CARE HOMES FOR OLDER PEOPLE
Cedar Court [General Unit] Bretby Park Bretby Derby DE15 0QX Lead Inspector
Vanessa Davies Unannounced 24 August 2005 10.00am 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 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 [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cedar Court [General Unit] Address Bretby Park Bretby Derby DE15 0 QX 01283 211412 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Lindsay Mulholland Your Health Limited Mrs Marie June Pickering Care Home with Nursing 30 places Category(ies) of 30 Older People registration, with number 3 Physical Disability of places Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 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 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. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and information for this report was gathered by speaking with the manager and reading necessary information, including residents files. What the service does well:
Prior to any move to the home the manager completes an enquiry form, which gives enough information to establish whether needs can be met at the home. All residents have detailed assessments of need in place. Care plans and risk assessments are developed from these. Prior to moving to the home prospective residents and relatives are invited to visit. The manager completes a number of other assessments in order to ensure all needs are met. All residents are registered with a GP. The manager carries out 3 monthly health checks on all residents. All care plans are reviewed monthly and residents and relatives are encouraged to become involved. There is an activity coordinator who arranges suitable activities. Relatives are made to feel welcome when visiting and are able to visit without restriction. Staff have completed Adult Protection training and there is a clear Adult Protection procedure in place. There is a complaints procedure in place and all complaints are documented and dealt with appropriately. At the time of inspection there were 27 residents at the home, 1 Registered Nurse and 4 care staff are on duty throughout the day, with 1 Registered Nurse and 2 care staff throughout the night. This is increased to 5 care staff during the day when there are 30 residents. A wide range of training is available for all staff to ensure the needs of the residents are met. The home has exceeded the National Minimum Standard of 50 of staff trained to NVQ 2. The home is well managed by a Registered Nurse with NVQ 3 & 4 in Management. The manager keeps all residents records securely.
Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 6 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 [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 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 standard(s) 3,4,5 Good clear assessments of need enable staff to meet residents’ needs, at the time of admission and an on-going basis. EVIDENCE: Two files were examined on this occasion. Each of the files had detailed assessments of need completed by a relevant professional. The assessments detail both health and social needs. The assessments detail all areas from the National Minimum Standards to ensure that all needs are met. Prior to any move to the home the manager completes a ‘New resident enquiry form’ with enough information to establish whether needs can be met by the home. The manager stated that all prospective residents and relatives are invited to visit the home prior to any move. During this visit they are able to look around, meet staff and speak with residents. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 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 standard(s) 7,8,11 The health and social needs of the residents are well met with evidence of good multi-disciplinary working. EVIDENCE: As stated previously each file had detailed assessments of need, highlighting the social and health needs of the resident. A nutritional assessment reviewed monthly, manual handling risk assessment and input planning and a continence assessment were also available. The manager carries out 3 monthly health checks, which included blood pressure, pulse, temperature, respirations and urine samples. The GP visits as necessary and staff document these visits. Each resident if offered the Flu vaccine and an agreement sought from the resident or a relative. There are detailed care plans in place, which are reviewed on a monthly basis, although the 2 files examined did not evidence resident or relative involvement, the manager produced a number of files with evidence of input from residents and their families. The manager does encourage relatives to become involved but some choose not to. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 10 The home now has an activity coordinator whose role it is to arrange activities suitable to meet the needs of the residents. The inspector did not examine activity records or speak with residents on this occasion, however the manager stated that activities are arranged for residents. During the inspection an elderly gentleman came into the office with a handful of tomatoes for the manager, which he had grown himself in his greenhouse. The manager has a detailed document for residents or their relatives to complete regarding terminal illness and death. Again some residents and relatives choose not to complete as they find it to difficult, however they are given the opportunity. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 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 standard(s) 13 Relatives and friends are made to feel welcome, supporting residents to continue contact with their community. EVIDENCE: It was evident in the files examined that relatives are supported and encouraged to visit and be as involved as possible with the residents care, in agreement with the resident. A number of relatives were seen visiting during the inspection. Staff were observed to be very welcoming and friendly. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16,18 The procedures and training in place for staff ensures that the residents are listened to and protected from abuse. EVIDENCE: The home has a clear complaints procedure, which appears to be easy to understand and follow. The manager should ensure that CSCI details are available in the procedure. All complaints are documented and fully investigated and clear records kept by the manager. The training records examined evidenced that staff have completed Adult Protection training. There is a detailed Adult Protection procedure in place. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 13 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 standard(s) EVIDENCE: The inspector did not assess the environment on this occasion, this will be done on the next inspection. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Due to a range of training provided and a high ratio of staff trained to NVQ 2 minimum, residents receive a good standard of care and their needs are met. EVIDENCE: At the time of inspection there were 27 residents, staffing for this is currently 1 Registered Nurse and 4 care staff throughout the day, with 1 Registered Nurse and 2 care staff through the night. The manager stated that when there are 30 residents at home care staffing numbers are increased to 5 throughout the day. The organisation employs a training officer, whose role it is to organise training to meet the needs of the residents and staff. Training records evidenced a range of training provided; Fire Safety, Infection Control, Manual Handling, First Aid, a number of staff still need to complete First Aid training. Diabetes, MRSA and Heart Failure training are also provided. The home employs 14 care staff, including 1 bank staff, 5 staff have NVQ 2 and 2 are completing it, 4 staff have NVQ 3 with 1 completing it. The home exceeds the National Minimum Standard of 50 qualified by 2005. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37,38 The manager provides good clear leadership supporting staff to meet the needs of the residents. Her annual audits ensure that the service provision is monitored and improved. EVIDENCE: The Registered Manager has a number of years experience, she is a Registered Nurse and has completed NVQ 3 & 4 in Management. She also undertakes regular training in order to keep herself updated. The contents of this report highlight her ability to support the staff to ensure that service users needs are clearly met. Throughout the inspection staff came to her for advice and assistance and she clearly has an open-door policy, which staff take advantage of. The Responsible Person does not currently undertake Regulation 26 monitoring visits. The manager sends out questionnaires to residents, their relatives and
Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 16 other professionals on an annual basis to monitor the quality of service provided. Results of these audits are published. The manager provides irregular supervision for all staff, although she does ensure that the National Minimum Standard of 6 per year is met. Staff also have an annual appraisal, these were seen by the inspector. Detailed policies and procedures are in place to ensure that the residents are safe. All records are kept securely. Records seen on the day of inspection were accurate and up to date. Fire records were up to date, with regular fire drills being held. The manager keeps a record of all accidents and incidents and informs the relevant authorities as necessary. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 4 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 x x 3 3 3 Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 18 YES Are there any outstanding requirements from the last inspection? 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. 2. Standard 30 33 Regulation 18.1 C i 26 Requirement Staff must receive the training needed to complete their role. The Responsible Person must visit the home in accordance with this regulation. Timescale for action 30.11.05 30.09.05 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 16 30 Good Practice Recommendations CSCI details should be documented in the complaints procedure. All staff need to complete First Aid training. Cedar Court [General Unit] C52 C02 S2105 Cedar Court General V244338 240805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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