Inspection on 29/11/07 for Cedar Court Nursing Home (Dementia Unit)

This inspection was carried out on 29th November 2007.

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... 18/12/06

Cedar Court Nursing Home... 22/11/05

Cedar Court Nursing Home... 07/07/05

Cedar Court Nursing Home... 09/03/05

Cedar Court Nursing Home... 16/06/04

Cedar Court Nursing Home... 22/12/03

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 (Dementia Unit) Bretby Park Bretby Derbyshire DE15 0QX Lead Inspector Angela Kennedy Unannounced Inspection 29th November 2007 08:40 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 (Dementia Unit) DS0000002160.V354312.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 (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Court Nursing Home (Dementia Unit) Address Bretby Park Bretby Derbyshire DE15 0QX 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) 01283 211412 01283 552220 admin@cedarcourtcare.co.uk www.cedarcourtcare.co.uk Your Health Ltd Mrs Joy Theaker Care Home 50 Category(ies) of Dementia (50) registration, with number of places Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Option of admitting up to 10 persons aged 50 years and over within the total number registered 18th December 2006 Date of last inspection Brief Description of the Service: Cedar Court Care Home has two units. The larger unit provides nursing and personal care for up to fifty persons aged 65 years and over with dementia, including up to ten places for persons aged 50 years and over. Cedar Court is situated in a rural location near to the village of Bretby, South Derbyshire. Your Health Limited owns the home. Cedar Court is a two-storey building, adapted for use as a care home. The unit has 34 single and 8 double bedrooms. 30 bedrooms have en-suite facilities. Access to the first floor is by a stairs and a passenger lift. The unit has three lounges and dining areas on the ground floor and the first floor, and has a large enclosed garden area that is accessible to the residents. Although the ground floor is for both male and female residents, there is a specific area on the first floor for male residents. The fees for residency at Cedar Court are as per social service rates. Further information regarding the fees can be obtained by contacting the registered manager at Cedar Court. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took place over approximately eight hours. 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 the people using the service. 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 assessment has been used within this inspection report. On the day of this inspection the registered manager was not on duty, therefore the deputy manager assisted the inspector with any records required. Some of the residents were spoken with, although the information they provided was somewhat limited due to their health care needs. As the residents were unable to express their opinions of the service and care provided, time was spent over the lunch time period, observing in detail the support being given to a small group of residents. The observations recorded were discussed with the deputy manager and the findings of those observations are included in the main body of this report. Eleven surveys were completed by resident’s representatives, such as family and friends. The information provided within these surveys is included within this report. Three members of staff were spoken with at length to ascertain their views on the care and services provided to residents, and their opinion of the training and support offered to staff. Two staff surveys were returned and the information provided within these surveys is included within this report. At this inspection two residents were case tracked. 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 care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.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: 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. The summary of this inspection report can be made available in other formats on request. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 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 (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 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. 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. Resident’s needs were assessed before admission to the home was agreed, this ensured that each individual was confident that the service could meet their needs. EVIDENCE: Written information provided by the service prior to this inspection visit stated: We undertake a full detailed pre admission assessment. Emergency admissions have detailed faxed information from social services or CMHT. Within the next 12 months we will allocate carers to undertake life histories, this will provide more background and social history for each resident. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 9 Information gathered at this inspection visit, and from surveys returned demonstrated that detailed needs assessments were undertaken for each individual prior to admission to Cedar Court. The needs of the two residents case tracked had been thoroughly assessed. The assessments looked at 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 ensured that the care and support provided at Cedar Court was suitable to meet each individual’s assessed needs. Comments from resident’s representatives demonstrated that residents were assessed prior to admission and that information regarding the services and support provided at Cedar Court was made available to them. