Inspection on 06/02/07 for Cedar Grange

This inspection was carried out on 6th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cedar Grange 18/03/09

Cedar Grange 17/01/06

Cedar Grange 13/06/05

Cedar Grange 15/10/04

Cedar Grange 02/07/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cedar Grange Whitehill Road Holmfield Halifax West Yorkshire HX2 9EU Lead Inspector Karen Westhead Key Unannounced Inspection 6th February 2007 08:50 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.V323156.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 Grange DS0000000988.V323156.R01.S.doc Version 5.2 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 Mrs Sandra Poyser Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Cedar Grange is a care home providing personal care for 15 older people. The home is in the Holmfield area of Halifax and can be reached by bus from the town centre. There are shops a short walk away. Prior to the home being converted it was a Vicarage. The home is on two floors. There are eleven single and two double bedrooms. There is a lift to the first floor. There are steps and a ramp to some rooms on the first floor therefore residents who use these rooms need to be fully mobile. Three of the bedrooms have en suite toilets. There are communal toilets within easy reach of all areas of the house. The home has two bathrooms but as only one of these has assisted bathing equipment it is the only one used. The house is surrounded by large gardens which are accessible to residents. There is car parking to the front. On 6th February 2007 the fees were between £339 and £379 per week. Additional charges are made for hairdressing and private chiropody treatment. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was done by one inspector and had not been prearranged with the Manager. This meant the inspector was able to observe how the home is run on a day-to-day basis, without any changes being made to the usual routines of residents and staff. The reason for the visit was to make sure the home was being run for the benefit and well being of the residents and in line with the standards. The inspector arrived at 8.50am and left at 5pm. At the end of the visit, the manager, area manager and owner were told how well the home was being run and what needed to be done to make sure the home meets the required standards. Before the inspection information already known about the home was reviewed. This included looking at the number of reported incidents and accidents, the action plan provided following the last inspection and reports from other agencies such as the fire safety officer’s report. This information was used to plan the inspection visit. Comment cards were left at the home for relatives and visitors to complete. At the time of writing this report none had been returned. Therefore only what they said to the inspector is included in this report. Most of the day was spent talking to residents, visitors and staff, to find out what it is like to live and work at Cedar Grange. What the service does well: Cedar Grange is a well managed and friendly home. Staff work hard to give residents a good quality of life, by maintaining their independence, supporting them with their care and health needs, and providing a comfortable place to live. Staff recruitment and training is good. But some staff now need extra training to make sure their knowledge is kept up to date. This will make sure staff can continue to provide support and care to the residents. The staff are well organised and work well as a team. They are experienced, know what they are doing and have a good knowledge of the residents they care for. They have good relationships with residents and relatives. Relatives are made to feel welcome at the home, by the way staff greet them and offer refreshments. There is a warm and supportive atmosphere in the home. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 6 The standard of information available to people who are considering living at Cedar Grange is good and should help people decide if this is the home they want to move to. The environment is well maintained. However some cosmetic redecoration is needed to give a fresher look to communal areas. At the time of the visit both double rooms were being used as single. This had been decided by the residents using the rooms to give them extra privacy and space. 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 Grange DS0000000988.V323156.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 Grange DS0000000988.V323156.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): 1, 2, 3, 4 and 5 (Standard 6 - N/A, the home does not provide intermediate care) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good information for residents and relatives so they can make an informed decision about the home before they move in. Good preadmission information is gathered by the staff, to make sure they know a residents needs, before they move in. EVIDENCE: Written information about the home is available to anyone interested in moving in. It gives clear, detailed information in a range of documents. These include a Statement of Purpose, and Service User Guide. They were up to date and give relevant information about services provided at the home. All prospective residents are visited and their care needs assessed before they move to the home. This is completed by the manager or senior member of Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 9 staff. Prospective residents are encouraged to visit and talk to staff and residents. Two residents were able to recall their admission. One resident had trusted their relative to chose the home. Another had visited for a couple of meals before deciding to move in. The pre-admission records are thorough, and provide information to staff about the care needs of the resident when they move to the home. Two preadmission assessments were looked at, both appeared to accurately reflect the needs of the residents. The manager confirmed that all residents are given a contract at the point of admission. However, no evidence was found on any of the residents files seen to show they had been given one. Cedar Grange DS0000000988.V323156.