Inspection on 26/02/07 for Cedar House

This inspection was carried out on 26th February 2007.

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

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

Other inspections for this house

Cedar House 27/04/09

Cedar House 27/10/08

Cedar House 01/10/07

Cedar House 07/09/06

Cedar House 19/04/06

Cedar House 04/01/06

Cedar House 02/08/05

Cedar House 09/09/04

Cedar House 26/04/04

Cedar House 17/03/04

Cedar House 19/01/04

Cedar House 18/09/03

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

CARE HOMES FOR OLDER PEOPLE Cedar House 39 High Street Harefield Middlesex UB9 6EB Lead Inspector Mrs Clare Henderson Roe Key Unannounced Inspection 26th February 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cedar House DS0000010927.V329597.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 DS0000010927.V329597.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar House Address 39 High Street Harefield Middlesex UB9 6EB 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) 01895 820 700 01895 820 600 www.schealthcare.co.uk Southern Cross Healthcare Services Limited Manager post vacant Care Home 42 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0) Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To comply with the Minimum Staffing Notice required by the previous regulator as at 31st March 2002. Five of the beds currently registered can be used for service users of 55 years of age and over, as agreed by the Commission for Social Care Inspection, on 1st February 2005. 7th September 2006 Date of last inspection Brief Description of the Service: The home is situated in Harefield village. The village centre is within walking distance of the home and public transport, that being bus services, are available. Cedar House offers care to service users who are over 65 and suffer from Dementia. It is a purpose built care home with service user areas on two floors and services and staff areas on the third floor. The floors are interconnected by a lift, which also accesses the third floor. There is parking to the front and an enclosed garden to the rear. The home is entered and exited by a keypad system. The administrators office is sited near the reception area. There is a designated person who oversees leisure activities. There are two General Practitioners providing input for the home, both of whom visit weekly. Monthly visits from a psychiatrist take place to review the service users mental health needs. The fees range from £620 - £813 per week. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection carried out as part of the regulatory process. A total of 10 hours was spent on the inspection process. The Inspector carried out a tour of the home, and a selection of service user plans, medication records, staff records, administration records and servicing & maintenance records were viewed. 6 service users, 9 staff and 5 visitors were spoken with as part of the inspection process. It must be noted that it is sometimes difficult to ascertain the views of service users with dementia care needs. What the service does well: What has improved since the last inspection? There has been an improvement in the completion of service user plans, with minor shortfalls only identified, which should be easily addressed. Overall they are up to date and provide a comprehensive picture of each service users needs and how these are to be met. Action has been taken to ensure all service users receive their meals hot and are assisted with mealtimes if necessary. Staff have received training in POVA and are aware of Whistle Blowing procedures. Induction and foundation training is in place, and this is to be discussed with the Southern Cross Healthcare training department to ensure it has been updated in line with the Skills for Care Common Induction Standards. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. Input to include training and environmental assessments in line with current dementia care research is received, thus providing staff with the knowledge and the home with an environment to meet the service users care needs. EVIDENCE: Four service user plans were sampled as part of the inspection process. Preadmission assessments had been carried out in all cases, and for some service users copies of the Social Services assessments had also been obtained. The assessments viewed provided a clear picture of the service user and their needs. Since the last inspection the activities co-ordinator has undertaken training in respect of the Alzheimer’s Society dementia care course, ‘Yesterday, Today & Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 9 Tomorrow’ and will be cascading this down to the staff in the home. The home is also receiving input from the Southern Cross Healthcare dementia care specialist in order to ensure the homes environment and practices in dementia care are based on current research. Staff had previously undertaken training in topics relevant to the service users diagnoses. