Inspection on 09/05/08 for Cedar House

This inspection was carried out on 9th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cedar House 23/10/08

Cedar House 26/04/07

Cedar House 20/04/06

Cedar House 01/11/05

Cedar House 04/01/05

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cedar House 6 Dryden Road Enfield Middlesex EN1 2PP Lead Inspector Tony Brennan Unannounced Inspection 9th May 2008 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar House Address 6 Dryden Road Enfield Middlesex EN1 2PP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8360 8970 020 8360 3613 Cedar House Company Limited Mary Ezzat Jennifer Swords Care Home 17 Category(ies) of Dementia - over 65 years of age (8), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (16), Physical disability (2) Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (Maximum number of places: 16) Dementia - Code DE(E) (maximum number of places: 8) Mental disorder, excluding learning disability or demantia - Code MD (maximum number of places: 1) Physical Disability - Code PD (maximum number of places: 2) The maximum number of service users who can be accommodated is: 17 26th April 2007 2. Date of last inspection Brief Description of the Service: Cedar House is a care home registered to provide residential care for seventeen elderly people of either sex, one of whom may have a mental health disorder. The home is a limited company owned by Dr G. Kattan and Ms Mary Ezzat. The home is located in a quiet residential area in Bush Hill Park about two minutes walk away from a train station. Enfield town centre is one stop by train and cafés, newsagents, restaurants and a post office are within two to three minutes walk from the home. The home has a large garden. The bedrooms are arranged on two floors. There are eleven single rooms and three double rooms. On the ground floor there is a lounge overlooking the garden and the dining room is at the front of the house. A room next to the kitchen is also used as a dining room. The table in this room is used for different purposes at different times. It is sometimes used for games, for writing and for eating. Another lounge is provided in the extension part of the building adjacent to the back garden. A table and chairs are available for service users to sit in the garden if they wish and if the weather permits. The home aims to provide care and support that is tailored to each service user’s needs. The home also seeks to provide supportive dementia care in a homely environment. The fees are between £420 and £450 a week. Copies of this report available from the Commission’s website. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 5 This report is available from the CSCI web site. Service users or members of the public may also contact the registered provider who will be able to provide them with copies of this report. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection was undertaken as part of the annual inspection programme. We sought to confirm that the seventeen areas for improvement identified at the last inspection had been addressed. Prior to the inspection the home had completed its Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at any other information we had received about the home since the last inspection. This included any information regarding incidents that the home had told us about. As part of this inspection we looked in detail at how the home safeguards people. We discussed this with staff, the registered manager and people who live at the home. We looked the homes of safeguarding policy, and records relating to how the home dealt with safeguarding issues. We have recorded our findings in the relevant outcome areas. The inspection took place over one day. We were assisted by Jenny Swords, the registered manager, with the inspection. Comment cards were received from residents and relatives. We spoke with four the people who live at the home, two members of staff and two relatives. We observed care practice and interaction between staff and people living at the home. We toured the building and examined a number of records relating to the care, health and safety and management of the home. At the end of the inspection feedback was given to the registered manager, and areas for improvement were discussed. We would like to thank the staff that assisted us by answering questions about the running of the home. We would also like to thank the people who live at the home who discussed their views of the service they receive. What the service does well: Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 7 A person who has recently come to live at the home told us she had been given information about Cedar House. The home understands the importance of having sufficient information when choosing a care home. People case tracked had both assessments from placing authorities, and ones carried out by the home. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. People spoken to said that staff respected their privacy and treated them with respect. People are supported to maintain their privacy to enhance their well being. Falls and manual handling assessments are in place. Each care plan includes a manual handling risk assessment. Management of risk ensures that safety issues are addressed whilst improving the quality of life for people. Relatives commented that there were no restrictions on visiting the home. A relative commented that the home was always, “ friendly and welcoming.” People are supported to maintain contact with their family and friends. The home has a system for obtaining the views of the quality of the service it provides. People’s views are sought and provide the basis for improving the quality of the service. What has improved since the last inspection? There were seventeen areas for improvement identified at the last inspection. Ten areas for improvement were found to have been addressed. We found that medication administration records are now fully completed, contain the required entries, and are signed by appropriate staff to ensure peoples safety. Systems are in place to make sure medications are handled safely. All medication cupboards are