Inspection on 29/08/07 for Cedar Grange Residential Home

This inspection was carried out on 29th August 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

Similar services:

Snydale Care Home

Abbey The

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 Residential Home Main Street Cherry Burton East Yorkshire HU17 7RF Lead Inspector Eileen Engelmann Key Unannounced Inspection 29th August 2007 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 Residential Home DS0000069694.V349619.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 Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Grange Residential Home Address Main Street Cherry Burton East Yorkshire HU17 7RF 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) 01964 551580 01964 551025 Southern Cross Healthcare (Focus) Limited Denise Lawson Care Home 31 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (31) of places Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 31. 2. Dementia - Code DE, maximum number of places 31 The maximum number of service users to be accommodated is 31. Date of last inspection New service Brief Description of the Service: Cedar Grange is located in the village of Cherry Burton, two and a half miles from the historic market town of Beverley. The home is set in well-stocked and well-tended grounds and provides pleasant accommodation for up to 31 older people some of whom may suffer from dementia. The home consists of two buildings; the main house is a large period building offering accommodation to 23 residents and the Lodge is a purpose built bungalow offering accommodation to a further 8 residents. Both buildings provide pleasant views across the well-kept gardens. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Information given by the manager during this visit indicates the home charges fees from £334.50 to £475.52 a week depending on the source of funding and the dependency needs of individuals. There is top-up fee of £15.20 for all accommodation. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager and can be found in the Service User Guide. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last visit to the home the service has been re-registered and on this basis is classified by the Commission for Social Care Inspection as a NEW service. Information has been gathered from a number of different sources over the past 6 months since the home was re-registered, this has been analysed and used with information from this visit to reach the outcomes of this report. The unannounced visit was carried out with the manager, staff and people living at Cedar Grange. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files and records relating to the service. Informal chats with a number of people and staff took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people using the service and staff and their written response to these was good. We received 13 back from relatives (54 ), 1 from staff (7 ) and 13 from people using the service (65 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. What the service does well: All of the people living in the home were positive about the home and like living there. Two people said they loved living at the home and the care was very good. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 6 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 Residential Home DS0000069694.V349619.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 Residential Home DS0000069694.V349619.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 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: People who are interested in moving into the home are given a pack of information including the statement of purpose and service user guide, which are written in a clear, large print. Survey responses show that everyone was satisfied that they received sufficient information about the home to help them make their decision about accepting a placement if offered. People are given a statement of terms and conditions/contract at the point of admission, which they are expected to sign and return a copy to the home. Those looked at during the visit are from the previous provider and do not Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 9 include the price of extra services such as chiropody, hairdressing and newspapers included within them. The responsible person must make sure that the homes statement of terms and conditions/contract is developed to meet the criteria of Regulation 5 of the Care Home Regulations and includes the information asked for in the Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006 (for Regulation 5), which came into force on 1st September 2006. Each person has their own individual file and four of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Discussion with the manager indicated there is a formal, written process of offering placements to people who are interested in using the service. People and their relatives are very pleased with the care and support given by the staff. The majority of those who responded to the surveys said the home met the needs of people living there and commented that ‘the care staff that we see are very competent and helpful’, ‘we have been very impressed by the staff’ and ‘the care seems good and appropriate’. Two people were not satisfied that new staff and those younger members of the team had the necessary skills and experience; they said that ‘most of the staff have the right skills, but new staff seem to lack basic training’ and ‘some staff seem far too young and training does not always manifest itself in the care given’. These concerns were discussed with the manager. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that although staff have access to a wide range of training subjects including basic mandatory safe working practice training, there is some reluctance from certain individuals to attend. As a result of this there is a percentage of staff who are not up to date and this is impacting on the quality and standard of care being given (see comments from relatives above). Discussion with the manager indicated that she is aware of the problem and is working towards improving the attendance of staff at the mandatory training sessions, future action may include following the disciplinary process. The home employs a multi-culture of staff including individuals from Asia and South Africa. People using the service are able to make a choice of staff gender when deciding whom they would like to deliver their care, as the home has 4 male care staff. Discussion with people indicated that they have a good relationship with the staff and are comfortable in asking for specific individuals to deliver their personal care. Preferences for staff gender when giving personal care are documented in the individual care plans. