CARE HOMES FOR OLDER PEOPLE
Cedar Court Lensbury Way Abbey Wood London SE2 9TA Lead Inspector
Maria Kinson Announced Inspection 5th January 2006 09:30 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 Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 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 DS0000006786.V266542.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cedar Court Address Lensbury Way Abbey Wood London SE2 9TA 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) 020 8311 1163 020 8311 1193 Southern Cross Healthcare Services Limited Mrs Kim Madeline Brown Care Home 47 Category(ies) of Dementia - over 65 years of age (47) registration, with number of places Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: Cedar Court is a purpose built home, which was originally registered in 1996. In 1997 the home was taken over by Southern Cross Healthcare Ltd and was registered for 47 mentally infirm people. At that time, 10 places provided nursing care. On the 4 March 1999, the registration was changed and the home now provides 47 residential places for older people with dementia. The home is located a short distance from Abbey Wood station, bus routes and shops. It has 41 single and 3 double bedrooms. The home is on two floors and has a sitting room and dining room on each floor. There are additional communal rooms on each floor. From the ground floor service users have access to the garden, which is enclosed. On the ground floor there are offices, a laundry, kitchen and storage rooms. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 05.01.06 between 09.30am and 17.50pm. A partial tour of the home was undertaken and the inspector spoke with two residents and three members of staff. Care, recruitment and health and safety records were examined. Comment cards were distributed to relatives and health and social care professionals that were in regular contact with the home. Ten comment cards were returned to the commission. What the service does well:
This home provides a consistently good standard of care for older people with dementia. Feedback from health and social care professionals that were in regular contact with the home was positive. No concerns were raised about the service, visiting professionals commented, “The care provided at Cedar Court is exceptional in terms of the commitment of staff”, “In my opinion this is an outstanding home”. Feedback from relatives was good. Relatives were satisfied with the visiting arrangements and said they were kept informed about important issues. One relative said, “the staff are all very caring and attentive”, we know our mother is safe. Staff undertook a comprehensive assessment of resident’s needs prior to admission. Care plans were developed to outline the support that was required to meet the needs of the whole person. Staff worked in partnership with health and social care professionals to ensure that residents health, social and psychological needs were met. Staff supported residents with advanced dementia to spend their last days in the comfort of the home, where possible. Staff provided a varied programme of activities in the home and community to meet resident’s needs and enhance their well-being. The food provided in the home was satisfactory. Staff provided regular drinks and snacks to supplement resident’s dietary needs. All parts of the home were clean, tidy and odour free. The building was well maintained and health and safety issues were monitored and addressed. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 6 The staffing arrangements were good. Residents were mostly cared for by the same group of staff that were familiar with their preferences, strengths and needs. Staff listened carefully to resident’s comments and showed concern for their welfare. The number of care staff that had attained a vocational qualification in care was high. This home has exceeded the recommendation made by the Department of Health about vocational training for care staff. Staff received dementia training and had a good understanding about dementia and its possible effects. Staff were aware of the procedure to follow if an allegation of abuse was made. Abuse awareness training was provided for staff. The home was well managed. The manager had a good understanding of dementia and worked in a flexible manner to support staff and provide a good quality of life for residents. What has improved since the last inspection? What they could do better:
This home meets or exceeds all but one of the key standards. One requirement was set as a result of this inspection. Staff received induction training but the training provided for new staff did not comply with nationally recognised standards. Good systems were in place to protect resident’s money but the current system for recording valuable items could be improved.
Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 7 Some of the information provided for the commission in response to a complaint, was not accurate. 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 DS0000006786.V266542.R01.S.doc Version 5.0 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 Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Staff carried out a comprehensive assessment of prospective resident’s needs. This enabled staff to meet residents needs on admission to the home. This home provides a consistently good standard of care for people with dementia. EVIDENCE: Prior to admission staff undertook a thorough assessment of residents needs. The assessment considered the individuals level of functioning and included general information about the resident’s health, personal and social needs. Personal preferences and issues of importance were recorded. The care provided in this home promotes the well being of older people with dementia. The home has a stable team of competent and caring staff that work hard to meet resident’s physical and psychological needs. Interaction between staff and residents was excellent. Staff communicated effectively and
Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 10 were friendly, helpful and kind. Residents were recognised and treated as individuals. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 11. Staff worked in partnership with other agencies to ensure that resident’s needs were assessed and met. The management of medication was good. Staff worked hard to avoid unnecessary hospital admissions and to provide end of life care, in familiar surroundings, for residents with dementia. EVIDENCE: Two care plans were examined. Overall the standard of documentation was good. Both of the residents had a comprehensive assessment and care plan. Care plans provided information for staff about resident’s current needs and were personalised in parts to incorporate individual preferences. Daily records provided detailed information about the action that was taken by staff to meet resident’s needs and included information about challenging behaviour and indicated when residents had declined care. One resident had a care plan for a poor appetite. The records stated that the resident had been referred to the GP and was weighed regularly. Staff were monitoring the residents food and fluid intake. Some care plans about continence did not state the frequency that the resident required assistance to use the toilet. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 12 Feedback was obtained from five health and social care professionals that were in regular contact with the home. All of the respondents said that staff had a good understanding of residents needs and were satisfied with the overall standard of care provided in the home. The following comments were included with some of the responses received “I am impressed by the range of activities and outings provided for residents”, “Staff are friendly and welcoming” and “Care at Cedar Court is exceptional”. The previous requirement regarding the management of medication had been addressed. Two medication charts were assessed. Records of receipt and administration of medication were good and staff had made reference to other relevant documentation where appropriate. Staff indicated that residents could choose to spend their last days in the home if their needs could be met. The home received good support and advice from other professionals when end of life care was provided in the home. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. A regular programme of activities was provided in the home and community. Visiting arrangements were satisfactory and relatives had an opportunity to comment about the management of the home. The food provided in the home met residents nutritional needs and tastes. EVIDENCE: Senior staff were responsible for arranging a regular programme of activities for residents. The programme was displayed in the home and was carried out by care staff at different times throughout the day. Regular outings were organised to places of interest and local shops and parks. In house activities included arts and crafts, sing- along, chair aerobics, massage and aromatherapy. Staff recognised the importance of providing daily stimulation and variation for residents. Some of the health care professionals that visited the home were “Impressed by the range of activities and outings provided for residents”. Feedback from relatives was good. All of the relatives that returned comment cards to the commission said they were kept informed about important issues, were satisfied with the visiting arrangements and overall standard of care provided in the home. Relatives said that staff were helpful and kind and one
Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 14 relative compared the care her mother received in the home to the care she would provide. Regular meetings were held for relatives. This provided an opportunity for relatives to ask questions about the management of the home, make suggestions and obtain information and support. The minutes of the last meeting indicated that relatives had watched a video about dementia, asked questions about staffing and received an update about the progress of the redecoration programme. The Manager had recently joined an organisation that will provide telephone advice for resident’s representatives about financial and benefit issues. Breakfast was served in the lounge as new flooring was being laid in the ground floor dining room. Residents were offered a choice of sausage or egg sandwiches and a hot drink. Because work was still in progress during the lunch period lunch was served in the activities room. This did provide some challenges for residents and staff due to lack of space. The manager was confident that the work to replace the dining room flooring would be completed on the day of the inspection. Residents were offered regular drinks and snacks throughout the day. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home had a comprehensive complaints and adult protection procedure for responding to complaints or allegations of abuse. Care must be taken to provide accurate and up to date information for complainants. EVIDENCE: The complaints procedure was displayed in the reception area. A complaints file was kept in the office and all complaints were reported to head office. The home had not received any complaints since the last inspection. The commission had received one anonymous complaint about employment issues. This complaint was passed to the Registered Person to investigate. Examination of staff files during this inspection indicated that some information provided in the response to the complaint was not accurate. This issue was discussed with the manager. See requirement 1. The homes adult protection procedure had not changed. Records indicated some staff had attended abuse awareness and whistle blowing training sessions. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 16 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 and 26. The standard of décor and furnishings provided in the home had improved. EVIDENCE: Since the last inspection a significant amount of work had been undertaken to make the home more welcoming and comfortable for residents. The carpet or flooring in the dining rooms, some bedrooms and both corridors had been replaced. The first floor dining room and kitchen had been redecorated and new furniture and fittings had been purchased for communal areas and bedrooms. A large screen television had been purchased for the ground floor lounge. Further improvements were planned, this includes replacing the carpet or flooring in the first floor lounge and hairdressing room, redecorating the laundry and purchasing a second large screen television, new chairs, bedding and curtains. The carpet in the manager and administrators office was worn and stained. This issue did not pose a risk to residents but did not create a positive first impression of the home.
Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 17 Although a new boiler and radiators had been fitted to some parts of the home some bedrooms did not feel warm. Additional heaters were in use and staff were monitoring the temperature. The commission was advised after the inspection that the heating system had been repaired and was in full working order. A local environmental health inspector had visited the kitchen in October 2005. The report from this visit indicated that the home had good food handling systems in place but deep cleaning should be improved. The manager said that action had been taken to address this issue. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 18 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 and 30. This home has a stable and competent team of staff. Access to vocational training was good but induction training did not comply with nationally recognised standards. The homes recruitment procedure provides good protection for residents. EVIDENCE: The arrangements for staffing the home were satisfactory. There were eight care staff on duty during the day and four care staff overnight. The manager worked mostly office hours but undertook some evening and night duty shifts where necessary. Kitchen, domestic and maintenance staff provided additional support. Two staff had resigned since the last inspection but these posts had been filled. Retention of staff was good. This provided good continuity of care for residents. The home had not used agency staff during the past eight weeks. Regular staff meetings were held in the home. All of the residents spoken with said that staff were helpful and friendly. Staff interacted with residents in a caring and friendly manner and had a good understanding of residents needs. The atmosphere in the home was calm and relaxed and it was apparent that staff had established positive relationships with a number of residents. Staff made sure that residents were not left alone by bringing work into the lounge where necessary.
Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 19 77 of care staff had a vocational qualification in care at level 2 or above. This exceeds the standard set by the Department of Health for fifty percent of care staff to achieve this qualification by December 2005. Two staff recruitment files were assessed. All of the necessary paperwork and checks were obtained and undertaken. The manager was asked to provide additional information for the commission about one criminal record bureau check. Individual training files were maintained for each member of staff and training needs were identified during supervision. During the past year some staff had attended mandatory health and safety training updates and other relevant sessions such as infection control, abuse, dementia awareness, first aid, aromatherapy, nail cutting, falls awareness and COSHH. Seven staff had completed specialist dementia training ‘Person Centred Approach to Care’. Some of the staff that had attended this training were identified as having suitable skills and knowledge to facilitate ‘Person Centred Approach to Care’ training sessions for other staff. New staff received induction training but this was not to nationally recognised standards. See recommendation 1. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 20 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, 35, and 38. This home was well managed. The atmosphere in the home was open and supportive. Staff worked hard to provide a good quality of life for residents with dementia. The arrangements for safeguarding resident’s money were good. EVIDENCE: The management arrangements in the home were stable. The manager had completed a NVQ level four in care and management and some of the units towards the Registered Managers Award. Two of the resident’s personal money records were examined. All transactions were recorded and receipts were issued when relatives handed money over to staff. Two signatures were obtained for all transactions and receipts were kept for all purchases and services such as hairdressing, chiropody or newspapers. The manager carried out regular checks to ensure that the homes procedure was followed. Valuable items handed to staff for safe keeping were recorded in
Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 21 the residents care notes. Staff should consider maintaining a central log so that regular checks can also be made on these items. See recommendation 2. A variety of health and safety certificates and reports were examined. Equipment and utilities were checked at regular intervals and action was taken to address recommendations. Fire safety arrangements were satisfactory with detailed records maintained about staff attendance and response to fire drills. A fire risk assessment was carried out in May 2005. One accident form was examined for a resident with facial bruising. A factual account of what staff had seen was recorded and appropriate care was provided for the resident. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 22 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 4 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 23 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 OP16 Regulation 22 Requirement The Registered Person must ensure that all complaints are properly investigated and that information provided in response to a complaint is accurate. Timescale for action 17/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP30 OP35 Good Practice Recommendations The Registered Person should that induction training is to National Training Organisation standards. The Registered Person should maintain a central log of valuable items that are held for safekeeping. Cedar Court DS0000006786.V266542.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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