Inspection on 27/11/09 for Cedar House

This inspection was carried out on 27th November 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cedar House 23/02/10

Cedar House 14/05/09

Cedar House 29/05/08

Cedar House 11/01/07

Cedar House 09/05/06

Cedar House 14/09/05

Cedar House 24/05/05

Cedar House 04/11/04

Cedar House 06/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Cedar House Cedar House 47 Smethurst Street Middleton Manchester M24 2BA Lead Inspector Lucy Burgess Key Unannounced Inspection 27th November 2009 09:00 Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Cedar House Address Cedar House 47 Smethurst Street Middleton Manchester M24 2BA 0161 6553553 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) Mrs Ann Merabi Ms Valerie Hewitt Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 16 Date of last inspection 14th May 2009 Brief Description of the Service: Cedar House is a care home providing personal care for 16 adults, who have been diagnosed with a mental disorder. Three places are registered for residents over the age of 65 years. The home provides 16 single bedrooms, a lounge, conservatory, dining room, communal toilets and bathing facilities. Cedar House is located at the end of a residential street, approximately two miles from the town centre of Middleton. A number of small local shops and pubs are near by. The home has a car park for residents and visitors. A grassed area is provided to the rear of the house and small garden areas to the front. The most recent Care Quality Commission (CQC) report is available in the office. The home makes charges over and above the weekly care and accommodation fees for chiropody, hairdressing, magazines and newspapers, toiletries, activities, clothing and transport. Fees charged by the home in May 2009 ranged from £328.00 to £380.00 per week. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This was the second key inspection for Cedar House, which included a site visit and took place over one day by 2 inspectors and a pharmacy inspector, for a period of 7½ hours. The service did not know that the inspectors were to visit. As part of the inspection process the manager was asked to complete an Annual Quality Assurance Assessment (AQAA). This was completed prior to the first key inspection. During the visit time was spent looking at records including care files, recruitment and health and safety. Time was also spent looking at the environment. A full audit of the medication system was also carried out. Due to concerns identified at the key inspection in May 2009, a management review had taken place to discuss what action was needed. An improvement plan was requested and provided and a statutory requirement notice was served with regards to poor recruitment practices. We carried out a random inspection in August 2009 to follow up on compliance with regards to the statutory requirement notice. The notice had been met. At present the local authority is not making placements at the home due to ongoing concerns about the standard of care provided. During this visit serious concerns were noted in relation to the management of medication in addition to the management and conduct of the service. We explained to the registered manager and the provider’s representative that this information will now be considered as part of a further management review and may result in enforcement action being taken. Whilst feedback surveys were not sent out prior to this visit, time was spent speaking with people at the home, staff and the manager during the visit. Comments have been included in the report. All the key standards were looked at during this inspection visit as well as the action taken to address the requirements and recommendations identified during our last visit. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans need to be reviewed and updated to ensure that they reflect the current and changing needs of people so that staff are able to support them in a way, which ensures their health and well being is maintained. Risk assessments should reflect all areas of concern as well as detailing the support and intervention required to minimise such risk ensuring peoples safety. In consultation with people more meaningful opportunities should be provided so that they are able to take part in a variety of activities, including educational and training, should they wish too. Arrangements should be made for this information to be archived so that all current and relevant documentation is easily accessible. All documents should be stored securely within the office so that information is kept safe and confidential. Records of medicines received into the home, given to people and leaving the home must be clear, accurate and complete so that all medicines can be fully accounted for. We told them that medicines must be given to people as Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 7 prescribed because receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. The manager must ensure that any issues brought to her attention are addressed in a timely manner. Records should clearly show how these have been explored, the outcome and any action taken where necessary. This will demonstrate that comments made are taken seriously and people feel they are listened to. As discussed with the provider’s representative, arrangements should be made to dispose of unwanted items stored throughout the home. Where necessary vanity units in need of attention should also be addressed and any broken furniture items should be replaced so that people are provided with a better standard of furnishings. Adequate staff training needs to be provided for all staff ensuring they have the knowledge and skills needed to support the specific needs of people living at the home. Without this there is no assurance that peoples needs will be safely met. Sufficient staffing must be provided at all times so that people are able to access the support that they need. There is an outstanding recommendation in relation to management training. This must be addressed to show that the manager is committed to providing clear leadership, support and direction ensuring the service provides a good quality service to people who live there. The provider has previously been asked to complete records to demonstrate when she visits the home as part of her monthly monitoring visits. These have yet to be done. The provider must ensure that this area is address in order to demonstrate that she is carrying on the service in best interest of those living at the home. Copies of the reports should be forwarded to us each month. The manager must ensure that all incidents in line with Regulation 37 are notified to us along with any action required to show that people are being kept safe from harm. The registered provider must ensure that she fulfils her responsibility as an employer, in that, staff working at the home are provided with adequate statements of wages earned and deductions taken from their wages. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present no new placements are being made at the home until such time the standard of care provided has improved ensuring resident’s needs are fully met. EVIDENCE: Over the last year no new placements have been made at the home due to issues identified in relation to the standard of care provided. These have been considered by relevant parties in line with the local authority safeguarding procedures. Due to this the local authority made the decision to suspend placements at the home until such time they were satisfied that people would receive a good standard of care and were kept safe. Therefore we were unable to review the assessment information gathered prior to people coming to live at the home. We will look at this area during our next inspection. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed care plans and risk assessments need to be in place so that staff have the information needed to support people in a manner in which they choose and which meets their needs. EVIDENCE: There are currently 11 people residing at Cedar House. Files were looked at for two people. Individual records are held and include the person’s personal details, a care plan, risk assessments, monitoring sheets and additional correspondence such as financial information and letters regarding health appointments. Information looked at on the first file did not reflect the information that we had been told by staff. Whilst the care plan and risk assessment did include details support and advice from staff in managing issues around substance Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 12 misuse. The care plan and assessments were out dated and did not include recent changes that had taken place, which included the person taking up an employment opportunity and a referral to the drug and alcohol team. On the second file the care plan was also in need of updating. Information did not reflect support currently provided by staff and the community nursing team, nor what we had been told by staff. Information about the persons treatment needs to be clearly detailed in the plan so that all staff are aware of what support needs to be provided. Monitoring sheets are also completed on a weekly basis detailing what has taken place. The manager also told us that any appointments attended would also be recorded. Information seen did not evidence this and some information was illegible. The manager needs to ensure that clear and accurate records are maintained and outcomes to appointments are clearly recorded so that any follow up action required can be monitored. People appeared very relaxed and were happy to spend time talking with us. Routines continue to be flexible with people spending time in the communal areas as well as relaxing in their own rooms. It was found during the visit that a lot of information held in the office and corridor area were old records. Arrangements should be made for this information to be archived so that all current and relevant documentation is easily accessible. All documents should be stored securely within the office so that information is kept safe and confidential. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for personal growth and development have improved however this should be explored further so that people receive a service, which is based on their specific choices and preferences. EVIDENCE: Routines vary depending on the needs and wishes of people. During our visit people were seen to come and go as they choose. On the day of our visit one person was starting a new job, which had been offered through REDS, Rochdale Employment Development Services, which is part of Rochdale MBC. Another person spoke about their plans to undertake further educational courses having recently completed an NVQ. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 14 Most of the other residents undertake more informal activities. These include watching TV, listening to music, visiting family, meals out, shopping in Rochdale. The large lounge provides a comfortable room for people to relax. Furniture items and a large television had been purchased by one of the residents. This was said to have been arranged by the person’s family. During our visit we observed and spent time with a number of people chatting in the lounge. Generally people looked well and their appearance was good. Comments from people living at the home were positive about the support they receive. These have been detailed further in the report. The service has previously been asked to explore arrangements in relation to opportunities made available and consider the development of a programme of more meaningful activities in relation to education and training activities. This has yet to be done. Individuals continue to maintain friendships and relationships with family and friends away from the home. People have keys to their rooms and are able to spend time in private should they choose to. Arrangements in relation to meal times remained unchanged. A designated cook is identified on the rota between the hours of 11am and 5pm and prepares the meals. We saw that morning routines were relaxed with people coming down for breakfast at varying times. A separate dining room is provided. A recent complaint had been raised with us about insufficient food stocks, this is detailed further in the report. The registered person must ensure that sufficient items are available at all times so that people have a choice. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about people and how they continue to be supported in meeting their physical and mental health needs to be improved. The management of medication was poor and need to be addressed to ensure that people received their prescribed medication safely. EVIDENCE: As detailed earlier in the report information recorded on the care plans and risk assessments need to be updated to show the current needs of people and the support provided. Clearer records should also be made with regards to health appointments and any intervention required so that is clearly demonstrate that the health and well being of people is being addressed. In the main most people are able to manage their own person care needs however support and encouragement from staff is offered. Bathroom facilities are provided on both the ground and first floor and therefore easily accessible to everyone. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 16 In relation to the mental health needs of people this continues to be monitored by mental health professionals. Formal reviews are held in line with the CPA programme, where necessary, so that the health needs of some people can be formally monitored and medication reviewed. Residents also have access to other NHS entitlements such as being registered with a local GP as well as accessing the dentist, opticians and hospital where specific treatment is required. Staff will provide support to appointments. Where necessary arrangements had been made for people to access other services, for example, district nurses. We checked a sample of medicines records and stocks. Most medicines were supplied in a monitored dosage system and this was used correctly. But, it was not always possible to account for (track) the handling of medicines in traditional boxes and bottles because there was no clear system of stock control. Medicines were not always properly recorded when received into the home and quantities of medicines carried forward each month were not shown. It was of concern that we also saw examples where medicines could not be administered because there were none in stock to give. One person was without one of their prescribed medicines for almost two months and a stock of ‘when required’ tablets for a second person were sent for safe disposal, leaving none in stock for nearly two weeks. We found that there was a lack of clear up-to-date guidance for staff about when ‘when required’ medicines may be needed. At a previous visit we found that medication for one person had not been administered following a change in dosage instructions. At this visit we similarly found an example where medication had not been given correctly following a dose change. All medicines were safely locked away but medicines stock was poorly organized. There were several discontinued, overstocked or otherwise unwanted medicines in stock. In the medicines trolley we found two unlabelled inhalers and a box of paracetamol dispensed for one person, with another persons name added on. Prescribed medicines should be safely administered from each person’s own labelled supply. Most medicines administration records were pre-printed by the pharmacy but where handwritten records were made in the home these were generally poorly completed and did not support the safe administration of medication. It was of concern that for one month all the pre-printed records had the wrong start date. As a result, there were duplicate records of administration on one day, and no records of any medicines being administered on another. There was sometimes a lack of clarity on the medicines administration record as staff used codes for which there was no key, so it was not possible to tell why medicines had not been administered. Complete records of medicines supplied for administration away from the home were not made and risk assessment were not carried out to ensure they were supplied in the best way. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 17 We found that regular audits (checks) of medicines handling were not carried out so weaknesses in medicines handling were not being promptly identified and addressed. Staff spoken with were uncertain about the medicines training they had received; records did not show that all staff handling medicines had completed certificated medicines training. There was no evidence of any competency assessment to help ensure staff understand and follow safe practice when handling medicines. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager must ensure that all concerns are appropriately responded to and records evidence that people have been listened to and relevant action has been taken to ensure their safety and protection. EVIDENCE: Over the last year there have been several safeguarding issues, which the local authority has been investigating. People living at the home are aware of the complaints procedure and know who to speak with if they have any issues or concerns. Four concerns had been raised by individual residents and were noted in the homes complaints file. We spoke with the manager about these issues to establish what action had been taken. The manager explained that these had yet to be concluded. This must be addressed and records should show what action, if any, has been taken so that people feel confident they are listened to. Prior to our visit we had received an anonymous complaint with regards to food stocks, laundry and hygiene standards within the home. The cook explained that whilst the manager had been off work arrangements for the weekly shop had not been carried out therefore resulting in stocks running low. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 19 The provider also advised us that the washing machine had recently broken resulting in laundry building up. This had now been addressed however whilst looking at one of the bedrooms we found a number of washing baskets full of clothing. We were told that these items were clean and were to be taken to the charity shop. This should be done. The accounts of two residents were examined and there were detailed methodical records to show incoming and outgoing expenses. The systems in place to monitor finances ensured that service users were fully protected. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More investment could be made in the environment so the people are provided with a good standard of accommodation which is comfortable and safe for them to live in. EVIDENCE: Cedar House provides accommodation for up to 16 people. Single bedrooms are provided along with a large lounge, conservatory, dining room and several communal toilets and bathing facilities. The home is located at the end of a residential street, approximately two miles from the town centre of Middleton. A number of small local shops and pubs are near by. The home has a car park for residents and visitors. A grassed area is provided to the rear of the house and small garden areas to the front. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 21 Action identified at our previous inspection had been addressed. This included the cleaning of the UPVC window frames in the conservatory, which were deeply stained (with nicotine), new flooring had been fitted in the dining room, tiles on the kitchen walls had been cleaned and re grouted, cupboards had been cleaned, the ceiling had been painted and the laundry room had been replastered behind the sink and the room cleaned and painted. During this visit we looked at communal areas, bathrooms and toilets and bedrooms. We identified that attention was needed to several vanity units, some beds needed to be replaced and unwanted items being stored in the unused bedrooms also needed disposing of. Before completing the inspection the provider’s representative had arranged for the beds to be replaced. We were also told that old/broken furniture items would be replaced where necessary. The provider must ensure that people are provided with a good standard of accommodation. As identified during our previous visit, satisfactory arrangements for a designated smoking area must be made as this continues to be within the dining room. Domestic tasks continue to be undertaken by a designated staff member each morning. The manager did express that further supplies were required with protective clothing however a new order would not be supplied due to an unpaid invoice. This again is poor and must be addressed to ensure that staff are provided with items to carry out their work safely. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 34 and 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff need to be provided at times when people need support so that their needs can be fully met. Opportunities for training and development must also be provided so the people are supported by staff that have the knowledge and skills required for their role. EVIDENCE: Staffing levels within the home were seen to meet the needs of residents. Care staff carried out their duties in a friendly and caring manner and promptly supported people’s needs. People spoken with confirmed that staff were always respectful and met their needs competently. In the main, residents were satisfied with the support they were given. Feedback was provided by staff with regards to staffing levels. We were told that at time there has been a reliance on agency staff to cover the sleep-ins. We were also told that if this was not possible then on occasion the wake in staff member would work alone. The registered person must ensure that staffing levels are kept under review ensuring there are sufficient numbers provided at all times. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 23 The atmosphere in the home was relaxed, and staff were seen engaging in meaningful conversation and interactions with residents. All comments made by residents about staff were extremely positive. Comments included: “Staff treat me respectfully”, “I have never found fault with the carers, my care has been excellent”, “The care staff are good at looking after our physical health” and “The staff treat me with respect. I would not be as well as I am today if it wasn’t for the care they have given me”. At our Random Inspection in August 2009 we examined the recruitment and personal files of two new members of staff who were about start working as carers at the home. You provided us with documentary evidence which confirmed that all staff working in the home had a Criminal Records Bureau check at enhanced level and POVAfirst. On examining the files of the prospective workers we found that all of the required checks had been carried out satisfactorily. We informed you that all future recruited staff would require a similar level of detailed documentation. Examination of the staff file of a recently employed member of staff confirmed that that appropriate paperwork and Criminal Record Bureau checks (CRB) and two written references had been obtained prior to commencement in the home. An employment history was also included on the file. However the registered person must ensure that where a POVAfirst checks has been received but they are still awaiting the CRB new staff must not work unsupervised. In relation to staff training this could be improved. We had been advised that courses had been arranged for all members of the team with regards to safeguarding, food hygiene and first aid, however certificate to confirm these had been satisfactory completed had not been received. The manager advised that this was due to an unpaid invoice. The manager was asked why free training provided by the Local Authority was not accessed. We were told that she had contacted the authority however had been told that this was not available to them. It was also noted that only 3 members of the team have completed NVQ training. This is also an outstanding area for the registered manager. The manager advised us that arrangements were being made in the area and that a training provider had been identified who would also facilitate training for the team. The Provider must ensure that all staff receive good quality training relevant to their role, for example medication, mental health awareness, care planning, infection control, health and safety, substance misuse, so that they have the knowledge and skills needed to support people safely. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 42 and 43 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Persons must ensure that the service is conducted in such a way that the health and well being people living at the home is not placed at risk. EVIDENCE: Poor financial management and investment in the business by the Provider is potentially compromising the health and welfare of residents and placing people at risk. We are aware that essential bills for the electricity supply to the home have not been paid. The Registered provider has been made aware of the situation by letter but has failed to respond to us. There is no evidence that Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 25 the Provider is making a visit to the home, at least monthly, and providing a written report of the visit as is required under the Care Home Regulations. The manager has not recommenced the Registered Manager’s Award to complete the remaining units that are outstanding. We were assured that she would do so when the training provider was paid for the outstanding invoices. We have previously checked this and had it confirmed that no invoices are outstanding. Therefore it is expected that the manager now finish her management training without further delay. The home does not act as appointee for any residents. However, they do manage the personal allowances of a number of residents Information provided by the manager and examination of the records, confirmed that all safety equipment is regularly serviced. A current certificate of inspection was available for the electrical and gas supplies to the home. The provider’s representative also stated that a recent fire risk assessment had been completed on the home however they were waiting for the report to be forwarded to them. Any action identified must be complied with to ensure peoples safety. We had been made aware through a meeting with the local authority of the death of a person living at the home. During our visit we also saw a report about an incident involving another individual. These should have been reported to us in line with Regulation 37 detailing any action taken, where necessary, ensure the safety and protection of people. Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 1 X 1 X X 1 2 Version 5.3 Page 27 Cedar House DS0000041209.V378603.R01.S.doc Are there any outstanding requirements from the last inspection? YES 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 YA6 Regulation 15 Requirement The registered person must ensure that care plans are kept under review and updated when necessary to show the current and changing needs of people so that staff are clear about the support to be provided. The registered person must ensure that risk assessment are reviewed and updated ensuring that information reflects the current support needs of people. The registered person must ensure that medication is given as prescribed or a clear reason for the non-administration clearly documented in the MAR so that the residents and the manager can be confident medication is being given as prescribed. The registered person must ensure that complete, clear and accurate records of medicines received, administered and leaving the home are maintained to support and evidence the safe handling of medication. DS0000041209.V378603.R01.S.doc Timescale for action 30/01/10 2 YA9 12 30/01/10 3 YA20 13 27/11/09 4 YA20 13 24/01/10 Cedar House Version 5.3 Page 28 5 YA20 13 The registered person must ensure that adequate stocks of medication are maintained without overstocking to enable continuity of treatment. The registered person must ensure that all concerns brought to her attention are addressed in a timely manner and relevant action taken, where necessary, to ensure people are being protected. The registered person must ensure that where a POVAfirst checks has been received but they are still awaiting the CRB new staff must not work unsupervised ensuring people are kept safe. The registered person must ensure that the staff team receive training specific to the role and responsibilities to ensure their continued professional development as well as being able to meet the needs of service users in a safe way. This should be detailed in a training plan and should courses in medication, mental health awareness, care planning, substance misuse, health and safety, infection control etc The registered manager must provide evidence to show that she is undertaking the registered manager’s award so that service users benefit from a qualified registered manager. On completion of the award copies of the certificates should be forwarded to us. The Provider must carryout the monthly monitoring visits in line DS0000041209.V378603.R01.S.doc 24/01/10 6 YA22 22 24/01/10 7 YA34 19 30/11/09 8 YA35 18 30/01/10 9 YA37 10 30/01/10 10 YA39 26 30/01/10 Page 29 Cedar House Version 5.3 with regulation and record her findings to show that the service is being monitored as part of a thorough quality reviewing process. Copies of the reports should be forwarded to the CQC. 11 YA42 37 The registered person must ensure that all incidents, which potential affect the health and being of residents are reported to us in line with regulation along with details about they are being kept safe. 30/01/10 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 YA10 Good Practice Recommendations Arrangements should be made for records to be archived so that all current and relevant documentation is easily accessible. All documents should be stored securely within the office so that information is kept safe and confidential. In consultation with people more meaningful opportunities should be provided so that they are able to take part in a variety of activities, including educational and training, should they wish too. Consideration should be given to people’s medicines needs when away from the home to help ensure they are supported in the best way. Written risk assessments should be completed. Regular medication audits (checks) should be carried out to help ensure any weaknesses in medicines handling are promptly identified and addressed. The premises must be kept in a good state of repair at all times, so that residents live in a safe and comfortable environment. DS0000041209.V378603.R01.S.doc Version 5.3 Page 30 2 YA12 3 YA20 4 YA20 5 YA24 Cedar House 6 7 YA32 YA33 50 of the care staff group should be trained to NVQ level 2 standard. The registered person must ensure that staffing levels are kept under review so that sufficient numbers are provided at all times ensuring people receive the level of support needed to meet their needs. A quality assurance and monitoring system should be set up so that the owner and manager can measure outcomes for the people living at the home. Staff must be issued with a personalised ‘wage slip’ summarising their pay and what deductions have been made. A P60 should be issued to all staff at the end of each tax year. 8 YA39 9 YA43 Cedar House DS0000041209.V378603.R01.S.doc Version 5.3 Page 31 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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