now locked and the person in charge holds the key. Regular management checks are carried out to make sure that medication is handled safely. At this inspection we found that the carpet in bedroom 2 has been cleaned. Carpets must be clean to make sure that people live in a clean environment. We observed that staff were only using disposable gloves when they were going to provide personal care to people. Liquid soap and paper towels are Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 8 now available throughout the home. Effective infection control measures are in place to ensure the safety of people living at the home. Training record confirmed that since the last inspection training had been provided on first aid and food hygiene. All staff receive relevant training that is focused on delivering improved outcomes for people. The files contained all the required information relating to recruitment of these staff. This included CRB’s and two references. The home recognises the importance of effective recruitment procedures in the delivery of a quality service and to protect people. Since the last inspection staff have received regular supervision. Staff are supported and supervised to make sure that they can meet the needs of people. Since the last inspection fire drills have been taking place and the fire alarm has been tested regularly. Health and safety checks make sure that people living in the home are safe. What they could do better: Twenty areas for improvement have been identified at this inspection. Staff must have necessary skills and understanding of the needs of people to make sure that the aims set out in a statement of purpose can be achieved. Care plans did not reflect how care would be delivered for individuals based on the ways they liked things to be done. Care plans must include people’s preferences about how they wish to be cared for to make sure their well being is supported. We discussed with staff what being a key worker involved. They said that they mainly focused on tidying their key clients bedroom and providing personal care. Key workers need to support people in ways that meet their full range of needs. The medication policy was not available. A medication policy that explains the system for ordering, administering and the safe return of medications by the home must be in place to ensure the safety of people. When we looked at care plans there was no record to show that people had agreed to care workers giving them medication. People should be consulted about how they wish their medical needs to be met. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 9 A relative commented that people who live at the home, “ could have more outings and activities to help with their memory.” A person who lives at the home told us, “ Theres nothing organised in the way of activities.” People living at the home must be supported to engage in meaningful activities to enhance their well being. We found that no menus were available at this inspection. One person said, “ the food is good, but it tends to be the same things all the time.” Menus must reflect people’s choice of meals. We found that the complaints policy was not available as all procedures were being updated. The complaints policy needs to be available so that people know how to make a complaint. There has been one adult protection investigation since the last inspection. The registered persons had not informed the Enfield Social Services or the Commission about the incident. All adult protection allegations must be reported to the host local authority and the Commission following relevant guidance and procedures to ensure the safety of people. We found that there was no procedure available to guide staff in how to report safeguarding allegations. An adult protection policy must be in place that provides all the guidance necessary to keep people safe. Training did not cover the host local authority’s adult protection procedures and guidance. Staff needs to be trained so that they know how they should respond in line with the host Local Authority’s procedures. We found that two waking staff were only on duty three nights of the week. The staffing level at night does not meet the needs of people. The health of people is therefore adversely affected. Training records showed infection control training had not been provided. Staff need training in infection control so that people are protected from the risk of cross infection. The registered manager explained that training on equality and diversity had not been provided. People need to be supported by staff that understand, respect and promote their diversity and equality. The annual quality assurance assessment showed that the home has not achieved 50 of staff with the National Vocational Qualification in care. The home needs to make sure that all staff receive relevant training that is focused on delivering improved outcomes for people. The registered manager still feels that a deputy would enable her to make sure that people have the support and care they need. A deputy manager must be Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 10 appointed to ensure the continued effective management of the service to meet people’s needs in line with the home’s statement of purpose. We spoke with the registered manager who told us there were not many issues regarding equalities and diversities in the home. Policies and procedures need to provide guidance on how the diverse needs and lifestyles of people will be supported and promoted. The home does not have an equalities and diversity plan in place. People who live at the home need to be confident that all their needs will be met. Five requirements made at the last inspection have not yet been met and have been restated in this report, with a new timescale for compliance. The date in bold type relates to the new timescale. Further information about unmet requirements can be found in the relevant section. Unmet requirements impact upon the welfare and safety of people. