Random inspection report
Care homes for adults (18-65 years)
Name: Address: Cedar House 47 Smethurst Street Cedar House Middleton Manchester M24 2BA zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lucy Burgess Date: 0 2 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Cedar House 47 Smethurst Street Cedar House Middleton Manchester M24 2BA 01616553553 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Ann Merabi care home 16 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 16 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: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 16 Date of last inspection Brief description of the care home Cedar House is a care home providing personal care for 16 adults, who have been diagnosed with a mental disorder. Three places are registered for residents over the age of 65 years. The home provides 16 single bedrooms, a lounge, conservatory, dining room, communal toilets and bathing facilities. Cedar House is located at the end of a residential street, approximately two miles from
Care Homes for Adults (18-65 years) Page 2 of 17 Brief description of the care home the town centre of Middleton. A number of small local shops, post office and pubs are near by. The home has a car park for residents and visitors. A grassed area is provided to the rear of the house and small garden areas to the front. Fees charged by the home in May 2009 ranged from 328.00 to 380.00 pounds per week. The home makes charges over and above the weekly care and accommodation fees for items such as hairdressing, magazines and newspapers, toiletries, activities and clothing. Care Homes for Adults (18-65 years) Page 3 of 17 What we found:
This was a random inspection visit by an inspector and pharmacy inspector. The purpose of our visit was to look at what progress had been made following our key inspection on the 27 November 2009. As a result of the key inspection we issued a Statutory Requirement Notice due to poor medication practice and a warning letter, which highlighted other areas of improvement needed. These included care planning, staff training and development, responding to complaints, routines and management and conduct. Further concerns were also noted with regards to finances and unpaid bills. Due to our concerns we have held management review meetings to discuss what further action needs to be considered by us. It was agreed that a letter be sent to the registered provider requesting that up to date accounts be provided. These have not been received. The current quality rating for the home is 0 stars, outcomes are judged as being poor. Due to this and other concerns raised with the local authority, placements are currently not being made at the home. Following the key inspection the manager and provider were given an opportunity to respond to the draft report, Warning Letter and Statutory Requirement Notice. The manager provided a response to the draft report and warning letter requesting amendments were made, an improvement plan was also received. No amendments were made to the report. The registered provider has not provided any response to our report or letters. We have also recently met with the owners of the home. They outlined to us their plans in relation to the future of the home. We again asked about the audited accounts for the service and were advised that these had not been completed since approximately 2005. We requested that this was put in writing to us. This has not been received. Prior to this visit we received an anonymous complaint about the home. The complainant expressed their concerns in relation to inadequate food provisions and poor quality food, lack of personal money made available to people enabling them to have some choice in what they do each day and issues with the washing machine and laundry not being done. These areas were looked at as part of our inspection visit. We visited the home on the 23 February 2010 and again on the 2 March 2010. At the time of our initial visit only 2 care staff were on duty. They contacted the manager and owner, the registered providers representative, who attended the home. During the second visit the registered manager was on duty. The purpose of this visit was to look at action taken to improve the identified areas including care planning and medicines handling in order to meet with current requirements. Previous visits to the service found weaknesses in care planning and medicines handling that need to be addressed to help ensure people at the service are best protected. We looked at care documentation within the home and the medication systems that were in place and spoke with the support workers about the arrangements made for handling peoples medicines. Serious concerns about the safe handling of
