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Inspection on 13/06/06 for Cedar House Nursing & Residential Home

Also see our care home review for Cedar House Nursing & Residential Home for more information

This inspection was carried out on 13th June 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents are cared for by staff who are motivated and well trained. There is a good atmosphere in this home that is relaxed and friendly. Good interaction between residents and staff was observed. The home has a very good approach to staff recruitment and training. The staff records showed that appropriate checks and references are made before new staff are employed. The training arranged by the manager and her deputy is relevant to the needs of the people living at this home. Residents have access to activities that they can join in with if they wish. A sponsored walk by staff and residents took place at the time of this inspection and generated plenty of interest and discussion.

What has improved since the last inspection?

There have been some improvements to the premises although these are less than would have been desirable. Residents now have locks to their doors and lockable facilities in each room are gradually being introduced. Locks have been fitted to WC`s and bathing facilities. Repairs have also been effected to the laundry equipment and wheelchair lift.

What the care home could do better:

There remain continuing concerns about the environment at this home and the slow response from the company to deal with the issues consistently raised by CSCI. There are matters they have been identified previously as representing risk to residents, staff and visitors and these must be dealt with without any further delay. The areas of concern are itemised in this report. There is significant pressure on the staff group at this time due to the prolonged absence of one of the domestic staff. This has resulted in the home being dirty in places. Staff are doing their best to keep a level of cleanliness in the home but there is a real concern that this will take them away from their care duties. The current arrangement is not adequate to maintain a hygienic environment.

CARE HOMES FOR OLDER PEOPLE Cedar House Nursing & Residential Home Church Road Yelverton Norwich Norfolk NR14 7PB Lead Inspector Mrs Geraldine Allen Unannounced Inspection 13th June 2006 09:15 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 Nursing & Residential Home DS0000015626.V300614.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 Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar House Nursing & Residential Home Address Church Road Yelverton Norwich Norfolk NR14 7PB 01508 494207 01508 495602 Cedars@caringhomes.org 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) Cedar House (Norfolk) Limited Ms Sharon Marie Hart Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to accommodate a maximum of twenty-six (26) older people of either sex, not falling into any other category. 13th December 2005 Date of last inspection Brief Description of the Service: Cedar House is a period residence, with an extension, situated beside the church in the village of Yelverton and is one of three homes in Norfolk offering nursing care, owned by Caring Homes Ltd. It is registered as Cedar House Limited to provide nursing and residential care to older people (not falling into any other category, e.g. with dementia). The main house is on 3 floors served by staircases and a lift. The majority of service user accommodation is on the ground and first floor. The care home’s offices and 2 service users’ rooms are situated on the upper floor. On the first floor the landing area has split-levels and four bedrooms are accessed by a separate wheelchair lift. Cedar House stands in pleasant surroundings, having a large garden that is mostly laid to lawn and is surrounded by mature trees. The location is rural, to the south east of Norwich, and there are no amenities in the immediate area. Access to the nearest shopping and social centre is by private car or by a bus service the regional manager says runs three times daily. The manager, Ms Sharon Hart, confirmed that the home’s current fee rates were between £325:00 and £550:00. There are additional charges for items such as hairdressing, private chiropody, newspapers and toiletries. Residents are requested to make a £10:00 contribution towards the cost of outings and trips. A copy of a previous inspection report is available in the entrance hall. On the day of inspection, the report related to an inspection carried out in 2004 and needs to be replaced with a more up to date published report to better reflect the current situation at this home. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the day of 13 June 2006. By arrangement, a further inspection visit took place during the morning of 15 June 2006. Twenty-four residents were living at the home at the time of this inspection. Information was obtained from a variety of sources. Prior to this inspection, Ms Hart returned a completed pre-inspection questionnaire to CSCI. Disappointingly, no comment cards were received from either the residents or visitors to the home prior to this inspection. A visitor completed a comment card at the time of inspection. Comment cards were seen available to visitors on the entrance hall table. On the day of inspection, various documents were looked at, including records kept about the care given to residents, files and information held about staff, and other records relating to health and safety issues. Many residents were seen and spoken to in brief and 2 residents were spoken to at length. Many of the staff were spoken to briefly, with 3 being spoken to in private. Three visitors to the home were also spoken to. A tour of the building was made and lunch was eaten with residents in the dining room. Overall, the provision of care in this home is good. However, this is let down by the poor maintenance of the premises. What the service does well: Residents are cared for by staff who are motivated and well trained. There is a good atmosphere in this home that is relaxed and friendly. Good interaction between residents and staff was observed. The home has a very good approach to staff recruitment and training. The staff records showed that appropriate checks and references are made before new staff are employed. The training arranged by the manager and her deputy is relevant to the needs of the people living at this home. Residents have access to activities that they can join in with if they wish. A sponsored walk by staff and residents took place at the time of this inspection and generated plenty of interest and discussion. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents or their representatives are given information about the home to help them make an informed decision about living there. The pre-admission assessment of needs is comprehensive although it would benefit from more assessment of the social and emotional needs of the person. EVIDENCE: An updated copy of the resident information pack was provided. The pack contains the home’s Statement of Purpose and Service User Guide, together with information about the contract of residence, information about the facilities, a copy of the complaints procedure and sample menus. Two care plans were seen and provided evidence of thorough care and physical needs assessment. The social, emotional and spiritual needs assessment is minimal. There was evidence of the involvement of other agencies in the assessment process including, GP, dietician, physiotherapist. There was also evidence of the assessment leading to a relevant care plan. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home has good care plans in place. The care plans would however benefit from improved specific care plans and daily records that reflect the physical, social and emotional care given. Residents receive good healthcare support and advice is sought from healthcare professionals in a timely manner. Residents were treated with dignity and respect at the time of inspection although concerns were expressed about the practice of 1 member of staff that needs to be investigated. Significant concerns were raised about some of the practice used in the administration and recording of medicines. EVIDENCE: Two care plans were case tracked in detail, with further care plans being looked at in brief. There was evidence that the initial care plans were developed based upon the pre-admission assessment. Frequent and regular reviews informed any change to the care plans and these were clearly written and provided staff with sufficient information to be able to give the appropriate care. There was evidence of good practice. For example, relatives are encouraged to be fully involved in the care planning and review process and this was confirmed during discussion with a visiting relative. The care plans Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 11 seen were well written, relevant and very informative. There was evidence of reviews taking place at least monthly but more frequently where there were changes in condition or events. Staff are commended. There are 2 areas where improvement could be made. The daily records suggest a very task orientated approach to care and the majority of entries consisted of statements such as “slept well” and “all nursing care needs met”. There needs to be more information about physical and emotional care given. Requirements and recommendations have been made. Documentation shows that the person’s interests are identified but there was little evidence within the records that they are supported to follow them. For example, 1 care plan stated that the resident enjoyed football but there was no mention within the care plan or daily record, setting out how this resident would be supported to watch the World Cup even though verbal evidence was obtained that this is occurring. The care plans provided ample evidence that residents receive good healthcare support at this home. Ms Hart described the arrangements with the 2 surgeries that visit residents at the home. The care plans gave good information about all healthcare interventions and advice received from other agencies. Specific care plans had been amended to reflect any changes as they occurred and were clearly written so that staff would be aware of the changes. A specialist pharmacist inspector conducted an inspection of the medicine arrangements at this home. A separate report is available on request. Requirements have been made. Observations of care practice throughout this inspection provided evidence that residents were treated with respect and dignity. However, discussion with some visitors to the home raised serious concerns about the conduct of a qualified member of staff. This matter was referred immediately to Ms Hart. See standard 18. Four requirements were made in respect of this standard at the last inspection. Concerns had been expressed about resident’s privacy and dignity being compromised due to the lack of privacy bolts to toilet, bathing and bedroom facilities. These requirements have been met. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in a range of activities in and outside of the home. Residents are treated with respect and dignity. Visitors are made to feel welcome at the home. The residents enjoy a choice of food that is freshly prepared and nutritious. EVIDENCE: Residents and staff were taking part in a sponsored walk during the course of this inspection and there was discussion about this event during the day. Most residents were seen and spoken to briefly during the course of this inspection and 2 residents were spoken to in detail. Three relatives/visitors were spoken to in private and most staff spoken to, with 2 being seen in private. On the day of inspection, arrangements were in hand for a sponsored walk, scheduled to take place the following day. The hairdresser was also on the premises and residents were seen enjoying having their hair done. The preinspection questionnaire shows a varied range of activity taking place both in and outside of the home. Visits to the local pub were spoken of and outings to various venues are enjoyed by some residents. On the day of inspection, residents were involved in various activities in their own rooms and communal Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 13 areas. Because of the fine weather, some residents were also spending time in the garden. Residents and visitors spoke warmly about most of the staff and the interaction observed