CARE HOMES FOR OLDER PEOPLE
Cedar House 6 Dryden Road Enfield Middlesex EN1 2PP Lead Inspector
Tony Brennan Unannounced Inspection 26th April 2007 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.V333305.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.V333305.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 Dr G.V Kattan & Mrs M.S.Ezzat Ms Jenny 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.V333305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. As agreed on the 26th September 2006, Two (2) specified service users under 65 years of age and also has a physical disability may be accommodated in the home. The home must advise the CSCI if either of the service users vacate the home. 20th April 2006 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 £380 and £550 a week. 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.V333305.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken as part of the annual inspection programme. I sought to confirm that the eight areas for improvement identified at the last random inspection were addressed. The inspection took place over one day. Jenny Swords, the registered manager, assisted me with the inspection. I spoke with four people who live at Cedars House, one friend and three members of staff. I observed care practice and interaction between people living at the home and staff. I toured the building and examined a number of records relating to the care, health and safety and management of the home. I would like to thank Jenny Swords and staff who assisted me by answering questions about the running of the home. I would also like to thank the five people who live at the home who discussed their views of the service they receive. What the service does well:
Two people who had recently come to live explained that they had been consulted and involved in their move to the home. One person said, “ I got to see the place, and they gave me a brochure about the home.” The two people case track had recently come to live at the home, they had been assessed prior to the admission. The daily notes show that the people case tracked had received appropriate medical support. The optician, dentist and chiropodist had made visits to the home recently. People living at the home receive appropriate health care. People living at the home are offered supplementary care by an organisation that provides physiotherapy, speech and occupational therapies. The records of medicines received, administered and returned to the pharmacist were all complete. I found that the medication for each of the people case tracked was accurately recorded. Medication is managed in ways that ensure the safety of people living at the home. I spoke with a friend of one of the people living at home she confirmed they could visit when they choose. A person who lives at the home said, “they ask Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 6 who you want to see”. People are supported to maintian contact with family and friends. The menu showed that options are offered at each meal. I observed a number of people enjoying their choices of meals. People who live at the home told me that they were generally pleased with the quality of the food provided. A person who live at the home said, “ the food is good”. Meals are provided that reflect the personal preferences and dietry needs of people living at the home. I spoke with people who live at the home they were confident that any concerns they had about how they were cared for would be addressed. One person spoken to felt that, “ you can tell the staff if something is wrong and they will do their best to sort it out.” There were comprehensive policies on handling abuse and protection. I found that staff have received training on adult protection matters. People are protected and their complaints are addressed. I walked round the home and found that it was well decorated and appropriately furnished. I found that bedrooms were personalised with items of furniture, pictures and other personal possessions of people who live at the home. The home’s environment is personalised to meet the needs and preferences of people. Appropriate signage is in place to ensure that people with dementia are able to identify their bedrooms and other communal areas. The home has been abducted so that people with physical disabilities are able to access all areas and use the facilities of a home safely. The home has introduced internal and external ramps. Also appropriate adaptations such as grab rails above beds have been put in place. In the bedroom occupied by a person with a physical disability the bath has been adapted to meet his needs. In addition there is a battery operated toilet seat to aid access in the main disabled toilet. What has improved since the last inspection?