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 13 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose is an accurate description of the service provided. People’s needs are assessed prior to admission to the home to ensure they receive the care and support they need. National minimum standard number six does not apply to the service. EVIDENCE: We found that the needs of the people case tracked were within a range of those specified in the statement of purpose. Staff do not have all the skills to deliver the aims of the home as set out in the statement of purpose. The statement of purpose stated that the home could support people with dementia Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 13 and physical disabilities. The annual quality assurance assessment highlighted that the home needed to increase the number of staff who were qualified to meet “these sometimes complex needs” of people. A concern received by the Commission said that staff did not understand how to meet the needs of people who live at the home. Training records showed that staff had not received training in either dementia or meeting the needs of people with physical disabilities. Nor have they completed national vocational qualification in care. This is discussed in more detail in the section on staffing in this report. Staff must have necessary skills and understanding of the needs of people to make sure that the aims set out in a statement of purpose can be achieved. A person who has recently come to live at the home told us she had been given information about Cedar House. She said that the home’s brochure, “told her what she needed about the home.” The annual quality assurance assessment stated, “ Service users and family members are given a brochure. They are invited to view the home and can stay a few days.” A relative told us that they had been able to visit the home to decide if it could meet their needs. The home understands the importance of having sufficient information when choosing a care home. The annual quality assurance assessment highlighted that, “ a detailed needs assessment is carried out.” The people case tracked had both assessments from placing authorities, and ones carried out by the home. As part of the assessment process information on the needs of people had been obtained from health professionals. This had been used to inform the home’s own assessment. The way people wish to live was reflected in the initial assessments of their needs. For example, one person’s initial assessment highlighted that they regularly attended church. We spoke with them, and they confirmed that the home supported them to attend church. A relative commented that since coming to the home her mother “has settled well, and is generally well cared for.” Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples preferences as to how they wish their personal, medical and social needs met are not part of their care plans. People who use the service are fully protected by safe procedures for handling medication. Peoples right to privacy is supported. EVIDENCE: The annual quality assurance assessment highlighted that care plans had developed with the involvement of people living at the home. We found that care plans did not include reference to peoples preferences as to how they wish to live in the home. Care plans did not reflect how care would be delivered for individuals based on the ways they liked things to be done. Care plans must include people’s preferences about how they wish to be cared for to make sure their well being is supported. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 15 We found that the care plans of all the people case tracked were identified how the physical and medical needs of people. Care plans were based on initial assessments of the people case tracked. There were clearly defined actions highlighted in the care plans to meet the needs of people. Care plans had been reviewed. Care plans make sure that people’s personal care and medical needs are addressed. There is a key worker system for people living at the home. A person who lives at home said, “Staff are quite friendly.” We discussed with staff what being a key worker involved. They said that they mainly focused on tidying their key clients bedroom and providing personal care. People case tracked have dementia and need support to maintain their emotional well being. Therefore, it is recommended that the registered manager works with staff to further develop the key worker role to include support of people’s emotional well being. Key workers need to support people in ways that met their full range of needs. People spoken to said that staff respected their privacy and treated them with respect. We saw that people were able to spend time in their bedrooms. A person spoken to told us, “staff understand I like to be alone.” We observed that people living at the home are able to go where they wanted to. We observed that two people spend time sitting in the garden. A relative explained that she is able to spend time alone with her sister. People are supported to maintain their privacy to enhance their well being. There were falls and manual handling assessments in place. Each care plan includes a manual handling risk assessment. Equipment had been provided to assist people to mobilise safely. We observed two staff assisting one person with a hoist. They took time to explain what they were doing. They checked the equipment and used it in a way that made sure the transfer was done safely. Management of risk ensures that safety issues are addressed whilst at the same time improving the quality of life for people living at home. Diary notes showed that appropriate medical attention and advice is sought. Diary notes also confirmed that the people case tracked had access to their General Practitioner when necessary. We found where the General Practitioner had made changes to peoples medication this was signed to confirm the change had been made. We found that the medication for each of the people case tracked was accurately recorded. The records of medication received and administered showed that they were getting the medicines prescribed for them. The medication policy was not available. The registered manager explained that all policies are being updated. Therefore no medication policy was available