Inspection on 19/02/09 for Cedar House Care Home

This inspection was carried out on 19th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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The Highlands

Turret Villa Retirement Home

Moor House

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Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cedar House Care Home Cedar House 3-4 The Cedars Ashbrooke Sunderland SR2 7TW     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: Hilary Stewart     Date: 1 0 0 3 2 0 0 9 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. that people have said are important to them: They reflect the things 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 27 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Cedar House Care Home 3-4 The Cedars Cedar House Ashbrooke Sunderland SR2 7TW 01915655385 01915141443 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Parkside Northern Limited care home 31 Number of places (if applicable): Under 65 Over 65 0 0 31 0 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: 23 1 0 4 2 The maximum number of users who can be accommodated is - 31 The registered eprson 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: Dementia - Code DE, maximum number of places, 23 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 1 Old age not falling within any other category - Code OP, maximum number of places 31 Physical disability - Code PD, maximum number of places, 4 Sensory impairment - Code SI, maximum number of places 2 Date of last inspection Care Homes for Older People Page 4 of 27 Brief description of the care home Cedar House has been converted from two large, redbrick Victorian semi-detached villas into a residential care home providing personal care to older persons and a separate unit providing care for older people with dementia. The Providers also operate an 8-place day care centre for older people, which is within the same building but do not impose on the service provided in the home. The home cannot provide nursing care. The accommodation is laid out over four floors, including a basement where a number of the bedrooms are also situated. Each of the floors is accessible by a lift. The new owner has made improvements to some areas of the home and intends to improve all of it. There are two parts to the home, each with its own lounge and dining room. To the rear is a large garden and a small car park to the front of the building. The property is close to a large municipal park, on a leafy, mainly residential street, although a number of other care homes are also nearby. Sunderland city centre is a short distance away and this may be accessed by public transport, which passes frequently. Care Homes for Older People Page 5 of 27 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. How the inspection was carried out. Before the visit we looked at the information we have received since the home was registered. How the service dealt with any complaints and concerns. The providers view of how well they care for people and the views of people who use the service and the staff. An unannounced visit was made on19th February 2009 and the 10th March 2009. Care Homes for Older People Page 6 of 27 During the visit we talked with people who use the service staff and the manager.We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept and checked that staff had the knowledge, skills and training to meet the needs of the people they care for.We also looked around the building to make sure it was clean safe and comfortable. We checked what improvements had been made since the last visit.Then we told the manager what we found We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. The home charges from 402 and 417 pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: If all of the care plans had sufficient detail and all parts of the plan were completed, staff would know that the information in them was up to date and correct. This would mean that they would be sure they were providing the people at the home with the support and care they need. If staff recruitment records showed that all of the staff have been properly vetted this would demonstrate that the organisation have made sure that they only employ suitable people to work at the home and therefore safeguard the people who use the service. If the staff at the home all had up to date training in adult protection procedures and were informed of the whistle blowing procedure this would make them more skilled at safeguarding the people at the home. Care Homes for Older People Page 8 of 27 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. 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. Care Homes for Older People Page 9 of 27 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 27 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. Peoples needs are assessed before people receive the service, so plans can be devised to make sure they get the care and support they need. The home does not provide intermediate care. Evidence: People have an assessment by their care manager before they are referred to the home. The manager looks at this assessment to see if the home can meet the persons needs. They then carry their own assessment out prior to the person moving in so they can use this information to write their care plan. Information is gathered from the person, their family and anyone else who may be involved in their care. People can visit the home for lunch or afternoon tea before they make a decision about whether they would like to use the service. Care Homes for Older People Page 11 of 27 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. All of the people who live at the home have individual care plans, through which staff monitor and promote the health of the people at the home to maintain their wellbeing. Some care plans did not have enough detail and some health needs needed to be re assessed. Evidence: The manager said and records showed that each person who lives at the home has an individual care plan. They said that they are in the process of reviewing all of them. Records showed that the plans covered health and areas of daily living. The care plans looked at were general and each persons needs were presented in a similar way. Some needed more detail about how to meet the individual needs of each person. The manager said that they were aware of this and intended to improve them in the near future. For example one persons care plan it said staff to assist them to undress but it didnt say how many staff were needed, where this was to be carried out or whether verbal or physical prompts were needed or if in fact staff needed to carry out the task for them. Another persons care plan said