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 10 Information from the Annual Quality Assurance Assessment and discussion with the people using the service indicates that all of the people are of white/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the people who live in the home are clearly documented and are being met by the service and staff. EVIDENCE: The care of four people was looked at in depth during this visit and included checking of their personal care plans. These are detailed and include specific information on an individual’s health and their medical conditions. The plans are updated regularly and include risk assessments. Any changes in care are documented and actioned by the staff. Information about the person’s social interests, likes and dislikes, spiritual needs are included within the individuals care plan. The funding authorities are carrying out yearly reviews of the care plans and the minutes of these meetings show that people have input to this process (where possible), and family/representatives are also invited to the reviews with the person’s permission. This process of review is carried out by the home, for self-funding people. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 12 There is little evidence that people are consulted on an ongoing basis about their care, especially when staff are completing the monthly evaluations. This was discussed with the manager and she said she would look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. Relatives are satisfied that the home keeps them up to date with any changes in their loved one’s care. Individuals said ‘I see my relative every other day and the home would ring me if needed, as his/her sight is poor’, ‘we keep in touch all the time except for holidays when I telephone. At these times the home are very helpful by taking their mobile phone into my relative so that I can talk to him/her’ and ‘my family member has a recurring medical problem, which the staff monitor very well and always send for the district nurse or doctor when required. The staff are very good at keeping me informed’. Information from the surveys indicates that the majority of people who responded are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. Most people feel there is sufficient staff on duty to offer them the care they need, but sometimes there is a delay in getting a response to their calls for assistance. Three people commented that ‘ I feel that someone could check on me more often than they do’, ‘sometimes staff seem to have too many people to see to at the same time’ and ‘sometimes staff are committed to other people when I need them’. People have good access to their GP’s, chiropody, opticians and other external services. Responses to the surveys indicated that people and their relatives are satisfied with the level of medical support given to the people living at the home. Entries in the care plans specify where individuals have dietary needs, including supplement drinks and thickened or pureed diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses and seat cushions. Checks of the medication show the home is using Boots the Chemist as their pharmacy supplier and their MDS system of medication is in use. Observation of the medication records show these are audited monthly by the manager and the records are up to date and well managed. Checks of the controlled drugs and register showed that these medicines are monitored carefully, stored correctly and records are accurate. All staff have received medication update training and 83 have had safe handling of medication training. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 13 they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were that ‘my relative is happy and well cared for’ and ‘staff are friendly and helpful’. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: The home has an activities co-ordinator who organises and runs a weekly programme of social events; information about this is on display in the reception area. Meetings for people using the service and their relatives are held on a regular basis; these are used as an opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Entertainers from outside to the home are booked to come in and perform for people and the home is looking to organise more trips out for those who wish to join in. Records are kept of all the social interactions going on in the home and evidence seen at this visit indicates that people are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 15 There are monthly in-house church services from the Church of England, and the catholic priest will visit anyone, wishing to take communion, on request. One person commented that ‘since Andy (the activities organiser) came here the activities are very good’. Two people spoken with said they enjoyed the social events taking place in the home, although staff did respect the times when they did not want to join in. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the village. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to us showed a high level of satisfaction. Individuals said ‘there is a friendly and happy atmosphere amongst the people and staff’, ‘staff are patient, kind and polite to people and visitors’, ‘good atmosphere and my relative is kept involved and has a good rapport with the staff’. Information about advocacy services is on display in the home and discussion with the manager indicated that no one at the home is currently using an advocacy service, although these have been accessed in the past. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. People spoken to are satisfied that they can access their personal allowances when needed. Comments from the people living in the home and their relatives are on the whole very positive about the meals and kitchen service provided. Individuals commented that ‘the food is excellent’, ‘the home has an excellent cook who provides good wholesome food and who is a valuable and kind member of staff’ and ‘the meals are perfect’. The lunchtime meal was well presented and offered a good choice of food, menus were available and the dining room was welcoming and spacious. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who needed help with eating and drinking. Cedar Grange Residential Home DS0000069694.V349619.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): People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good complaints system with some evidence that peoples’ views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. Improvements to the uptake of staff training in safe guarding of adults is needed to ensure people using the service are protected and kept safe at all times. EVIDENCE: The home has a complaints policy and procedure that is included in the statement of purpose and service user guide. It is also on display within the home and all thirteen of the survey responses from people using the service showed individuals have a clear understanding about how to make their views and opinions heard. Those people spoken with said ‘we would talk to the staff or Denise if we had any problems’. Twelve out of the thirteen relatives who completed a survey said that they felt the home responded appropriately if they raised a concern and minor issues were dealt with quickly. One relative said ‘sometimes I feel I am always complaining about the same things, as action is taken but then things slip back and I start again’. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 17 The home has been given new complaints formats for recording any issues raised and the manager said she will be completing monthly audits of the process as part of the quality assurance programme within the home. A niggles and grumbles book is in place and the manager records any minor issues and the action taken to resolve these. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. Information in the staff training files showed that 53 of the staff have attended Safeguarding of Adults training, 44 have attended Challenging Behaviour training and 41 have attended dementia awareness. Discussion with the manager indicates that the company has recognised the need to improve attendance at this type of training and staff are continually reminded to attend as part of their conditions of employment. These courses are part of the rolling programme of staff training. The responsible individual must make sure that the uptake of the staff training is improved and that staff understand their roles and responsibilities around Safe Guarding of Adults procedures (abuse) and have knowledge of how and when to make referrals to the appropriate Social Service Teams. Discussion with the people using the service indicates that they feel safe within the home and are confident that staff would help them if they had any concerns or problems. Cedar Grange Residential Home DS0000069694.V349619.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, 22, 25 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent investment has significantly improved the appearance of the home creating a comfortable and safe environment for those living there and visiting. EVIDENCE: Comments from the surveys and discussion with people using the service and the manager indicate that the environment within the home is slowly improving as Southern Cross (the company provider) is investing money into new furnishings and ongoing decoration. People commented that ‘the home provides a safe environment, rooms are kept extremely clean and the atmosphere is pleasant’, ‘decoration in some of the rooms could do with freshening up and bed linen and curtains need replacing’. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 19 Recent improvements include new specialist beds (profiling) where people are identified as needing this type of equipment, a number of bedrooms have been repainted and had new furniture and soft furnishings supplied. Areas that still require some attention include • The corridor ceiling outside of the dining room has been damaged during recent heavy rainstorms and the water coming in has made the plaster fall off. Contractors were in the building during the visit and arrangements have been made to replace the damaged section. A number of radiators in the building including those in bedrooms do not have thermostatic valves so people are unable to alter the temperature of their rooms. Comments received in the surveys show that excessive heat is impacting on the comfort of the people living in the home and visitors. The manager said the company is aware of the issue and is hoping to take action about it in the near future. A notice on a window in the conservatory (bungalow area) says the window is broken and cannot be opened. A relative also complained that the sash window in her mother’s room is broken and has not been repaired despite her making staff aware of this. The responsible individual must make sure these are repaired or replaced. Armchairs in the lounge of the main house are looking worn and tired and should be considered for replacement. • • • The manager has been given a budget to replace furnishings over the next year and this will be done on a monthly basis. It is anticipated that within the next 12 months the home environment will improve tremendously. Comments from the surveys indicate that some people would like to see a secure garden area created for those with dementia. At the moment the home has large, well-tended gardens that are enjoyed by the more able people, but these are not secure and individuals could wander from the grounds. The manager has identified an area that could be made secure, but it requires substantial work doing before it could be used safely. The company has asked for the work to be priced and forwarded to them. Plans are in progress to upgrade one bathroom with a new specialist bath and a communal toilet area that is no longer used is to be altered into a ‘wet room’. Other alterations planned for the future are the storage area on the ground floor is to be opened up to become a more useful area which can be used by the hairdresser. It is planned to move the medication room to a different location. Inspection of the home showed that it is a listed building that has been sympathetically altered to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 20 wheelchairs, and corridors are spacious enough for people in wheelchairs or with walking frames to move along comfortably. The home is built on three floors and accommodation on the first floor is accessible by a passenger lift and/or stairs. The second floor is used as administration offices. There are flat walkways inside and out, providing safe and secure footing for people with limited mobility. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage their independence within the home. This includes a mobile hoist/ stand aid, slide sheets, moving and handling belts and handrails. The main bathroom is fitted with an electric seat hoist, and there is a mobile electric hoist for the en-suite bathrooms. The environment is clean, warm and comfortable and few malodours were present. Comments from the day of this visit indicate that the people using the service find the home to be clean and tidy and they are satisfied with the laundry service provided by the home. Cedar Grange Residential Home DS0000069694.V349619.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 and 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training and development of the staff must be improved to ensure they have the skills and knowledge to meet the needs of the people living in the home. Failure to do so may result in the health, safety and wellbeing of people being put at risk. EVIDENCE: Comments from the relatives and people using the service indicate that the home is extremely busy at times and individuals may wait for attention at peak times, but the friendly attitude of the staff and their willingness to help make up for this. Individuals commented that ‘this is a well run home, but they do not have sufficient care staff on duty’ and ‘staff look after people well, but when they are short staffed this changes’. At the time of this inspection there were 28 people living in the home, 19 of these people have some degree of dementia, and staffing levels are as follows From 7:30am to 9:00pm there are four staff on duty (this includes one person who looks after the lodge). From 9:00pm to 7:30am there are 3 staff on duty (this includes one person who looks after the lodge). Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 22 Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. There is an induction course for new members of staff, and 25 of the care staff have achieved an NVQ 2 or 3, with 3 working towards this award. The home provides a mandatory staff-training programme and this includes some more specialised training to help staff develop their skills and knowledge around customer care, pressure care, care planning, dementia, safeguarding of adults and challenging behaviour. The manager has recognised that more must be done to improve the percentage of staff attending the training sessions as only 44 have attended moving and handling, health and safety, COSHH, Nutrition, Infection control, challenging behaviour, dementia awareness and around 50 have attended food hygiene and safe guarding of adults. Better results were seen for fire safety (72 ), safe handling of medication (83 ) and care planning (100 ). Staff are continually reminded that they must attend statutory training as part of their conditions of employment and in future failure to do so may result in disciplinary action being taken. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The manager said that she has tried to recruit more male carers in the past as she is aware that the majority of staff are female, but this has proved difficult as there have been few suitable applicants. She is aware that this may affect people’s wishes regarding gender choice for giving of personal care, and this is discussed before an individual is offered a placement at the home. Comments from the manager indicate that the people living in the home are from a white British background, but the home is able to offer a range of services when they are approached from someone of another culture or ethnic group. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 23 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): People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of residents, staff and relatives. EVIDENCE: Denise Lawson is the registered manager for Cedar Grange, she has been in post for three and a half years and was the assistant manager for over three years before that. Denise has achieved her Registered Managers Award and attends regular training updates to keep her skills and knowledge current and proactive. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 24 The manager has a good understanding of the areas in which the home needs to improve and arrangements are being progressed for them to be sourced and implemented. Comments from the staff, people and relative surveys are very positive about the manager and the way that she runs the home. One individual said ‘Denise is always approachable and listens to what you have to say’. The home has achieved the local councils quality award (QDS) parts one and two. Continuous monitoring and assessment of the home and its practice/service by the Council’s Quality Assurance Team is an essential part of the process leading to the awards being reaffirmed year after year. Meetings for people using the service are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the responsible individual does spot checks and completes the regulation 26 visits. A copy of the monthly visit is sent to the commission. Checks of the finance systems within the home found that computerised records are kept for people’s personal allowances; the administrator on a daily basis up dates these. Information from the Annual Quality Assurance Assessment indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the person’s individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where applicable. Staff are able to access training in safe working practices, although not everyone is up to date (see notes in staffing section) and the manager has completed generic risk assessments for a safe environment within the home. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 25 Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 26 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 2 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 2 2 X X 3 X X 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(b)(c) Requirement The responsible person must ensure the homes statement of terms and conditions meet the criteria of Regulation 5 of the Care Home Regulations and includes the information asked for in The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006 (for Regulation 5), which came into force on 1st September 2006. This is so people know how much they have to pay for their care, what they are getting for their money and the cost of any additional extra services they may wish to purchase. The responsible individual must make sure that staff, individually and collectively, have the skills and experience to deliver the services and care which the home offers to provide. So people can be confident that their needs relating to old age and personal conditions are Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 28 Timescale for action 01/12/07 Amended regulations 2006 2. OP4 12(1) 01/01/08 3. OP18 13(6) recognised and managed appropriately. The responsible individual must make sure that the staff attend appropriate training in Safeguarding of Adults procedures, management of challenging behaviour and dementia care. To prevent residents from being harmed or suffering abuse or being placed at risk of harm or abuse. The responsible individual must make sure that all repairs and renewals as highlighted in this report are carried out. This will enable people using the service to live in a safe and wellmaintained environment, which meets their needs and the outcomes of the statement of purpose. The responsible individual must make sure that radiators are fitted with thermostatic valves. So people can alter the level of heat in their bedrooms themselves to find a suitable temperature, which is comfortable for them and their visitors whilst in their rooms. The responsible individual must make sure that more staff receive appropriate training in safe working practices and other specialist subjects linked to the needs of people with old age and/or dementia. So staff have the knowledge and skills to meet the needs of the people living in the home and understand the specialist conditions relating to old age and dementia. 01/12/07 4. OP19 23(1)(2) (a) 01/06/08 5. OP25 23(1)(a), (2)(p) 01/03/08 6. OP30 OP38 18(1)(a) (c) 01/12/07 Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP7 OP28 Good Practice Recommendations The manager should consider how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. 50 of care staff should have achieved a NVQ 2 in care by June 2008. Cedar Grange Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Residential Home DS0000069694.V349619.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!