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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social needs of residents are met, in a way that maintains their dignity and independence. However, staff have to make sure that records show what they have done. EVIDENCE: Four care plans were looked at in detail. These had been fully completed and gave a good indication of the needs of the resident named. Therefore giving staff clear guidance on how to meet the needs of the resident. Timescales for reviewing care plans were appropriate and records showed care needs are being evaluated. However, one resident was showing a change in behaviour and this had not been followed through to make sure the resident was properly placed or to protect other residents. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 11 Residents with low weight are being monitored weekly. Staff work closely with the district nurses to make sure they are providing residents with the proper equipment and care to maintain their health and welfare. This includes pressure relieving cushions and mattresses, special beds and toilet seats. One resident, who staff are closely monitoring for fluid and diet intake was being looked after well, however the records charting the care provided were not being completed accurately and did not reflect what the resident was doing. There was evidence that external health professionals provide an effective responsive service to meet the health needs of residents at the home. These are recorded within the individual care plan. The home has a very thorough medication procedure, and all staff are trained to administer medication safely, to make sure the resident receives the correct medication at the time prescribed by the doctor. However, staff must keep the records up to date. Two examples were seen where drugs had been given but not signed for. None of the residents look after their own medication. Medicines are stored safely, and are checked to make sure they are correct when they arrive from the pharmacist. The procedure for the management of controlled drugs is good. The home uses two main doctors surgeries and to provide a consistent approach, there is one allocated district nurse who visits the home daily. Staff spoke highly of the working relationship they have with her. They said she had provided training in the home and was very approachable. This means staff can ask for advice if any matters arise and put preventative measures in place before problems arise. Comments made by residents and the observations made of staff practice show that staff treat residents with sensitivity and respect. All those residents, who were able to share their views, said staff were very caring and the relationships they had with them were warm. Residents views about how they would like to be cared for in their final days of life are know to staff. This means staff know the wishes of residents before they become ill or are in the final stages of their life. One visitor said their relative had ‘picked up since coming in.’ Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are part of the local community; spend their day as they choose, with whom they choose, when they choose. EVIDENCE: In discussion with residents and visitors, it was clear that staff help residents to live their lives as they wish within the home. One relative said, “the staff are very good. They make me feel welcome when ever I visit.” Staff were seen offering visitors cups of tea on their arrival. Residents said they were happy with the level of activities in the home. Some said they went out often with their relatives and some just enjoyed ‘doing their own thing in their room.’ One resident, a keen sports follower, said he enjoyed watching television in his room and that there was no pressure to join in the communal activities in the home. One resident said they enjoyed the quizzes, and liked getting a newspaper twice a day, which she had delivered. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 13 A cook is employed who works from 9.30am until 1.30pm – Monday to Friday. All other times staff on duty are expected to provide the breakfast and teatime meal. Staff did not see any problems with being able to work this into their other duties. They said they knew who was cooking on the shift and worked together to make sure residents were given a good service even when the cook was not in. Residents confirmed this. They said they were given a hot choice at breakfast, before the cook arrived, if that is what they asked for and there was always a hot snack at teatime. The main meal of the day was sampled. This was hot, tasted good and was well presented. Staff were seen giving out the meal. They did this in a calm and unhurried way. Staff offered to assist residents, when required, in a sensitive manner. The kitchen was generally clean and tidy. So residents are provided with their meals from a well-organised and clean kitchen. Residents said there was a choice at all mealtimes and gave examples of when they had not liked the meal offered or had been too poorly to take a full meal and had been given a suitable alternative which they liked. One resident, who is very deaf, is not able to communicate well. Staff had agreed with this resident to communicate using a large board and felt pen. This was working well. The resident gave their views to the inspector using this method. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can complain, and all staff are trained to make sure they understand adult abuse, to protect residents at the home. EVIDENCE: The home has a complaints procedure. Residents and visitors said they would complain if they needed to. One resident said ‘I know who to talk to if I am unhappy.’ A book to record complaints was seen, which was started following the last inspection in January 2006. Two complaints were recorded properly and the complainants satisfied with the outcome. Staff have been trained to understand, recognise and report abuse, which may put residents at risk of harm. Evidence of this was seen in three staff files, and confirmed in conversations with staff. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a home that is safe, well maintained and of a good standard. EVIDENCE: Residents are using all bedrooms as single rooms at the moment. They said they like this as it helps them maintain their privacy and dignity. A number of resident’s bedrooms were seen and were highly personalised, with items of furniture and pictures from their own homes. One resident said they particularly liked the old style pictures and features in the home, which helped keep its character. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 16 There is a lounge, which residents wishing to smoke can use. There are a range of different lounges so residents can move around the home if they wish. However, it was clear that residents tend to sit with the same people through choice. All linen and towels are provided by the home unless residents prefer to bring and use their own. Linen stores were found to be well stocked and the quality was acceptable. Residents have access to the garden to encourage them to spend time outside. Some residents said they enjoyed sitting out when the weather allowed. The house is clean, tidy and does not smell. All laundry is dealt with by the home and this was well organised. Resident’s comments were: • This is a nice place to live. • I like the staff, they keep my room lovely. • They iron my things well. I never have to wait for things being brought back. • It doesn’t smell does it? There are certificates and records to show that the home and equipment is being properly maintained. There is only one bathroom in use because the second bathroom does not have equipment to help residents get in and out of the bath. The owner has submitted plans to upgrade the home and has not addressed this matter. The path leading from the bottom of the external fire escape was covered in moss and leaves. The mechanical extractor fans in bathrooms and toilets were not being kept clean. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedure for the recruitment, training, and deployment of staff is good and makes sure only staff who are suitable to look after vulnerable residents work at the home. EVIDENCE: The number of staff on duty was appropriate to meet the current needs of the residents. The recruitment file of two members of staff were looked at. It contained all the necessary information, with evidence that all pre employment checks had been made before the member of staff was employed. The induction programme for new staff is good and the management team makes sure that staff have understood the training they have received, before they work alone with residents. Staff said they enjoyed the range of training they received, and felt it helped them to provide good levels of care to residents. Some of the training, for example first aid and moving and handling is due for either repeating or updating. The manager was organising this. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 18 The management team have been active in trying to improve attendance at work for some staff. This had been dealt with in a direct way and meetings had been recorded. Despite this, staff talked about the teamwork which existed and the commitment staff felt to the residents living at the home. Just before this visit, information was received to say that instead of there being two waking night staff on shift, this had been changed to one waking and one sleeping in member of staff. The manager, area manager and owner were individually asked about this and records were checked to confirm what they said. The staffing had been changed for one night only. This was shown to be insufficient when a resident, who needed two members of staff to assist them, was readmitted from hospital. So although the information received was correct this happened on one night only. The owner confirmed that staffing levels would not be changed without the agreement of the Commission. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Cedar Grange is a well managed home, where residents feel safe and staff feel valued. EVIDENCE: The atmosphere in the home puts residents first and each resident is treated as an individual. The manager has many years experience working with older people and is in the middle of completing a management qualification. This will enhance her existing skills and knowledge. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 20 The owner is keen to hear the views of residents and visitors and provides ample opportunity for their views to be heard. Any residents’ monies held at the home is managed in a safe way. There are records, which show who, and how resident’s money is spent. Receipts are kept to account for any expenditure. Relatives are encouraged to manage the financial affairs of any resident unable to manage their own money. Staff continue to receive regular one to one supervisions at least six times a year. Staff said they found these useful to discuss their own practices and training opportunities. The home has procedures in place to check health and safety matters to make sure everyone in the building is protected and safe. There is a team of maintenance personnel who have the responsibility of checking things such as hot water temperatures and the fabric of the building to make sure it is safe. All staff spoken to during the visit said they liked the manager and she was easy to get on with. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 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 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 2 3 2 X 3 3 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 3 3 X 3 3 X 3 Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 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 OP21 Regulation 23 Requirement A second bathing facility must be provided. Previous timescales of 30/9/05 and 17/1/06 not met. The registered person must make sure that all residents have an up to date contract setting out the terms and conditions of their stay in the home. The registered person must make sure that all records relating to resident care are kept up to date and reflect the care being provided. Where the needs of residents change this must be followed through to make sure the resident is appropriately placed and their behaviour does not adversely affect other residents. The registered person must make sure the medication records are being completed properly. The registered person must DS0000000988.V323156.R01.S.doc Timescale for action 30/04/07 2 OP2 17(2) Schedule 4,8 30/03/07 3 OP7 17(1)(a) Schedule 3,3(k) 14/03/07 12.(1)(a) and (b) 4 OP9 17(1)(a) Schedule 3, 3(i) 23(4) 14/03/07 5 OP19 14/03/07 Page 23 Cedar Grange Version 5.2 make sure the fire exits are kept clear of moss and leaves. 23(2)(p) That the mechanical extractor fans are kept clean. 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 OP19 Good Practice Recommendations The registered person should consider redecorating parts of the home to make them look fresher. Cedar Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Grange DS0000000988.V323156.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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