staff to check skin integrity but again did Care Homes for Older People Page 12 of 27 Evidence: not give any detail about how staff did this,what gender or where they needed to carry out this task. Risk had been assessed during the care planning process, especially around people who staff need to move and handle or need pressure relief equipment. In one persons risk assessment it stated that the night shift should check pressure relief equipment is in place but it did not say what type of equipment this is. However staff could describe how they meet peoples needs and who needs pressure relief equipment. Continace needs of residents had been assessed but some areas of need were still not being met. The manager agreed to act on this immediately. A document called This is your life had not been filled in in one persons care plan. The manager said that care plans are reviewed every month and there is a review with the person and their care manager every year. There are procedures for staff to follow when they deal with medication. A new medication system was being introduced to the home at the time of the visit. The manager and staff were being given instruction by the pharmacy representatives on how to use the system. The manager said that only staff who have received training in how to safely administer medication are given this task. Staff said and records showed that any changes of medication or medication procedures are recorded and followed. Two staff always sign them as a safety measure. The manager said that people are supported to manage their own medication after being risk assessed to see if it was safe enough. The medication records were up to date and an audit of some of the medication was correct. Records showed that the peoples health care needs are met at the home. Details of visits by the district nurse, visits to their GP and hospital appointments are recorded in the individual files. The manager said that the health and welfare of the people who live at the home is monitored all of the time. One person who lives at the home said when asked what they would do if they felt unwell said the staff would know. The people who live at the home looked comfortable. One person said I am very pleased with the care I receive another said I am very happy in here. Staff said that they understood the rights of the people at the home and always treated them with dignity one example was placing a towel over someone when they were carrying out personal care fore them. Staff also said that they always knocked on peoples doors and waited until they were asked before entering. Care Homes for Older People Page 13 of 27 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 people who live at the home are able to follow their own daily routines which satisfy their social cultural and religious needs. They can see their family and friends at any reasonable time. This helps to prevent them from feeling and becoming isolated. Evidence: The manager and staff said that they arrange a variety of outings for the people who live at the home. There is a residents forum where people can suggest where they would like to go on trips and the manager and owner said that they seek peoples views on what activities they would like to take part in. Records showed that people are asked to suggest what they would like to do. The manager said that they have made staff aware of the need to include social activity in the care of the people at the home. They have an entertainer at the home every month and people can choose whether they take part or not. Residents birthdays are celebrated and there are photographs on the wall showing some of the social events that have taken place. They have themed events such as Burns night and they had a valentines dinner party. One resident said they keep my brain stimulated another said we have some good entertainers. The manager said that in warmer weather residents can go out to dinner, to pubs and restaurants. They have just planned a trip to go and see the Angel Care Homes for Older People Page 14 of 27 Evidence: of the North. Records showed that some people had been involved in a variety of activities such as trips to the park and the coast. The home has use of a minibus and the manager said that they want to try and increase the amount of trips out to the theatre and for meals even though some residents are reluctant to go out. A church minister visits the home regularly and holds services. During the visit some staff were observed talking to the people and activities were planned for that evening. Staff and the residents confirmed that relatives and visitors are welcome and encouraged to visit at any reasonable time throughout the day and evening. Visitors were observed during the visit. One visitor said I can visit at any time. The manager said that the people asked for their opinions about the food provided at the home every residents forum meeting and the menus are based on the likes and dislikes of the people who live there. A cook is employed and they said that there are choices at meal times and if people want something different they will make it for them. Special diets can be catered for. One person said when asked what they thought of the meals said its nice another person said its alright. Hot drinks and snacks are always available throughout the day and evening. The kitchen was well stocked and there was fresh fruit and vegetables. Staff were observed sitting with people at meals times and talking with and supporting them. Care Homes for Older People Page 15 of 27 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. Complaints are dealt with so any problems are taken care of quickly which helps good relationships to be maintained. Staff know about and most have had training in how to protect people from harm, so the people who live at the home are kept safe. Evidence: A copy of the homes complaints procedure is displayed in the entrance hall they are also in the information about the home. The manager and staff said that the residents and their relatives know how to make a complaint. The manager said that there had not been any complaints made since they were registered. A record of complaints is kept at the home. One of the people at the home said when asked if they knew how to make a complaint I would tell them if I wasnt happy most of people who returmed a survey indicated that they had been informed about the the complaints procedure two said that they did not. The manager said that most of the staff have had training in the homes safeguarding procedures. Some of the more recent staff haven.t but they have dates for them to recioeve this. There is a copy of the Local Authority safeguarding procedures and the home keeps copies of