between staff and residents was friendly and appropriate. Laughter was heard frequently. One visitor described the staff as “very good” and stated that there were no concerns about the care provided. Visitors were seen throughout the inspection and those spoken to confirmed that they felt able to visit the home when they wished and always felt welcomed by staff. Staff were observed treating residents with dignity and respect. Where assistance was provided, it was done so discreetly, and with consideration to the dignity of the resident. A meal was eaten with residents. Although the dining room was cramped (see environment), residents appeared to enjoy the food on offer. Choices were available and residents were seen eating different meals dependent on the choices they had made. Assistance was given to a resident in the dining room and this was done discreetly, with the member of staff sitting beside the resident and speaking quietly to them throughout. Other assistance was given in rooms or the lounge as preferred by the residents. Residents were seen using aids that enabled them to remain independent of staff help. The meals arrived ready plated but the plates were uncovered. When asked about this, Ms Hart stated that the home only has 6 plate covers and these are used to transport food to residents eating in their own rooms. It was also noted that crockery did not match and this needs to be rectified. Recommendations have been made. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is known to relatives and residents. The home keeps records of any complaints received and the investigation and action taken as a result. Staff receive training in adult abuse awareness and were able to speak knowledgably about this. EVIDENCE: The home has a complaints procedure in place that is made available to residents in their information pack. The procedure is displayed in the main entrance hall and visitors to the home confirmed they knew the procedure and 1 confirmed that he had used this to raise concerns. Two staff were spoken to in private. Both had been recruited from overseas and had worked at the home for a considerable time. Both confirmed they had received adult abuse awareness training and were aware of the home’s whistle blowing policy. The home’s training record showed that staff received adult abuse awareness training in April & May 2006. During the course of this inspection, discussion with 2 different visitors to the home suggested that a qualified member of staff had used inappropriate behaviour towards residents that had caused some distress to residents and also the visitors who witnessed this. This matter was immediately brought to the attention of Ms Hart, who confirmed that the member of staff concerned was not on the premises. Ms Hart stated that she had not been made aware of the incident and no staff had made use of the whistle blowing policy if they had Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 15 been aware of what took place. Ms Hart referred this matter to the appropriate authorities during the course of this inspection. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not maintained to a good enough standard internally and arrangements need to be put in place to ensure safe access to the external environment. Areas of the home are not kept as clean as is desirable and particular attention needs to be made in respect of carpets and floor coverings. EVIDENCE: A tour of the premises was conducted with Ms Hart. Some but not all bedrooms were inspected and all communal areas were seen. Concerns about these premises have been subject to CSCI comment over a considerable period. At the last inspection, a total of 9 requirements were made and not all have been met. The standard of maintenance of the fabric of the building is disappointingly poor and although improvements have been made since the last inspection they are inadequate, with a substantial amount of work still needing to be done. There is also evidence of deterioration in some areas. The findings are as follows: Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 17 Ground Floor Corridors – the carpets are in urgent need of deep cleaning and/or replacing in some places. The corridor from outside bedroom 7 onwards is uneven and represents a hazard to residents who may be unsteady on their feet. Main Lounge – is small and does not have enough space to allow chairs to be arranged other than by being placed around the walls. This inhibits conversation between residents. The carpet is in a poor state and is in need of deep cleaning or replacement. The inspection was conducted in daylight however the room was dull even with the lights switched on. Dining Room – is too small to comfortably accommodate the residents who were eating their meal in this room. For example, one resident was required to vacate her seat to allow another resident to reach the dining table. The room was dark and the artificial light was insufficient to compensate. The carpet was unacceptably dirty and the radiator cover had a broken screen. Ms Hart stated that this room is due to be refurbished and new flooring will be laid at that time. No date has been fixed other than the refurbishment will occur after the conservatory is built. Because of the continuing delays to the construction of the conservatory, this is no longer an acceptable arrangement and the refurbishment of the dining room must commence without further delay. Assisted bathroom – the Parker bath located on the ground floor is not usable with a hoist and its use is therefore limited. The floor around the WC was very stained and in need of cleaning. There was no curtain at the window and this made the bathroom feel very institutionalised and cold. Lobby to Garden – is located below the staff toilet (see 2nd floor) and has a crack in the ceiling. Egress from the lobby to the garden is via a slope over the doorway. Shower – the shower room was seen but records of water temperatures in this room suggest that it is seldom used, the last entry being 17 January 2006. Ms Hart confirmed that most residents preferred to use the bath on the 1st floor. Garden – The patio paving is uneven, with weeds growing through the cracks making the surface unsafe for residents with poor mobility. The area is in use by residents during the warm weather. The flowerbeds were unkempt and overgrown with weeds. The conservatory is to be built in this area. The construction of the conservatory has again been delayed, with the original planned date for commencement being put back from March 2006 until mid July 2006. This is very disappointing as it would have been beneficial for residents had the conservatory been available for the summer months as originally anticipated. If the latest intended date for construction is realised, residents will not be able to access this part of the grounds for much of the summer. Small/quiet lounge – This area was being used by the hairdresser on the day of inspection. 