Background to this inspection
Updated
11 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This was a comprehensive inspection that took place on 24th August 2018 and was announced. We gave the service 72 hours’ notice of the inspection visit because the service is a small care home for people with learning disabilities and/or autism who are often out during the day. We needed to be sure that they would be in. We arranged and made follow up calls to relatives to seek their views on 6th September 2018.
The inspection was carried out by one adult social care inspector.
When planning this inspection, we used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed statutory notifications received from the service. Statutory notifications provide details of incidents or events that the registered person is legally obliged to inform us of.
We requested information from four local authority commissioners, the local safeguarding adults team and Healthwatch England. Healthwatch England is the independent consumer champion for health and social care. We received neutral feedback from one local authority commissioning team and Healthwatch England. We did not receive any feedback from any of the other stakeholders contacted.
During the inspection we carried out pathway tracking, observations and reviews of records. We spoke with the registered manager, the acting manager, four care staff, the domestic and four people who used the service. We then spoke with two relatives on the telephone following the site visit.
We looked at two care files, four sets of medication administration records (MAR’s), two personnel files, record logs in relation to health and safety of the premises and training records. We also looked at quality governance audits and checks carried out by both the registered manager and a representative of the provider.
Updated
11 October 2018
The inspection took place on 24 August 2018. The inspection was announced. This was because the service is a small care home for people with learning disabilities and/or autism who are often out during the day. We needed to be sure that they would be in. Telephone calls were made to relatives on 6 September 2018 in order to capture their views and experiences of the care provided to their loved ones.
8-8a The Cedars is a residential care home for 10 people with learning disabilities and / or autism. There were seven people receiving care at the time of this inspection aged from early 20’s to 60 years of age. There are two buildings making up the premises, people with a range of needs live in the main building and people with more complex needs live in ‘The Coach House’. Bedrooms in the main building are decorated and furnished as flats, with two self-contained flats within The Coach House.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
At this inspection we found the service remained Good.
The care service had adopted the principles and values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. Some people with learning disabilities and autism using the service can live as ordinary a life as any citizen. For others there were some limitations to this due to their complex care and support needs.
Staff had received relevant training and the provider employed robust recruitment procedures to keep people using the service safe. Staffing levels were appropriate and reflected people’s needs with risks appropriately assessed, monitored and mitigated. Medication was safely managed in line with relevant guidelines and were being consistently reviewed to improve administration practices. Premises were safe, clean and tidy and infection control procedures were in place to minimise risk.
Care and support needs were appropriately assessed to ensure that people’s ongoing needs and required outcomes were captured. Staff had received appropriate training to deliver effective care and support and this was monitored and managed by the registered manager and the provider central function. People had access to various healthcare professionals and this was well managed with information routinely shared across organisations. The service supported people to maintain healthy lifestyles and this included specific exercise plans and good nutrition and hydration. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Premises were adequately adapted and designed to meet the specific needs of people who lived at the home.
There was a strong staff group who understood people’s needs. Staff had developed positive relationships with people and there was a relaxed and happy environment throughout the home. Staff used a variety of resources to ensure that people were involved in decisions about their care and support which included signing and visual aids. Staff protected people’s privacy, dignity and respect by affording people their own space, holding confidential discussions in private areas of the home and being unobtrusive in their presence.
The staff team adopted a person centred care approach when setting goals and outcomes with people who lived at the home. Goals were focused on what the individual wanted to achieve as opposed to what others wanted the individual to achieve. This included proactive planning in respect of end of life care which focused on ensuring this type of care would be positive and based on the wishes of the person and where appropriate their relatives. The provider had an appropriate complaints, compliments and concerns policy in place which was accessible to people.
There were robust and effective quality monitoring processes in place. The registered manager promoted a strong culture of openness within the service based on the values of the organisation. Staff told us they felt the registered manager was very supportive. There were a number of ongoing initiatives within the service which the registered manager was involved in setting up, and developing across the provider following input from various other organisations.
Further information is in the detailed findings below.