Care Homes for Adults (18-65 years) Page 4 of 17 medicines were identified at our previous visit. A Statutory Requirement Notice was issued to the registered manager and registered provider of the home in January 2010. This notice required the manager and owners operating the home to improve the control of medicines. At this visit we found some improvement in medicines record keeping but weaknesses in the arrangements for handling and administering peoples medicines continued to put people at risk of not having their medicines when needed. This meant that the requirements of the Statutory Requirement Notice served in January 2010 were not met, in that they remain in breach of Regulation 12 (1) (b) and regulation 13 (2). We examined a sample of medicines records and stock. We found that medicines record keeping had improved to better support the administration of medicines in the home. All medicines were safely locked away and medicines stocks were better organized. But, we were concerned to find that someone had missed doses of medication for the previous month because there was no stock in the home. A supply of medication had been received with the next monthly delivery but this could have been followed up more quickly by support staff. As at our previous visit, most medicines were supplied in a monitored dosage system and this was used correctly. But, it was not always possible to account for (track) the handling of medicines in traditional boxes and bottles because the quantities of any medicines carried forward to the next months records were not shown. At out previous visit we found that someone had not been given their medication correctly following a dose change. Similarly, at this visit we were concerned to find that advice to try and support someone to reduce the use of a night time medication had not been promptly followed up by the home. We looked at how care plans supported the safe use of medicines. As previously seen there was a lack of clear up-to-date guidance for staff about when when required medicines may be needed. Additionally, several medicines administration record showed that doses of medication had been missed because people were away from the home at the times medicines were normally administered. We found that for most people, consideration had not been given to their medication needs when away from the home. There was no evidence that advice had been sought to see if these medicines could be given at different times to better fit with peoples lifestyles and choices. Since our previous visit staff had completed refresher medication training but there were no regular audits of medicines handing and competency assessments had been carried out to help ensure that staff understand and follow the homes written procedures for handling medicines. The manager explained that the medicines records were checked at the end of each month, but these checks had not been effective in identifying the concerns seen out our visit. It is important that regular audits are completed to help ensure that should any weaknesses arise, they can be promptly addressed. Other concerns were noted with regards to the lack of up to date information about individuals and their support needs, routines, the management and recording of finances, the ineffective relationship between the manager and owner and the viability of the home. It was clear from discussions with the registered manager and owner that relationships were strained. It appeared that each were not taking personal responsibility for their role and were blaming each other for the difficulties being experienced within the home. We found that new care plan documentation was being introduced and files reorganised
Care Homes for Adults (18-65 years) Page 5 of 17 so that only current information was available to staff. However on four of the files examined the current care plan had been archived and no new plan had been developed. This meant that there was no information available for staff about the current needs of residents and how they wish to be supported. The health care needs of one person had not been followed up. Information provided on the review minutes held in November 2009 showed that inadequate arrangements were in place with regards to continence care. We were told by staff that this was still an ongoing issues. The manager explained that aids provided had been unsuitable so alternative items were now being purchased. These were being bought by the resident and were not being provided as part of the persons health care needs. The manager should make referral to the continence advisor so that suitable provisions can be made available. One staff member of staff spoken with had introduced a night communication book. This detailed the routines and behaviours of people throughout the night, providing information which could be used to monitor the needs of people. However this had only been completed by the one member of staff and was therefore stopped. Daily records are not completed by day staff. Monitoring sheets examined varied in relation to the level of information provided and frequency in which they were completed. Whilst some had continued to be completed on a weekly basis, others had no evidence of a recent entry. Again this provided no evidence of peoples routines or any patterns in relation to the changing needs of people. We spoke with one member of staff who said that they were not generally involved in completing documentation. It was unclear how staff know how to support people when there are no detailed care plans for some people, providing direction for staff or evidence of daily records, monitoring or formal hand overs. It is concerning that without up to date accurate information staff are not provided with clear guidance about how to safely