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 10 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 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the service user plans are well completed and maintained up to date, thus giving a good picture of the service users needs and how these are to be met. Medication management in the home is fair, however shortfalls identified could potentially pose a risk to service users. Staff care for service users in a gentle and professional manner, thus respecting their privacy and dignity. Systems are in place for end of life care, thus respecting the wishes of service users and their representatives. EVIDENCE: Overall the service user plans viewed were comprehensive and up to date, giving a good picture of the service user and their needs, and how these are to be met. There was evidence of care plans being formulated for newly identified needs. Daily records were informative and any significant events had been clearly recorded. In one service user plan two documents no longer applied to the service user and these were archived at the time of inspection. Risk assessments for falls were in place and there was evidence of appropriate action being taken in the event of an accident occurring in the home. In two of Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 11 the service user plans viewed a review document had been completed with the service users’ representative, carrying out a review of the service users care and service user plan. There was also evidence of some input from service users representatives in areas of the service user plans and this was discussed with staff who were aware of the need to include service users, where able, or their representatives in the formulation and review of the service user plans. No service users had pressure sores. Pressure sore risk assessments had been completed and where any bruising or minor injury is identified, these are recorded on the body map document and also in the daily record. Daily skin checks are carried out for all service users and a record kept as to the condition of their skin. Information regarding the pressure relieving equipment in use for each service user is available and weekly checks of the equipment are recorded. Nutritional assessments had been carried out and monthly weights are recorded routinely, with the frequency being increased should a problem be identified. Clear care plans for any nutritional needs are also in place, for example, if a service user has swallowing difficulties or other nutritional needs. Moving & handling assessments are in place, and the specific equipment to be used had not always been identified. Care plans for moving & handling and safety were in place. Continence assessments had been carried out with one being completed at the time of inspection. Care plans for service users continence care needs with toileting regimes were seen. The care plans identified the service users mental health needs and how these affected their ability to participate in their care needs. Risk assessments for the use of bedrails were in place and signed consent for their use had been obtained. Medication records were sampled on each floor. There is a signature and initial list for most of the registered nurses and the need to ensure any new registered nurses involved in administering medications also complete this form was discussed. There is a front sheet for each service user with their name and photograph plus additional information to include any drug allergies and specific administration instructions. One viewed required updating due to a change in the service users medication and this was discussed with the Manager Designate. Copies of the prescription for the current months medication supply were available. Clear administration instructions had been recorded. Daily medication fridge and room temperatures are recorded and these were within acceptable limits. All receipts, administration and disposal of medications had been recorded. The home uses a monitored dosage system for the majority of medications. Where medications are supplied in a box or in liquid form, the containers had been dated when opened. The home was using labelled individual finger pricking devices for testing blood sugar in diabetic residents. The advice from MHRA is that only professional lancing devices are used, to prevent the risk of transmission of infection. Clear procedures and documentation are in place for the covert administration of medications. It was noted that ‘non supplied’ had been written alongside the instruction box for several medications. On discussion with staff this was mainly because the medication had been discontinued, and in some cases because the home Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 12 already had a supply of the medication, for example, special shampoo and nutritional supplements. The need to liaise with the GP and dispensing chemist to remove any entries still being recorded for discontinued medications and also to ensure clarity for any cases where medications are already in stock in the home was discussed. One printed entry on a medication administration chart (MAR) was partly illegible and the registered nurse said they would have this reviewed. It was thought to be for a medication being infrequently required. Controlled drugs records were viewed and these were up to date and correctly completed. At a previous inspection the up to date medication policy and procedures from Southern Cross Healthcare were in place. These could not be found on the day of inspection, however they were available on the computer and the Manager Designate has confirmed that 4 copies are now available in the home. Staff were seen caring for and conversing with service users in a gentle, courteous and professional manner. Service users who were able expressed their satisfaction with the home and visitors spoken with were very pleased with the high standard of care being provided by the home, and said that staff are very kind, patient and helpful. The Inspector witnessed staff showing great care and patience with service users, and it was pleasing to observe a service user who had been quite agitated and distressed at a previous inspection but who was calmer and happier on this occasion, and staff were being very caring towards them. In the laundry items of personal clothing viewed had been labelled and relatives are asked to ensure any new items brought in are labelled. Service users are able to bring in personal belongings in line with health & safety, and several of the bedrooms viewed had been personalised. The home has procedures in place for the care of the dying. In some service user plans viewed it was clear that this topic had been discussed with the service users representatives to ascertain the wishes of the service user and their family in respect of any deterioration in the service users health and also their care during their final days. Visitors can stay with their loved one if they so wish and comfortable seating and refreshments are available. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 13 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. Activities and outings take place and service users previous interests are ascertained, thus providing activities to meet their needs. The home has an open visiting policy, thus encouraging service users to maintain contact with family and friends. Changes to advocacy services are taking place and the Manager Designate is taking action to access alternative services, thus ensuring the service users have access to independent representation. The food provision in the home is good, offering variety and choice, to meet the service users needs. EVIDENCE: The full-time activities co-ordinator has recently left and the home has a parttime person in post, currently also assisting with the administration work. The need to ensure that the activities provision in the home is maintained was discussed with the Manager Designate. The activities co-ordinator showed the Inspector the activities diary for each service user and also some additional documentation being introduced to include a social history for each service user. Any outings are assessed for each person and written consent obtained from the service users representative. The home uses the ‘Jumbulance’ coach service, which has been especially built to provide safe and suitable transport Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 14 for service users with care needs. An activities programme for the week was available. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are always made very welcome at the home and refreshments are offered. Service users can receive visitors in the communal rooms or in their own bedrooms. Information about advocacy services is available in the home. The Hillingdon Rethink Mental Health Advocacy Service is closing down as from 30/03/07 due to the withdrawal of funding. The Manager Designate said that he is in discussion with the Alzheimer’s Society regarding advocacy provision, and also going to contact Age Concern. The Manager Designate is very aware of the need for advocacy services for the service users. The Inspector viewed the kitchen and it was clean and tidy. The kitchen records were up to date. Information regarding service users specific dietary requirements, for example, pureed food, finger food or diabetic needs was available. Service users meal choices are recorded daily on each floor. There is a 4 week menu and the cook explained that on occasion supplies are not available for some planned meal options, so an alternative is given. The Inspector asked that this be recorded so as to provide an accurate picture of the meals choices provided each day. The Inspector sampled the lunchtime meal and it was well presented and tasty. Snacks and drinks are available throughout the 24 hour period. Staff were available to assist service users with their meal, and following the last inspection the system for serving meals has been reviewed to ensure all service users receive their meals hot and that there are enough staff available to assist those who require it. The breakfast time was discussed as on occasion the serving of breakfast is near to 10am, however this does seem to depend on the varying needs of the service users on any one day, due to the nature of their diagnoses. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 15 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. There are clear procedures in place for the management of complaints and for POVA and these are followed, thus protecting service users. EVIDENCE: The home has a clear complaints procedure with timescales for investigation and response. There has been one complaint since the last inspection and there was evidence that this had been fully investigated and responded to. The home has policies and procedures in place for the protection of vulnerable adults, plus they follow the Hillingdon POVA procedures. Following the last inspection staff had received POVA training and also had been given a copy of the Whistle Blowing procedure. Policies for the management of service user aggression and for the use of restraint were available. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 16 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, 21 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas of the home are in need of redecoration and refurbishment in order to maintain an attractive and homely environment for service users to live in. Systems are in place for infection control, thus protecting service users, visitors and staff. EVIDENCE: The Inspector carried out a tour of the home. Some areas are beginning to look worn, for example, carpets in some bedrooms and communal rooms, walls marked and paint chipped off doors and walls, and the cupboards in the kitchenettes. There are plans to make some additions to the décor of the home in line with current dementia research, but the need to also maintain the homes overall décor and furnishings to a good standard throughout was also discussed. All aspects of the environment need to be included when formulating an up to date redecoration and refurbishment plan for the home. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 17 The Inspector viewed the assisted bath, shower and toilet facilities. These were clean and uncluttered. There were dark, sticky marks on the windows in the bathrooms, possibly from the putty for the glass panels, and the Manager Designate said this would be investigated and addressed. The shower room on the first floor smelled very damp and the cause needs to be investigated and addressed. Some of the hot and cold indicator discs on the taps were missing and need to be replaced. It is acknowledged that safety valves for maintaining the hot water at a safe temperature are in place in areas accessible to service users. The laundry room was viewed and was clean and tidy with service users clothing being appropriately laundered and cared for. Protective clothing to include gloves and aprons was available in the home. Policies and procedures for infection control are in place, plus good practice notices in line with infection control were seen in the laundry and kitchen areas. The home was clean and smelled fresh throughout. It was clear that the domestic staff work very hard to maintain a good standard of cleanliness throughout the home. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Although for the majority of the 24 hour period the home is being staffed to meet the service users needs, further review for the evening time is required to ensure the needs of the service users are met at all times. Systems for vetting and recruitment practices are in place, thus protecting service users. Staff receive training in topics relevant to the home, thus providing them with the knowledge to meet the needs of the service users. EVIDENCE: The Manager Designate said that the staff team is of a good calibre and work well together, and staff spoken with also commented on the good teamwork between colleagues. The Registered Manager said that he does keep the staffing under review in order to ensure the needs of service users are being met. The Inspector was still present in the home at 7.10pm and it was noted that some service users were in their night attire and seated in one of the day rooms. The service users appeared content and were watching the TV. The need to ensure service users are not being got ready for bed early unless it is their wish to do so was discussed with the Manager Designate. Staffing to provide a ‘twilight’ shift, in order to help the evening staff and the early part of the night shift, should be considered. A new administrator has been appointed for the home and will commence once all necessary employment checks are complete. The Manager Designate reported that he has been receiving weekly administration support from the Regional Administrators and also Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 19 administrators from other homes. As discussed in Standard 12, the hours for the activities co-ordinator need to be reviewed to maintain a good provision of social and leisure activities for service users. The Manager Designate reported that over 50 of the care staff are trained to NVQ level 2 in care or the equivalent. Further NVQ in care training is planned, plus 4 of the domestic and catering staff are undertaking an NVQ in housekeeping and catering. Three sets of staff employment records were viewed. With the exception of one photograph these contained the information required under the Care Homes Regulations 2001. The Manager Designate reported that the photograph would be replaced. Southern Cross Healthcare has an induction and foundation programme that meets the Skills for Care core standards. The Manager Designate reported that new staff receive a general induction to familiarise them with the home during their first week and then undertake a 6 week induction programme. Skills for Care have introduced common induction standards to combine induction and foundation training and the Manager Designate said he would look into this with the Southern Cross Healthcare training department. Staff spoken with said that the training provision has improved and a Training Planner was available for January to June 2007, to include topics relevant to the diagnoses and needs of the service users. In addition, the Manager Designate has accessed information for distance learning courses for infection control, dementia awareness, health & safety and equality & diversity, and is encouraging staff to undertake these courses to further their knowledge and skills. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 20 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager Designate has the nursing qualifications and experience to manage the home, and does so effectively. He is aware of the need to complete an appropriate management qualification and to apply for registration with CSCI, which is yet to be done. Systems for quality assurance are in place, thus providing an ongoing process of system and practice review. Service users monies are appropriately managed in the home, thus safeguarding their interests. Overall the systems for the management of health and safety are good, thus safeguarding service users, staff and visitors. EVIDENCE: The Manager Designate is a first level registered nurse with a mental handicap qualification. He has been in post for 10 months, and previously worked for Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 21 several years as a unit manager in a care home environment. He is yet to undertake an NVQ level 4 in management qualification or the equivalent. The Manager Designate said he had not yet submitted his application for registration as the Registered Manager to CSCI, and the need to do this was again discussed. Staff and representatives spoken with said that the Manager Designate is approachable, supportive, and deals with any issues raised. The home has a system of audit in place and there was evidence of monthly home audits to include many aspects of practice within the home. Staff meetings take place, with the minutes to be typed up when an administrator is available. The Manager Designate has a weekly evening for meeting with visitors, plus he operates and ‘open door’ policy so service users, staff and visitors can discuss any issues with him. A visitors