Inspection on 18/12/06 for Cedar Court Nursing Home

This inspection was carried out on 18th December 2006.

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

Cedar Court Nursing Home 08/08/07

Cedar Court Nursing Home 13/02/06

Cedar Court Nursing Home 24/08/05

Cedar Court Nursing Home 09/03/05

Cedar Court Nursing Home 25/08/04

Cedar Court Nursing Home 03/09/02

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cedar Court Nursing Home Cedar Court (general) Nursing Home Bretby Park Bretby Derby DE15 0QX Lead Inspector Angela Kennedy Key Unannounced Inspection 18 December 2006 02:00 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 Nursing Home DS0000002105.V293208.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 Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cedar Court Nursing Home Address Cedar Court (general) Nursing Home Bretby Park Bretby Derby DE15 0QX 01283 211412 01283 552220 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) Your Health Ltd Mrs Marie June Pickering Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (3) of places Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 places for PD aged 50 years and over included in the total above. Date of last inspection 13th February 2006 Brief Description of the Service: Cedar Court care home has two units. This is the smaller unit and provides nursing and personal care for up to 30 persons aged 65 years and over, including up to 3 places for persons aged 50 years and over with a physical disability. Cedar Court is situated in a rural location near to Bretby village. Your Health Limited owns the home. The home is a two-story building; adapted for use as a care home. Residents have access to all parts of the home including a large enclosed, well kept garden. The fees for residency at Cedar Court are as per social service rates, although private rates are applicable to residents who are self funding. Further information regarding the fees can be obtained by contacting the registered manager at Cedar Court. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection, which means that the service was assessed against all of the key national minimum standards. The inspection took place over two days, as the registered manager was not on duty on the first day and therefore not all of the required information and documents were available. Other information regarding the service was obtained prior to the inspection, such as information regarding the meals provided, the number of complaints received by the service in the last twelve months, maintenance records, policies and procedures in place, the activities provided to residents and training undertaken by staff. During the inspection several documents relating to the above areas were assessed. Medication practices were looked at and the practice in place for resident’s finances was looked at. Three residents personal files were read, looking at the care plans, risk assessment and other relevant documents that related to the care and support provided to them. These residents were able to express their views of the service provided. Residents were observed throughout the inspection, undertaking their daily activities and routines, which allowed an opinion to be formed of their general well being. Some relatives were available to speak with and expressed their views on the quality of the care and support provided to the residents. Three staff files were seen, looking at the recruitment practices in place and the training provided. Five members of staff were spoken with to gather their opinion on the support and training provided. What the service does well: Assessments were undertaken before admission to ensure the needs of each individual could be met by the service. Care plans and risk assessments clearly informed staff of the care and support required to meet the needs of each individual. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 6 The rapport between staff and residents was relaxed and friendly. Comments made by residents were very positive regarding the care and support provided by the staff team. What has improved since the last inspection? 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 Nursing Home DS0000002105.V293208.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 Nursing Home DS0000002105.V293208.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 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Assessments were undertaken before admission to ensure the needs of each individual could be met by the service. EVIDENCE: Three residents care files were seen and all included a detailed needs assessment that had been undertaken prior to admission to Cedar Court, this information included each residents personal information, including next of kin and the professionals involved in their care, past medical history, their current prescribed medication, all healthcare needs, communication methods, personal care needs, mobility, hobbies and recreational interests and needs, and their personal safety needs. This demonstrates that the needs of each resident were thoroughly assessed prior to admission; to ensure that the care and support provided at Cedar Court was suitable to meet each individual’s assessed needs. Cedar Court Nursing Home DS0000002105.V293208.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 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to the service. Resident’s health, personal and social care needs were set out within their plan of care and health care needs were met as required. The medication practices in place ensured that resident’s welfare was maintained. Staff practice ensures that residents were treated respectfully and their dignity maintained. EVIDENCE: Of the three residents care files seen all had care plans and risk assessments in place that clearly informed the staff team of the care and support required to met the needs of each individual. The care plans in place identified healthcare, personal, social, cultural and religious care needs. These care plans had been developed from the needs assessment undertaken. All of the care plans seen had been reviewed monthly or sooner if needs changed. Risk assessments had been developed for each individual that clearly identified any areas of risk, such as falls assessments, mobility, pressure area risk assessments, moving and handling assessments, Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 10 nutritional assessments including weight monitoring, continence assessments and assessments that were specific to individuals health care needs. Evidence was in place within the five residents care files seen to demonstrate that healthcare professionals were consulted and involved in residents care. Records of general health