support the needs of people. Furthermore there is no evidence to show that the health and well being of people is being monitored ensuring they are kept safe. Meal arrangements were also looked at due to the concern raised. The manager, owner and cook felt that there were suitable arrangements in place and that sufficient food stocks were provided. The owner did states that they shopped around but bought quality food at a more affordable price. We looked at the stock available. Sufficient meat was available as well as fish, pizzas, quiche and fruit. Dry goods were also available however there was little food in the fridge. The owner stated that shopping was bought as and when needed depending on what meals were being provided and also staff purchased items locally when needed. We did find that only long life skimmed milk was provided. The owner said that this was due to the number of drinks people had. Consideration should be given to the nutritional needs of people and their preference. Further concerns were found with regards to finance records and unpaid bills. We were told that the telephone had been cut off and the rubbish bins had not been emptied. This was said to be due to unpaid invoices. Further concerns were raised with us by Eon due to considerable money still outstanding on the account. They were now considering disconnection proceedings. This information has been shared with the local authority. We found that washing had piled up due to the machine being broken. The manager said that this had happened over the previous weekend, however the company had not been
Care Homes for Adults (18-65 years) Page 6 of 17 contacted due to the phone not working and staff not wanting to continually use their own phones. During our visit the repair man arrived to fix the machine. This was repaired however it appeared that staff made no effort to start the washing. This was concerning as we were aware that there were issues in relation to incontinence. When we visited the home again on the 2 March 2010, we were told that the machine had broken again and that washing had not been done. This is not acceptable. Adequate arrangements must be made so that this does not reoccur and items are laundered promptly to minimise any health and safety issues. The manager also told us that staff had received letters from Revenue and Customs in relation to their wages and contributions. We have previously identified that staff are not provided with a detailed payslip showing their income tax and national insurance contributions. The owner advised us that they had made contact with a payroll firm and arrangements were being made for this to commence in April. The owner also advised us that they too were to be visited by Revenue and Customs within the next few weeks. In relation to personal allowances we were advised by the owner that cash contributions made by 3 residents on a fortnightly basis were used to pay the personal allowances of 6 residents and food money. Alternate weeks were then paid by the owner through the business. Finance records showed where contributions had been paid however there were no clear records to show how and where this money had been distributed. In order to be able to clearly audit transactions, clearer records need to be in place evidencing that money is being handled properly. Issues in relation to people finances have been shared with the local authority. Considering the lack of accounts available and the improper financial management of the service this does not demonstrate that the service is being conducted in a way to safeguard the future of people at the home. One area we identified during our last visit was in relation the lack of opportunities offered to people in relation to their daily routines. In the main the residents spend a lot of time in the home relaxing with each other. During this visit we saw minutes from a residents meeting conducted by the manager. In it the manager had advised people that the CQC requested that they residents do something more constructive with their time, for example, work placements or education courses. This does not provide an accurate account of what was advised nor does it demonstrate the managers understanding in relation to affording people more control over their own lives both within and outside of the home. Furthermore, during our visit we observed two members of staff spending time playing backgammon together, however this did not involve any resident. They were left to occupy their own time. Throughout the day there appeared to be no constructive support offered by staff other than general conversation. Staffing rotas were also looked at. We found that staffing levels had been reduced since our last visit, with just 2 care staff on throughout the day, which may include the manager or deputy manager and 2 staff at night. Staffing levels do not provide any flexibility in support considering individual routines or appointments. The manager hours were looked at, we found that a large number of shifts were undertaken over the weekend period. This would mean that the manager was not available at core times during the working week for people to contact her. This needs to be addressed so that she is able to respond in a timely manner to any action required.