meeting had been planned for a few days after the inspection and one of the points for discussion was the proposed changes to the décor in line with current dementia research, in order to keep the families of service users informed and give them the opportunity to express their views. Regulation 26 unannounced visits to the home on behalf of the Responsible Individual are carried out. At the time of inspection hard copies of some of the up to date policies and procedures could not be found, however the Manager Designate has reported that these are now available in the home. The Manager Designate was awaiting clearance to access the secure records held on the homes computer. These include the records for any monies being held on behalf of service users. The Manager Designate reported that these records are updated at the weekly support visits from administration staff. Evidence of receipts for income and expenditure were available. Invoices from the chiropody and hairdressing visits were also available. The Manager Designate reported that there had been no change to the system being used for the management of service users monies. The Inspector viewed the computerised records at the key inspection carried out on 19/04/06. The Manager Designate reported that he has completed a certificated Health & Safety course and is reviewing the training in this area for staff. The Manager Designate reported that he had ensured that all staff had received training and updates in moving & handling, fire safety, food hygiene and other topics under health & safety legislation. The Training Planner document evidenced that First Aid training has been planned and the Manager Designate is aware that staff trained in First Aid must be available in the home. Risk assessments for equipment and safe working practices were available in the laundry, kitchen and administration office areas. Servicing and maintenance records were viewed and with the exception of the servicing of the hoists and baths, these were up to date. The Manager Designate has investigated this and found the servicing company has changed. A service visit for this equipment has since been arranged. Fire safety records were viewed and these were up to date. The fire risk assessment was last completed in April 2006 and the shortfalls identified in the document had been addressed. The Inspector suggested that a Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 22 copy of the actions taken with dates of completion be put alongside the fire risk assessment as evidence of this. It was reported that the kitchen lift is regularly out of order despite engineers attending to repair it. The Manager Designate said that he is aware of this and that action is being taken with the engineers to address the problem in full. The passenger lift is kept locked when not in use. This means that people can get into the lift but the lift will not travel between floors. This is to prevent service users from accessing the second floor, where the laundry, kitchen and staff areas are and this could pose a risk to service users. On the day of inspection 3 people got stuck in the lift due to not realising about the locking system in place. There is an alarm system in place and action was taken promptly to release them, however clear instructions must be available in the lift to explain the security system in place. In order for the lift to be used the key has to be obtained from staff, which is time consuming for visitors and staff alike. A safe system, for example a keypad system, must be considered as a permanent way of minimising the risk to service users. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 23 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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 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 2 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(5) Requirement The specific moving & handling equipment to be used for each service user must be identified in the service user plan. The home must use a fingerpricking device or lancets for professional use. All entries on the MAR must be legible. A full environmental audit must be carried out and a redecoration and refurbishment programme with timescales for completion formulated and actioned. The windows in the bathrooms be made good and the sticky marks removed. The staffing must be kept under review to include the evening provision and also ensure that appropriate hours are provided for administration and activities. An application for registration for a Registered Manager for the home must be submitted to CSCI. The passenger lift must be reviewed and an effective system of security for service DS0000010927.V329597.R01.S.doc Timescale for action 16/03/07 2. 3. 4. OP9 OP9 OP19 13(2) 13(2) 23(2)(b) & (d) 09/03/07 09/03/07 01/05/07 5. 6. OP21 OP27 23(2)(b) & (d) 18 01/04/07 01/04/07 7. OP31 8, 9 01/04/07 8. OP38 13(3) 01/04/07 Cedar House Version 5.2 Page 25 users put in place, whilst allowing staff and visitors to use the lift freely. Clear instructions of the system currently in use must be available for the lift. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 2. Refer to Standard OP9 OP15 OP38 Good Practice Recommendations It is strongly recommended that the home liaise with the GP and dispensing pharmacist to remove any entries for discontinued items from the MAR. Any changes in the menu choices should be recorded. Where action has been taken to address any shortfalls identified in risk assessments, a copy of the action plan with dates of completion should be kept with the risk assessment concerned to evidence the work has been carried out. Cedar House DS0000010927.V329597.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 DS0000010927.V329597.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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