to guide staff. A medication policy that reflects and explains the Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 16 system for ordering, administering and the safe return medications by the home is to be in place to ensure the safety of people. No one living at the home self administers medication. When we looked at care plans there was no record to show that people had agreed to care workers giving them medication. Nor did the care plans reflect the personal preferences of the people case tracked about how they wished to be supported with the administration of the medication. This was highlighted with the registered manager who agreed to ensure peoples consent was sought and this was recorded. People should be consulted about how they wish their medical needs to be met. At the last inspection it was found that there were a number of gaps in the administration of medication records. We found that medication administration records are now fully completed, contain the required entries, and are signed by appropriate staff to ensure peoples safety. The registered manager explained in the annual quality assurance assessment that “ medication administration records are checked by the manager daily ensuring medication has been given and appropriately signed for.” No controlled drugs are being used in the home. A safe recording and storage system is in place if any of the people living at home need to have controlled medication. Systems are in place to make sure medications are handled safely. Since the last inspection theres been an improvement in the secure storage of medication. All medication cupboards are now locked and the person in charge holds the key. All medicines are stored at the appropriate temperature. Regular management checks are carried out to make sure that medication is handled safely. Training has been provided on the safe administration of medicines. We spoke with staff; they were clear about their responsibilities when handling medicines safely. Training records also contained certificates confirming that this training had taken place. We were able to observe staff administering medication, and confirmed that this was done safely. Staff understand how to administer medication safely to people. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are not provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. There is no menu reflecting the preferences of people living at the home to show that a balanced diet is offered. EVIDENCE: At the last inspection we found that no activities were being provided. People who live at home and their relatives told us they felt that more activities were needed. The home had stated in its annual quality assurance assessment, “ we need to be more consistent with our activities.” A relative commented that people who live at the home, “ could have more outings and activities to help with their memory.” we observed that no activities were provided on the day of the inspection. However, there were a large number of board games, and craftwork was on display in the dining room. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 18 The registered manager told us that there was no activities programme to show what activities would be provided on different days. A person who lives at the home told us, “ Theres nothing organised in the way of activities.” Two other people living at the home told us they did attend church with the help and support staff. When asked about other activities one of them said that she “ could not think of anything else that they do” in the home. Daily diary notes did not record that the people case tracked had been involved in activities. This issue was discussed with the registered manager and the importance of providing regular activities was emphasised. People living at the home must be supported to engage in meaningful activities to enhance their well being. Relatives commented that there were no restrictions on visiting the home. A relative commented that the home was always, “ friendly and welcoming.” People told us that they could see visitors in private if they wish to. The annual quality assurance assessment highlighted that two people attend a “week day club keeping them involved in the local community.” People are supported and maintain contact with their family and friends. At the last random inspection we found that no menu was available. People told us that there was little variety in the meals provided. The annual quality assurance assessment stated that the home, “ caters for different tastes, and offers alternative menus.” We found that no menus were available at this inspection. The registered manager and the Cook said that menus were still being updated. While people spoken to said that the food was generally good they still felt that there was not a great deal of variety in meals provided. One person said, “ the food is good, but it tends to be the same things all the time.” Menus must reflect people’s choice of meals. We observed that the meal was well presented. The meal was provided in a relaxed manner. People were supported to eat. We observed two staff assisting people to eat. This was done at the pace of the people being assisted. Tables were laid out so that people could easily access condiments. People are provided with the support they need to eat at their own pace. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are not confident that their complaints will be listened to, taken seriously and acted upon. The home’s procedures do not protect people from abuse. EVIDENCE: The annual quality assurance assessment stated, “ The complaints procedure is clear.” We found that the complaints policy was not available as all procedures were being updated. It was not possible to establish if the complaint procedure would tell people how they could make a complaint. The complaints policy needs to be available so that people know how to make a complaint. We found that the complaints book recorded the actions that had been taken to address issues. One complaint had been referred by the Commission to the home since the last key inspection. The home had responded to this in detail and in a timely fashion. The relative of the person involved in this complaint ha d told the provider he had been inconsistent and defensive in dealing with their concerns. The provider had told the relative that he would not allow him to visit his terminally ill mother. The provider had sent letters from his solicitor Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 20 stating that legal action would be taken against the relative if he continued to complain about the home. The home does not have an open culture that responds sensitively to peoples complaints. As part of this inspection we looked in detail at how people are safeguarded to ensure their protection from abuse. There has been one adult protection investigation since the last inspection. The registered persons had not informed the Enfield Social Services or the Commission about the incident. The registered manager told us she had been instructed by the provider not to report the issue. We became aware of the incident through an anonymous concern. Adult protection allegations must be reported to the host local authority and the Commission following relevant procedures to ensure people’s safety. We found that there was no procedure available to guide staff in how to report safeguarding allegations. The policy had been removed from the home. The registered manager said it was being updated. The policy was discussed with the registered manager, and she could explain how she dealt with adult protection issues. The current policy does not include information on contacting Enfield Social Services if an allegation is made. An adult protection policy must be in place that provides all the guidance necessary to keep people safe. Staff were asked about their understanding of the policy. They did understand the need to report any incidents to the registered manager. Neither of the two members of staff spoken to fully understood what was meant by safeguarding people living at the home. Staff had recently been on training relating to adult protection. The registered manager had also completed the training. We found that the registered provider has not been on training on adult protection. The training did not cover the host local authority’s adult protection procedures and guidance. This was discussed with the registered manager. Staff need to be trained so that they understand the forms of abuse and how they should respond in line with the host Local Authority’s procedures. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a homely environment. The home is not completely clean and hygienic. EVIDENCE: We walked round the home and found that it was appropriately furnished. A passenger lift provided access for people to the first floor. We observed that people were able to access all areas in the home safely. The home has the necessary adaptations to support people to move around safely. There are large dining and sitting areas for the use of people. The garden is accessible and well presented. People said that they used the garden regularly in good Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 22 weather. The home provides an accessible and safe environment for people to live in. Bedrooms were personalised with items of furniture and pictures belonging to people. Bedrooms are decorated to a good standard. One person said, “My bedroom is nice.” People are encouraged and supported to personalise their bedrooms. At the last random inspection we found that the carpets in bedrooms 2 and 10 had not been cleaned. The carpet in bedroom 10 was covered in dirty marks and had a strong unpleasant odour. At this inspection we found that the carpet in bedroom 2 has been cleaned. The carpet in bed with 10 was still covered in dirty marks and had a strong odour. The registered manager explained that the carpet still needed cleaning. Carpets must be clean to make sure that people live in a clean and pleasant environment. Appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Staff confirmed that they had access to disposable gloves and aprons. We observed that staff were only using disposable gloves when they were going to provide personal care to people. We spoke to staff who understood that disposable gloves should only be used for this purpose. Liquid soap and paper towels are now available throughout the home. Effective infection control measures are in place to ensure the safety of people living at the home. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff not are available at all times to meet the needs of people who live at the home. Staff do not have all the skills to meet all the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: The rota showed that a consistent staffing level was being maintained in the home during the daytime. Staff said that the current staffing level allowed them to meet the needs of people. People living at the home told us that staff are available to meet their needs in the daytime. At the last random inspection it was found that due to the increasingly complex needs of people living at the home that two waking that staff were needed. We found that this had not been actioned until an adult protection strategy meeting highlighted the lack of support for people at night. The registered manager agreed to make sure that two waking night staff were on duty. The registered manager explained that she was not able to do this until the end of Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 24 April 08. We found that two waking that staff were only on duty three nights of the week. At this inspection we found that staff had been recruited and were about to commence work at the home. This was discussed with a registered manager who agreed to make sure that two waking night staff are always on duty. A concern received after this key inspection from a relative highlighted that there were two people who were awake at night and in need of staff supervision. There were not sufficient numbers of staff available. Sufficient staff needs to be available all times to meet the needs of people living at the home. The annual quality assurance assessment highlighted that staff had been on a range of courses. Training records confirmed that since the last