Care Homes for Adults (18-65 years) Page 7 of 17 Rotas showed that on occasion the owner was also providing cover on the rota where this was needed. We asked to see the recruitment file and criminal record check of the owner, as these records should be held if they are working at the home. Information could not be provided. During our visit the manager spoke with the owner who advised that a criminal record check had been carried out by the Commission. It was unclear why this would have been done as the owner is not registered with us. We issued an immediate requirement and asked that evidence of such check be provided to us by the 5 March 2010. This has previously been an area of concern, which resulted in a Statutory Requirement Notice being serviced in July 2009. At that time the notice was met. Some progress had been made with regards to staff training. Recent courses had been undertaken with regards to first aid, medication and social care induction. However considering new staff have little or no experience of working with people with mental health needs, there has still been no training provided into the specific needs of people they support. We identified during our last visit in November 2009, that a number of residents had raised concerns. This was discussed with the manager who explained that at that time she was in the process of speaking with the staff member concerned. During this visit we were advised that one matter was still outstanding and the staff member had yet to be spoken with. The manager must ensure that issues raised with her are addressed within a timely manner so that this demonstrates that issues raised are taken seriously and people feel they are being listened to. Others areas remain outstanding with regards to management training and the provider monthly visit reports in relation to regulation 26. These have now been identified on several occasions and have yet to be addressed. Again this does not demonstrate a commitment to improving and developing the service. The owner advised us that he would be completing the regulation 26 monthly visits on behalf of the registered provider and that a copy would be sent to us. It was agreed that written confirmation would be forwarded to us by Friday 26 February 2010 with regards to a further payment to Eon, payment for the bins, arrangements for the managers training, that the washing machine and telephone repairs had been carried out. They owner said that they would also provide a copy of the regulation 26 report. At the time of completing this report no information had been received. This again does not demonstrate a commitment to delivery a reliable efficient service. Due to our concern we took copies of information under a code B. A further management review would be held to consider what action needs to be taken to address the on-going concerns. What the care home does well: What they could do better:
Care Homes for Adults (18-65 years) Page 8 of 17 Individual care plans must be implemented and kept under review so that they reflect the current and changing needs of people ensuing they are supported in a way, which ensures their health and well being is maintained. Risk assessments should be developed in all areas of concern and detail the support and intervention needed so that risks are minimise ensuring people are kept safe. Records should be developed in relation to recording peoples health care, routines and behaviour. This will enable the team to monitor any changes so that should additional support or intervention be required this can be done so in a timely manner. Effective communication systems need to be developed between the team so that everyone is aware of the current and changing needs of people in order to promote and proper arrangements for the health and well being of people. More meaningful consultation should be held with people about the opportunities made available to them so that they are able to take part in a variety of activities both within and away from the home, based on their individual needs and wishes. The manager needs to liaise with relevant health care professional so that proper arrangements can be made for peoples continence care ensuring their health and well being is maintained. The registered person must ensure that medication is given as prescribed or a clear reason for the non-administration clearly documented in the MAR so that the residents and the manager can be confident medication is being given as prescribed. The registered person must ensure that complete, clear and accurate records of medicines received, administered and leaving the home are maintained to support and evidence the safe handling of medication. The registered person must ensure that adequate stocks of medication are maintained without overstocking to enable continuity of treatment. Consideration must be given to peoples medication needs away from the home to ensure that as far as possible arrangements are made for medicines to be taken safely as prescribed as the best and right times. The manager must ensure that any issues brought to her attention are explored in a timely manner. Records should be clearly show how these have been explored, the outcome and any action taken where necessary. This will demonstrate that comments made are taken seriously and people feel they are listened too. More effective systems should be put in place with regards to the recording and management of individual finances so that the systems are robust and clearly demonstrated that money is being managed safely. More suitable arrangements need to be made in the laundry to prevent infection and the spread of infection within the home. Care Homes for Adults (18-65 years) Page 9 of 17 The register provider must ensure that anyone working, managing or carrying on at the home is robustly recruited and that all relevant information and checks are completed and available for inspection. This is to ensure that only those people fit to do so work at the home so that people are kept safe. Sufficient staffing must be provided at all times ensuring there are sufficient number of duty to meet the health and well being of people providing flexible support. Further training and development of staff needs to be provided ensuring all staff have the knowledge and skills needed to support the specific needs of people living at the home, for which it is