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Inspection on 07/07/05 for Cedar Court Nursing Home (Dementia Unit)

Also see our care home review for Cedar Court Nursing Home (Dementia Unit) for more information

This inspection was carried out on 7th July 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Residents and relatives are encouraged to visit the home prior to moving. Residents have access to a wide range of health care professionals. It was evident on the day of inspection that staff treat residents with respect. The home employs an activity organiser and there are a range of activities on offer. The home integrates as much as possible with the local community and has a VE Day celebration/fete planned for July 9th. Religious needs are met with a vicar providing a monthly service and a Roman Catholic priest providing communion weekly. The manager keeps a clear record of complaints made. The resident and relative spoken with were confident that any complaint they had to make would be addressed appropriately. The Registered Person has almost completed the Registered managers award, there are a number of staff with or working towards NVQ 2 & NVQ 3 & NVQ 4.

What has improved since the last inspection?

The organisation has appointed a corporate training manager who is in the process of arranging training for staff. The Registered Person has completed a training course to provide Adult Protection training for staff. Regulation 26 visits are now carried out and a report is made available for the manager. The manager has developed resident and relative questionnaires, in order to assist in the development of the service provided. The manager now completes annual appraisals with staff.

What the care home could do better:

There are a number of areas within the home, which are in urgent need of updating. There are worn carpets that need to be replaced and the malodour in one bedroom needs to be prevented. The woodwork in places needs to be repainted. Furniture for residents bedrooms highlighted within the minimum standards, should be provided or a risk assessment in place detailing why it is not. There are 2 bathrooms which residents are unable to use. Staff require training on Adult Protection or Management of aggression, this has been an ongoing requirement since July 2003. Staff still need to complete mandatory training to ensure they are able to meet the needs of the residents. Staff supervision needs to take place in line with the requirements and recommendations of the National Minimum Standards.