inspection training had been provided on first aid and food hygiene. Speaking with staff and looking at their training records showed all areas of statutory training apart from infection control had been provided. Staff need to be trained in infection control so that people living at the home are protected from the risk of cross infection. Training needs were discussed with the registered manager who explained that there was no training plan in place. A training plan is to be put in place in order to make sure that staff had all the necessary skills to meet peoples needs Registered manager explained that training on equality and diversity had not been provided. We looked at training records that showed no training has been provided on equalities diversity issues. Staff need to develop the skills to promote peoples equality and diversity. It is recommended that training on equality adversity be provided for staff. People need to be supported by staff that understand, respect and promote their diversity and equality. The annual quality assurance assessment showed that the home has not achieved 50 of staff with the National Vocational Qualification in care. Training records confirmed this. The registered manager explained that the home had difficulties in finding a training provider able to deliver this training. The home needs to make sure that all staff receive relevant training that is focused on delivering improved outcomes for people. At the last inspection it was found that CRB’s had not been obtained for staff. We examined three staff files. The files contained all the required information relating to recruitment of these staff. This included CRB’s and two references. We found that there were no unexplained gaps in the employment history of recently recruited staff. A health check had been carried out to ensure that staff could safely meet the needs of people. The home recognises the importance of effective recruitment procedures in the delivery of a quality service and to protect people. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 37 38 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are not place to ensure that people receive the care they need. There is an effective system in place to consult people who live at the home about the quality of the service. People who live at the home have their financial interests protected by the home’s procedures. People’s health and safety is promoted. EVIDENCE: The registered manager has extensive experience of managing a service for older people. The registered manager has maintained and updated her skills regularly. We observed that the registered manager spent time talking to people in the home. Any issues they raised with her were immediately Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 26 addressed. The registered manager was also available to discuss issues with staff. Staff spoken to confirmed that they could talk to the registered manager. At the last inspection the need to have a deputy manager was highlighted. The role of the deputy manager is mentioned in the statement of purpose. The registered manager explained that the deputy manager has not yet been recruited for the home. The registered manager still feels that a deputy would enable her to make sure that people have the support and care they need. A deputy manager must be appointed to ensure the continued effective management of the service to meet people’s needs in line with the home’s statement of purpose. The home does not have an equalities and diversity plan in place. Equalities and diversity issues are not fully addressed as part of the planning and delivery of care to people. As outlined in the outcome area staffing, staff had not had training on equalities and diversity issues. There is an effective system in place to make sure that any money held on behalf of people would be held securely. The home has a system for obtaining the views of the quality of the service it provides. The home makes sure that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals was in place. People who live at the home have meetings on a regular basis to discuss how they wish the home to be run. Staff meetings take place to ensure staff are aware of plans to develop the service. People’s views are sought and provide the bases for improving the quality of the service. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. People use the service trust the home to handle their money safely. Since the last inspection staff have received regular supervision. We were able to see supervision records for all staff. These were all up-to-date. Staff spoken to told us that they had received regular supervision. The registered manager explained that she has also been discussing issues as part of the regular staff meetings. Staff are supported and supervised to make sure that they can meet the needs of people. We spoke with the registered manager who told us there were not many issues regarding the equalities and diversities issues. The registered manager explained that there were no people living at home from diverse cultural backgrounds demonstrating a lack of understanding. As was highlighted in outcome areas in this report a number of key policies were not available on the Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 27 day of inspection. All policies need to be reviewed in order to make sure that they promote equality and diversity of people who live at the home. Policies and procedures need to provide guidance on how the diverse needs and lifestyles of people who live at the home will be supported and promoted. Since the last inspection fire drills have been taking place and the fire alarm has been tested regularly. We found that the fire risk assessment includes an assessment of all the potential fire risks in the home. We questioned staff on the fire safety procedures and found that they understood fire safety issues. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. We discussed health and safety issues with staff and they demonstrated their understanding. There is a system for monitoring accidents to ensure the safety of people who live and work at the home. The temperature of food delivered to and cooked was recorded. The temperatures of the fridges and freezers were recorded and within safe limits. Health and safety checks and training make sure that people living in the home are safe. Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 28 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 3 2 3 Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The registered persons must make sure that the necessary resources are available to achieve the aims as sent out in the statement of purpose. Staff must have necessary skills and understanding of the needs of people to make sure that the aims set out in a statement of purpose can be achieved. The registered persons must make sure that people’s preferences about how they wish their needs to be met are included in their care plans. Care plans must include people’s preferences about how they wish their needs to be met to make sure their well being is supported. The registered persons must make sure that a medication policy is in place. A medication policy that reflects and explains the system for ordering, administering and the safe return medications by the home is to be in place to ensure the safety of people. DS0000010650.V362398.R01.S.doc Timescale for action 15/07/08 2. OP7 15(1) 30/06/08 3 OP9 13(2) 30/05/08 Cedar House Version 5.2 Page 30 4 OP12 16(2)(m)( n) 5 OP15 16(2)(i) 6 OP16 22(1) 7 OP18 13(6) 8 OP18 13(6) 9 OP18 13(6) The registered persons must ensure that activities are provided regularly that meet the needs and personal preferences of people. People living at the home must be supported to engage in meaningful activities. The timescale of 30/11/07 was not met. This requirement is restated. The registered persons must ensure that a menu is in place that offers a varied diet in line with peoples preferences. Menus must reflect people’s choice of meals. The timescale of 30/11/07 was not met. This requirement is restated. The registered persons must make sure that there is a complaints procedure available in the home. The complaints policy needs to be available so that people know how to make a complaint. The registered persons must make sure that any allegations are reported promptly to the host Local Authority and the Commission. All adult protection allegations must be reported to the host Local Authority and the Commission following relevant guidance and procedures to make sure that people are protected from harm. The registered persons must make sure that there is an adult protection policy available in the home that reflects the host authority’s adult protection procedures. An adult protection policy must be in place that provides the necessary guidance to keep people safe. The registered persons must make sure that staff attend training provided by the host DS0000010650.V362398.R01.S.doc 09/06/08 09/06/08 09/06/08 09/06/08 09/06/08 02/07/08 Cedar House Version 5.2 Page 31 10. OP26 23(2)(d) 11 OP27 18(1)(a) 12. OP30 18(1)(a) 13 OP30 18(1)(a) 14. OP32 18(1)(a) Local authority’s training on adult protection. Staff needs to be trained so that they understand the forms of abuse and how they should respond in line with the host local authorities procedures. The registered persons must ensure that the carpet in bedroom 10 cleaned or replaced. Carpets must be clean to make sure that people live in a safe and hygienic environment. The registered persons must ensure that two staff are on waking night duty at all times. The staffing level at night does not meet the needs people. The health of people is therefore adversely affected. The timescale of 30/11/07 was not met. This requirement is restated. The registered persons must ensure that training is provided on meeting the needs of people with physical disabilities. This will make sure that care is provided by staff that understands how to met the individual needs of people. The timescale of 20/12/07 was not met. This requirement is restated. The registered persons need to make sure that training is provided on infection control. Staff needs to be trained on infection control so that people living at the home are protected from the risk of cross infection. The registered persons must ensure that a deputy manager is appointed. A deputy manager must be appointed to ensure the continued effective management of the service to meet peoples needs in line with a home’s DS0000010650.V362398.R01.S.doc 09/06/08 16/06/08 15/07/08 02/07/08 09/07/08 Cedar House Version 5.2 Page 32 15 OP37 12(4)(b) statement of purpose. The timescale of 30/12/07 was not met. This requirement is restated. The registered persons must ensure that all Policies and procedures are reviewed so that they provide guidance on how the diverse needs and lifestyles of people will be promoted. All policies need to be reviewed in order to make sure that they promote equality and diversity of people. 01/07/08 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 OP7 Good Practice Recommendations The registered persons should make sure that staff are aware of the responsibilities of key workers to promote people’s emotional well being. Key workers need to support people in ways that met their full range of needs. The registered persons should make sure that people’s consent to care workers administering their medication is sought and recorded. People should be consulted about how they wish their medical needs to be met. The registered person needs to put in place a plan so that 50 of staff achieves the National Vocational Qualification at level 2 in care. Staff needs to have a qualification that shows that have the skills to support people living at the home. The registered persons should make sure that training is provided on meeting people’s diversity and equalities. People need to be supported by staff that understand, respect and promote their diversity and equality. The registered persons should make sure that a equalities and diversity plan is in place. People who live at the home need to be confident that all their needs will be met. 2 OP9 3 OP28 4 OP30 5 OP32 Cedar House DS0000010650.V362398.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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