranged for example gardening, swimming, attending the gym, drama group and attending a group Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 14
for people with learning disabilities. Various outings were arranged through the group to the cinema, pub, Walton on the Naze and Buckingham Palace. Residents are offered the opportunity to take holidays with the homes owners and their family or other organised holidays. One resident told us that they had gone on holiday to Turkey which was the first time they had flown and to Dublin and they planned to go to the Isle of Wight during May this year and a cruise to Norway with the manager and her husband. They also told us I really like living here. The statement of purpose included the home s visiting arrangements and also states that residents can choose who visits their room. Both residents described how the owners supported them to keep in touch with their family and friends. One told us they often spoke with their relatives by telephone and were going to stay with them at the weekends which they often did. They also spoke of a friend of the opposite sex whom they saw at weekends and who was coming to stay with them. Both residents relatives were contacted by telephone to seek their views about the care home. One told us We have a very good relationship with Teresa and Alec (the owners). Teresa is very good. She rings us and lets us know of anything of concern and discussed options with us and they are very good at recognizing changed in behaviour and communicating with us. It was evident that both residents participate in and are involved in making decisions about the day-to-day running of the home. The home s daily routines were observed to be very relaxed. Residents were responsible for undertaking some domestic tasks including keeping their rooms clean and tidy. The kitchen was domestic in size and residents ate either in the kitchen/diner or dining room. Residents were responsible for preparing their own breakfast and lunch and mealtimes were flexible to enable them to take part in their individual activities. We were informed that some cookery instruction was given and each resident was responsible for preparing an occasional meal for the family when they would eat together at the table. Shopping was undertaken by Mr McTaggart and healthy eating was encouraged with snacks of fruit provided. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 15
Personal and Healthcare Support The intended outcomes for Standards 18-21 are: 18. Service users receive personal support in the way they prefer and require. 19. Service users physical and emotional health needs are met. 20. 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. 21. 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): Quality in this outcome area is excellent based on inspected standards 18, 19 & 20. People living at Cherries can expect to have their personal and health care needs met and to be safeguarded by the home s medication policy, procedures and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident had their own room with door lock and shared the bathroom. Both residents were independent and managed their own personal care. From observation it was clear that privacy and dignity was upheld. One resident told us they were offered a choice of food and liked to watch TV and go to bed when they liked. The other resident told us they were able to go shopping abnd buy their own things. The AQAA informed us that residents had access to GPs, community nurses, social workers, occupational therapists, dentists and osteopaths. The arrangements for meeting the healthcare needs of both residents were discussed with the manager. A healthcare professional told us the home had Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 16
close links with the community health team and their communication was excellent. They also enabled medical access and preventing crises occurring. The medication systems for the home were discussed with the manager. The home had a medication policy and procedures. We were informed that a pharmacist was providing assistance to review the policy and procedures. One resident self managed their medication and held their own prescription. They had a lockable box for storing their medicines. The manager checks occasionally to monitor compliance. Room temperatures were also undertaken to ensure they remained within safe recommended levels (not to exceed 25 Centigrade). Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 17
Concerns, Complaints and Protection The intended outcomes for Standards 22 23 are: 22. Service users feel their views are listened to and acted on. 23. 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): Quality in this outcome area is excellent based on inspected standards 22 & 23. People living at Cherries can expect to have their concerns and complaints listened to and acted upon and to be protected by safeguarding adult procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints policy and procedures that included timescales for a response. The procedure was included in the statement of purpose and promoted in the service user guide. No complaints had been received by the home or the Commission since the previous key inspection. A relative told us they were aware of the complaints procedure but had not had a reason to complain and said the service is excellent there is nothing they could improve. The home had a safeguarding adults policy and procedures. The manager said she planned to review the policy during the next few months. A copy of the recently reviewed Essex Safeguarding procedures was available in the home for staff guidance. There had been no allegations of abuse received by the home or the Commission since the previous inspection. We were informed that the manager had provided training for two members of staff from the Dengie service that she was responsible for. Both residents had the capacity to report if they were not being treated properly. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 18
The systems for dealing with residents monies were discussed with the manager. One resident managed their own money with support of their relative. The second resident managed their own money with some support from the family and the manager. Both residents confirmed these were the agreed arrangements and they were happy with them. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 19
