Inspection on 23/10/08 for Cedar House

This inspection was carried out on 23rd October 2008.

CSCI found this care home to be providing an Adequate service.

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 09/05/08

Cedar House 26/04/07

Cedar House 20/04/06

Cedar House 01/11/05

Cedar House 04/01/05

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Cedar House 6 Dryden Road Enfield Middlesex EN1 2PP Lead Inspector Tony Brennan Unannounced Inspection 23th October 2008 11:00 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 House DS0000010650.V373596.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 House DS0000010650.V373596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar House Address 6 Dryden Road Enfield Middlesex EN1 2PP 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) 020 8360 8970 020 8360 3613 Cedar House Company Limited Mary Ezzat Jennifer Swords Care Home 17 Category(ies) of Dementia - over 65 years of age (8), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (16), Physical disability (2) Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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: 16) Dementia - Code DE(E) (maximum number of places: 8) Mental disorder, excluding learning disability or demantia - Code MD (maximum number of places: 1) Physical Disability - Code PD (maximum number of places: 2) The maximum number of service users who can be accommodated is: 17 31st July 2008 2. Date of last inspection Brief Description of the Service: Cedar House is a care home registered to provide residential care for seventeen elderly people of either sex, one of whom may have a mental health disorder. The home is a limited company owned by Dr G. Kattan and Ms Mary Ezzat. The home is located in a quiet residential area in Bush Hill Park about two minutes walk away from a train station. Enfield town centre is one stop by train and cafés, newsagents, restaurants and a post office are within two to three minutes walk from the home. The home has a large garden. The bedrooms are arranged on two floors. There are eleven single rooms and three double rooms. On the ground floor there is a lounge overlooking the garden and the dining room is at the front of the house. A room next to the kitchen is also used as a dining room. The table in this room is used for different purposes at different times. It is sometimes used for games, for writing and for eating. Another lounge is provided in the extension part of the building adjacent to the back garden. A table and chairs are available for service users to sit in the garden if they wish and if the weather permits. The home aims to provide care and support that is tailored to each service user’s needs. The home also seeks to provide supportive dementia care in a homely environment. The fees are between £420 and £450 a week. Copies of this report are available from the Commission’s website. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 5 This report is available from the CSCI web site. Service users or members of the public may also contact the registered provider who will be able to provide them with copies of this report. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was undertaken as part of the annual inspection programme. We sought to confirm that the areas for improvement identified at the last inspection had been addressed. Prior to the inspection the home had completed its Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at any other information we had received about the home since the last inspection. This included any information regarding incidents that the home had told us about. As part of this inspection we looked in detail at how the home safeguards people. We discussed this with staff, the registered manager and people who live at the home. We looked at the homes of safeguarding policy, and records relating to how the home dealt with safeguarding issues. We have recorded our findings in the relevant outcome areas. The inspection took place over one day. We were assisted by Jenny Swords, the registered manager, with the inspection. Comment cards were received from residents and relatives. We spoke with three people who live at the home, and two members of staff. We observed care practice and interaction between staff and people living at the home. We toured the building and examined a number of records relating to the care, health and safety and management of the home. At the end of the inspection feedback was given to the registered manager, and areas for improvement were discussed. We would like to thank the staff that assisted us by answering questions about the running of the home. We would also like to thank the people who live at the home who discussed their views of the service they receive. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 7 What the service does well: People case tracked had both assessments from placing authorities, and ones carried out by the home. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. People spoken to said that staff respected their privacy and treated them with respect. People are supported to maintain their privacy to enhance their well being. Falls and manual handling assessments are in place. Each care plan includes a manual handling risk assessment. Management of risk ensures that safety issues are addressed whilst improving the quality of life for people. We found that care plans do include reference to peoples preferences as to how they wish to live in the home. One person told us, “Staff are helpful.” People’s preferences about how they wish to be cared form part of their care plans so that their well being is supported. The registered manager explained that she had met with people living at the home and created a programme of activities that met their needs. One person said, “ I often see activities taking place, and have taken part in them.” People living at the home are supported to engage in meaningful activities to enhance their well being. Relatives commented that there were no restrictions on visiting the home. A relative commented that the home was always, “ friendly and welcoming.” People are supported to maintain contact with their family and friends. The menu is varied offering a number of choices of meals. We spoke with people who were generally pleased with the quality of the food provided. A resident told us, “ The food is always good.” Another resident said, “They ask you what you want to eat.” People are offered a variety of meals that reflects their personal preferences, and meets their dietary needs. The home has a system for obtaining the views of the quality of the service it provides. People’s views are sought and provide the basis for improving the quality of the service. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Nine areas for improvement were identified at this inspection. We found that most medication for each of the people case tracked was accurately recorded. We found that one of the people case tracked is on Warfarin medication. This had recently been changed to increase one of the two daily doses. However, the examination of the medication administration record showed that this has not been recorded and administered to the resident. People must receive all their medication to make sure their health is maintained. Discussions with the registered manager and the examination of training records showed us that most staff had not received training in adult protection. Staff need to be trained in safeguarding procedures to make sure that people will be protected from abuse. Liquid soap and paper towels were not available in all bathrooms and toilets. We discussed this with the registered manager who agreed to address this issue. It is recommended that liquid soap and paper towels are provided in all bathrooms to promote infection control. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 9 The rota did not show who was in charge in the absence of the registered manager. It is recommended that the rota be amended to show who is leading staff over the weekend period. Residents need to be confident that decision is taken to meet their needs and maintain their well being. Training records showed that no training had been provided on equalities and diversity issues. People need to be supported by staff that understand, respect and promote their diversity and equality. Training records and discussions with staff highlighted that they had not all received training in infection control. The registered manager agreed to ensure this training was provided to promote the health and safety of residents. The registered manager explained that an equalities and diversity plan still needs to be put in place. Equalities and diversity issues are not fully addressed as part of the planning and delivery of care to people. The registered manager explained that all policies and procedures still need to be reviewed to ensure they reflected diversity and equalities issues. Policies and procedures need to provide guidance on how the diverse needs and lifestyles of people who live at the home are to be supported and promoted. We found when looking at staff records that they had not had regular supervision. The registered manager agreed to ensure that staff receives regular support and supervision to meet the needs of residents. 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 House DS0000010650.V373596.R01.S.doc Version 5.2 Page 10 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 House DS0000010650.V373596.R01.S.doc Version 5.2 Page 11 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): 13 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose needs to be updated to provide an accurate description of the service. People’s needs are assessed prior to admission to the home to ensure they receive the care and support they need. National minimum standard number six does not apply to the service. EVIDENCE: We found that the needs of the people case tracked were within a range of those specified in the statement of purpose. Staff do have all the skills to deliver the aims of the home as set out in the statement of purpose. Since the last inspection staff have had training on dementia. Training records showed that training had been provided on dementia care. Staff spoken to, and those Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 12 we observed, demonstrated their understanding of dementia care. The registered manager explained that further training is planned in dementia care. Training records showed that staff had completed training on meeting the needs of people with dementia. Staff have the necessary skills and understanding of the needs of people to make sure that the aims set out in a statement of purpose can be achieved. The statement of purpose confirmed that the cultural and religious needs of people would be respected. Records showed that people were supported by the home to maintain contact with their church or other community groups. People are supported to maintain their cultural and religious identity. The statement of purpose states that the home has a deputy manager to provide support to the registered manager. The registered manager has recently reviewed the management needs of the home. As a result the registered manager now manages the home with the assistance of two senior care assistants. We found that the statement of purpose has not been amended to reflect this change. The registered manager agreed to amend the statement of purpose so that it provides an accurate description of the management structure of the home. The annual quality assurance assessment highlighted that, “ a detailed needs assessment is carried out.” The people case tracked had both assessments from placing authorities, and ones carried out by the home. As part of the assessment process information on the needs of people had been obtained from health professionals. This had been used to inform the home’s own assessment. The way people wish to live was reflected in the initial assessments of their needs. For example, one person’s initial assessment highlighted that they regularly attended church. We spoke with them, and they confirmed that the home supported them to attend church. A relative commented that since coming to the home her mother “has settled well, and is generally well cared for.” Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples preferences as to how they wish their personal, medical and social needs met are part of their care plans. People who use the service are not fully protected by safe procedures for handling medication. People’s right to privacy is supported. EVIDENCE: The annual quality assurance assessment highlighted that care plans had been developed with the involvement of people living at the home. We found that care plans do include reference to peoples preferences as to how they wish to live in the home. The registered manager told us that she spoken with people living at the home and made sure that people’s preferences were recorded in their care plans. We case tracked three people and found that their care plans referred to their preferences as to how they wish to be supported. One person Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 14 told us, “Staff are helpful.” Staff spoken to were able to describe the personal needs of the three people case tracked. People’s preferences about how they wish to be cared for form part of their care plans so that their well-being is supported. A relative told us that she was “Happy with the care at Cedar House.” We found that the care plans of the people case tracked identified how the physical and medical needs of people would be met. Care plans were based on initial assessments of the people case tracked. There were clearly defined actions highlighted in the care plans to meet the needs of people. Residents and relatives told us that they had been consulted about the care plans. A relative said, “They talked through the care plan with me and always discuss changes in my mum’s needs.” We saw that care plans had been reviewed. Care plans make sure that people’s personal care and medical needs are addressed. There is a key worker system for people living at the home. A person who lives at the home said, “Staff are quite friendly.” Staff spoken to were aware of the importance of supporting residents’ emotional well being. We observed that staff spent time talk with and answering residents questions. A resident said, “There is a lovely atmosphere here.” When we looked at care plans they contained information on how people’s emotional well being would be supported. The registered manager explained that she has been consulting residents, relatives and their key workers to establish the best ways to support them. People’s emotional well being is supported. People spoken to said that staff respected their privacy and treated them with respect. We saw that people were able to spend time in their bedrooms. A person spoken to told us, “staff understand I like to be alone.” We observed that people living at the home are able to go where they wanted to. We observed that two people spend time sitting in the garden. People are supported to maintain their privacy to enhance their well being. There were falls and manual handling assessments in place. Each care plan includes a manual handling risk assessment. Equipment had been provided to assist people to mobilise safely. We observed two staff assisting one person with a hoist. They took time to explain what they were doing. They checked the equipment and used it in a way that made sure the transfer was done safely. Management of risk ensures that safety issues are addressed whilst at the same time improving the quality of life for people living at home. Diary notes showed that appropriate medical attention and advice is sought. Diary notes also confirmed that the people case tracked had access to their General Practitioner when necessary. We found where the General Practitioner had made changes to peoples medication this was signed to confirm the change had been made. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 15 We found that most medication for each of the people case tracked was accurately recorded. We found that one of the people case tracked is on Warfarin medication. This had recently been changed to increase one of the two daily doses. However, the examination of the medication administration record showed that this has not been recorded and administered to the resident. People must receive all their medication to make sure their health is maintained. The registered manager has completed revising the medication policy. This contained all the necessary information on the administration of medication to ensure people’s safety. We found when case tracking people that this had now been recorded in their care plans. People spoken to told us that they had been consulted about what assistance they needed to take their medication. People are consulted about how they wish their medical needs to be met. No controlled drugs are being used in the home. A safe recording and storage system is in place if any of the people living at home need to have controlled medication. Systems are in place to make sure medications are handled safely. Training has been provided on the safe administration of medicines. We spoke with staff; they were clear about their responsibilities when handling medicines safely. Training records also contained certificates confirming that this training had taken place. We were able to observe staff administering medication, and confirmed that this was done safely. Staff understand how to administer medication safely to people. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. The menu reflects the preferences of people living at the home and shows that they are offered a balanced diet. EVIDENCE: The registered manager explained that she had met with people living at the home and created a programme of activities that met their needs. We saw a copy of the activities programme in the dining room. People told us that regular activities were being provided. One person said, “ I often see activities taking place, and have taken part in them.” The registered manager explained that a record is maintained of activities, and who has participated in them. This record showed us that activities are taking place regularly. The registered manager has recently appointed a part-time activities organiser to carry on Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 17 developing the activities. We spoke with the activities organiser who explained that she has consulted residents and relatives to make sure that activities reflect residents’ interests. People living at the home are supported to engage in meaningful activities to enhance their well-being. We observed that activities were taken place on the day of the inspection. Residents told us they had been involved in a pottery session. We saw an exercise group taking place in the afternoon. There were photographs of other activities that residents had participated in recently. These included arts and crafts and sing a longs. Two residents regularly attend church. Other residents told us that they had seen the priest or vicar when they visit the home. The activities coordinator explained that she was in the process of developing activities for people who have dementia. Residents have started, with the support of staff, to prepare life history books. Activities are provided that support peoples cultural and diverse needs. Relatives commented that there were no restrictions on visiting the home. A relative commented that the home was always, “ friendly and welcoming.” People told us that they could see visitors in private if they wish to. The annual quality assurance assessment highlighted that two people attend a “week day club keeping them involved in the local community.” People are supported and maintain contact with their family and friends. The menu showed that options are offered at each meal. The menu is varied offering a number of choices of meals. We spoke with people who were generally pleased with the quality of the food provided. A resident told us, “The food is always good.” Another resident said, “They ask you what you want to eat.” We observed that at mealtimes people were asked about what they would like to eat. The registered manager monitors the nutritional content of the meals provided. This makes sure that people are offered a balanced diet. People are offered a variety of meals that reflects their personal preferences, and meets their dietary needs. We observed that meals are well presented. The meal was provided in a relaxed manner. People were supported to eat. We observed two staff assisting people to eat. This was done at the pace of the people being assisted. Tables were laid out so that people could easily access condiments. People are provided with the support they need to eat at their own pace. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. Staff do not have all the skills necessary to make sure that people are protected from abuse. EVIDENCE: The annual quality assurance assessment stated, “ The complaints procedure is clear.” We found that the complaints policy was available and had been recently updated. It clearly identified how people can complain. A copy of the complaints policy was available in the dining room for people to consult. A person told us, “ I know that if I was unhappy about anything I can raise it with the manager and it will be dealt with.” The complaints policy is available so that people know how to make a complaint. We found that the complaints book recorded the actions that had been taken to address issues. One complaint had been referred by the Commission to the home since the last key inspection. The home had responded to this in detail and in a timely fashion. The complaints record showed us that issues are addressed and resolved quickly. People who live at the home told us they felt that the registered manager would take their complaints seriously. A person Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 19 who lives in the home said, “ I feel that if I had a complaint the manager will take it seriously”. The home has an open culture that encourages people to express their views, and concerns in a safe and understanding environments. Residents spoken to told us that they felt the home would safeguard them from abuse. There were policies on handling abuse and protection. People living at the home felt confident that any concerns they raised would be handled sensitively and appropriately. A person told us, “ I can tell staff if I am worried about things.” Since the last key inspection there have been no further safeguarding allegations. The one adult protection issue had been addressed at the last key inspection. We have confirmed all issues had been addressed. Discussions with the registered manager and the examination of training records showed us that most staff had not received training in adult protection. Staff needs to be trained in safeguarding procedures to make sure that people will be protected from abuse. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 20 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 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a homely environment. Infection control measures need to be improved to ensure the health and safety of residents EVIDENCE: We walked round the home and found that it was appropriately furnished. A passenger lift provided access for people to the first floor. We observed that people were able to access all areas in the home safely. The home has the necessary adaptations to support people to move around safely. There are large dining and sitting areas for the use of people. The garden is accessible and well presented. People said that they used the garden regularly in good weather. The home provides an accessible and safe environment for people to live in. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 21 The registered manager showed us that a number of other improvements had been made to the homes environment. This included the replacement of the carpet in another bedroom. The purchase of some new bedroom furniture. Also a number of bedrooms have been redecorated. The registered manager explained that ongoing improvements to the homes environment were being planned. The home provides a safe and pleasant environment for people to live in. Bedrooms were personalised with items of furniture and pictures belonging to people. Bedrooms are decorated to a good standard. One person said, “My bedroom is nice.” People are encouraged and supported to personalise their bedrooms. Appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Staff confirmed that they had access to disposable gloves and aprons. We observed that staff were only using disposable gloves when they were going to provide personal care to people. However, as highlighted in the outcome area staffing, training has not been provided in infection control. Liquid soap and paper towels were not available in all bathrooms and toilets. We discussed this with the registered manager who agreed to address this issue. It is recommended that liquid soap and paper towels are provided in all bathrooms to promote infection control. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 22 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 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available at all times to meet the needs of people who live at the home. Staff do not have all the skills to meet all the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: The rota showed that a consistent staffing level was being maintained in the home. Staff said that the current staffing level allowed them to meet the needs of residents. We observed that staff were always available to meet the needs of people living at the home. A resident said, “Staff are always ready to help.” Residents told us they were generally happy with the availability of staff. They felt that staff are always available to meet their needs. People told us that two staff are on duty at night to meet their needs. The rota showed that two night staff are always on duty at night. The registered manager had explained in the annual quality assurance assessment that there had been positive feedback from both residents and relatives regarding the increase of staffing at night. Sufficient staff are available at all times to meet the needs of people living at the home. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 23 When we checked the rota we saw that the registered manager does not usually work at weekends. The rota did not show who was in charge in the absence of the registered manager. This was discussed with the registered manager who agreed to make sure that the rota clearly showed who was responsible for leading the shifts over the weekend period. It is recommended that the rota be amended to show who is leading staff over the weekend period. Residents need to be confident that decision be taken to meet their needs and maintain their well being. At the last inspection it was recommended that training be provided on equalities and diversity issues. The registered manager explained that this training has yet to be provided to staff. Training records showed that no training had been provided on equalities and diversity issues. People need to be supported by staff that understand, respect and promote their diversity and equality. Staff training records showed that staff had completed most of the essential areas of training such as food hygiene, first aid and the administration of medication. Training records and discussions with staff highlighted that they had not all received training in infection control. The registered manager agreed to ensure this training was provided to promote the health and safety of residents. The home has achieved 50 of staff with the National Vocational Qualification in care. Training records confirmed this. The registered manager explained that all staff are registered for the qualification. Training has also been booked on supporting people with physical disabilities. Discussions with the registered manager and training records seen showed us that staff had either received training on dementia care or were about to attend relevant training on this area. Staff we spoke to, and observed demonstrated the understanding of dementia care. People spoken to said staff understood how to support them and they were meeting their needs. One person told us, “The staff are good and very caring.” The home makes sure that all staff receive relevant training that is focused on delivering improved outcomes for people. We looked at two staff files. These contain all the necessary documentation to ensure that these members of staff were safe to work at the home. The employment records had been checked. Two references and a POVA first/CRB check had been obtained prior to them starting work at the home. This showed that the home followed a clear recruitment procedure that ensures the safety of residents. The staff group reflected the cultural backgrounds of people living at the home. People living at the home said they felt that staff could be trusted. Robust recruitment procedures are followed to ensure the safety and well being of residents. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 38 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people receive the care they need. There is an effective system in place to consult people who live at the home about the quality of the service. People who live at the home have their financial interests protected by the home’s procedures. Staff need to be supported to meet the needs of people of the home. People’s health and safety is promoted. EVIDENCE: Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 25 Since the last inspection an effective management structure has been put in place. The registered manager explained that she has appointed two senior care workers. This has helped her to manage the home in a way that makes sure that peoples needs are met. The registered manager felt that having two senior care workers provided her with the same support as having a deputy manager. The management structure of the home makes sure that peoples needs are met. The registered manager has extensive experience managing a service for older people. The