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Inspection on 08/08/07 for Cedar Court Nursing Home

Also see our care home review for Cedar Court Nursing Home for more information

This inspection was carried out on 8th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Detailed pre admission assessments were undertaken that assessed the needs of individuals, before admission to the service was agreed. This ensured the service was confident that each individuals needs could be met, before an agreement regarding admission was made. The care plans and risk assessments seen were detailed which ensured the staff team had all of the relevant information needed to support individuals in their care needs. The relationship between staff and residents appeared positive and comments from residents and their visitors were complimentary regarding the support and care provided by the staff at Cedar Court.

What has improved since the last inspection?

An activities coordinator was now in post and there was evidence that a more structured activities and events programme was in place at Cedar Court. This included one to one activities with residents who were unable to participate within group activities or who spent all or most of their time within their own rooms. Pro-active steps had been taken to address the malodour that was noted in some areas of the home at the last inspection. This included the purchase of deodorisers. Laundry services had been improved; the new housekeeper now oversaw this service. Residents spoken with were happy with the laundering and ironing of their clothes.

CARE HOMES FOR OLDER PEOPLE Cedar Court Nursing Home Cedar Court (general) Nursing Home Bretby Park Bretby Derby DE15 0QX Lead Inspector Angela Kennedy Unannounced Inspection 8th August 2007 10:30 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 Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 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 admin@cedarcourtcare.co.uk www.cedarcourtcare.co.uk Your Health Ltd 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) 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.V341472.R01.S.doc Version 5.2 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 18th December 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. At the time of this inspection the private amount to pay for self-funding residents was £390.00 a week. Items not included in this fee were: Toiletries Specific newspapers/ magazines (the company purchases a daily and evening newspaper for residents) Opticians (not including eye tests) Chiropody Dentist (for privately funded residents) Activities/ outings Varies Varies Varies £10 per visit Varies Paid for through fund raising and donations to the home. Further information regarding the fees can be obtained by contacting the registered manager at Cedar Court. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was unannounced and took place over two days, as on the first day of inspection the registered manager was not on duty and information relating to staff recruitment and records of complaints was not accessible, as they were held in the managers office which was locked when she was not on duty. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with residents and their representatives. The inspection was focused on assessing compliance with defined key National Minimum Standards. The commission had requested the service to complete an Annual Quality Assurance Assessment and the information provided within this has also been used to inform this inspection report. Care home surveys were sent out to residents however no completed surveys were returned prior to this inspection report. The opinions within these surveys are therefore not included within this report. As stated above the registered manager was present at the second day of this inspection visit, on the first day of inspection the registered nurse on duty assisted the inspector in providing the required documentation and a tour of the building. Some of the staff team were spoken with to ascertain their views of the service and their opinion of the training and support provided to them. Two residents were case tracked and these residents were spoken with. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at plans and other documents relating to that persons care, talking to staff regarding the care they provide, talking to the resident if they are able to communicate or observing the care they receive. Some of the other residents at Cedar Court and two visitors were also spoken with to ascertain their opinions of the service and support provided to them. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The homes complaints procedure should be amended to inform complainants that their complaint could be referred to the commission for social care inspection at any stage of the complaint. The policy relating to safeguarding adults did not clearly link to the local authority policy nor refer to it. This needs to be addressed to ensure the staff team follow the correct procedure in all safeguarding adults referrals and investigations. Please contact the provider for advice of actions taken in response to this Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed assessments were undertaken before admission to ensure the needs of each individual could be met by the service. EVIDENCE: The written information provided by the registered manager prior to this inspection visit stated: We introduce prospective clients and relatives to the home and answer questions. We give clients informed choice. We provide a family environment with emphasis on community contact and involvement of friends and family. We include clients in the decision making process. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 10 A full assessment is undertaken prior to admission. We liaise with professionals and access referrals through G.P’s. The manager is ‘hands on’, part of the team, and a good rapport with other professionals is maintained. On the day of the inspection visit. The assessments and information obtained prior to admission was looked at for the two residents case tracked. The information held for both residents was detailed and demonstrated that a thorough assessment of each persons needs had been undertaken before admission to the service was agreed. The pre admissions process included assessments that were undertaken by the service and, for residents that were funded by the local authority a care management assessment of needs. The assessments undertaken by the service 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.V341472.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of residents were set out within their plan of care and health care needs were met as required. The medication practices in general were good but required further development for residents who self-administered their medication. Staff practice ensures that residents were treated respectfully and their dignity maintained. EVIDENCE: The written information provided by the registered manager prior to this inspection visit stated: We provide holistic, individualised care. Safe administration of medicines is undertaken according to guidelines set out by pharmaceutical society. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 12 Our evidence to show that we do it well is our philosophy of care and the care plans and assessments in place. We provide concise documentation and qualified nurses undertake care plan reviews. Our improvements in the last 12 months are that care plans are more accessible by client/relative. A form is available to sign when care planning has been explained. We have a closer liaison with professionals, e.g. through tissue viability nurse, continence nurse, to ensure care plans are updated. We have trained staff in documentation for end of life care. On the day of the inspection visit. The assessments in place for the two residents case tracked were detailed and clearly informed the staff of the level of support required in each area of care to ensure the individuals needs could be met. Assessments were in place that looked at mobility, pressure areas and pressure sore prevention, maintaining a safe environment, personal care and dressing assistance, sleeping, continence, nutrition and dietary requirements and preferences, recreation, worshipping, pain and pain relief and residents wishes regarding death. Where assessed areas identified risk, risk assessments were in place that informed staff of how the risk was to be managed to ensure the individuals health and safety could be managed. Records seen included assessments on nutrition, mobility, pressure areas and pressure relief, falls and continence, Evidence was in place within the 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. A proactive approach to health care was noted on the day of inspection, when concerns regarding a residents health was referred to their doctor who came out to visit the resident and made an immediate referral to hospital. The relatives of this resident were promptly contacted to inform them. This demonstrates that the health and welfare of residents is monitored and any issues or concerns are promptly made to the relevant health care professionals, ensuring that relatives are informed as a matter of priority. The medication practices were looked at and found to be in general 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 Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 13 administration were accurately recorded. Medication requiring cold storage was stored correctly and the temperatures maintained and recorded of the clinical fridge. It was confirmed that one resident had chosen to self-administer a nighttime medication. Although records were in place that demonstrated that discussions had taken place with this resident regarding self administering this medication, these records did not provide sufficient detail to demonstrate that this resident had the capacity to safely store and administer this medication. Discussions took place regarding the need for a risk assessment to be in place to demonstrate that this resident (and any resident wishing to self administer their medication) has the understanding and ability to do so safely, ensuring that neither themselves or any other resident are put at risk. Residents and relatives spoken with were very complimentary regarding the care provided to them by the staff team and comments made included “ the staff are very caring, they can’t do enough for you” and “ the care here is very good, the staff are always helpful and very kind”. Residents spoken with confirmed that the staff were respectful towards them and treated them with dignity. Observations of staff with residents and their visitors confirmed this. The atmosphere appeared relaxed and friendly and staff were seen on several occasions in discussion with residents and their visitors. Residents had access to the cordless telephone that was carried by the staff team, residents were able to use this phone to make and receive calls Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Improvements in the activities available indicated that resident’s social and recreational needs were better met. The staff team ensured that contact with family and friends was promoted and maintained. The dietary requirements of resident’s were well catered for with a choice and variety of meals available that in general met with resident’s approval. EVIDENCE: The written information provided by the registered manager prior to this inspection visit stated: When possible residents have control over their finances. Staff practice encourages residents to exercise choice and control over their lives We promote personalisation of resident’s rooms. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 15 Interaction with community care into the home is undertaken such as, fellowship and communion services. Resident’s social and recreational needs have improved due to an activity programme. We employ an activity coordinator for 30 hours a week to provide activities, escort clients on outings and maintain hobbies and interests. We have provision of daily newspapers, a library service, and a hairdressing facility. The staff team ensure that contact with family and friends is promoted and maintained. Visiting is open and we encourage the involvement of families and pets in the home, we now have 4 budgies. We have upgraded the menus; Dietary needs of residents are well catered for with a choice and variety of meals available that meet resident’s tastes and choices. We accept student placements from colleges and schools to improve community contact. . On the day of the inspection visit. The activities coordinator was spoken with regarding the hours they worked and the activities undertaken. The activities coordinator confirmed that they worked five and a half hours a day over five days a week. This included every other weekend. Activities provided were music sing a longs, baking- such as cakes, painting, jigsaws and card games, manicures, garden activities, growing tomatoes and cucumbers, and seasonal crafts and activities. The activities coordinator stated that she also worked with residents on a one to one basis, including residents who spent their time in their bedrooms, such as residents with health care needs. Within the wider community shopping trips had been organised and provided by the activities coordinator on a one to one basis with residents. This was confirmed by a resident who said they had been into the nearby town centre the week before. This resident also confirmed that they were going to the cinema with the activities coordinator during this coming week. It was confirmed that a garden fete had recently taken place at Cedar Court for this unit and the dementia unit adjoined, where money had been raised for further activities and outings for the residents. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 16 The activities coordinator also discussed plans to introduce further trips out for residents. Cedar Court employs a hairstylist therefore there were no additional charges for any residents who wished to use this service The local priest provided Holy Communion 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 is open and observations demonstrated that visitors were made welcome. One person spoken with visited his wife on a daily basis and was able to have lunch with her each day. This visitor was very complimentary regarding the staff team saying “ they’re absolutely brilliant a lovely bunch of staff, can’t fault them” and when asked about the meals this visitor said “ they great, very good indeed”. Residents were able to personalise their own private accommodation with their personal possessions and records were maintained of resident’s personal possessions within the two residents files seen. It was confirmed that none of the residents at the present time used external advocacy services. Advocacy services were advertised in the reception area of Cedar Court. The meal choices for the day were on display 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. It was confirmed by staff that residents were asked each evening for their preferred meal choices the next day. The residents spoken with were able to tell the inspector of the lunchtime meal they had chosen that day. Although in general the comments regarding meals was good, one resident said that they did not enjoy the meals at lunchtime as they were always cold and stated they did not like cold dinners. When asked if they had made the manager aware of their concerns they said they had not. This person was asked if there was a reason why they had not raised their concerns and stated that they never really thought about doing this. This resident confirmed that they were aware of their right to raise any issues or concerns and stated that they knew how to make a complaint. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 17 Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are acted upon, however the policies in place regarding complaints and safeguarding adults do not clearly demonstrate a transparent approach is undertaken. EVIDENCE: The written information provided by the registered manager prior to this inspection visit stated: We have an open door policy for clients and family to speak to the manager. We assist clients to complete postal votes or attend the polling station. We train staff in safeguarding adults and have a policy in place. Our complaints policy is displayed in reception. Copies of the complaints received are kept in the registered manager’s office. We have had two complaints in last twelve months and are still awaiting the outcome of one of these complaints. On the day of the inspection visit. Residents spoken to stated that they were confident that if they had any concerns the registered manager would address them. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 19 One resident said they were not aware of the complaints procedure but did confirm they had received a copy of the homes service user guide although they could not remember seeing the complaints procedure within this guide. A copy of the homes complaints procedure was available within the service user guide, although this procedure stated “ in the event that the complaint remains unresolved the complainant may wish to refer the matter to the national commission for social care inspectorate.” This should be amended to inform complainants that their complaint can be referred to the ‘commission for social care inspection at any stage of the complaint.’ Two complaints had been received by the service and both complaints had been recorded, including the actions taken and the outcome of the complaints. Residents were able to vote in elections, either at the local polling station, if they were able and wished to, and transport was arranged if required. Other residents chose to vote by post. The policy relating to safeguarding adults was looked at. Although this policy referred to social services supporting and advocating for residents, the procedure to follow was not in line with Derbyshire’s local authority policy, who are the lead investigators in safeguarding adult’s referrals and investigations. The policy did not clearly link to the local authority policy, as it stated that the course of action to be taken following a safeguarding adults referral or investigation would be agreed by senior managers /directors of the company, rather than agreed by the local authority lead in safeguarding adults. The policy also stated that senior managers/ directors of the company would decide upon police involvement and whether an internal investigation is undertaken. These decisions should be made under the direction of the local authority lead in safeguarding adults. Other areas of the policy, which related to the immediate action that should be taken pending an investigation, had the potential to put residents and the alleged perpetrator (if they were employed at Cedar Court) at risk. This was discussed with the registered manager. Safeguarding adults is covered as part of the staff induction program. The majority of the staff team had undertaken safeguarding adults training. Two members of staff were due to undertake this training in the near future. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 20 Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe environment and good standards of hygiene are maintained. EVIDENCE: The written information provided by the registered manager prior to this inspection visit stated: We promote personalisation of resident’s own space and provide good outside space. We provide a family like environment. There is a Loop system in lounge and there is access to T.V and music in lounges. Call system are in place in all areas. There is secure lighting outside the building. Lifts are available to first floor. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 22 We have the provision of differing types of showers and baths and new foot operated bins in toilets/bedrooms. All bedrooms have lockable doors and a lockable drawer. Double rooms have privacy curtains. We have replaced some divans with adjustable height beds We have improved by providing installation of air fresheners throughout. We have new light up fire signage and improved the laundry service. There is a laundry and kitchen onsite. All staff are trained in infection control. We have purchased an apron and glove dispenser. A new housekeeper has been employed to oversee laundry/domestic staff. Staff are trained as fire marshals. On the day of the inspection visit. Some of the resident’s private accommodation was seen and these rooms had been personalised to reflect each resident’s preference and individuality. Some bathrooms and shower rooms were seen and provided sufficient moving and handling equipment to ensure resident’s safety could be maintained when providing personal care. It was observed in the residents rooms seen that locks were fitted to bedroom doors and the top drawers of bedside cabinets. Within the two residents files seen it was noted that records were held that demonstrated that resident’s had been asked if they wanted the keys to their bedroom doors and lockable drawer. Signatures had been obtained from the resident or their representative in agreement to their preferred choice. A new housekeeper had been employed that oversees the laundry services at Cedar Court. A minimum of two laundry staff was available seven days a week from 7am-3: 30pm. The residents and representatives that were spoken to confirmed that they were happy with the laundry services provided at Cedar Court. Outside seating with shade was available to residents in the garden area. On the second day of the inspection visit the manager confirmed that some of the residents had participated in a game of ‘hook a duck’ in the garden area. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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 enhanced the resident’s protection. EVIDENCE: The written information provided by the registered manager prior to this inspection visit stated: The numbers of staff employed are nine full time care staff plus four full time nurses. Five part time care staff are employed plus one part time bank staff One other member of staff is employed that does not provide care. Separate support services staff are employed and are shared with the Dementia Care Unit such as domestic, kitchen and laundry staff, a hairdresser and receptionist. A maintenance manager and staff team are employed to cover both units. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 24 We provide a good skill mix of staff; the manager is part of the working team. We have a link nurse in tissue viability and infection control, and a staff mentor for new staff. Agency staff cover staff shortages. All staff attend mandatory training. Care staff are trained to NVQ 2 and 3. Eleven care staff have an NVQ2 or above, which equates to 73.3 of the staff team. On the day of the inspection visit. 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. Residents and visitors spoken with felt that the numbers of staff on duty were sufficient to meet the needs of the residents. Improvements have been made to the number of trained care staff with eleven care staff having achieved a National Vocational Qualification at level 2 or above in care, which means the service has exceeded the national targets set. Two staff files were looked and both contained satisfactory criminal records bureau checks, medical health questionnaires and two forms of proof of identity including photo identity. Both members of staff had two references in place. At the last inspection in December 2006 the employment application forms were looked at, and 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. However no new staff had been employed since the last inspection and therefore the amended application forms were not seen. The training undertaken by staff since the last inspection included; infection control, fire safety, manual handling, first aid, food hygiene, safeguarding adults, health and safety and training specific to residents needs, such as the Liverpool Care Pathway and continence training. Four members of staff were booked to attend Dementia training in October 2007. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well managed and their financial interests were safeguarded. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The written information provided by the registered manager prior to this inspection visit stated: Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 26 The manager has worked at Cedar Court for 20 years and has been the manager for seven years. The manager has level 3 & 4 in management, is a registered general nurse and has achieved an assessor’s award. We maintain good record keeping and have a good core staff with many years of experience. The manager is a hands on team member and leads by example and is approachable. We provide quality assurance questionnaires to residents and a copy of results is available in reception, quality assurance questionnaires to G.P’s and a copy of results are available in the office. And a suggestion book in available in reception. As a result of listening to people who use the service we have continuously updated documentation, staff training to meet required standards, train staff as link nurses in continence, tissue viability, infection control and have updated questionnaires. We have an infection control policy in place and an infection control assessment. Nineteen staff are trained in infection control. We plan on training staff in end of life care. On the day of the inspection visit. The registered manager held a first level general nursing qualification and had achieved a National Vocational Qualification in management at level 3 and 4. Training undertaken by the registered manager since the last inspection included safeguarding adult training, moving and handling, continence training, the Liverpool Care Pathway and fire marshal training. Both staff and relatives were very complimentary regarding the manager’s ability to manage the service. Satisfaction surveys were sent out to residents and their representatives, and general practitioners every six months. The registered manager stated that few people had responded to the recent satisfaction questionnaire. The results of satisfaction questionnaires were audited and the information, along with any action taken was advertised on the notice board in the reception area of Cedar Court. Resident’s finances were securely stored and records were maintained. The monies held for one resident case tracked was counted and corresponded with the records kept. The other resident case tracked retained their own money. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 27 It was noted that not all financial transactions had two signatures in place and it is recommended that two signatures be obtained for all financial transaction records as a matter of good practice. Some of the safe working practices at Cedar Court were assessed and found to be satisfactory, and included: weekly fire tests, emergency lighting checks, visual fire fighting equipment checks and the maintenance records of fire fighting equipment. Water temperature checks were undertaken and recorded each month and staff recorded bath water temperatures. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 28 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 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.V341472.R01.S.doc Version 5.2 Page 29 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 22.7 Requirement Timescale for action 01/12/07 2. OP18 13.6 The complaints procedure should be amended to confirm that complaints can be referred to the commission at any stage should they wish to do so. The policy on safeguarding 01/12/07 adults must be in line with the Derbyshire local authority policy, to ensure the correct procedure is followed in the event of a safeguarding adult referral or investigation. 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 OP35 Good Practice Recommendations Two signatures should be obtained on all residents’ financial transaction records. Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedar Court Nursing Home DS0000002105.V341472.R01.S.doc Version 5.2 Page 31 - 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. 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