Inspection on 02/08/05 for Cedar House

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cedar House 27/04/09

Cedar House 27/10/08

Cedar House 01/10/07

Cedar House 26/02/07

Cedar House 07/09/06

Cedar House 19/04/06

Cedar House 04/01/06

Cedar House 09/09/04

Cedar House 26/04/04

Cedar House 17/03/04

Cedar House 19/01/04

Cedar House 18/09/03

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

CARE HOMES FOR OLDER PEOPLE Cedar House 39 High Street Harefield Middlesex UB9 6EB Lead Inspector Clare Henderson-Roe Unannounced 2 & 3 August 2005 10:40am nd rd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cedar House Address 39 High Street Harefield Middlesex UB9 6EB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01895 820 700 01895 820 600 Southern Cross Healthcare Services Limited Care Home 42 0, MD (E) Mental Category(ies) of DE (E) Dementia - over 65 registration, with number Disorder - over 65 0 of places Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. To comply with the Minimum Staffing Notice required by the previous regulator as at 31st March 2002. 2. Five of the beds currently registered can be used for service users of 55 years of age and over, as agreed by the Commission for Social Care Inspection, on 1st February 2005. Date of last inspection 8th, 9th & 10th September 2005 Brief Description of the Service: The home is situated in Harefield village. The village centre is within walking distance of the home and public transport, that being bus services, are available.Cedar House offers care to service users who are over 65 and suffer from Dementia. It is a purpose built care home with service user areas on two floors and services and staff areas on the third floor. The floors are interconnected by a lift, which also accesses the third floor. There is parking to the front and an enclosed garden to the rear. The home is entered and exited by a keypad system. The administrator’s office is sited in the foyer. There is a designated person who oversees leisure activities and an aroma therapist visits twice weekly. There are two General Practitioners providing input for the home, both of whom visit weekly. Monthly visits from a psycho geriatrician and a psychiatrist take place to review the service users mental health needs. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 13 hours were spent on the inspection process. The Inspector carried out a tour of the home, and inspected service user plans. 8 service users, 6 visitors and 12 staff were spoken with as part of the inspection process. It must be noted that it is sometimes difficult to ascertain the views of service users with dementia care needs. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. The home does not provide intermediate care. Service users are assessed prior to admission to ensure the home suitable to meet their needs. EVIDENCE: A registered nurse carries out a pre-admission assessment for all prospective service users who are not referred under continuing care arrangements. For those referred under continuing care, the assessment is in letter form and comes from the Consultant Psychiatrist responsible for the mental health care needs of the service user. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The health and personal care needs of service users had been identified and were being met. Shortfalls identified in the management of medications could potentially place service users at risk. Staff are courteous to service users and generally personal support is provided in such a way as to promote and protect the service users privacy and dignity. EVIDENCE: Samples of service users plans were viewed. These were comprehensive and identified service users needs and the action to be taken to meet these needs. Monthly updates had been carried out and there was evidence of new care plans being formulated for new problems identified. Risk assessments for falls were in place. One viewed had not been updated following a fall. Risk assessments had been formulated to cover areas of risk identified for each individual. There was evidence of input from representatives in the service user plans, and some representatives spoken with confirmed this involvement. Waterlow pressure sore risk assessments had been carried out. Documentation for wound care was comprehensive and clearly demonstrated the progress of a wound. For one service user whose wounds had healed this needed fully clarifying in the service user plan. There was evidence of input from the Tissue Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 9 Viability Nurse Specialist. Pressure relieving equipment was seen in use in the home. Assessments for moving & handling, continence and nutrition had been completed. Bedrail assessments and written consents for their use were in place. The service users are registered with one of two GP’s who attend the home. There is a monthly meeting with the Consultant Psychiatrist, Psychologist and GP to review service users who are accommodated under ‘continuing care’ arrangements. For service users who are under the Care Programme Approach a Psychiatrist and Community Psychiatric Nurse attend the 6 monthly review meetings. Aromatherapy is provided for continuing care service users and can be purchased privately by other service users where appropriate and wanted. Healthcare services are accessed on behalf of the service users. Medication records were sampled on both floors. The date of opening was written on all liquid medications viewed. Fridge and room temperatures had been recorded daily. Medications are stored securely. Receipts for medications are recorded on the medication administration record (MAR) chart. Care plans and risk assessments were seen for service users who are non-compliant with their medications, with one risk assessment to be completed. On the first