register manager has maintained and updated her skills. She has been on the course on dementia care. The registered manager has a clear understanding of the key principles and focus on the service to make sure that people receive the care and support they need. A resident told us, “The manager is interested in what you have to say.” residents and relatives commented positively on the improvement in the approach and attitude of staff. The registered manager told us that she has been working with staff so that they are clear about their roles and responsibilities within the home. The registered manager has a clear understanding of how to deliver improved outcomes for residents. The registered manager explained that an equalities and diversity plan still needs to be put in place. We discussed with the registered manager how the plan could be developed. Equalities and diversity issues are not fully addressed as part of the planning and delivery of care to people. The registered manager explained that all policies and procedures still need to be reviewed to ensure they reflected diversity and equalities issues. Policies and procedures need to provide guidance on how the diverse needs and lifestyles of people who live at the home are to be supported and promoted. The home has a system for obtaining the views of residents and their representatives regarding the quality of service it provides. The home makes sure that any areas for improvement are addressed. The survey of the views of people in the home, relatives and professionals has been carried out. Any issues raised by this have been addressed. Residents told us that they were consulted and involved in decisions about the home. Peoples views are sought and provide the basis for improving the quality of service. We found when looking at staff records that they had not had regular supervision. Staff told us that they had not had regular supervision from the registered manager. The registered manager explained that supervision has not been provided on a regular basis. The registered manager agreed to ensure that staff receive regular support and supervision to meet the needs of residents. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 26 The home does not hold money for residents. The home invoices the families or the relevant social services department for any expenditure made on their behalf. The system is in place to make sure that receipts are obtained for any expenditure. Residents can be confident that there are procedures in place to make sure that their money is handled safely. The home has the necessary procedures in place to make sure residents’ health and safety is promoted. Fire drills were taking place and the fire alarm was tested regularly. We found that the fire risk assessment includes an assessment of all potential fire risks at the home. We questioned staff on the fire safety procedures, and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. We discussed health and safety issues with staff and they demonstrated an understanding. The home has an effective system for monitoring accidents to make sure the safety of people who live and work at the home. The temperatures of the fridges and freezers were recorded and within safe limits. Health and safety checks, procedures and training make sure that people living the home are safe. Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 27 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 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 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 28 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 Standard OP9 Regulation 13(2) Requirement Timescale for action 20/12/08 2 OP18 13(6) The registered persons must make sure that residents receive all the medication that they are proscribed. Residents must receive all the medication they need to maintain their safety and well being. The registered persons must 20/12/08 make sure that training is provided in the host Local Authority’s safeguarding procedures. Staff needs to be trained in safeguarding procedures to make sure that people will be protected from abuse. The registered persons must make sure that training is provided on infection control. Staff need to be trained in how to protect residents from the risk of cross infection. 01/01/09 3 OP30 18(1) Cedar House DS0000010650.V373596.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 Refer to Standard OP1 Good Practice Recommendations The registered persons should update the statement of purpose so that it provides an accurate description of the home’s management structure. The statement of purpose should provide an accurate description of the management structure of the home for residents and their representatives. The registered persons should make sure that liquid soap and paper towels are available throughout the home. Residents should be protected by the home infection control procedures. The registered persons should make sure that the rota shows who is in charge of the home in the absence of the registered manager. Residents need to feel confident that staff are provided with clear leadership so that their needs are met. The registered persons should make sure that staff receive training on diversity and equality. People need to be supported by staff that understand, respect and promote their diversity and equality. The registered persons should ensure that all policies and procedures are reviewed so that they provide guidance on how the diverse needs and lifestyles of people will be promoted. All policies need to be reviewed in order to make sure that they promote equality and diversity of people. The registered persons should make sure that an equalities and diversity plan is in place. People who live at the home need to be confident that all their needs will be met. 2 OP26 3 OP27 4 OP30 5 OP32 6 OP32 Cedar House DS0000010650.V373596.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 House DS0000010650.V373596.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. 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