Inspection on 22/02/08 for The Cedars Care Home (Ashford) Ltd

This is the latest available inspection report for this service, carried out on 22nd February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Cedars Care Home (Ashford) Limited 16 Fordbridge Road Ashford Middlesex TW15 2SG Lead Inspector Mary Williamson Unannounced Inspection 22nd February 2008 11:30 X10015.doc Version 1.40 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 The Cedars Care Home (Ashford) Limited DS0000066148.V357604.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 Older People. 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. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Care Home (Ashford) Limited Address 16 Fordbridge Road Ashford Middlesex TW15 2SG 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) 01784 242356 01784 241794 The Cedars Care Home (Ashford) Ltd Post Vacant Care Home 16 Category(ies) of Dementia (16), Dementia - over 65 years of age registration, with number (16), Old age, not falling within any other of places category (16) The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2006 Brief Description of the Service: The Cedars is a care home for older people. Service provision includes dementia care for up to nine service users. The home is located in a residential area, within walking distance of the town of Ashford and conveniently situated near to all community facilities. These include shops, banks, post office, and a day care resource for older people. The home is well served by public transport and there is off road parking facilities. Accommodation is arranged on three floors, the first accessible by passenger lift and the second by chair lift. Service users occupying the second floor bedrooms must be fully ambulant. Communal areas on the ground floor include a front lounge, a combined lounge/dining room with patio doors opening onto a sunroom overlooking a mature enclosed garden. Bedroom accommodation includes 13 single rooms, and one shared, there are bathing and toilet facilities on all floors, these include bathrooms, a shower room and a walk in bathing facility all within easy access of the service users. The range of fees charged in the home is between £510 and £520 per week information obtained on 22/02/2008. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.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 a two star rating. This means that people who use this service experience good quality outcomes. This was the first site visit of a key inspection and was unannounced. Mary Williamson regulation inspector undertook the inspection. The responsible individual was present for most of the inspection. A tour of the premises was undertaken and some residents invited the inspector to view their rooms. Records relating to the management of the home and the care of the residents were sampled. This included needs assessments, care plans, medication records, contracts of occupancy, staff recruitment files, staff training files, and health and safety documents. It was possible to talk with some of the residents, some in more detail than others, about their experience about living in the home. It was also possible to meet with all the staff on duty and get their views about working in the home and the support and training available to them. The provider completed an Annual Quality Assurance Assessment (AQAA) and the information provided has been used as part of this inspection process. No resident/relative surveys were received. The Commission for Social Care Inspection would like to thank the residents, staff and management team for their cooperation and hospitality in this inspection. What the service does well: The home has good care plans in place based on detailed needs assessments providing carers with appropriate information to meet resident’s needs. Residents live in a homely and safe environment, which meets their individual and collective needs. Communal space includes a lounge; dining room and conservatory where residents can socialise of take part in group activities. The atmosphere in the home is warm and friendly. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 6 The home promotes and encourages contact with family and friends, and the local community. The home is run in the best interest of the residents. Procedures are in place to promote and protect the health, safety, and welfare of the residents and staff. What has improved since the last inspection? What they could do better: Support and encouragement must be provided for residents to make more choice in their daily choice of food. The provider stated, and the AQAA indicated that residents have a choice of menu. There was no evidence of this seen during the inspection and lunch was provided with the supplies available. The plans in place to provide relief for the cook during leave must be reviewed to ensure that resident’s nutritional needs, and expectations are being met. The staff recruitment procedures in place must be followed to ensure that written references are in place to protect the residents living in the home. The management team must be mindful to report significant events in line with Regulation 37 notification procedures. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 7 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. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 6. Residents who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives are provided with sufficient information to make a choice regarding the home. Pre admission needs assessments are undertaken and contracts of occupancy are in place. The home does not provide intermediate care. EVIDENCE: The home has a statement of purpose and residents information guide in place and all prospective residents and their relatives have access to a copy of this prior to admission it help them make an informed choice about living in the home. A prospective relative was viewing the home and was given a copy of these documents. All residents have a copy of the residents guide in their bedrooms. Individual contracts of occupancy are in place, which include the accommodation provided, the fees payable, and the method and frequency of The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 10 payment. These contracts have been reviewed and updated as a requirement from the last inspection. All prospective residents have a full needs assessment undertaken by the home manager prior to being admitted to the home. This will establish if the home is suitable to meet the specific needs of residents. Four needs assessments were seen and are detailed and informative. The home does not provide intermediate care. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Residents who use this service experience good quality outcomes in the outcome area. This judgement has been made using available evidence including a visit to this service. Individual care plans outline the care provided. Appropriate arrangements are in place to meet the health care needs of residents, and they are also protected by the medication policy in place. Privacy and dignity is respected. EVIDENCE: Each resident has a care plan in place which has been written on the information gathered from the needs assessment, input from the resident whenever possible and information available from relatives. Four care plans were examined which are well maintained, and included a personal profile, risk assessments, and are reviewed monthly. A daily record of care and significant events is maintained. Residents are not really aware of their care plans, and the provider stated that relatives would be informed of changes to care and treatment. Residents are registered with a local GP, who visits the home when required. There is also good support from the district nursing team, providing staff with The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 12 advise on dressings and insulin administration. Chiropody and dental care are provided by a domiciliary service, and an optician also visits annually. Records are kept in the care plans of visiting professional’s visits. The home has a medication policy in place and all staff who administer medication are familiar with this procedure. A local pharmacy supplies medication to the home in blister pack format, and also undertakes audits of medication. The medication recording charts (MAR) were seen and are well maintained. Regular staff training is provided and staff demonstrated their understanding of medication safety. Privacy and dignity are respected. Staff were observed to knock on residents doors prior to entering. Some resident’s doors are kept locked during the day when they are not occupied, as a resident who constantly wanders will enter uninvited. This arrangement is documented in residents care plan, and relatives have signed this document specifically requesting this. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Residents who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. An activity programme is available to residents in accordance with the routine of the home and their capacity. Opportunity to exercise choice is limited. Family links are maintained. The meal observed was not appealing, however the menus did not indicate this. EVIDENCE: There is an activities programme in place for every afternoon, and includes music in the lounge, dominoes, reminiscence, art and craft, quiz and ball games. A member of care staff is booked to attend a course on “bringing creative therapy to your home” on 28/02/08, and will then become the activities coordinator. A ball game was observed during the afternoon of the inspection between some residents and staff. Family links are maintained and visitors are welcome in the home at any reasonable time. A relative was visiting and had photographs of the recent 100th birthday party, which he was sharing with the residents. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 14 Community links are maintained and the provider stated that the local church visits occasionally. Fordbridge Day Centre is located nearby and residents may attend this centre with an escort. The provider stated that residents are given a choice when they get up and go to bed, the activities they participate in and their choice of food, however residents did not have a choice of food on the day of the inspection. The catering arrangements were not satisfactory on the day of the inspection. The regular cook was having some planned time off and the kitchen assistant had been allocated to cook the meals. The menus were displayed in the dining room and lunch should have been fish, chips and peas. The lunch served to the residents during the inspection consisted of sausages, baked beans and boiled carrots. The reason for this was given by the administrator as the “supplies had not been delivered”. On further exploration there was sufficient potatoes, frozen chips, and peas in the larder. The cook had difficulty expressing himself in English, and had no understanding of the nutritional needs on the residents he was catering for. A discussion was held with the provider regarding the choice of food and her responsibility for the provision of wholesome food for residents with limited capacity to represent themselves. A resident with cultural needs was offered an omelette. The kitchen was clean and the requirements from the last Environmental Health Inspection on 0/1/08 had been completed. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, and 18. Residents who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The complaints procedure and abuse awareness procedure in place protects residents living in the home. EVIDENCE: The home has a complaints procedure in place, which is part of the resident’s information guide. There is also a copy of this displayed in the main hallway. Residents rely on friends and relatives to make a complaint on their behalf due to capacity. There is a complaints log in place and there have been two formal complaints noted since the last inspection. These were managed efficiently, within the time frame, and according to procedure. The home has a safeguarding policy in place and all staff undertake abuse awareness training as part of their induction training. The local authority multi agency procedures on Safeguarding Vulnerable Adults is also in place and the provider stated that she is currently seeking a place to access this training which is oversubscribed. While viewing records the home failed to notify CSCI in accordance with Regulation 37 of an incident, which took place in July 2007, which could have been referred to the safeguarding team. A discussion took place between the management team and the inspector regarding their responsibility for notifying the appropriate agencies of such events. The provider stated that the new The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 16 manager is aware of her responsibilities regarding the safeguarding of vulnerable adults. There is also a whistle blowing policy in place. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, and 26. Residents who live in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home meets its stated purpose providing residents with ample communal space. The standard of hygiene and cleanliness is good. EVIDENCE: The home has an ongoing programme of maintenance in place. The hall, stairway and landings have been fitted with new carpets. The lounge, conservatory and dining room provide communal space where residents socialise and take part in activities. Bedrooms are mainly single occupancy, with one shared room, and are located over three floors, without en-suite facilities. These have been personalised with individual possessions, and prior arrangement can be made for residents to bring personal furniture with them. There are bathrooms located on all three floors. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 18 The standard of cleanliness is good and staff are aware of the control of infection policy in place. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30. Residents who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents needs are met by the number and skill mix of staff employed. Recruitment procedures are generally safe however shortfalls were noted in employment files. EVIDENCE: Duty rotas were seen and the number and skill mix of staff on duty was sufficient to meet the current assessed needs of the residents in the home. The training and development of staff is ongoing and all staff undertake a fourweek induction programme. This is accompanied by an induction workbook, which is signed by the manager and staff member once assessed as competent. Mandatory training also takes place and all staff undertake this at various times. This can also include staff from the other homes in the organisation. The provider stated and the AQAA demonstrated that NVQ training is in place and staff are undertaking this training at different levels. One staff member has an NVQ level 4, there are three staff currently undertaking level 3, and four staff have undertaken level 2. The home has a recruitment procedure in place, which generally protects the residents living in the home. Three staff recruitment files were seen. These had The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 20 written application forms, employment history, and Criminal Records Bureau (CRB) disclosures in place. However only one file had two written references available. A discussion took place between the management team and the inspector regarding the importance of having references in place for the protection of the residents. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Residents who live in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed in the best interests of the residents. The health, safety, and welfare of the residents and staff is promoted and protected. EVIDENCE: The home was functioning well in the care of a senior carer. The manager was on leave, and the administrator was working from the home in her absence. The provider was contacted and was present for most of the inspection. The current manager has been in post since October 2007. She is in the process of making an application to CSCI to become registered. She is undertaking her Registered Managers Award (RMA), and has a diploma in dementia care. There is currently a vacancy for the deputy manager’s post, The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 22 which is being addressed by the management team. The home is one of three in the organisation and the provider and the administrator provider management support for this service when the manager has time off. Systems are in place to monitor quality assurance. The provider undertakes regulation 26 visits monthly and written reports are retained in the home for information. Relative/resident questionnaires are distributed and feedback is acted upon. Following the last questionnaire an action plan was put in place to revise the menus in the home, and consider residents likes, dislikes, and special needs. In theory this is in place but was not observed on the day of the inspection. (See standard 15). Regular audits of medication, care plans, and health and safety are undertaken. The home does not handle resident’s personal money. Relatives are invoiced for hairdressing, chiropody, and newspaper accounts. No staff member acts as an appointee for residents. The health, safety and welfare of the residents and the staff are promoted. Risk assessments are in place for all identified risks and safe working practice. Staff undertake health and safety training to include COSHH awareness. A full fire risk assessment was undertaken on 10/12/07, and the requirements have been acted upon. There is a contract in place for the maintenance of fire fighting equipment and emergency lighting. All staff attend fire safety training yearly. There is maintenance person available within the group of homes to attend to the ongoing maintenance requirements The Cedars Care Home (Ashford) Limited DS0000066148.V357604.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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. 1 Standard OP14 OP15 Regulation 12(2) 16(2)(i) Requirement The registered person must ensure that residents have the opportunity to choose their food from an appropriate menu daily taking into account their likes, dislikes and needs. The registered person must also ensure that adequate supplies of stock are available to provide residents with a well balanced, appetising, and wholesome diet, cooked in accordance to their dietary needs. Timescale for action 28/03/08 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 OP18 OP29 Good Practice Recommendations It is recommended that the management team notify the CSCI of any event in the home that may adversely affect the well-being of the residents. It is recommended that two written references are DS0000066148.V357604.R01.S.doc Version 5.2 Page 25 The Cedars Care Home (Ashford) Limited obtained for all staff in accordance with the home’s recruitment policy. The Cedars Care Home (Ashford) Limited DS0000066148.V357604.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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