CARE HOMES FOR OLDER PEOPLE
Cedar Court 37 New Road Whittlesey Cambridgeshire PE7 1SU Lead Inspector
Mrs Jenny Cangy Unannounced Inspection 11th April 2006 12:00 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 Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 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. Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cedar Court Address 37 New Road Whittlesey Cambridgeshire PE7 1SU 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) 01733 350320 01733 205930 Cedar Court Care Limited Anund Oogorah Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (24), Physical disability (1), Physical disability of places over 65 years of age (24) Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 1 named female with physical disabilities under 65 years of age (PD) for the duration of her residency only 24 older people (OP) for the duration of condition 1 The maximum number of places not to exceed 25 Date of last inspection 22nd September 2005 Brief Description of the Service: Cedar Court is a single storey purpose-built home that provides personal and nursing care and support for up to 25 people over the age of 65 years. It is owned by Cedar Court Care Ltd The building is situated in the market town of Whittlesey and is within reach of shops, pubs and other local amenities. Accommodation comprises 21 single bedrooms, all but two of which have en-suite facilities, and 2 double rooms, which also have en-suite facilities. There are a total of three day/quiet rooms and the home has bathing and toilet facilities, which are provided with aids to enable the needs of the residents to be met. The home has transport available to service users, including two wheelchair accessible vehicles, for visits into the community. Service users have access to a garden and patio area at the front of the building. Weekly fees range between £478 and £535 depending on the source of funding. Service users pay individually for newspapers, private chiropody and hair dressing. Basic toiletries are provided. The home does not have an email address or web site currently. Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 12:00 noon and was admitted to the home by the cook who first checked the inspector’s identity. The deputy manager and the head of care were both on duty and participated in the inspection. The National Minimum Standards not met at the last inspection were reviewed and all the key standards were inspected. The inspector toured the building and met service users, staff and one visitor. The inspector also met one service user who receives day care. A sample of service user records and care plans were seen as were a sample of staff records. What the service does well: What has improved since the last inspection?
Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 6 The CSCI has recently agreed a variation of registration to enable them to admit 3 service users with a diagnosis of dementia. The service user guide and statement of purpose has been updated to reflect this. Care plans have been reviewed and updated. A senior member of staff assesses prospective service users prior to admission. This assessment forms the basis of their care plan. Outside healthcare professionals are consulted whenever needed. The correct recording of controlled drugs is in place. All prospective staff under go the necessary recruitment checks and the Manager is now registered with the CSCI. All exposed hot pipe work is now covered. 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. Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 7 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 Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 No service user moves into the home without having needs assessed and assurance they can be met. Cedar Court does not offer intermediate care. EVIDENCE: All service users have a needs led assessment prior to admission. This is in addition to any health and social service assessment and is conducted by a senior member of staff. The assessment forms the basis of the care plan. No service users are accepted if their needs cannot be met. An application to vary the registration to admit three service users with dementia has been processed and approved by the CSCI. The statement of purpose and service user guide has been amended appropriately the state this. All service users have a care plan for all aspects of the care and theses are appropriately updated and reviewed. Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Service users health, social and personal care needs are met and service users choice and dignity are respected in all areas of their care. More information is needed for service users preferences in final illness and after death. EVIDENCE: All service users have a care plan for all aspects of the care and these are appropriately updated and reviewed. Several care plans were inspected and apart from very minor omissions were found to be satisfactory. Service users spoken to were happy with their care and the attitude of staff toward them. The home is currently in discussion with the local pharmacist to improve the medication ordering and storage system to the benefit of both staff and service users as the current system is time consuming for staff. All controlled drugs kept in the home are appropriately recorded. Discussion took place about the need for secure storage of topical medication in individual bedrooms. All personal and nursing care is conducted according the service users wishes and in the privacy of their bedroom or the bathroom. Service users are addressed in the way they request and all staff have training in privacy and dignity as part of their initial training. This is reinforced regularly. It is the intention of the manager to introduce the Liverpool pathway method for the planning and recording of service users wishes during final illness and after death. This is not yet in place and NMS 11 is not yet met.
Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users are able to lead as full a lifestyle as their frailty will allow and their choices and wishes are considered at all times. Service users have a choice of meals from a menu presenting a well balanced diet EVIDENCE: The home has a dedicated activity organiser who plans activities both within and outside of the home. All service users have activities available to them and those too frail to participate have one to one input regularly. There are frequent service user meetings where their views are sought on all aspects of their life in the home. The home has two disabled access vehicles for outings and also has visiting entertainers. Service users spoken to stated the food was good and that choice was available. The inspector was shown a copy of the menu by the cook on duty and told that all cakes were home baked. Special diets are catered for. Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Service users, their family and friends are confident their views will be listened to and that the service users are protected from abuse. EVIDENCE: The home has a clear complaint procedure that is contained within the service user guide. Since the current providers took over ownership last year there have been no serious complaints. All staff have Protection of Vulnerable Adult training or have a date set to do so. The manager is currently undertaking training to be a POVA trainer. Recruitment procedures for staff ensure all required checks are done to ensure the protection of service users. Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 26 Service users live in a clean, safe, well-maintained environment with appropriate facilities, adaptations and equipment to meet their needs. However some attention is needed to the dining room carpet to ensure safety is maintained. EVIDENCE: The home is purpose built with the original building being 12 years old and an extension being 7 years old. It is well decorated throughout and redecoration is carried out whenever and wherever needed. All but 3 rooms have en-suite facilities 2 having their own shower. There are additional bathrooms and toilets that meet the requirements and are suitable adapted for the need of the service users. Aids and adaptations are provided according to individual need and outside professional help is sought when needed. The home was found to be clean and fresh throughout and there is a domestic staff team employed. The laundry facilities meet the needs of the service with one washing machine having a thermal disinfection cycle. There is a launderer employed. Hand washing facilities are available throughout the home and staff are provided with protective aprons and gloves to minimise the risk of cross infection.
Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 A good skill mix and number of staff with appropriate qualifications care for Service users. Recruitment methods and training ensures the service users are kept safe and well cared for EVIDENCE: Staffing levels meet the needs of the service users with a registered nurse on every shift including night duty. The rota was seen by the inspector to confirm this. Extra staffing is put into place when needed to ensure service users needs are met at all times. Agency staff are rarely used giving service users continuity of care by staff they are familiar with. Care assistants have regular training and all care the staff have either NVQ level2 in care or are working toward it. 2 care staff have NVQ level 3 in care. Qualified nurses are supported in attending study days to ensure they maintain their skills. All staff have required pre appointment checks including verification of Nurse registration, where appropriate, work permits and Criminal Record Bureau enhanced checks. In addition there Protection of Vulnerable Adults registers is checked, two references are sought and proof of identity required. One reference must include the previous or last employer and all gaps in work history are investigated. Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Service users live in a home that is managed by some fit for the purpose and all records are kept in line with regulations. Suitable regard is paid to health and safety and the monitoring and supervision of staff. Quality assurance monitoring is not currently in place EVIDENCE: The manager is a first level registered nurse who is currently undertaking his NVQ level 4 registered managers award. A quality assurance tool has been devised but is not yet in use. However there are frequent service user meetings when residents can express their views. The manager and staff do not act as appointees or manage any service users money. One service user has a small amount of cash held for safekeeping and appropriate records are kept. There is a formal method of staff supervision with records kept. All
Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 15 records are kept as required and health and safety issues regularly monitored. All water taps accessed by service users have thermal mixer valves in place and regular hot water checks are made. All fire safety checks are conducted as required and records kept. Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 16 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 3 3 3 Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 17 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 OP11 Regulation 12(3) Requirement All service users must have a care plan that adequately reflects their wished during final illness and after death The registered person must take action to ensure the safety of service users and remove the ridge in the dining room carpet. The registered person must conduct a quality assurance survey as soon as possible and copy the report to the CSCI. Timescale for action 30/05/06 2. OP19 23(2(6)) 30/05/06 4. OP33 24 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cedar Court DS0000063735.V288186.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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