their own adult protection procedures for staff. Staff could describe what they needed to do if they suspected someone was being abused. They said that they were familiar with the homes safeguarding and whistle blowing procedures. Care Homes for Older People Page 16 of 27 Care Homes for Older People Page 17 of 27 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. People live in a safe and clean home, although some repairs and improvement are necessary. Evidence: The home is comfortable, warm and clean. There are enough bathrooms and showers for the people who live at the home. One upstairs bathroom the flooring was coming aware from the bath exsposing the floor boards underneath. This would be difficult to clean and a possible source of cross infection. The owner said that they would repair this immediately. Staff were observed cleaning the stairs and the bathrooms. All of the bathrooms had hand soap and paper towels to help avoid the risk of cross infection. Each person has their own bedroom and they looked comfortable and clean. They were all personalised and made very individual. One of the rooms had a noticeable odour, the owner said that this would be rectified as soon as possible. Most bedrooms have been improved and now have en suite facilities.The laundry is organised and clean. There are adequate sluice facilities and the staff are provided with the necessary protective equipment. Care Homes for Older People Page 18 of 27 Care Homes for Older People Page 19 of 27 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. Sufficient numbers of staff are in post to meet the diverse needs of the people who live at the home and they have opportunities for training so they know how to give them good care and meet their needs. Furthermore the home has a recruitment procedures in place, which help to prevent risk of harm to the people who live there. Some records did not show that all checks had been carried out. Evidence: Staff said that they receive training, which helps them with their work. The manager said that all staff receive the training and support they need. Staff said and records showed that they all have mandatory training such as first aid food hygiene and fire training. The manager said that eighteen of the staff have vocational qualifications. Sufficient staff were on duty at the time of the visit. Staff said and records showed that sufficient staff had been on duty in the home the previous week. One member of staff said yes we have enoughone of the residents said there are always people about. The manager said that all staff have been CRB Criminal Records Bureau checked at an enhanced level to make sure they are suitable people to work at the home. All staff go through a recruitment process and they cannot not start to work at the home until this Care Homes for Older People Page 20 of 27 Evidence: is completed. They are interviewed and are only successful when they have two satisfactory references. Copies of staff records showed that checks had been carried out. Some records showed gaps in staffs work history that had not been explored during the recruitment process. Care Homes for Older People Page 21 of 27 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 is experienced and runs the home in the best interests of the people who live there and there are procedures in place that make sure they are protected as much as possible. Evidence: The manager is is not registered with the Commission but is in the process of applying. The are in the process of completing the registered manager award. They have experience of working in care settings and have worked at this home for some time. Since being in post the manager has been proactive in looking at ways to improve the care at the home. They are part of the NHS South of Tyne and Wear group who are looking at falls assessment and management, the aim of the group is to look at ways to reduce the risk of people having falls when they are older. The manager said that the people who live at the home and their families are asked their views about the running of the home as much as possible. One person said If I Care Homes for Older People Page 22 of 27 Evidence: ask they will listen to me. The is a quality assurance system and the manager and owner use this to improve the service and the quality of the home. Safety checks have been carried out on the equipment in the home such as testing electrical equipment and the servicing the central heating boiler. The manager said that fire safety risk assessments had been completed. The fire logbook showed that fire drills and fire instruction take place but fire instruction was not as regular as it should be. Staff said that they have fire drills and instruction. Records showed that regular training is provided for staff in fire safety and first aid. Environmental health had recently visited the home and records showed that they had complied with their recommendations which had been very few. The owner of the home is in the process of completing training in Health and Saftey. It was observed that there was a friendly atmosphere at the home and a pleasant rapport between the people who live at the home and the manager and staff. Staff said that they liked working at the home. The owner is in frequent contact with the manager. The home has procedures for staff when they deal with the peoples money so it is kept safe. Records showed that staff sign records when any of the residents money is used and the manager checks them regularly. The transactions had not been signed by two staff to show that it was witnessed. Care Homes for Older People Page 23 of 27 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 27 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 7 15 The Registered Manager must make sure that care plans have sufficient detail and are accurate. So the staff have accurate and up to date information to inform them how to provide each person at the home with good care. 31/05/2009 2 18 13 All staff must have adequate 31/08/2009 training in how to protect vulnerable adults. This means that staff will be able to recognise when to make an alert. 3 29 19 The registered person must 30/04/2009 have a full employment history for every member of care staff they employ at the home. This will help safeguard the people who live at the home by making sure only suitable people are employed to work there. Care Homes for Older People Page 25 of 27 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 26 The manager should look at solutions for keeping all parts of the home free from offensive odours. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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. 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