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 10 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. Detailed individual plans of care enabled staff to support residents, which ensured their needs were met. The medication practices in place ensured that resident’s welfare was maintained. Staff practice ensured that residents were treated respectfully and their dignity maintained. EVIDENCE: Written information provided by the service prior to this inspection visit stated: We provide detailed care plans for everyone. Carers are achieving NVQ’s and gaining better knowledge. Regular G.P and psychiatric visits, input from other resources which include; physiotherapist, speech therapist, occupational therapist, court of protection officers, solicitors. We have open visiting and relatives are encouraged to have meals with their family. We have regular hairdressing service and residents are able to personalise their rooms. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 11 We believe more staff would allow more time for extra care. Information gathered at this inspection visit and from surveys returned demonstrated that care plans had been developed from the needs assessments undertaken before admission. The care plans seen for the two residents case tracked identified their healthcare, personal, social, cultural and religious care needs. Within the two resident’s care files seen their representatives had signed the care plans to demonstrate their involvement and agreement in the care being provided. Comments from residents’ representatives included, “ they always ring when any alterations are needed to ask my views”. All of the care plans seen had been reviewed monthly or sooner if needs had changed. Comments from resident’s representatives were positive, such as “they identify my sisters needs and act upon them”. Risk assessments were in place within the resident’s files that clearly identified each area of risk and instructed staff as to how each risk area was to be managed. The risk assessments seen included: falls assessments, pressure area risk assessments, moving and handling assessments, nutritional assessments including weight monitoring, continence assessments and assessments that were specific to individuals health care needs. Copies of care reviews from the local authority were also in place within the residents files seen. Records of general health checks were in place within the residents files seen; these were undertaken regularly and included resident’s weight, blood pressure, temperature, pulse and respirations. Consent forms for the flu vaccine were in place within residents files seen these had been signed by relatives. Evidence was in place to demonstrate that healthcare professionals were consulted and involved in residents care, this included, consultant psychiatrists, general practitioners, district nurses and tissue viability nurses. Residents representatives stated that they were informed of any changes in their relative/friend’s health, comments made included, “I am always kept up to date with anything that involves mum” Daily records were in place within both of the residents files seen. This ensured that any events, visits and the daily lives of each person were communicated throughout the staff team. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 12 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. Staff were observed in their interactions with residents and this was relaxed and friendly. Staff addressed residents by their preferred name and residents appeared comfortable and relaxed when interacting with staff. From the observations seen it was apparent that the staff team had a good understanding of each individuals needs. Relatives were very complimentary regarding the support and care provided by the staff team, comments included “ staff are always friendly and help. They always have any information ready. They know all the clients by name even pet names sometimes. It’s a pleasure to visit” and “ my mother receives the best care she can and everyone who deals with her are wonderful” Although the majority of residents were unable to express their views of the care and support provided, three of the residents were able to do so. These residents confirmed that the care and support they received was very good and that the staff team treated them with respect. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Activities were implemented for residents that catered to their individual needs and contact with family and friends ensured residents well-being was maintained. The meals provided were of a good quality and enjoyed by residents, which demonstrates that their preferences and tastes were accounted for. EVIDENCE: Written information provided by the service prior to this inspection visit stated: We have flexible routines to suit individual needs. We have an activities coordinator 5 days a week. We could provide a more organised table of events, but this can prove difficult for our resident group. Regular parties are organised around specific themes, such as Christmas, special birthdays and wedding anniversaries. Visiting is open. We undertake fund raising events and in the last 12 months we have purchased nice garden furniture through fund raising. Laundry facilities are provided. We have 4 weekly rotation on menus and Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 14 provide homely food to meet individual’s needs. Special diets are catered for. Menus are on display. Food hygiene training has been done by 88 care staff. Unknown re catering staff as facilities manager has this information. Information gathered at this inspection visit and from surveys returned demonstrated that the service strived to provide activities and events that would meet the needs of the resident group. The activities co-ordinator was spoken with regarding the different activities that were provided to the residents, and she demonstrated a good understanding of the needs of people with dementia. The activities co-ordinator stated that residents activities had