Inspection on 26/06/07 for Cedar House Nursing & Residential Home

This inspection was carried out on 26th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cedar House Nursing &... 13/06/06

Cedar House Nursing &... 13/12/05

Cedar House Nursing &... 28/07/05

Cedar House Nursing &... 24/10/04

Cedar House Nursing &... 15/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cedar House Nursing & Residential Home Church Road Yelverton Norwich Norfolk NR14 7PB Lead Inspector Mrs Geraldine Allen Unannounced Inspection 26th June 2007 09:00 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 Nursing & Residential Home DS0000015626.V344491.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.V344491.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.V344491.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 June 2006 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. Ms Hart said the current fee range was between £375:00 and £580:00. People were advised of the fee range verbally at the time of enquiry. The person or their representative is advised of the amount payable once confirmation is received that the person wishes to move into the home. She confirmed that all people were aware of the fees in writing before they moved into the home. A contract is provided on admission to the home and this is updated as necessary at the end of the trial period. 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.V344491.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 26th June 2007. Ms Hart completed and returned a pre-inspection questionnaire, providing information about the day-to-day running and maintenance of the home. Two relatives and 1 health professional returned completed questionnaires to the Commission. On the day of inspection, information was obtained by looking at records, talking with residents, staff and visitors to the home, touring the premises and observing practice. Overall, people described satisfaction about the home and the care they or their relative received. People seemed happy and many were prepared to chat about their life at the home. Many positive responses and statements were made. However, disappointment was expressed by 2 relatives about the time it has taken Caring Home to finally start building the new conservatory. Both described the overcrowding in the lounge and difficulty for staff in preserving people’s dignity because of lack of space. The resolution of this matter is imminent and it is anticipated people will be able to enjoy much improved communal space. As a result of this inspection, no requirements have been made and only 1 recommendation about good practice has been set. What the service does well: People living at the home said they enjoy a lifestyle that reflects their own preferences. They said staff treated them very well, were kind and thoughtful. Staff at the home work hard to protect people’s rights of citizenship. An example was given as a result of recent elections, when all residents were given the support they needed in order to cast their vote if they wished. People receive good care that is provided by staff who have received the relevant training. The training programme demonstrates a commitment on the part of Ms Hart and Caring Homes, to ensure care delivery is of a good standard. Cedar House Nursing & Residential Home DS0000015626.V344491.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. The summary of this inspection report can be made available in other formats on request. Cedar House Nursing & Residential Home DS0000015626.V344491.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.V344491.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. 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. People have sufficient information to help them make a positive choice to live at the home. Admissions are not made until a full needs assessment has been completed. New residents are provided with a Contract of Residence. EVIDENCE: Ms Hart said there were 23 people living in the home on the day of inspection, with a further 2 people in hospital. Updated copies of the Service User Guide and Statement of Purpose were provided. These are contained in an information pack that also includes a blank copy of the contract of residence. All documents clearly set out information that will help a person to decide if they wish to live at the home. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 9 Three care plans were looked at and all contained evidence that a thorough needs assessment was completed before admission to the home. The preadmission assessments were completed in full, signed and dated. The home does not provide intermediate care. Cedar House Nursing & Residential Home DS0000015626.V344491.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs are clearly recorded in each resident’s plan although the daily record needs to include more information about how the person spends their day. The delivery of individual care is flexible and responds to personal choice. Staff respect privacy and dignity. The home has an efficient medication policy supported by procedures and practice guidance that staff understand and follow. EVIDENCE: Three care plans were looked at in detail. The pre-admission assessment was in each file and informed the care plans. Each file contained a biography page but these were not completed consistently. Each file also contained consents & care plan review forms but these were not completed in all cases. Relevant care plans were in place and all were reviewed and updated monthly. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 11 Care plans have improved and more accurately reflect the care needed and provided to each person although the daily records need to be developed further to ensure social and emotional needs are reported alongside the physical needs on a daily basis. The appointment of an activity co-ordinator is beginning to have an impact, with social and emotional needs being established more consistently. The arrangements for the administration and control of medicines were looked at. Safe administration practice was seen and good storage and recording was also in place. All requirements made at a previous inspection have been met. The provision of care was observed discreetly throughout the day. Staff made sure that all personal care was provided in private and that people’s dignity was protected. Cedar House Nursing & Residential Home DS0000015626.V344491.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. 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. People who use the service have the opportunity to maintain personal and family relationships. The practice of staff promotes individual rights and choice. People can access meaningful activity of their own choice and according to their personal preferences. Care staff offer sensitive assistance to people who find it difficult to eat. Meals are varied and nutritious with choices available. EVIDENCE: Evidence was obtained by talking with 4 residents and chatting briefly with others sat in the lounge or having their hair done by the hairdresser. Practice was also observed and staff spoken with. Residents were seen in various parts of the home including the main lounge, quiet lounge and bedrooms. People were engaged in various activities such as watching the television, reading books or newspapers and talking with each other or visitors. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 13 Residents spoke about enjoying their preferred life style. They spoke about being able to make choices about their daily living, including where and how they spend their day and the food they eat. Residents were having their hair done by the hairdresser, who was doing manicures during the afternoon. There were some good examples of artwork in the entrance hall, dining room and manager’s office that reflected the impact of the activity co-ordinator on social elements of life. One resident said she was an artist and invited me to view her work displayed in her bedrooms. Four visitors were seen and spoken with. They all said they were made to feel welcome by staff. They said staff were always about and that they were friendly and polite. Visitors said they could visit whenever they wish. They were confident their relative or friend was well cared for. Residents said they looked forward to activities and felt they could join in if they wished. They said staff were always about if they needed them and they were very kind and helpful. Residents said they could spend time in their room if they wished, although on the day of inspection most people were in communal areas of the home. The arrangements at lunchtime were observed. People were eating their lunch where they wished and a significant number were eating in the dining room. Meals were served ready plated and were carried from the kitchen properly covered. Meals looked appetising and were well presented. Those people needing help were receiving discreet assistance from staff. Where they needed to be fed, staff sat beside them. The atmosphere in the dining room was calm and relaxed. Tables had been attractively laid. Residents said they like the meals at the home and said they were tasty and there was plenty to eat. Residents were also seen having drinks served throughout the day. Cedar House Nursing & Residential Home DS0000015626.V344491.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is clearly written, easy to understand and well displayed in the home. People are supported so they can exercise their democratic rights. Training of staff in the area of protection is regularly arranged. Good recruitment practice helps to protect people from abuse. EVIDENCE: The complaints records were seen and included information about action taken and any issues to be dealt with as a result. The home’s complaints procedure was seen displayed clearly in the entrance hall. Residents and staff said they knew the complaints procedure. Residents said they would speak with Ms Hart or another member of staff if they had any concerns. Visitors were aware of the complaints procedure. Ms Hart described the arrangements made to support people to exercise their democratic rights at the last election. Three people voted in person and 21 people used postal votes. Those people voting in person were supported by staff to do so. The home’s recruitment procedures were robust. Staff receive regular training in respect of adult abuse awareness. No abusive practice was seen. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the needs of the people who live there. The service providers have commenced a significant programme of improvement to the environment. The home is clean and tidy and smells fresh. EVIDENCE: A tour of the home was undertaken with Ms Hart although not all bedrooms were seen. Work had started on the construction of the conservatory although the structure was not complete at the time of inspection. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 16 The progress on work to the environment was assessed against the home’s action plan time line. There was evidence of significant improvements and Ms Hart described the work still to be done over the coming months. There have been some changes to the plan but it was clear that the momentum has not reduced. Improvements have been made to 15 bedrooms, either through redecoration, deep cleaning, carpet replacement and/or new furniture. The entrance hall has been redecorated and re-carpeted and the ground floor toilet has been refurbished to provide disabled access. All bedrooms now have wheeled drawers for storing continence wear and toiletries. Ms Hart confirmed that quotations have been obtained for the refurbishment of the dining room once the conservatory is complete. Externally the courtyard garden has been enhanced by garden furniture. Ms Hart has plans to make further improvements to this area. The kitchen is due to be replaced imminently. Ms Hart said that arrangements are well advanced to ensure catering whilst the kitchen is not available. All areas of the home were clean and tidy and no lingering unpleasant odours were detected. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff rotas show that the home is staffed sufficiently. The service ensures that all staff receive relevant training. Staff are able to undertake external qualifications beyond the basic requirements. The service has a good recruitment procedure. EVIDENCE: Three staff files were looked at in detail. Each file contained relevant information about the person, their recruitment and training. Robust recruitment procedures were in evidence. Staff training records were looked at. These included induction, fire safety emergency 1st aid, health & safety, food hygiene, abuse awareness, NVQ, nutrition & diabetes and infection control. The induction records were compliant with Skills for Care. A copy of the staff rota for the week of inspection was provided. This showed that, in addition to Ms Hart, the home employs 1 qualified nurse and 4 care staff between 08:00 & 20:00. One qualified nurse and 2 care staff are employed between 20:00 & 08:00. The home employs domestic staff although it was established that Ms Hart had needed to vacuum 7 bedrooms the day Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 18 before inspection as 1 of the domestic staff was on holiday. Ms Hart said a new member of the domestic staff was due to start at the home shortly. She also said that it was intended a separate laundry person would be employed. The home has achieved Investors in People. The deputy manager is currently studying towards her Registered Managers Award. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualifications and experience and is competent to run the home. There is a quality assurance and monitoring process to ensure efficient running of the home. Staff meetings take place and there are regular supervision sessions. There are health & safety policies in place that protect people using, visiting or working at the home. EVIDENCE: Ms Hart is a qualified nurse and experienced and competent manager. She gave evidence of continuous learning including achieving train the trainer, phlebotomy and various updates. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 20 The most recent quality assurance summaries were provided during the inspection. These included a resident satisfaction survey and a meal survey conducted in June 2007. There was also a summary for the staff questionnaire. The summaries showed overall high levels of satisfaction from residents. Staff feedback was also positive. The only action point raised was regarding residents meetings. Ms Hart said that the home looks after personal allowances only. The records for one person were checked against money held and these were correct. Good practice was seen, with records including full details of expenditure and 2 signatures for all transactions. Receipts were also in place. Staff supervision records were looked at. All events are being recorded but it was noted that for 2 staff had not achieved 6 supervision events during the year. This was pointed out to Ms Hart. Appraisals are taking place annually. Accident records were seen and cross-referred to a notification received by the Commission. The accident records were well written. There was evidence that Ms Hart does a monthly analysis of accidents and looks at the location, time and type of accident in order that remedial action can be taken to reduce reoccurrences. Control Of Substances Hazardous to Health data sheets for laundry products were seen in the laundry. Ms Hart said that the suppliers were providing good training for staff. Legionella checks were taking place on the day of inspection. Service records were seen including the sluice (2/9/06), Portable Appliance Testing (03/07), Hoists (04/07), bath hoists (04/07) & Environmental Health Officer (18/1/07) at which it was advised the home needed a new chopping board. This was dealt with straight away. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 21 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 4 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 22 No 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. Standard Regulation Requirement Timescale for action 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 Daily care records need to include more information about the social and emotional needs of people and how they are met on a daily basis. Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI Cedar House Nursing & Residential Home DS0000015626.V344491.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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