There were eight areas for improvement identified at the last inspection and seven of these had been addressed. I also found that the registered manager and staff had made a number of other improvements that directly improved the quality of outcomes for people living at the home. The registered manager explained that since the last inspection the key worker system had been reviewed. Key workers now have clear guidance about their role and responsibilities. I spoke with people living at home who felt that they receive good individual attention from their key workers. The registered manager explained that she has encouraged staff to spend time talking with people who live at the home. One of the people case tracked told me that, “ there are a lot of activities, bingo, card games and staff spend time chatting
Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 7 with me.” I observed on a number of occasions throughout the inspection that staff would take time to sit and talk with people. People living at the home receive individualised attention from staff who understand their needs. I found that each person case tracked has an individual record of the activities they had been involved in. A new activities programme has been created in consultation with people living at the home. On the day of the inspection the hairdresser was visiting the home and I observed that staff provided activities. A range of activities ar provided that reflect the interestr of people living at the home. The home has also recruited an organisation to work with people live at the home. The organisation provides musical exercise and entertainment sessions once a week. The registered manager explained that since the last inspection a number of items of furniture had been purchased. This included new furniture for the sitting room and a new carpet for one of the bedrooms. Another bedroom had been decorated. Improvement are made to the home’s environment for the benefit of people who live there. Automatic door closing the devices had been installed so that people living at the home could have their bedroom doors open without this being a risk to them in the event of fire. Staff were also observed to spend time with people both individually and in small groups. This allowed more attention to the individual needs of people who live at the home. The registered manager explained that since last inspection training had been provided on fire prevention and manual handling. People living at the home are supported by staff who understand the safety issues in these areas. People live who home told me that that the registered manager was approachable and interested in their views of the home. I observed that the registered manager spent time talking with people who live at the home. A person who lives at the home said, “the manager is making things better for us.” The registered manager manages the home to ensure that the needs of people are met consistently. Since the last inspection a survey of the views of people living at the home has been carried out. The registered manager told me that she is preparing a report on the findings of the survey. The views of people living at the home are sought to improve the service. Records showed that fire drills are taking place regularly. The temperature of food is now being recorded. The safety of people living at the home is addressed in these areas. Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 8 What they could do better:
Ten areas for improvement have been identified at this inspection. At the last inspection care plans were found not to provide detailed information on the needs of people living at the home. The registered manager told me that some work had been done to improve the amount of information contained in care plans. However, case tracking also highlighted that information on how to meet the needs of people is still incomplete. One person case tracked had a diagnosis of diabetes. The care plan for this did not provide sufficient guidance for staff. There was no explanation of possible symptoms that might indicate that the person required medical attention. Detailed information on how to meet the needs of people must be available to ensure that consistent care is provided. I found that the people case tracked had not been consulted about the contents of their care plans. Care plans must reflect the views and preferences about how people wish to be cared for. I found that one of the people case tracked had three falls before being admitted to the home. This was highlighted as a risk in their initial assessment. The initial assessment identified that the cause of these falls was due to the indiviual’s vertigo. There was no evidence to show that the home has carried out a manual handling or falls risk assessment for this person. This needs to be put in place to ensure that the needs of people living at the home are met safely. Discussions with the registered manager and training records show that not all staff had received training in food hygiene and first aid. This must be addressed to ensure the safety of people living at home. Training must be provided for staff on how to meet the needs of people with physical disabilities. This will ensure that care is provided by staff that understand how to met the individual needs of people. The pre-inspection questionnaire stated that three members of staff are about to commence the National vocational qualification in health and social care. The registered manager explained that at present the home does not have 50 of staff with this qualification. It is recommendation that 50 of staff achieves this qualification. Staff needs to have a qualification that shows that they have the skills to support people living at the home.
Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 9 Two of the files seen newly appointed staff, they did not have POVA first or CRB check. I discussed this with the registered manager who explained that she needed to employ staff quickly so that adequate staffing was available at all times. CRB checks must be obtained to ensure that staff are safe to work with people who live at the home. The registered manager explained that she has to take on both the day-to-day management of the home and its development. It would assist her to have a deputy manager in post. It is recommended that a deputy manager be appointed for the home. This will ensure that the care and safety needs of people are addressed consistently. The registered manager explained that she has not been able to supervise staff ever two months. I found that supervision notes showed that staff had not received regular and consistent supervision to improve the care provided. This will ensure that staff are effectively support to meet the needs of people living at the home. The fire alarm was not being tested regularly. The fire alarm must be tested regularly to ensure the safety of people living at the home and staff working at the home. One requirement made at the last inspection has not yet been met and has been restated in this report, with a new timescale for compliance. In the ‘Timescale for Action’ column, the date in ordinary type relates to the timescale given at the last inspection. The date in bold type relates to the new timescale. Further information about unmet requirements can be found in the relevant section. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. 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.V333305.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.V333305.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are fully assessed prior to admission to the home to ensure they receive the care and support they need. EVIDENCE: I spoke with two people who had recently come to live at the home and they explained that they had been consulted and involved in their move to the home. One person said, “ I got to see the place, and they gave me a brochure about the home.” Another person who lives at the home said, “ my son and daughter found the home, they got an information pack for me before I decided to come here.” Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 12 The statement of purpose has recently been updated to include information to state that the home provides care and support to people with a physical disability. The statement of purpose contained all the relevant information on the service and adequately describes the service that the home provides. Two of the people case track had recently come to live at the home, they had been assessed prior to the admission. Pre admission assessments identified the major areas of need for the two people. These included assessments from social workers and health professionals dealing with their. One of these people confirmed that, “ staff are quite able and understand my needs.” The registered manager explained that she ensures that information on the needs of people is obtained prior to the admission. The registered manager explained that no one is admitted to the home before they are assessed. Cedar House DS0000010650.V333305.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal, social and medical care needs are not fully planned for or met. People who use the service are fully protected by safe procedures for handling medication. People’s right to privacy is supported. EVIDENCE: At the last inspection care plans were found not to provide detailed information on the needs of people living at the home. The registered manager told me that some work had been done to improve the amount of information contained in care plans. I case tracked three people who live at the home and found that there had been some improvement in the information contained in care plans. However, case tracking also highlighted that information on how to meet the needs of people is still incomplete. One person case tracked had a diagnosis of diabetes. The care plan for this did not provide sufficient guidance
Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 14 for staff. There was no explanation of possible symptoms that might indicate that the person required medical attention. Another person case tracked had been identified in the initial assessment as needing to be prompted to support him to remain continent. The care plan did not reflect this. Care plans had been reviewed monthly, but I found that the people case tracked had not been consulted about the contents of their care plans. The daily notes show that the people case tracked had received appropriate medical support. The optician, dentist and chiropodist had made visits to the home recently. I found that one of the people case tracked had three falls before being admitted to the home. This was highlighted as a risk in their initial assessment. The initial assessment identified that the cause of these falls was due to the persons of vertigo. There was no evidence to show that the home has carried out a manual handling or falls risk assessment for this person. The register manager explained that since the last inspection the key worker system had been reviewed. Key workers now have clear guidance about their role and responsibilities. I spoke with people living at home who felt that they receive good individual attention from their key workers. The records of medicines received, administered and returned to the pharmacist were all complete. Medicines were stored safely. A new medicines cabinet has recently been purchased for this purpose. All medicines are stored at the appropriate temperature. There are no controlled medication currently held in the home. I found that the medication for each of the people case tracked was accurately recorded. Training records also contained certificates confirming that this training had taken place. I was able to observe staff administering medication and confirm that this was done safely. Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. 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 offers a balanced diet. EVIDENCE: At the last inspection it had been found that more than periodic activities needed to be provided. Activities did not reflect the personal preferences and needs of people living at the home. The registered manager told me that more periodic activities are now being provided. The registered manager explained that she has encouraged staff to spend time talking with people who live at the home. One of the people case tracked told me that, “ there are a lot of activities, bingo, card games and staff spend time chatting with me.” I observed on a number of occasions throughout the inspection that staff would take time to sit and talk with people.
Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 16 I found that each person case tracked as an individual record of the activities they have been involved in. A new activities programme has been created in consultation with people living at the home. On the day of the inspection the hairdresser was visiting the home and I observed that staff provided activities. I spoke with a friend of one of the people living at home she confirmed they could visit when they choose. A person who lives at the home said, “they ask who you want to see”. The inspector observed that staff treated visitors well and they were given information on the needs of people who they were visiting that live at the home. The menu showed that options are offered at each meal. I observed a number of people enjoying their choices of meals. People who live at the home told me that they were generally pleased with the quality of the food provided. A person who lives at the home said that “ the food is good”. Another person commented about the choice of food offered and that staff had “asked about what food I like. I saw that meals were well presented and they were provided in a relaxed environment. Sufficient staff were available, and when necessary, people who live at home were assisted to eat. Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. 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. People who use the service are protected from abuse. EVIDENCE: I spoke with people who live at the home they were confident that any concerns they had about how they were cared for would be addressed. One person spoken to felt that, “ you can tell the staff if something is wrong and they will do their best to sort it out.” Since the last inspection there had been one complaint. The complaints report showed that this had been dealt with appropriately. The complaints policy explained how to make a complaint and how it would be dealt with. There were comprehensive policies on handling abuse and protection. I found that staff have received training on adult protection matters. No adult protection issues have been raised about the home since the last inspection. I observed that staff were caring and supportive towards people who live at the home. A person spoken to said, “ staff are kind and understanding.” Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that does provide a safe and homely environment. The home is clean and hygienic. EVIDENCE: I walked round the home and found that it was well decorated and appropriately furnished. The registered manager explained that since the last inspection and number of items of furniture had been purchased. This included new furniture for the sitting room and a new carpet for one of the bedrooms. Another bedroom had been decorated. The registered manager explained that there was an ongoing programme for the refurbishment of the home.
Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 19 At the last inspection it had been found that a number of bedroom doors were wedged open. This would be a hazard in the event of fire and would it affect the safety of people living at the home. I found that this had now been addressed. Automatic door close the devices had been installed so that people living at the home could have their bedroom doors open without this being a risk to them in the event of fire. I found that bedrooms were personalised with items of furniture, pictures and other personal possessions of people who live at the home. There are adapted bathrooms and toilets on each floor. These are accessible to people who have mobility difficulties. There are two adapted toilets on the ground floor. These were put in place to assist two people who have physical disabilities. Hoists are available. Records showed that these had been maintained. Appropriate measures are in place to prevent cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. The home has detailed policies on the prevention of cross infection. The registered manager was able to show me evidence that she had booked training for staff on infection control. Staff spoken to understood how to work to minimise the possibility of cross infection. Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 20 Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. 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 not protected by the home’s recruitment practices. EVIDENCE: I spoke with staff who said that sufficient staff were available to meet the needs of people who live at home. I observed that staff were available at key times a day (e.g. mealtimes) to assist people. Staff were also observed to spend time with people both individually and in small groups. This allowed more attention to the individual needs of people who live at the home. The rota showed that a consistent staffing level was being maintained in the home. The registered manager explained that since last inspection training had been provided on fire prevention and manual handling. However discussions with the registered manager and training records show that not all staff had received training in food hygiene and first aid. This must be addressed to
Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 22 ensure the safety of people living at home. Both staff spoken to and training records seen confirmed that training had been provided on dementia care. I spoke with staff that were able to explain how dementia affected people who live at the home. The registered manager explained in the Pre inspection questionnaire that further training was planned in adult protection and medication administration. Staff spoken to told me that they had been allocated places on this training. The home was recently had a major variation granted to admit to people with physical disabilities. Staff spoken to had not received training in this area. This was discussed with the registered manager and it was agreed that it would be recommended that training be provided on how to meet the needs of people with physical disabilities. The pre-inspection questionnaire stated that three members of staff are about to commence the National vocational qualification in health and social care. The registered manager explained that at present the home does not have 50 of staff with this qualification. It is recommendation that 50 of staff achieves this qualification. I examined three staff files and found that these did not contain all the required information relating to their recruitment. Two of the files seen newly appointed staff, they did not have POVA first or CRB check. I discussed this with the registered manager who explained that she needed to employ staff quickly so that adequate staffing was available at all times. CRB checks must be obtained to ensure that staff are safe to work with people who live at the home. I found that there were no unexplained gaps in the employment history of recently recruited staff. A health check has been carried out to ensure that staff coming to work at the home could safely meet the needs of people. Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An appropriate management structure is place to ensure that the needs of people living at home are met consistently. People who live at the home are consulted about the quality of the service provided and encouraged to make suggestions for improvement. People who live at the home have their financial interests protected by the home’s procedures. Staff are not appropriately supervised to ensure the safety and well-being of people who live at the home. People who live at the home and staff are not protected by the home’s health and safety procedures. EVIDENCE:
Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 24 People living at home told me that that the registered manager was approachable and interested in their views of the home. I observed that the registered manager spent time talking with people who live at the home. A person who lives at the home said, “the manager is making things better for us.” The registered manager explained that since starting at the home she has sought to improve the quality of the care for people. I found that all but one of the requirements from the last inspection has been addressed. I found that this has resulted in a general improvement in the service received by people living at the home. The registered manager explained that a deputy manager needs to be appionted. This will assist with the the further development of the home. The registered manager explained that she has to take on both the day-to-day management of the home and its development. It would assist her to have a deputy manager in post. It is recommended that a deputy manager be appointed for the home. This will ensure that the care and safety needs of people are addressed consistently. Since the last inspection a survey of the views of people living at the home has been carried out. The registered manager told me that she is preparing a report on the findings of the survey. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. People who live at the home have meetings to discuss their views of how they wish the home to be run. Staff meetings are taking place to ensure staff are aware of plans to develop the service. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. The registered manager explained that she has not been able to supervise staff every two months. I found that supervision notes showed that staff had not received regular and consistent supervision to improve the care provided. I discussed option to improve this situation. The registered manager will be exploring the possibility of using a combination of individual and group supervision. This will ensure that staff are effectively support to meet the needs of people living at the home. Records showed that fire drills are taking place regularly. But the fire alarm was not being tested regularly. I 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. COSHH guidance was in place and chemicals were stored safely. I discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents to
Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 25 ensure the safety of people living at the home. The temperature of food is now being recorded. The temperatures of the fridges and freezers were recorded and within safe limits. Under the outcome area staffing training on first aid and food hygiene was identified as being required. This will ensure that staff have the skills to meet people’s needs safely. Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 x 3 2 x 1 Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 27 Yes 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 OP7 Regulation 15(1) Requirement The registered persons must ensure that care plans provide detailed information on how the needs of people should be met. Care plans must provide detailed guidance on how the needs of people will be met. (The timescale of 01/11/06 was not met). The registered persons must ensure that people are consulted and involved in the development of their care plans. Care plans must reflect the views and preferences about how people wished to be cared for. The registered persons must ensure that risk assessments and prevention plans are place for the prevention of falls and manual handling needs of people living at the home. These assessments will ensure that the needs of people living at the home are met safely. The registered persons must ensure that POVA first and CRB’s are obtained before staff
DS0000010650.V333305.R01.S.doc Timescale for action 30/06/07 2 OP7 15(1) 30/07/07 3 OP8 13(4)(c)( 5) 15(1) 30/06/07 4 OP29 19(1)(a)( b) 30/05/07 Cedar House Version 5.2 Page 28 5 OP30 18(1)(a) 6. OP36 18(2) commence work at the home. This information must be obtained to ensure the safety of people living at the home. The registered persons must ensure that training is provided on first aid and food hygiene. Staff must have the necessary skills to meet the needs of people safely. The registered persons must ensure that staff have supervision six times a year and that this is recorded. Staff must be supported to meet the needs of people living at the home. The registered persons must ensure that fire alarms are tested weekly. This will ensure the safety of people living and working at the home. 30/07/07 30/06/07 7. OP38 23(4)(e) 30/05/07 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 OP28 Good Practice Recommendations The registered person needs to put in place a plan so that 50 of staff achieves the National Vocational Qualification at level 2 in care. Staff need to have a qualification that shows that have the skills to support people living at the home. The registered persons enable training to be provided on meeting the needs of people with physical disabilities. This will ensure that care is provided by staff that understand how to met the individual needs of people. The registered persons consider appointing a deputy manager. This will ensure that consistent care is provided at all times. 2 OP30 3 OP32 Cedar House DS0000010650.V333305.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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
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