been limited recently as due to staffing levels the activities co-ordinator had been supporting the care staff at meal times, which in turn had reduced the amount of time spent on activities with residents. The activities coordinator discussed events that were planned and booked for the Christmas period, such as external entertainers and craftwork with residents such as Christmas Card making and Christmas Cracker making. The activities coordinator stated that activities were designed around individual needs that related to their earlier lifestyle, such as hobbies that they had undertaken or their employment history, as this was more likely to engage and interest them. The activities co-ordinator confirmed that the majority of residents enjoyed singing and dancing and this was a popular activity within Cedar Court as residents were always able to remember the words to songs and participate fully. One resident spoken with talked about some knitting they had done and staff confirmed that this resident enjoyed knitting. Cedar Court employs a hairstylist therefore there were no additional charges for any residents who wished to use this service Residents were supported to maintain their religion and faith beliefs, one resident’s representative said, “ they have encouraged mum and supported her to continue her faith as much as possible. Holy Communion was provided by the local priest at Cedar Court on a weekly basis for any residents who wished to participate and every month the local vicar held a service within Cedar Court for residents who wished to attend. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 15 The deputy manager confirmed that visiting was open at Cedar Court. Comments from resident’s representatives confirmed that they were made welcome by the staff team and included, “ the home encourages families to participate in activities, join in with lunch, open visiting and a friendly welcome from the staff”. None of the residents were able to manage their own finances and either relatives or Cedar Court managed these. Residents were able to personalise their own private accommodation with their personal possessions and records were maintained of resident’s personal possessions. Discussions with the facilities manager confirmed that all catering staff had undertaken basic food hygiene training, although one member of staff was due for a refresher course and this person had been booked onto this training within the near future. Residents that were spoken with all confirmed that the meals were very good, and comments from residents representatives included, “ there’s always a good choice and plenty” and “ my uncle loves the food and enjoys every meal…you are asked if you want a drink or any food with your family”. The menus were seen and demonstrated that a good variety of meals were available with alternative choices offered at each mealtime. Cooked breakfasts were available each day and vegetarian options provided. As stated in the summary of this report, time was spent over the lunch time period, observing in detail the support being given to a small group of residents. It was noted throughout this observation period that staff were attentive to residents needs and supported them in a respectful and patient manner, staff were observed supporting residents to eat their lunch and this was done at the pace of each individual, ensuring the mealtime was a pleasurable experience. Staff were observed positively interacting with both the residents they were supporting throughout the lunch time period, and with other residents who were able to eat their lunch independently. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The complaints procedure and practices in place allows residents, their representatives and anyone involved with the service to complain or make suggestions for improvement. Specific guidance is available to a competent staff team to enable residents to be protected from abuse. EVIDENCE: Written information provided by the service prior to this inspection visit stated: No complaints received we have an open door policy to everyone. The complaints policy is in the service user guide. We keep a log of verbal complaints made and actions taken. Staff have attended training on adult protection and certificates are available to demonstrate this. Information gathered at this inspection visit and from surveys returned confirmed that no written complaints had been received by the service since the last inspection. Records were in place for verbal complaints and concerns raised, and the actions taken were recorded. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 17 The healthcare needs of the residents made it difficult to discuss with them their understanding of the complaints procedure at Cedar Court. However comments from relatives demonstrated that they were aware of the complaints procedure and how to make a complaint. The copy of the complaints procedure seen in the reception area referred to the previous local office contact details. However following the inspection confirmation has been provided, to demonstrate that the Complaints procedure has now been amended to the new area office address. No safeguarding adult referrals or investigations had been undertaken at Cedar Court. The safeguarding adults policy was seen and was in line with the local authority safeguarding adults’ procedure. A copy of the local authorities multi agency safeguarding adults’ policy was also in place. Staff had received training in safeguarding adults, and evidence of this training was seen in the staff files looked at. Staff spoken with had a good understanding of the procedures to follow in the event of any safeguarding concerns. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 18 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, which in general provides good standards of hygiene and housekeeping. This ensures residents’ safety and comfort is maintained. EVIDENCE: Written information provided by the service prior to this inspection visit stated: We have a safe environment with a keypad system. The unit is open plan for ‘wandering’ and we have an enclosed pleasant garden. Rooms are personalised and cleaned daily. We have a gate to the stairs. All staff have received training in infection control. We have improved the service by decorating and gardening being undertaken. We have ordered new bedding/ curtains. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 19 We use outside agencies for window cleaning and gardening. Our own maintenance crew do weekly checks on air fresheners to reduce odours. Carpets are cleaned as needed and outside agency booked to steam clean large lounge area. We have systems in place for reporting problems/ breakages. Ongoing redecoration is planned for the next 12 months and monthly managers meetings have been arranged. We could increase the signs to locate rooms more suitably for residents with dementia. We need to look at our laundry service, as verbal concerns have been made to the facilities manager by relatives. At this inspection visit a partial tour of the home was undertaken. Redecoration to some areas of the home has been undertaken. New bedding and curtains were seen within some of the bedrooms viewed. Corridors had been repainted and the reception area was being repainted at the time of this inspection visit. Comments from residents representatives regarding the housekeeping standards maintained were generally positive, however some comments made indicated that the communal areas where not always considered satisfactory by some visitors, such as “ it smells” and “ there are unpleasant odours that you smell” and “bedrooms very good, downstairs untidy at times” On the day of the inspection visit the home appeared clean and tidy, air fresheners were in place throughout the home and no unpleasant odours were noted. From the information provided prior to this inspection and from discussions with the deputy manager and facilities manager at this inspection visit, it was apparent that the laundry facilities in place were not considered to be satisfactory by the representatives of some residents. Comments from resident’s representatives included “laundry facilities poor, I wash and iron own woollens as these are particularly ruined by the laundry. Often other items not ironed, takes away dignity of individual” Discussions took place with the facilities manager regarding the concerns raised about the laundry services. It is acknowledged that the laundry provides services for both the dementia unit and the general unit, which in total provides laundry facilities for up to eighty people. The method of the laundering of delicate items therefore should be given special consideration, such how these items of clothing are sent to the laundry services and how, when they reach the laundry services they are identified and washed at the correct temperature to avoid damage. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 20 Consideration should also be given to the standard of ironing and how this can be regularly audited. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 21 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. The numbers and skill mix of trained staff on duty ensured that resident’s needs were met. The homes recruitment practices and procedures enabled the resident’s welfare to be safeguarded. EVIDENCE: Written information provided by the service prior to this inspection visit stated: We have regular staff with a good skill mix and age. We have 2 nurses per day shift and 1 at night. We run on a full quota of staff, who are allocated each day the areas to work in. There is a diary listing the staff allocation of lounges. NVQ’S achieved and ongoing for over 50 of staff team. (19 permanent care staff 1 bank staff, 7 with NVQ 2 and 4 working towards NVQ 2). A full detailed employment application form is in place and a contracted company provides training. At this inspection visit the staffing levels were assessed. The staff rotas demonstrated that eight or nine staff were rostered on shift throughout the day, with at least one of these being a registered nurse, often there were two Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 22 nurses on duty throughout the day. Three staff were rostered on duty throughout the night, one being a registered nurse. At the time of this inspection staffing levels were reduced due to staff sickness and the activities coordinator was supporting staff with resident’s care, such as at meal times. Generally the comments made by resident’s representatives regarding the levels of staff were positive, and included; “ there are usually plenty of experienced staff around who are trained in this environment”. Some comments made indicated that not all visitors considered the staffing levels to be sufficient at times. Comments regarding this included; “ there are times when I feel more carers should be available, occasions when only one member of staff in charge of the lounge and therefore unable to attend to immediate needs. Could affect dignity of individual”. As stated in the summary of this report, time was spent over the lunch time period, observing in detail the support being given to a small group of residents. Sufficient staff were available to support those residents who were unable to eat independently, and the staff approach and rapport with the residents was positive and patient, which created a relaxed and friendly atmosphere. Seven care staff had achieved a National Vocational Qualification (NVQ) at level 2 in care and it was stated by the deputy manager that a further three care staff had now achieved this qualification