checks were in place within the residents files seen; these were undertaken every three months and included resident’s weight, blood pressure, temperature, pulse and respirations. The medication practices were looked at and found to be satisfactory. Medication administration records had been completed accurately and the medication was stored securely and in line with pharmacy guidelines. Controlled medication was correctly stored and the records of stock and administration were accurately recorded. All medication received and returned was recorded. Information was in place that looked at a pharmacy error that had been identified by the deputy manager this had been addressed and demonstrated that robust medication procedures were maintained to protect residents. An observation of staff with residents was undertaken and it was noted that the atmosphere was relaxed and friendly. Staff addressed residents by their preferred name and residents appeared comfortable and relaxed when interacting with staff. Residents had access to the cordless telephone that was carried by the staff team, residents were able to use this phone to both make and receive calls. The three residents whose files were looked at were spoken with and all three confirmed that the staff treated them with respect. Comments made were; “The staff are very nice, very good, they look after us well” and “staff are very kind” and “ we’re well looked after, the staff are very good”. In general the relatives spoken with felt the staff were respectful of the residents and their needs although one relative felt that a few of the staff did not always attend to residents needs upon request but stated that in general she felt the staff worked very hard. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Resident’s social and recreational needs were not fully met due to the lack of an activity programme. The staff team ensured that contact with family and friends was promoted and maintained. Staff practice encouraged residents to exercise choice and control over their lives. Dietary needs of residents were well catered for with a choice and variety of meals available that met resident’s tastes and choices. EVIDENCE: Activities were not undertaken frequently as there was nobody in post to coordinate activities. The registered manager stated that the post for a motivator had been advertised and interviews for the post were still taking place. Activities and events that had taken place included a Christmas party for the residents and a Christmas Carol service. Outside entertainers also visited the residents each month and a choir had been recently to sing Christmas Carols. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 12 The manager said that care staff sometimes took residents into town either on a one to one basis or within small groups, and stated that books, magazines and newspapers were available to residents. All of the residents spoken with stated that there was not enough to occupy them during the day. Cedar Court employs a hairstylist therefore there were no additional charges for any residents who wished to use this service. Holy Communion was provided by the local priest at Cedar Court on a weekly basis for any residents who wished to participate and every three months the local vicar held a service within Cedar Court for residents who wished to attend. Visiting at Cedar Court was open and relatives spoken with stated that they were always made to feel welcome by staff when they visited. None of the residents were able to manage their own finances and these were managed by either relatives or Cedar Court. Residents were able to personalise their own private accommodation with their personal possessions and records were maintained of resident’s personal possessions. The registered manager confirmed that none of the residents at the present time used external advocacy services, but stated that advocates had been used for residents in the past. Advocacy services were advertised in the reception area of Cedar Court. The menus were seen and demonstrated that a good variety of meals was available with alternatives offered at each mealtime. Cooked breakfasts were available each day and vegetarian options provided. Special diets were catered for. Residents that were spoken with all confirmed that the meals were very good. One relative spoken with said that she had not seen the meals but was aware that a good choice was available and stated that her mother seemed to enjoy the meals provided. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 13 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents felt confident that complaints would be listened to and acted upon and their legal rights were protected. The practices in place protected residents from abuse. EVIDENCE: Residents spoken to stated that they were confident that if they had any concerns the registered manager would address them. Cedar Court had received two complaints in the last twelve months; one of these had been received by the Commission and sent to the registered manager to investigate. Both complaints had been addressed within the 28day timescale and the outcome of both complaints had been recorded. Residents were able to vote in elections, one resident chose to vote at the local polling station and transport was arranged for this resident to do this. Other residents chose to vote by post. No safeguarding adult referrals or investigations had been undertaken at Cedar Court. A corporate training manager is now available who ensures that staff training is maintained and kept up to date and this included training in safeguarding Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 14 adults. Evidence was in place to demonstrate that staff had undertaken this training. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 15 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Although the environment is safe, it requires improvements in some areas to make it homely for the residents. EVIDENCE: A tour of the unit was undertaken. At the time of inspection, redecoration was taking place of all corridors. Some of the resident’s private accommodation was seen and these rooms had been personalised to reflect each resident’s preference and individuality. However an unpleasant odour was noted in some private accommodation. This was discussed with the manager. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 16 Some of the bathrooms and toilet areas were seen and provided sufficient space and moving and handling equipment to allow staff to support residents in personal care needs. The communal areas were seen and provided a safe and comfortable area for residents. The laundry area was looked at, and provided sufficient equipment to ensure disinfection standards were maintained. Laundry staff were employed to manage the laundering of residents clothing and it was confirmed that a member of the laundry team was available within Cedar Court every day, including weekends. On the day of inspection, it was observed that residents clothing appeared well laundered. However, one relative spoken with said that she felt the laundry services could be improved as not all of her mother’s clothes appeared to be ironed. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents needs were met by the numbers and skill mix of staff on duty who had the appropriate qualifications and training required to support and care for the residents. The homes recruitment procedures require further development to ensure the resident’s welfare is safeguarded. EVIDENCE: The duty rotas were looked at and demonstrated that five staff were on shift throughout the day, one of these being a registered nurse and two staff were on duty throughout the night again one being a registered nurse. Visitors spoken with felt that the numbers of staff on duty were sufficient to meet the needs of the residents. Sufficient staff were seen interacting and supporting residents on the day of inspection. Eight care staff had achieved a National Vocational Qualification at level 2 in care, this equates to over 50 of the care staff team. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 18 Three staff files were looked and all contained satisfactory criminal records bureau checks, medical health questionnaires and two forms of proof of identity including photo identity. Two members of staff had two references in place and the other member of staff had none. This was discussed with the registered manager, who stated that this member of staff had worked at Cedar Court previously and within the past twelve months, and her employment history since leaving Cedar Court appeared to be well known by the registered manager. The manager confirmed that references had been applied for. It was agreed that references would be obtained for this member of staff as a matter of urgency. All three staff had employment application forms in place. However these forms requested the last ten years employment history and not the required full employment history. It was confirmed that new application forms now requested a full employment history and a written explanation for any gaps in employment. The training undertaken during the last twelve months by the staff team was also looked at and included; control of infection and contamination, manual handling of people, safeguarding adults, basic food hygiene, nutrition and fire training and first aid. A training manager was now in employed that was responsible for ensuring staff training was kept up to date. Five members of staff were spoken with and confirmed that the training opportunities provided were very good. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 19 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Residents lived in a home that was well managed and run in their best interests. Residents financial interests were safeguarded and the health, safety and welfare of residents and staff was promoted and protected. EVIDENCE: The registered manager had been in post at Cedar Court for the last five years, although she has worked at Cedar Court since 1987. The registered manager held a first level general nursing qualification and had achieved a National Vocational Qualification in management at level 3 and 4. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 20 Both staff and relatives were very complimentary regarding the manager’s ability to manage the service. The quality assurance systems were looked at it was confirmed that the company send out questionnaires to relatives and residents. The registered manager stated that new satisfaction questionnaires had been sent out in October although to date a poor response had been obtained. The registered manager discussed questionnaires that had been sent out in June 2005 and the results of these questionnaires were looked. Twenty three questionnaires were sent out and fifteen replies were received, which amounted to 56 on which the figures were based. The questionnaires clearly demonstrated areas that were considered good and areas were improvements were required. 80 of relatives were consulted within these questionnaires. The results and any actions undertaken from questionnaires were made available to residents and relatives, and were displayed within Cedar Court. The registered manager stated that questionnaires had also been devised for general practitioners to complete and these were due to be sent out. Resident’s finances were securely stored and records were maintained. The monies held for two residents was counted and corresponded with the records kept. It was noted that not all financial transactions had two signatures in place, this was discussed with the administrator and registered manager and recommended that this been done as a good practice measure. Discussions also took place regarding the amounts of monies in place for some residents. The administrator agreed to look into this matter. Some of the safe working practices at Cedar Court were assessed and found to be satisfactory, and included: Monthly safety audits and monthly maintenance checks which were carried out by the qualified health and safety person. Fire alarms, which were checked each week and staff fire training which was kept up to date. Requirements had been left at the fire officers last visit, the registered manager discussed the requirements that were left and confirmed that these had been met. Hoist and adaptations were serviced in September 2006. The electrical wiring had been checked and a certificate issued in September 2006. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 21 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 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X 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 Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 22 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 OP12 Regulation 16 (2) (n) Requirement In consultation with residents a programme of activities must be arranged that meets residents social and recreational needs. Two satisfactory written references must be obtained for all staff employed. Timescale for action 01/04/07 2 OP29 19 4 (b) Schedule 2 01/02/07 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 OP26 Good Practice Recommendations The manager should ensure that areas within the home with a malodour are addressed. Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Cedar Court Nursing Home DS0000002105.V293208.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!