registered. Relationships between the manager and owner need to maintain good professional relationships with each other so that the conduct of the home is improved. Again arrangements in relation to management training remain outstanding. This must be addressed to show that the manager is committed to providing clear leadership, support and direction so that a quality service is provided. The registered provider has previously been asked to complete records to demonstrate when she visits the home as part of her monitoring visits. These have still yet to be done. The registered provider needs to demonstrate that she is carrying on the service in the best interests of those living at the home. Copies of the reports must be forwarded to us each month. The registered provider still needs to ensure that she fulfills her responsibility as an employer, in that, staff working at the home are provided with adequate statements of wages earned and deductions taken from their wages. The registered provider must ensure that the financial management of the service is conducted in such a manner that this does not compromise the service and the safety of those who live there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 10 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 6 15 The registered person must 30/01/2010 ensure that care plans are kept under review and updated when necessary to show the current and changing needs of people so that staff are clear about the support to be provided. 2 9 12 The registered person must ensure that risk assessment are reviewed and updated ensuring that information reflects the current support needs of people. 30/01/2010 3 20 13 The registered person must 24/01/2010 ensure that adequate stocks of medication are maintained without overstocking to enable continuity of treatment. 4 22 22 The registered person must ensure that all concerns brought to her attention are addressed in a timely manner and relevant action taken, where necessary, to ensure people are being protected. 24/01/2010 Care Homes for Adults (18-65 years) Page 11 of 17 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 5 35 18 The registered person must 30/01/2010 ensure that the staff team receive training specific to the role and responsibilities to ensure their continued professional development as well as being able to meet the needs of service users in a safe way. This should be detailed in a training plan and should courses in medication, mental health awareness, care planning, substance misuse, health and safety, infection control etc 6 37 10 The registered manager 30/01/2010 must provide evidence to show that she is undertaking the registered managers award so that service users benefit from a qualified registered manager. On completion of the award copies of the certificates should be forwarded to us. The Provider must carryout 30/01/2010 the monthly monitoring visits in line with regulation and record her findings to show that the service is being monitored as part of a thorough quality reviewing process. Copies of the reports should be forwarded to the CQC.
Page 12 of 17 7 39 26 Care Homes for Adults (18-65 years) Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 13 of 17 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 34 19 The register provider must 05/03/2010 ensure that anyone working, managing or carrying on at the home is robustly recruited and that all relevant information and checks are completed and available for inspection. This is to ensure that only those people fit to do so work at the home so that people are kept safe. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 11 16 More meaningful consultation 30/04/2010 must be held with people about the opportunities made available to them so that they are able to take part in a variety of activities both within and away from the home, based on their individual needs and wishes. 2 19 12 Records must be developed 30/04/2010 in relation to recording peoples health care, routines and behaviour. This will enable the team to monitor any changes so that should additional support or Care Homes for Adults (18-65 years) Page 14 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action intervention be required this can be done so in a timely manner. 3 19 12 The manager must liaise with 30/03/2010 relevant health care professional so that proper arrangements can be made for peoples continence care ensuring their health and well being is maintained. 4 20 12 Consideration must be given 23/03/2010 to peoples medication needs when away from the home to ensure that as far as possible arrangements are made for medicines to be taken safely as prescribed at the best and right times. 5 23 16 More effective systems must 30/03/2010 be put in place with regards to the recording and management of individual finances so that the systems are robust and clearly demonstrated that money is being managed safely. 6 30 13 More suitable arrangements 30/03/2010 must be made in the laundry to prevent infection and the spread of infection within the home. 7 33 18 Sufficient staffing must be provided at all times ensuring there are sufficient
Care Homes for Adults (18-65 years) Page 15 of 17 30/03/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action number of duty to meet the health and well being of people providing flexible support. 8 37 12 The manager and owner must maintain good professional relationships with each other so that the conduct of the home is improved. 9 43 25 The registered provider must 30/03/2010 ensure that the financial management of the service is conducted in such a manner that this does not compromise the service and the safety of those who live there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 30/03/2010 1 18 Effective communication systems need to be developed between the team so that everyone is aware of the current and changing needs of people in order to promote and proper arrangements for the health and well being of people. The registered provider still needs to ensure that she fulfills her responsibility as an employer, in that, staff working at the home are provided with adequate statements of wages earned and deductions taken from their wages. 2 43 Care Homes for Adults (18-65 years) Page 16 of 17 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 17 of 17 - 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!