but had not yet received their certificates. One member of the care staff team, who held the position of team leader, had achieved an NVQ at level 4. The deputy manager stated that this member of staff supported the nurses with residents health care needs, such as supporting doctors and chiropodists when they visited residents, and undertaking observations on residents such as blood pressure recordings. This demonstrates that staff are encouraged and supported in their professional development. The staff recruitment practices were looked at within two staff files, and all of the required information and records were in place, this ensures that resident’s protection from abuse is enhanced. The training undertaken during the last twelve months by these two members of staff was also looked at. These records demonstrated that mandatory training such as moving and handling and fire safety were kept up to date. There was also evidence to demonstrate that training specific to the needs of the resident group had also been undertaken A training manager was employed who was responsible for ensuring staff training was kept up to date. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 23 These two members of staff were spoken and both confirmed that the training opportunities provided were very good. Both members of staff demonstrated a good understanding of the needs of the residents. Comments from one member of staff stated “ the service does what it does best and that’s look after the residents in a professional manner. We all work in a team and that makes us better at what we do”. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 24 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 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, staff and visitors was promoted and protected. EVIDENCE: Written information provided by the service prior to this inspection visit stated: The manager has 12 years experience in management and 26 years as an RMN. Annual quality assurance questionnaires are sent out. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 25 Individual account sheets are in place for residents who have monies held by the home. Staff frequently shop for residents. Health and safety and fire training are all completed but more fire drills should be undertaken, this often overlooked by the heavy nursing load and more frequent maintenance checks on fire doors would ensure they work adequately. The registered manager had been in post at Cedar Court for the last four and a half years, and had twelve years experience in a management position. The registered manager held a first level nursing qualification in mental health and had achieved the Registered Managers Award. Both staff and relatives were very complimentary regarding the manager’s ability to manage the service, one relative said that a member of their family had initially been admitted to Cedar Court as an emergency and stated “ after the wonderful care and helpfulness of the manager, we decided to keep him there “ The quality assurance systems were looked at it was confirmed that the company send out questionnaires to relatives and any residents that are able to answer them. Questionnaires had been sent out to relatives in October 07. The feedback in general was very positive, however the feedback regarding the laundry service demonstrated that several relatives were dissatisfied. Discussions have taken place between the unit manager and the facilities manager (who manages the staff that work in the laundry) regarding how this can be resolved and these discussions continue to take place. It was confirmed that relatives have been informed of the difficulties in laundering delicate fabrics. (Please refer to Standards 19-26 for further information). Of the two residents case tracked, only one had money held for safekeeping by the service. The monies held for this resident was counted and corresponded with the records kept. Resident’s finances were securely stored and records were maintained, which included two signatures at each transaction. The administrator stated that she audited the monies held for residents on a monthly basis. However there were no signatures in place to demonstrate that this was being done, it was therefore recommended that this be done as a good practice measure. 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. Hoist and other moving and handling equipment was serviced every six months. The electrical installation certificate was in date and demonstrated this service was due again in 2010. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 26 Discussions with the facilities manager took place regarding the amount of fire drills that were undertaken at the unit. As from the information provided by the manager prior to this inspection visit, it was stated that more fire drills were required. Although it was established that fire safety practices were in place, the facilities manager confirmed that he had discussed this with the unit manager and they were planning to provide more fire drills. This indicates that a proactive approach to fire safety is in place, which will further enhance the safety of residents, staff and visitors to the unit. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 27 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 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 (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 laundry service should be improved to ensure residents clothing is laundered as per the manufactures instructions to avoid damage and ironed to a good standard. Cedar Court Nursing Home (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 (Dementia Unit) DS0000002160.V354312.R01.S.doc Version 5.2 Page 30 - 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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