1st Floor Bedroom 10 – was looked at as an example of the standard of redecoration and refurbishment. Whilst the decoration was good and the new furniture pleasing, it was disappointing to see that the carpet was in need of cleaning, Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 18 thus spoiling the overall effect. The floorboards in this room were uneven and the en-suite would benefit from having a small cupboard or shelf fitted to allow for better storage of toiletries. It was also noted that the curtains were falling off the rails, however Ms Hart stated that wooden curtain rails were due to be fitted. Bedroom 18 – was also found to have uneven flooring by the bed. This is of particular concern as the resident living in this room has limited mobility and shuffles with a walking frame and this therefore constitutes an elevated risk of falling. The assisted bathroom – on the first floor was in good order, however the tile grouting by the door needed to be finished off. The assisted bath offers a spa facility, which is enjoyed by residents. The bathroom was functional and would benefit from some storage and more domestic items such as appropriate pictures. The wheelchair lift – on this floor was in use at the time of inspection. 2nd Floor The staff toilet – also provides significant storage space for continence aids and other items. Concern was expressed to MS Hart at the time of inspection regarding the poor state of the ceiling and wall in this room. Plaster is raised from just below the eves and a crack is visible down the wall. It was not possible to reach the wall to measure the crack accurately but appeared to be approximately an inch wide in places. There was some question as to whether this is a load bearing wall and Ms Hart was advised that it would be judicious to arrange for a structural engineer to check this wall. The laundry – is located on the 2nd floor and CSCI was of the understanding that this would be relocated to the ground floor when the new conservatory was built. Recent correspondence from the company has advised that the relocation has been put on hold until after the new conservatory has been completed. As a result, there is no completion date available for this work. This is disappointing as the current arrangements are less than satisfactory, given the amount of laundry now being done on these premises and the inability of staff to deal with laundry at night due to noise levels affecting residents. The laundry was inspected whilst machines were in operation and it was noted that there was considerable vibration from one of the machines. New equipment recently installed in the laundry is causing the vibrations. Because of its location, health & safety considerations mean that staff cannot be expected to dry or air clothes outside. Good information and guidance was displayed on the laundry walls concerning machine operation and safe use of substances used in the laundry The carpet in bedroom 22 – was very dirty and needs to be replaced. The carpet in bedroom 23 – was rucked and represented a trip hazard to the resident living in this room and staff. The en-suite in this bedroom was untidy and in urgent need of discreet storage space for continence aids and other items. The toilet roll holder was located too far from the WC and as a result the toilet rolls were kept on a shelf above the WC. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home has a sound approach to staff recruitment and training. The shortfall in domestic staff cover needs to be addressed without delay as the home is not kept clean and care staff are needing to undertake domestic chores rather than provide care. EVIDENCE: Staff rotas for the week of inspection were provided. This showed that the home employs 1 qualified nurse and 4 care staff during the hours of 08:00 and 20:00. One qualified nurse and 2 care staff are employed between 20:00 and 08:00. These hours would be adequate but care staff are having to undertake some domestic and laundry duties. The domestic staff cover is currently inadequate and this is reflected in the poor state of cleanliness in the home. Two staff are normally employed to undertake domestic work, including laundry. One person works 12 hours and the other is employed to work 37.5 hours per week. Unfortunately, the full time member of staff has been unable to work since December 2005. This means that care staff are needing to undertake the more obvious domestic chores instead of their care duties from time to time and are also working additional hours on domestic duties. Ms Hart stated that a cleaning company is hired once per month to blitz clean the home over a 3-day period. However, it is unrealistic to expect the home to remain clean enough in the intervening Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 20 time, or for care staff to include domestic chores in their working day without this impinging on the time needed to provide care. Two staff files were looked at in detail. Both included documentation regarding recruitment that showed good practice is in place. Criminal Records Bureau and Protection of Vulnerable Adults disclosures were in place. Two written references were seen for each member of staff. The fully recorded induction training was signed off and dated and there was evidence to demonstrate a positive approach to staff training and development. The training record showed training is arranged that is relevant to the tasks required of staff. For example, 1 file contained certificates for adult abuse awareness, skin and wound care, fire, nutrition and diabetes, dementia care, venepuncture, quality care, COSHH management, food hygiene, emergency 1st aid and health & safety. The deputy manager is now a qualified trainer for manual handling. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home is well managed by a competent and experienced person. Staff are well supported through supervision. The views of residents and relatives are sought, although an action plan addressing any issues raised through this process needs to be made available to residents, relatives and CSCI. The home has good health & safety procedures and practices in place. EVIDENCE: Ms Hart is well qualified and competent as manager at this home. She works hard to ensure residents receive good care and staff described the teamwork approach at this home. All felt Ms Hart was prepared to listen and respond appropriately to suggestions and issues. Ms Hart is due to be absent from the home shortly, during which time the deputy manager, Anne Battley, will undertake an acting manager role. Ms Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 22 Hart is ensuring that Ms Battley is well prepared. Ms Hart was not able to confirm at the time of inspection that Ms Battley will be off the staff rota during her absence, although CSCI would expect this to be the case in order that Ms Battley is available to fully undertake management responsibilities effectively. The home’s quality assurance audit was discussed. Questionnaires are sent out to relatives and residents annually and their responses are returned to head office for analysis. The most recent analysis is not yet available, however a copy of the summary for the audit conducted in February 2005 was provided at the time of inspection. Unfortunately, there was no action plan attached to the summary and the company needs to make sure these are made available for future audits. The pre-inspection questionnaire provided by the home confirms that the home does not handle any money on behalf of residents. Financial affairs for residents are dealt with by their relatives as needed. Staff records showed that supervision is provided to staff. The responsibility is delegated to ensure it takes place in a timely way. Regular staff meetings also take place during which relevant issues around care and practice are discussed. Good records were seen. The home’s health & safety folder was looked at in some detail. Comprehensive risk assessments were in place for the premises and appliances. There was evidence that Ms Hart reviews these risk assessments monthly. This is good practice. The health & safety folder also contains policies and procedures for risk assessments relating to Legionella. Portable Appliance Test certificates and health & safety checklists for the staff and building were also seen and there was evidence they were updated regularly. The home’s maintenance folder included fire risk assessments carried out by Chubb. Fire evacuation training was held on 29 March 2006 and this is good practice. Weekly alarm checks were fully recorded and up to date. Both of the home’s 2 hoists were last serviced in May 2006. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 2 X X 2 1 1 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A 3 X 3 Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement The registered person must ensure that daily records within the care plan accurately reflect the care received by the resident and any issues or activity that has affected their ill or well being. The registered persons must ensure that care needed to meet recreational and social needs is delivered in accordance with the care plan. This requirement is repeated. The registered persons must provide lockable facilities for service users to store personal effects and provide keys unless contra-indicated by risk assessment. This requirement is repeated and has been a requirement since 24/11/04. The registered persons must ensure all areas are safe, with particular attention being made to the area around the 2nd floor staff toilet. The registered persons must submit a programme of work to redecorate and refurbish DS0000015626.V300614.R01.S.doc Timescale for action 18/08/06 2. OP12 12, 16(2) 18/08/06 3. OP10 12(4) 15/09/06 4 OP19 23 (a) 18/08/06 5. OP19 23(2) 18/08/06 Cedar House Nursing & Residential Home Version 5.2 Page 25 bedrooms in need of attention, in discussion with the manager of the home to identify priorities. This requirement is repeated. 6. 7. OP19 OP26 16(2) 23(2) 16(2) 23(2) The registered persons must replace worn and stained carpets. The registered persons must ensure that floors are treated and floor coverings replaced and properly sealed where these are defective and where there is odour in WC’s and en-suite facilities. The registered persons must review arrangements for ancillary staff to ensure that standards of cleanliness are maintained and laundry tasks are completed without routine recourse to care staff for completion. This requirement is repeated. The registered persons must ensure that the deputy is employed to work manager hours only during the absence of the registered manager to ensure continuity in meeting management responsibilities 18/08/06 18/08/06 8. OP27 18(1) 23(2) 16(2) 14/07/06 9 OP31 18 (b) 18/08/06 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 OP3 Good Practice Recommendations It is recommended that the pre-admission assessment includes an assessment of the social, emotional and spiritual needs of the person and that these are reflected in care planning. It is recommended that sufficient plate covers are DS0000015626.V300614.R01.S.doc Version 5.2 Page 26 2 OP15 Cedar House Nursing & Residential Home 3 4 OP15 OP18 purchased to ensure that all plated meals are covered when being transported from the kitchen to the dining room or elsewhere. It is recommended that crockery is purchased in sufficient quantity to ensure that residents receive their meals and drinks using matching crockery. It is recommended that all staff are reminded of the home’s whistle blowing policy to ensure understanding of its content and when it must be used. Cedar House Nursing & Residential Home DS0000015626.V300614.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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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