CARE HOMES FOR OLDER PEOPLE
Cedar Grange Whitehill Road Holmfield Halifax West Yorkshire HX2 9EU Lead Inspector
Lynda Jones Unannounced Inspection 17th January 2006 09:30 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 Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cedar Grange Address Whitehill Road Holmfield Halifax West Yorkshire HX2 9EU 01422 242368 01422 242368 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) Mr Stewart Leonard Crabtree Mrs Susan Linda Crabtree Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th June 2005 Brief Description of the Service: Cedar Grange is a care home providing personal care for 15 older people. The home is located in the Holmfield area of Halifax and can be reached by bus from the town centre. The nearest shops are a short walk away. Accommodation is arranged on two floors. There are eleven single and two double bedrooms. There is a passenger lift to the first floor. There are steps and a ramp to some rooms on the first floor therefore the occupants of these rooms need to be fully ambulant. Three of the bedrooms have en suite toilets. There are separate toilets within reach of all areas of the house. The home has two bathrooms but as only one of these has assisted bathing facilities it tends to be the only one used. The house is surrounded by a large lawned garden, with car parking to the front. Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has to carry out at least two inspections of care homes every year. The inspection year runs from April to March and this was the second inspection visit for 2005/2006. Copies of previous inspection reports are available at the home or on the Internet at www.csci.org.uk The last inspection of the home was unannounced and took place on 13 June 2005. An additional visit was made to the home by two inspectors on 21/11/05, in response to an anonymous complaint. On this occasion an Immediate Requirement Notice was left at the home requiring the Registered Person to make urgent repairs to part of the central heating system, install a tumble dryer and fit window restrictors to bedroom windows. All of these requirements were met within the timescales. This was an unannounced inspection carried out by two inspectors over a 6.15 hour period. The main purpose of the inspection was to make sure that the home provides a good standard of care for the people who live there. The methods used at this inspection included looking at care records, medication records, staff records, complaints log and records of money held for service users. A tour of the building took place and time was spent talking to service users, staff, the acting manager and area manager. What the service does well:
The home is small which suits the people who live there. There is a friendly atmosphere and visitors are made welcome. The staff know service users very well and they try to make sure they provide care and support in a way that suits each individual living there. The staff said they have time to spend talking to people. The routines that service users prefer are understood and supported, the staff know what people like to eat and what size of meal they like. The cook caters accordingly. The staff communicate well with each other and make sure information is passed on. The day to day records made by staff include quite a lot of detail that gives a good indication of how service users spend their time, whether they are well and whether there are any concerns to watch out for. All the
Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 6 credit for the service provided is due to the staff that work at Cedar Grange every day. The bedrooms are all different shapes and sizes, colour schemes and bedroom furniture are not always coordinated. Having said that, the rooms each have the personal stamp of the occupants. Everyone has managed to personalise their room with photographs, ornaments and plants and there is evidence that people have their own toiletries and other personal possessions around them. What has improved since the last inspection? What they could do better:
The home has been without a manager since 2001. A succession of people have “acted” in the manager’s role. A registered manager is needed to provide consistent leadership at the home. There needs to be a development plan for the home. Decorating takes place spasmodically; the staff don’t appear to be aware of an overall plan. Members of the maintenance team are despatched to carry out work in the home, the staff are not consulted and do not seem to be involved in future plans for the home. Additional staff need to be recruited as a matter of urgency to make sure that the needs of service users can be fully met. There is no weekend cook at the moment, the care staff are providing meals at the weekend. There is also a vacancy for a member of care staff. Existing staff are covering the vacant posts but this can only continue as a temporary measure. It would be helpful if service users knew what was on offer at meal times. Staff could be inventive in the way they depict what is on the daily menu so that it is presented in a way that service users can understand. The dining room and the dining tables could be made to look more attractive and inviting for service users.
Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 7 Service users do not have a choice of bathing facility in the home. There has only been one useable bathroom since the registered providers bought the home in 1997. The registered providers have said that this issue will be addressed when the home is extended. To date they have provided no plans and have not given any indication when any improvements to the home may take place. The bathroom in use is not particularly inviting and staff have said that some service users would probably benefit from the installation of a suitable shower. Staff indicated that the bath hoist that they use is difficult to manage with some service users. This needs to be addressed The staff recruitment procedure still needs some improvement. Members of the management team with responsibility for recruitment must ensure that all of the checks have been carried out to ensure that people living at the home are in safe hands. The staff talked very positively about the training they had been involved in. The training records need to be updated to evidence what they have achieved. The complaints log needs to be located. 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 Grange DS0000000988.V265868.R01.S.doc Version 5.1 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 Grange DS0000000988.V265868.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Prospective service users are always assessed before they move into the home to make sure that their needs can be met. EVIDENCE: Care plans relating to two people who had recently moved into the home were examined. One person had moved into the home the previous day, the other individual had lived at the home for five days. In both cases there was evidence that pre admission assessments had been carried out to ensure that the needs of each person could be met at Cedar Grange. Some basic information was recorded about the daily routines that people preferred and about what people liked and did not like to eat. Medical histories had been completed and details of medication were recorded. There were no details about the sort of lives people had led nor was there any information about the family and friends of the service users. Staff need to remember to sign and date all of the documents on individual files when they complete them.
Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9. Arrangements are in place to make sure that service users’ health care needs can be met. Records in relation to this are good. Medication records are well maintained. EVIDENCE: A care plan is in place in respect of everyone living at the home. The plans give directions to the staff about how each person’s health, personal and social care needs are to be met. The staff record details each day showing what action they have taken to meet these needs. The daily records are good, they give details about the care and support provided, they contain useful information about how service users have spent their time and highlight any particular concerns about individuals. A lot of information was held in the care plan file. The care plan format has recently changed and old care plans and outdated information was still held in some files, therefore it was difficult to find certain information. The acting manager said files were in the process of being sorted out and some information was being archived. Generally plans were reviewed regularly but
Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 11 one plan did not have information about changes that had taken place in December because the last review was held in November. The plans should be amended as soon as any changes take place. Details about the healthcare needs of service users are well documented on the plans. In addition, there are good records of all contacts with health care providers, showing the reason for the appointment, date and place of contact, the outcome of the appointment and details of any proposed follow up visit. The records show that care plans are amended appropriately in accordance with any advice received. During feedback at the end of the inspection, discussion took place with the acting manager regarding some comments made to one of the inspectors by a service user; the comments were about staff. The acting manager said the service user had raised this issues several times before. She was able to give a full explanation and she provided some useful information that gave some background to the comments. Inspectors felt that this was important information that should have been recorded in the daily records. The acting manager and area manager agreed with this view. Staff need to ensure that they support people to maintain their personal appearance at all times. Inspectors noted that one person was left with food on her clothes and face after lunch. Staff noted and commented on this but apparently forgot to help this individual to wash and change her clothes. This was discussed at the end of the inspection. The home was in the process of changing over the medication system to the Boots monitored dose system. The transition appeared to be well managed. Medication administration records were checked and were completed appropriately. Balances of medication held at the home corresponded with the records that were checked. Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The staff have a good understanding of service users’ personal preferences regarding meals and they cater accordingly. The presentation of the dining room could be improved. EVIDENCE: Most service users have their meals in the dining room, one person prefers meals in her room and this is easily accommodated. The staff report that meal time arrangements depend on personal preferences. It was noted that there were tablecloths on the dining tables during the morning, but these were removed at meal times and place mats were put on the tables. Inspectors asked why this took place. No one could recall a specific reason for this practice other than that this had always been the custom. At the end of the inspection the acting manager said she proposed to reverse this practice. One of the inspectors sat with service users during the mid day meal, the atmosphere was pleasant and relaxed. The care staff and the cook know people well and have a good understanding of what people like and dislike and of the size of portion that each person prefers. It was good to see that a variety of plate sizes were used to accommodate the varied appetites of
Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 13 service users and to make sure that individuals were not over faced with large portions. No one seemed to know what they were having to eat before the meal arrived on the table. Inspectors felt that this information should be on display and attention drawn to what was on the menu. On this inspection as on previous visits, service users said they enjoyed all of their meals. Menus were available but these were not generally followed. The cook records the main meal but not alternatives; therefore it is not possible to monitor all meals that have been served over a period of time and whether they are nutritionally balanced. For example, on the day of the inspection, two service users chose sausages as an alternative to the main meal but this was not recorded on the meals record. Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The record of complaints held in the home must be improved. EVIDENCE: There is a complaints procedure in place and new service users and their families are provided with information about this. A copy of a complaints form was available but the complaints log could not be found. There should be a record in the home showing the details of any complaints made, the action taken and the outcome of the complaint. The acting manager said no complaints had been received. Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21,26. The home is clean and tidy, all the bedrooms are individual and service users have personalised their rooms with help from their families and from staff. Bathing facilities are poor; there is no shower and no choice of bathroom. The bathroom in use is not particularly inviting. EVIDENCE: A tour of the building took place. Inspectors noted that the home was clean and tidy throughout. In all bedrooms there was evidence that service users have lots of their own personal possessions around them. Each room is decorated and set out differently to suit each person’s needs and tastes. There were plants, photographs and ornaments in most rooms and evidence that everyone had their own toiletries in their bedrooms. Although some of the bedrooms have locks on the doors, staff said the whereabouts of the keys was unknown. Staff reported that no one had ever said they wanted to lock their door, although in practice no one had ever been
Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 16 offered an option to do so. Service users should be offered the opportunity to being able to lock their door if they choose to and if it is safe to do so. All of the rooms have a chest of drawers with a lockable drawer that service users could use for safekeeping their personal items. The staff did not know where the keys were for the drawers. The acting manager later said the keys were in the office. No one uses these facilities and it is not clear whether service users and their families are informed that the keys are available. Since the last inspection two bedrooms, the kitchen and parts of the ground floor hallway have been redecorated. One vacant bedroom was in the process of being decorated and a new carpet was due to be fitted. During the inspection, a visitor to the home said she had been very concerned about the strong fumes from the paint when the kitchen was being repainted, particularly as the kitchen was in use that day. She said she had raised this with staff at the time. Service users do not have a choice of bathing facilities, as there is only one useable bathroom in the house. The second bathroom does not have an assisted bath and cannot be used by anyone living there. This bathroom is unpleasant and has not been decorated for many years. Requirements have been made in previous reports for the owners to provide details showing how this situation will be addressed but they have not replied to CSCI. One of the owners has said that this will be remedied when the home is extended, but no further details have been provided. In the meantime, this bathroom should be made fit for use. The National Minimum Standards state that there should be at least one assisted bath for eight residents. Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 Additional staff need to be recruited to ensure that service users’ needs can be fully met. Staff recruitment procedures need to be robust to make sure that people are suitable to work with older people. The records do not evidence the training undertaken by staff. EVIDENCE: The home is currently short of a member of care staff to cover 30 hours each week and a weekend cook. The care hours are currently being covered by existing staff who are working additional hours. The rota for the week following the inspection was examined and there were three afternoon/evening shifts where the number of staff on duty fell from three to two. The acting manager said she was confident that these shifts would be covered. At the present time there is no cook available at weekends, a member of care staff is currently preparing the meals. The weekday cook said she is organising the menus so that the proposed meals do not require lengthy preparation, in addition she is baking and preparing desserts ready for the weekends. Discussion took place about the staffing position with the acting manager and the area manager, at the feedback session at the end of the inspection. It is noted that this situation has only occurred very recently at the home and there is no evidence that this has had any impact on service users as yet. It was agreed however, that there is an urgent need to recruit additional staff to cover these two positions in order to ensure that service users needs can be fully met at all times.
Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 18 The staff gave an account of the training that they have recently undertaken. Courses have included health and safety, moving and handling and adult protection training. Three staff are currently undertaking NVQ level 2. The staff training records that were examined are not up to date and do not reflect the training that the staff talked about. These need to be reviewed. A staff file was examined to assess recruitment practice at the home. In the last report from the inspection in June 2005 concerns were noted because appropriate checks were not carried out on staff before they started work at the home. There was evidence on the file examined to show that checks had been carried out with the Criminal Records Bureau and the Protection of Vulnerable Adults register. Members of the management team with responsibility for staff recruitment are reminded of the importance of checking employment histories and exploring gaps in employment. In addition two written references should be obtained, one from the last employer. This was discussed in the feedback at the end of the inspection. Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,38. In the absence of a registered manager there has been no consistent leadership in the home. EVIDENCE: The home has been without a registered manager since 2001, there has been a succession of acting managers over this period. Three acting managers left the home without making an application to be registered by the Commission for Social Care Inspection. One acting manager withdrew her application during the registration process. The deputy manager is now the acting manager. A requirement is made in this report for an application to be submitted to the Commission for Social Care Inspection by the end of March 2006. The home holds money for service users that has been deposited for safekeeping by their relatives. Money and records are held securely. Details of all transactions are recorded on individual record sheets and where purchases
Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 20 have been made on behalf of services users, the receipts are attached to the respective record sheet. A new food store has been created in a building at the rear of the home. The floor has been sealed and the walls repainted. The room houses several freezers and fridges and food storage shelves. The last report from the Environmental Health Officer required the registered person to replace or repair the rusty shelving. This has not been done despite the fact that the timescale for doing this has been exceeded. On two of the freezers, the external bases are rusted and flaking. The cook said she thought there were plans to replace these but she had no idea when this would be. Inspectors were concerned to learn from staff that some people found it difficult to use the bath hoist for some of the heavier service users. This needs to be investigated as soon as possible to ensure that service users and staff are not at risk of harming themselves. The records show that the hoist is regularly serviced. All staff need to be reminded to lock away all cleaning products when they are not in use. The registered persons needs to ensure that all staff involved in the preparation of food have undertaken training in basic food hygiene, this is especially important as more staff are currently involved in preparing meals at the weekend. Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 X X X 1 X X X X 3 STAFFING Standard No Score 27 1 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X X 1 Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? yes 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 17 & Schedule 4 23 18 Requirement A record must be kept of all complaints made and of any action taken in respect of complaints A second bathing facility must be provided. Previous timescale of 30/9/05 not met. There must be sufficient numbers of staff on duty at all times to meet the assessed needs of service users All staff must have the necessary checks completed before they start work at the home. There must be two written references, one of which should be from the last employer. Gaps in employment history should be explored. An application must be made to the Commission for Social Care Inspection to register a manager for the home. Checks need to be made to ensure that the bath hoist is a) Appropriate for the safe moving of service users b) Can be used by staff without risk of injury.
DS0000000988.V265868.R01.S.doc Timescale for action 28/02/06 2 3 OP21 OP27 30/04/06 28/02/06 4 OP29 19 28/02/08 5 OP31 8 31/03/06 6 OP38 13 28/02/06 Cedar Grange Version 5.1 Page 23 7 OP38 16 The rusty shelving used in the food store must be replaced or repaired. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP7 OP15 OP30 OP38 Good Practice Recommendations Care plans should be updated as soon as there is any change to the plan. The records should accurately reflect any concerns that are perceived by service users and details of any action taken by staff. The record of meals needs to be improved to reflect what is actually served each day. Staff training records need to be updated. The rusty fridge/freezer in the food store should be replaced Cedar Grange DS0000000988.V265868.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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