CARE HOMES FOR OLDER PEOPLE Cedar Court Nursing Home Dementia Unit Bretby Park Bretby Derbyshire DE15 0QX Lead Inspector Vanessa Davies Unannounced 7 July 2005 10:00am th 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 Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cedar Court Nursing Home Dementia Unit Address Bretby Park Bretby Derbyshire DE15 0QX 01283 211412 01283 552220 admin@cedarcourtcare.co.uk Your Health Ltd 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) Joy Theaker CRH 50 Category(ies) of Dementia registration, with number of places Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 09.03.05 Brief Description of the Service: Cedar Court care home has two units. The larger unit provides nursing and personal care for up to 50 persons aged 65 years and over with dementia, including up to 10 places for persons aged 50 years and over. 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. This unit has 34 single and 8 double bedrooms. 30 rooms have ensuite facilities. Access to the first floor is by stairs and a passenger lift. The unit has 3 lounges and dining areas on the ground and first floor, and has a large enclosed garden, which is accessible to service users. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and undertaken following a complaint, therefore the inspector did not examine residents files in detail. Details of the complaint are documented within this report. Evidence was gathered by reading documentation, speaking with a relative and 1 service user. What the service does well: What has improved since the last inspection? What they could do better: Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 6 There are a number of areas within the home, which are in urgent need of updating. There are worn carpets that need to be replaced and the malodour in one bedroom needs to be prevented. The woodwork in places needs to be repainted. Furniture for residents bedrooms highlighted within the minimum standards, should be provided or a risk assessment in place detailing why it is not. There are 2 bathrooms which residents are unable to use. Staff require training on Adult Protection or Management of aggression, this has been an ongoing requirement since July 2003. Staff still need to complete mandatory training to ensure they are able to meet the needs of the residents. Staff supervision needs to take place in line with the requirements and recommendations of the National Minimum Standards. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 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 Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 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) 5,6 The manager encourages and supports prospective service users/relatives to visit prior to any move enabling individuals to make a decision about the home EVIDENCE: This area was not fully assessed. The inspector spoke with a relative and a resident, both confirmed that the manager invites prospective service users to the home to visit and to meet people. The home does not currently offer intermediate care. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 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) 8,10 Residents have their health needs met, with access to a range of health care professionals to ensure individual needs are addressed. EVIDENCE: The inspector spoke with the manager and a resident to assess how residents health needs are met. Both confirmed that GP appointments are made as necessary, along with chiropody and optician appointments. The psychiatrist visits the home monthly. It was evident on the day of inspection that residents are treated with respect, staff ensuring residents remained suitably dressed, speaking with them appropriately and knocking on doors before entering. This was confirmed when speaking with a resident and a relative. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 10 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) 12,13,14 Social activities and links with the community are given a high priority in this home giving residents a choice and variety of a range of activities. EVIDENCE: The inspector spoke with the Activity organiser during the inspection. A number of activities are arranged throughout the week, for example; walking, dancing, singing or a visit to the local pub. Outside entertainers are brought in on a monthly basis. A vicar visits monthly and a fellowship group is held in the adjoining care home, which residents are able to access. Roman Catholic communion is held weekly. There is a fete/street party arranged to celebrate VE Day on 9th July and the resident spoken with stated how she was looking forward to it. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 11 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 Although the Registered Manager has undertaken training in Adult Protection, residents are still at risk due to lack of staff training. EVIDENCE: The Commission have received 1 complaint since the last inspection. The complaint was not up held. The manager keeps a clear record of all complaints made in the home. The manager has completed a training course in Adult Protection, qualifying to be a trainer and plans to provide training for staff June and July. There are a number of staff who have received no training on adult protection, managing aggression or the use of restraint, therefore leaving residents at potential risk. The policy on the use of restraint is not in line with current guidance and does not clearly state what levels/type of restraint may be used, this needs to be reviewed. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 12 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) 19,20,21,23,24,25,26 There are areas of this home which are clean and pleasant for residents to live in, however there are a number of areas requiring urgent attention to ensure the safety and comfort of residents. EVIDENCE: The inspector highlighted a number of areas in need of updating, these have been highlighted at previous inspections. The residents are able to access a very pleasant, safe garden. The home is separated into 3 areas, 1 of which is a male only environment. There are a number of toilets throughout the home, all easily accessible. In addition a number of the bedrooms have en-suite facilities. The residents have access to an assisted bath. Two of the bathrooms are currently not in use by the residents as the facilities are not accessible. The inspector examined a number of bedrooms, all were very personal and met the needs of the residents. One bedroom had an offensive odour, which needs to be dealt with. Residents have access to the second floor via 2 passenger lifts. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 13 Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 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) 28,30 The organisation has addressed some areas of staff training, however the staff team have not completed mandatory training to ensure they are skilled and competent to do their jobs. This could potentially put residents at risk. EVIDENCE: One resident spoken with stated that “the staff are excellent” The Registered Person stated that there is now a corporate training manager who is arranging training. The issues of staff training have been highlighted earlier in this report, this affects residents safety and must be addressed. The home currently employs 14 day care staff, 6 night care staff and 5 qualified nursing staff. 2 care staff have completed NVQ 2, 2 are undertaking it and 2 are due to start September 2005, 3 care staff have completed NVQ3 and 6 are to start September 2005, 2 staff are doing NVQ 4. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 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 The home is generally well managed by an experienced manager, however there are a number of areas to be addressed. EVIDENCE: The Registered Manager has a number of years experience managing and is due to complete the Registered managers award, July 2005. She clearly has an excellent relationship with the staff team and has an open door policy. The manager evidenced service user and relative questionnaires used to evaluate the service. The responsible person completes monthly visits and provides detailed reports for the manager. The manager stated that she had started to carry out annual appraisals with staff and regular supervisions, however the supervisions do not meet with the minimum standards of 6 per year and this needs to be addressed. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 16 Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 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 x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 2 2 2 x 3 3 2 2 STAFFING Standard No Score 27 x 28 2 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 1 2 3 3 x x 2 x x Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 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. Standard 18, 28 Regulation 13 Requirement All staff must receive training on:1. prevention of abuse 2. prevention and management of aggression including use of restraint. (HIGHLIGHTED AT INSPECTION 17.07.03) The registered person must ensure that all staff receive training appropriate to the work they complete. (highlighted 17.07.03) The registered person must ensure that all parts of the home are kept clean and reasonably decorated. (highlighted 16.06.04) The registered person must provide in rooms occupied by service users, adequate furniture (highlighted 16.06.04) The registered person shall ensure that the premises are kept in a good state of repair externally and internally. (highlighted 16.06.04) The registered person must ensure that staff are appropriately supervised. (highlighted 16.06.04) The registered person shall Timescale for action 01.09.05 2. 38, 4, 30 13, 18.1 c 01.09.05 3. 19 23.2 d 01.09.05 4. 24 16.2 C 01.09.05 5. 24 23.2 a 01.09.05 6. 31, 36 18.2 01.09.05 7. 26 23.2 (d) 01.08.05 Page 19 Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 8. 30 18.1 (c) (i) ensure that the home is kept clean. The registered person must ensure that staff receive the training necessary to undertake their duties. 01.09.05 9. 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 19 Good Practice Recommendations The Registered Person should pursue changing bathroom 4 to a shower room and addressing the issue with bathroom 7. Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedar Court Nursing Home Dementia Unit C52 C02 S2160 CedarCourt(DE)Home V231784 070605 Stage 4.doc Version 1.30 Page 21 - 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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