floor, some gaps in signing for medication administration were noted. Where a code ‘f’ had been used when a medication had been omitted, no explanation of the reason for omission had been recorded. In one instance, medication prescribed for regular administration had been omitted on several occasions. The registered nurse explained the reason for this, including advice being sought from the GP, but the reasoning had not been recorded on the MAR chart. The Acting Manager brought this to the attention of the GP who visited on the second day of inspection to address this issue. On the ground floor medications had been signed for correctly. Full instructions for administration had been omitted for one medication. Prescription pads were seen in the controlled drugs cupboard, and the explanation was that the GP likes to leave these at the home for convenience. This is not acceptable practice and must be discussed and addressed with the GP’s. A system for disposing of medications in line with new legislation had not been introduced. The Acting Manager took action to address this promptly. The shortfalls were discussed with the registered nurses and the Acting Manager. An audit with an action plan to address shortfalls identified was to be carried out, plus additional training for registered nurses in the management of medications was to be carried out. Staff were seen caring for service users in a gentle and courteous manner. Staff showed respect to the service users and were aware of their frailties and mood swings. There was a very good atmosphere on both floors. Telephone facilities are available to service users, and private lines can be installed if wished. Service users were dressed in their own clothes, and their preferred term of address is recorded and respected. Visits by healthcare professionals are carried out in the service users own rooms. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 15 Visiting is encouraged and this enhances the service users lives and keeps them in touch with their families and friends. The meal provision is good and is adapted to meet the needs of each service user. EVIDENCE: The home has an open visiting policy, and service users receive visitors in the privacy of their own rooms. The Acting Manager said that if there were any issues with a service user not wishing to see a particular visitor, then this would be recorded and action taken to manage the situation appropriately. The lunch sampled was well presented and tasty. The cook was very knowledgeable regarding the food provision needs of individual service users. For example, due to their dementia, some service users find it much easier to manage ‘finger food’ and the menus are drawn up taking the needs of the service users into consideration. One service user who was wandering constantly was provided with sandwiches to eat as they walked along. The budget for meals and the reliability of the suppliers was discussed and some shortfalls identified. These issues were then brought to the attention of the Acting Manager, who addressed the situation to ensure the appropriate funds for the food budget are available. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 The home has a satisfactory complaints procedure, however the filing system required clarity to ensure that complaints are well managed. Service users rights are protected and advocacy services are in evidence. Protection of vulnerable adults procedures had not always been clearly followed, which could place service users at risk. EVIDENCE: The home has a clear complaints procedure, which is displayed in the home, and a monthly audit of complaints is carried out. The complaints folder was viewed. Additional documentation, which did not relate to complaints, had also been filed in the folder. Some of the complaints documentation needed reviewing to ensure a clear correspondence and documentation trail for each complaint. Information regarding the Re-Think Advocacy Service is on display in the home and the advocate attends service user and relatives meetings. Service users are on the electoral role, and if they wish to and are able to vote, then appropriate arrangements would be made. The home has policies and procedures in place for the protection of vulnerable adults (POVA), which dovetail with the Local Authority POVA documentation. Policies and procedures for the management of aggression and also the management of service users finances are also in place. Staff are receiving training in the management of challenging behaviour. Correct procedures had not been followed for one POVA issue, and this is being followed up. Staff spoken with said that they would report any POVA concerns. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Aspects of standard 19 were viewed. Overall the home is in a good state of décor, thus providing a homely environment for service users. EVIDENCE: The grounds were well maintained. Overall the home was in a good state of décor and there was evidence of ongoing maintenance. New adjustable beds had been purchased to meet the moving and handling needs of service users. Several of the service users are mobile and have divan beds. The cook reported that a recent Environmental Health Officers inspection report had been addressed. The home was clean and tidy and there were no odours noted. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 13 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The staffing needs to be reviewed to ensure that the safety and care needs of service users are managed at all times. EVIDENCE: The staffing roster did not evidence any changes in staffing. It was explained that whenever there is a change to the roster, a new roster is printed out. The need to show the original roster with any changes recorded thereon was discussed. The hours for the day and night shifts had recently been changed, and staff did not appear to have received appropriate notice of these changes. Several staff were spoken with and issues with shortages of staff, especially at times on night duty, were identified. Two service users require constant monitoring for their own safety. Additional funding had not been agreed for one to one supervision of these service users, but staff were seen to be doing there level best to provide one to one care for these service users whenever possible. The staff on both floors demonstrated a high level of commitment to the welfare of the service users. A review of the staffing provision to ensure appropriate levels of staff are on duty at all times to meet the assessed needs and dependencies of each service user must be a priority. Copies of the worked rosters for July and August 2005 for each floor must be forwarded to the CSCI with an action plan for addressing the staffing issues in relation to service user requirements. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 14 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36 & aspects of 38 Action has been taken to provide improved systems for the management of service users funds, assisting in the ongoing safeguarding and management of service users monies. Progress has been made with formal supervision for staff, thus promoting the forum for discussion and professional development. The home is well maintained, thus providing a safe environment for service users. However, other aspects of health and safety to include staff training were not fully evidenced, which could pose a risk to service users and staff. EVIDENCE: A full financial audit of the home was carried out in December 2004. One service user has clear records for monies banked and cash held by the home. Small amounts of cash are held securely for service users and three records were viewed at random and the amounts of cash held tallied with the records of income and expenditure. Receipts for all expenditure are kept. No staff at the home act as appointees for service users and action is taken to arrange Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 15 any court of protection requirements with Social Services. The home has a safe facility. No items are accepted for deposit in the safe. This standard will be revisited at the next inspection. A system of formal supervision for nursing and care staff has been introduced. Staff spoken with said that they had received training and updates in mandatory topics. The training records did not fully evidence this and the need to maintain evidence of up to date staff training was discussed. Maintenance and servicing records were viewed at random and those viewed were up to date. A copy of the up to date Southern Cross Healthcare Draft Health & Safety documentation was not seen in the home. Risk assessments were seen for several areas of risk to include COSHH, but none were seen for items of kitchen equipment in use. This standard will be revisited at the next inspection. Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x x x 3 3 x 2 Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 17 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 22 8 9 Regulation 13(4)(c) 17 13(2) Requirement Risk assessments for falls must be in place and must be updated following a fall. Documentation to include wound care must be kept up to date. To ensure that from the date of the inspection that all medicines are recorded when administered and if not the correct code used. (previous timescale 08/09/04 not met) Medication must be administered as prescribed. If a medication is being omitted on the instructions of the GP there must be evidence of GP input and a clear record of the instructions given. Arrangements must be reviewed to collect waste medicines. The food budget must be set at a level to ensure the food provision is appropriate to meet the needs of the service users. The complaints filing system must be reviewed to ensure all documentation pertaining to each complaint is clearly filed and accessible. In the event of any adult protection issues, the Protection of Vulnerable Adults procedures Timescale for action 01/09/05 01/09/05 05/08/05 4. 9 13(2) 05/08/05 5. 6. 9, 26 15 13(2) 12(1)(a) 16(2)(i) 22 05/08/05 05/08/05 7. 16 01/09/05 8. 18 13(6) 05/08/05 Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 18 must be clearly followed. 9. 27 18 The staffing provision must be assessed on an ongoing basis to ensure that there are sufficient numbers of staff on duty at all times to meet the assessed needs of the service users. (previous timescale 01/10/04 not met) Copies of the worked staffing rosters for July and August 2005 must be forwarded to the CSCI, together with an action plan to identify how service users needs are to be fully met. All staff must undergo mandatory training at intervals in line with current associated legislation. A record to evidence this must be kept. Up to date health & safety risk assessments to include equipment in use must be available in the home. Up to date Health and Safety documentation in line with current legislation must be available in the home. Copies of the updated documentation must be available to all staff. 05/08/05 and ongoing 10. 27 18 01/09/05 11. 38 18 01/10/05 12. 38 13(4) 01/09/05 13. 38 13(4) 01/09/05 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 9 Good Practice Recommendations It is strongly recommended that the home does not take responsibility for blank prescription pads. The GP should take this responsibility and bring a prescription pad to the home at each visit. 2. 9 Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedar House G61-G10 s10927 Una-Cedar House v239283 020805 Stage 4.doc Version 1.40 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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