Inspection on 27/10/08 for Cedar House

This inspection was carried out on 27th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cedar House 27/04/09

Cedar House 01/10/07

Cedar House 26/02/07

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 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cedar House 39 High Street Harefield Middlesex UB9 6EB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Henderson-Roe     Date: 2 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Cedar House 39 High Street Harefield Middlesex UB9 6EB 01895820700 01895820600 cedarhouse@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Healthcare Services Ltd Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: 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. To comply with the Minimum Staffing Notice required by the previous regulator as at 31st March 2002. Date of last inspection Brief description of the care home 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. It is a purpose built care home with resident 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 Care Homes for Older People Page 4 of 26 Over 65 0 0 42 42 Brief description of the care home 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 is one GP who visits the home weekly and the home also has regular input from the Community Psychiatric Nurse. The fees range from six hundred and thirty five pounds to eight hundred and seventy pounds per week. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out as part of the regulatory process. A total of 22 hours was spent on the inspection process and it was carried out by 2 Inspectors. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. residents, staff and visitors were spoken with as part of the inspection process. The Annual Quality Assurance (AQAA) completed by the home plus comment cards from residents, staff and healthcare professionals have also been used to inform this report. Where any issues were raised on the comment cards these were fed back to the home in general terms. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 26 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are fully assessed prior to admission to ensure that the home is able to meet their needs. Evidence: The home has a comprehensive pre-admission assessment that is carried out prior to admission for each resident. Those viewed had been completed. Copies of the social services assessments are also obtained. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the service user plans were being well completed to provide staff with the information to enable them to meet each residents needs. The health needs of residents are well met with evidence of good multi-disciplinary working taking place on a regular basis. Medications are being well managed, thus safeguarding the residents. Although residents are being well cared for, all staff need to develop the skills to communicate effectively with residents to ensure their well-being. Information regarding the wishes of residents and their families in respect of end of life care is ascertained, thus their wishes can be respected. Evidence: We sampled the service user plans on each floor. Those viewed had been well completed and gave a good picture of each resident and their needs. Risk assessments for falls had other risks had been completed. The service user plan documentation had been reviewed monthly and whenever there was a significant change in a residents condition. Reviews with the next of kin are carried out every 3-6 months and there was evidence of input from the next of kin in the service user plans. Audits of the Care Homes for Older People Page 12 of 26 Evidence: service user plans had been carried out and shortfalls identified, with action being taken to address these. Wound care documentation was viewed. Risk assessments for pressure ulcer risk were in place and wound assessment documentation evidenced the dressing regime and frequency of changes, plus the progress of each wound. Pressure relieving equipment was seen in use and there was evidence of input from the tissue viability nurse. Moving & handling assessments had been carried out and the equipment to be used for each resident had been identified. Nutritional assessments were in place and there was evidence of residents being weighed monthly plus nutritional supplements had been prescribed. Continence assessments were in place. Risk assessments and signed consents for the use of bedrails were in place. There was evidence of input from the GP, speech & language therapist, community psychiatric nurse, optician, Macmillan nurse and tissue viability nurse. Healthcare professionals were spoken to as part of the inspection process. Medication records and management was viewed on each floor. An information sheet for each resident to include their name, a photo, allergy information and other relevant details was in place. A list of staff signatures and initials had been completed. Fridge and room temperatures were within safe range. Copies of prescriptions were available. Liquid medications had been dated when opened. Medication receipts had been signed for. Administration records were up to date and 2 instances of signature omissions had been identified and action was taken to address the shortfall. Where a medication had been omitted or refused the correct coding had been used and an explanation recorded. The correct method for disposal of medications was in use. Controlled drugs were being correctly recorded and stored. Medications are securely stored in the home and overall are being well managed. We observed the interaction between residents and staff and staff were seen to be caring for residents in a gentle manner. Some staff were observed to be interacting well with residents, however there were some instances where staff were supervising residents in the day rooms and no interaction was taking place. It is important that all staff develop the skills to communicate effectively with residents, and in particular with those with dementia care and mental health care needs. Bedrooms had been personalised and residents were well dressed to reflect individuality. Care plans had been completed for health deterioration and end of life care needs. It was clear that these needs had been discussed to ascertain the wishes of the residents and their families, and these had been recorded. There was evidence of input from the palliative care team. Care Homes for Older People Page 13 of 26 Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity provision for the home is good, providing a variety of activities, outings and entertainments to meet the residents needs. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring the residents right to independent representation is respected. The food provision in the home is good, offering variety and choice to meet the residents needs. Evidence: The home has a full-time activities co-ordinator. There is a programme of activities on display, and this is subject to change dependent on the wishes of the residents. There was evidence of group and individual activities taking place. Outings are arranged and also in-house entertainers. There is a budget for activities which is appropriate to the current needs of the residents in this area. Records are kept of activities undertaken by the residents. The activities co-ordinator has completed her NVQ level 3 in activities. She also prepares a monthly newsletter which details any planned activities. The home has an open visiting policy and visiting is encouraged. Visitors spoken with at the inspection confirmed that they are made welcome and refreshments are offered. Care Homes for Older People Page 15 of 26 Evidence: Visitors can see their relative either in their bedroom or in one of the communal rooms. Information on advocacy services was clearly displayed in the main entrance of the home, to include contact details for Age Concern and MIND. We viewed the kitchen. This was clean and tidy and records viewed were up to date. Residents were observed to be enjoying their lunch on the first day of the inspection. Pureed meals are well presented. Staff were available to assist residents with their meals and seen doing so in a gentle and discreet manner. We were informed that their are issues with the water pressure in the kitchen and this is currently under investigation. The kitchen had been awarded a five star rating by the Food Standards Agency scores on doors scheme in June 2008. The home has introduced the Southern Cross NUTMEG nutritional programme. We sampled the lunchtime meal and this was well presented and tasty. Comment was received that the timing of breakfast is often late and this needs to be reviewed in order to ensure residents needs are met and that there are appropriate intervals between meals. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure in place to address any concerns raised by residents and their representatives. Policies and procedures are in place and are followed for safeguarding adults, thus protecting the residents. Evidence: The home has procedures in place for safeguarding adults and also follows the Hillingdon Safeguarding protocols. The home has received 8 complaints since the Manager came into post in August 2008. 2 had been sent via CSCI and 6 were received directly by the home. Clear records of the complaint, the investigation and response made were available, and there is also a complaints log kept. Staff spoken to were clear to report any concerns and understood Whistle Blowing procedures. There have been 2 safeguarding issues in the last year and action has been taken to address the shortfalls identified. This includes the introduction of additional moving & handling equipment and also of new weighing equipment. The training in moving & handling has also been reviewed to provide more comprehensive training for staff. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well maintained, providing residents with a pleasant and homely environment to live in. Procedures are in place for infection control and are being adhered to, thus minimising the risk of infection. Evidence: We carried out a tour of the home. The premises were clean and fresh and were being maintained. We were informed that requests have been submitted for the replacement of the ground floor corridor carpet and also for additional profiling beds and other equipment. Some of the bedroom carpets had been replaced. Overall the home is being maintained to a good standard. The Manager said that she was going to carry out an environmental audit. The home has received additional moving & handling equipment to meet the assessed needs of the residents. Also a weighing scale attachment used with the hoist has also been purchased so that all residents can be weighed in a safe and easy manner. The Manager said that she was also going to purchase some stand on weighing scales as some residents were able to use these. We discussed recording in each residents service user plan the type of scales in use for each individual, for continuity of recording. Care Homes for Older People Page 18 of 26 Evidence: We viewed the laundry and this was clean and tidy. It was noted that there was quite a backlog of laundry and the need to ensure laundry is completed in a timely fashion was discussed with the Manager and Area Manager, who said that this would be addressed. Procedures are in place for infection control and these are followed. Protective clothing to include gloves and aprons were available. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always appropriately staffed to meet the needs of the residents, and as a result this is having a detrimental impact on the standard and consistency of care offered within the home. There is a training programme in place to provide staff with the skills and knowledge to care for the residents. Systems for vetting and recruitment practices are in place and safeguard residents. Evidence: On the first day of inspection none of the registered nurses rostered for work on the morning shift had attended, and this had caused the Manager and Deputy Manager to have to work as the registered nurses on each floor. The Manager had, following consultation with staff, amended the rosters to provide appropriate cover over each 24 hour period. It was clear on speaking with some of the staff that they did not appear to understand the importance of ensuring that the home is staffed appropriately at all times, or to take this matter seriously. The nursing and care staff rosters evidenced frequent changes and shortages in staffing over the previous few weeks. Ancillary staff to include domestic, kitchen, maintenance and administration are in place and attend in such numbers as to provide a good standard of work in these areas. Information in the AQAA confirms that the majority of care staff are qualified to NVQ level 2 in care and some are undertaking level 3. The kitchen staff have undertaken Care Homes for Older People Page 20 of 26 Evidence: NVQ level 3 in hospitality, and the administrator is looking to do NVQ level 2 in administration. We viewed 3 sets of staffing records. With the exception of a copy of one reference and one photo these contained all the information required. The Manager has since confirmed that these documents are now in place on the files. Southern Cross has an induction programme based on the Skills for Care common induction standards. The Manager confirmed that these are being completed by all new care staff. In addition, staff receive training in other topics relevant to the needs of the residents. The home continues to advertise for registered nurses with an appropriate mental health qualification and recruitment processes are ongoing. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager has the skills and experience to manage the home effectively. Systems for quality assurance are in place, thus providing a process of ongoing review and feedback. Residents monies are being well managed, thus protecting their interests. Systems for the management for health & safety throughout the home are good, thus safeguarding residents, staff and visitors. Evidence: The Manager is a first level registered nurse. She has qualifications in front line management and in workplace assessment and training. She has undertaken postgraduate training in several topics relevant to her role and has several years experience in managing elderly care facilities. Some of the staff spoken with said that they felt the home is being managed well and that the Manager is approachable. There is a system in place for quality assurance. This includes regular audits of each aspect of the care provision, and it was clear from the service user plan and Care Homes for Older People Page 22 of 26 Evidence: medication management audits that these had identified shortfalls and work had been carried out to address them. There is a monthly Managers audit carried out, and this includes all aspects of the home. Regulation 26 unannounced inspections on behalf of the Responsible Individual are carried out, and reports for these are available. The Manager has scheduled meetings with staff, however she commented that attendance had been low. The Manager is available to meet with residents and relatives and has an open door policy. The Manager is very aware of the importance of keeping all aspects of the home under review in order to maintain and improve standards throughout. The home uses a computerised system for the management of any monies on behalf of residents. A sample of the records were viewed. Interest is allocated to each resident on a monthly basis. There is a clear record of all income and expenditure, and receipts are available. Servicing and maintenance records were sampled and those viewed were up to date. The fire risk assessment was last done in August 2008 and the Manager confirmed that the action plan points had been completed. Risk assessments are in place for equipment and safe working practices and these were to be reviewed to ensure all the information is the most up to date available. Records of day and night fire drills were available. The Manager said that she had worked hard to increase training in health & safety topics, and that all staff were now attending an extended training in moving & handling, to provide them with up to date skills in this area. The training matrix evidenced that there had been an increase in training, with some staff still needing to attend updates in health & safety topics in line with current legislation and good practice guidance. The Manager had already identified this and was working with staff to address it. The Area Manager confirmed that the trainers in health & safety topics undergo recognised training to provide them with the skills and knowledge to effectively train staff. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 All staff must have the skills to communicate effectively with residents. This is to ensure their needs are understood and fully met. 19/01/2009 2 27 18 The home must be appropriately staffed at all times. To ensure the needs of the residents can be effectively met. 19/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 15 That the timing of the breakfast meal be reviewed to meet the needs of the residents and provide appropriate intervals between meals. Care Homes for Older People Page 25 of 26 Helpline: 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 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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