Environment The intended outcomes for Standards 24 30 are: 24. Service users live in a homely, comfortable and safe environment. 25. Service users bedrooms suit their needs and lifestyles. 26. Service users bedrooms promote their independence. 27. Service users toilets and bathrooms provide sufficient privacy and meet their individual needs. 28. Shared spaces complement and supplement service users individual rooms. 29. Service users have the specialist equipment they require to maximise their independence. 30. 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): Quality in this outcome area is excellent based on inspected standards 24 & 30. People living at Cherries can expect to live in a clean, comfortable and homely environment that is appropriate for their needs and is well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken during the site visit. The home was a domestic house and family home that was the owners shared with the residents. There was a lounge/dining room, large kitchen and family room on the ground floor and on the first floor five bedrooms, a small office and one shared shower room with sink and toilet. The home was observed to be clean and comfortably furnished. Records viewed confirmed that fire safety equipment was appropriately maintained and fire safety practices were in place to meet the requirements of the local fire service. Systems were in place for regular maintenance and repair of the premises and confirmed from the records viewed. We were informed that redecoration of the premises was on Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 20
hold until the electrical systems had been upgraded. Resident had access to a large garden attached to the home that both helped to maintain. Both residents were independent in respect of their mobility and neither required specialist equipment. The premises were clean and free from odour throughout. Paper towels and liquid soap were available for staff hand washing. There was one washing machine that had the capacity to carry out sluice cycles and one tumble drier that were both in working order. Staff hand washing facilities (liquid soap and paper towels) were provided. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 21
Staffing The intended outcomes for Standards 31 36 are: 31. Service users benefit from clarity of staff roles and responsibilities. 32. Service users are supported by competent and qualified staff. 33. Service users are supported by an effective staff team. 34. Service users are supported and protected by the home s recruitment policy and practices. 35. Service users individual and joint needs are met by appropriately trained staff. 36. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT we looked at outcomes for the following standard(s): Quality in this outcome area is excellent based upon sampled inspected standards 32, 33, 34, 35 & 36. People living at Cherries can expect to be cared for by experienced and skilled staff who are competent in their practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and her husband (owners) of the home provided all care and no care workers were employed. Both have a social work qualification and the manager also has a management in care skills certificate. Residents appeared well cared for and comfortable and relaxed in the care of the owners of the home. A relative also told us they are very good at listening and recognizing changes in behaviours and communicating with us. A healthcare professional also told us the staff always make sure service users are well supported. The home did not employ staff as the owners provide all care. However a family member did provide occasional support and a CRB Disclosure was available for them. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 22
We were informed that the owners accessed local training. The records confirmed that emergency life support training had been undertaken on 30/04/07 and health and safety training had been untaken in October 2006. Mr McTaggart had undertaken food hygiene training on 12/04/07. The manager was a member of a local learning disabilities group that enabled her to keep updated with her practice. Due to sickness she had been unable to attend Deprivation of Liberty training but planned to attend the next arranged session. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 23
Conduct and Management of the Home The intended outcomes for Standards 37 43 are: 37. Service users benefit from a well run home. 38. Service users benefit from the ethos, leadership and management approach of the home. 39. Service users are confident their views underpin all self-monitoring, review and development by the home. 40. Service users rights and best interests are safeguarded by the home s policies and procedures. 41. Service users rights and best interests are safeguarded by the home s record keeping policies and procedures. 42. The health, safety and welfare of service users are promoted and protected. 43. 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): Quality in this outcome area is excellent based on inspected standards 37, 39, 41 & 42. People living at Cherries can expect to live in a well managed home with good standards of health and safety that protects them and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owners are both qualified social workers. The registered manager has also undertaken NVQ level 4 in Management. Both owners have substantial experience of care in learning disabilities and are skilled and experienced in their practice. The home s quality assurance programme was discussed with the manager. This included an annual resident and relative s survey, and surveys of GPs and Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 24
health and social care professionals. The programme also included a quality assurance evaluation from which an action plan was developed to continually improve practice. Surveys were viewed and the following comments seen I find the staff very approachable and a social worker commented all needs are met appropriately. The home had a health and safety policy and procedures in place. The records viewed confirmed that the manager had attended health and safety training. Systems were in place o ensure the ongoing maintenance of the home. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities (e.g. gas, electricity certificates, annual PAT testing etc.). Risk assessments were recorded for uncovered radiators, although neither resident were at risk. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 25
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 (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (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 CONCERNS AND COMPLAINTS Standard No Score Standard No Score 1 3 22 3 2 3 23 3 3 X 4 X ENVIRONMENT 5 X Standard No Score 24 3 INDIVIDUAL NEEDS 25 X AND CHOICES 26 X Standard No Score 27 X 6 3 28 X 7 4 29 3 8 x 30 3 9 4 10 x STAFFING Standard No Score LIFESTYLES 31 x Standard No Score 32 4 11 x 33 x 12 3 34 3 13 4 35 3 14 x 36 x 15 4 16 3 CONDUCT AND MANAGEMENT OF 17 3 THE HOME Standard No Score PERSONAL AND HEALTHCARE 37 4 SUPPORT 38 X Standard No Score 39 3 18 3 40 X 19 3 41 X 20 3 42 X 21 x 43 3 Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 26
Are there any outstanding requirements from the last inspection? N/A 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 Refer to Standard YA6 Good Practice Recommendations A person centred care plan should be developed by the home for each individual. This will ensure that where reviews are delayed the care plan includes the current needs of people receiving a service. Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 27
Commission for Social Care Inspection Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.gov.uk Web: www.cqc.org.uk This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherries Residential Home DS0000072841.V374638.R01.S.doc Version 5.2 Page 28