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Inspection on 28/07/05 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 28th July 2005.

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

The needs of residents are clearly set out in a plan of care. Care staff spoken to show a good understanding of their roles, and describe teamwork at the home as good. The manager has worked hard to ensure that care staff and nurses cooperate well together, and care staff say that nurses listen to and act on the information they give. During the course of the inspection staff were heard consistently to knock on residents doors before entering.

What has improved since the last inspection?

The deputy manager`s post has been filled and in the few months she has been at the home she has developed a good understanding of her role and she is to be commended for her hard work. This has allowed for some delegation of tasks to free up some of the registered manager`s time to attend to her responsibilities. Care staffing levels during the night have also improved to take account of the layout of the building and resident safety and dependency. Work is in progress to the exterior fabric of the building, improving its appearance, and sash windows in the dining room have been adjusted so that they do not fall closed presenting a risk to staff and residents. Locks have been purchased for residents` rooms and are in the process of being fitted. The standard of care planning and the regularity of review has improved greatly, as has the supervision of staff. Night staffing levels have improved and increase the flexibility of routine for residents as well as their safety.

What the care home could do better:

The inspector is concerned that where the numbers of "nursing" clients fell recently, staffing was cut and did not provide any additional input for those residents who were highly dependent but who were classified as residential care clients. It is understood that this is of the instigation of the company. This represented a failure to adequately staff the home and gave rise to a number of complaints. Although requirement is not made at this inspection, staffing levels must continue to provide for the full complement of residents. Care plans show the initial involvement of residents or their representatives, but there is no evidence that they are involved in or informed of reviews and subsequent changes. Action is needed to ensure that the "care" delivered by the activities organiser accords with the care identified as necessary to meet the recreational and social needs of residents, and that other staff are also able to attend to this area of care. There has been an increase of complaints recently, arising from changes in staffing levels predominantly. One of these has not been responded to with an investigation and details of action to be taken, within the required timescale. Residents still do not have lockable facilities in their rooms (although bedroom locks are now in the process of being fitted). Some staff have difficulty completing written evidence of their understanding of induction training delivered, so there is nothing to show that they are able to understand and apply the information given. Other methods of assessing competence need to be devised. Regular monitoring visits are undertaken, on behalf of the providers of the service, but these are always by arrangement with a telephone call being made in advance. This is not in accordance with the guidance of the regulations. Staff who are expected to deliver supervision to the staff team, should receive appropriate training.

CARE HOMES FOR OLDER PEOPLE Cedar House Nursing and Residential Home Church Road Yelverton Norwich NR14 7PB Lead Inspector Judith Huggins Unannounced 28 July 2005, 2.30pm 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 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 and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cedar House Nursing and Residential Home Address Church Road Yelverton Norwich Norfolk NR14 7PB 01508 494207 01508 495602 Telephone number Fax number Email 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 Hart Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 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. Date of last inspection 24 November 2004 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 service users’ rooms 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 or social centre is by private car or by bus service - running three times daily, according to the regional manager. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted 5 hours. The deputy manager assisted in the absence of the manager. During the inspection three care plans and a sample of other records was checked. Two residents, and two members of care staff were spoken to. The administrator and the cook were spoken to briefly. A short tour of the premises was made, but this was not fully inspected. What the service does well: What has improved since the last inspection? The deputy manager’s post has been filled and in the few months she has been at the home she has developed a good understanding of her role and she is to be commended for her hard work. This has allowed for some delegation of tasks to free up some of the registered manager’s time to attend to her responsibilities. Care staffing levels during the night have also improved to take account of the layout of the building and resident safety and dependency. Work is in progress to the exterior fabric of the building, improving its appearance, and sash windows in the dining room have been adjusted so that they do not fall closed presenting a risk to staff and residents. Locks have been purchased for residents’ rooms and are in the process of being fitted. The standard of care planning and the regularity of review has improved greatly, as has the supervision of staff. Night staffing levels have improved and increase the flexibility of routine for residents as well as their safety. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 6 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 and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 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 standard(s) 3 The standard of information gathered before admission has improved. Residents do not move into the home without having had their needs assessed and being sure these can be met. EVIDENCE: The pre-admission assessment for two people recently admitted were checked. These show that a good range of relevant information is collected before people are admitted. This is used, together with the resident or relative to complete other assessments and risk assessments promptly on admission. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8 and 9 Residents’ health, personal and social needs are set out in an individual plan of care. Residents’ health care needs are fully met. Where possible and a resident wishes, they are able to manage all or some of their medication (although without all having lockable facilities for storage). Where the home assumes responsibility for management, residents are protected by policies and procedures for dealing with medicines. EVIDENCE: Each resident whose file was seen, has a range of assessments of both needs and dependency. Care plan goals are identified together with the actions required of staff to meet them. Goals include encouraging choice and also reflect social and recreational needs. On one file the person’s risk of falling was cross-referenced with the use of bed rails. The use of these is verified by a “clinical risk assessment” carried out by one of the nursing staff. On one file the increased risk posed by use of these rather than a pressure mat has been recognised and the risk assessment reviewed and updated accordingly. This is very good practice. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 10 Files seen show that assessments (including dependency, nutrition, risk of pressure sores and self administration of inhalers) are reviewed regularly. Care plan goals are also reviewed monthly and updated to reflect changes in need. Goals cover areas such as personal care, memory and mental health, continence mobility, communication, pain management, medication and social interaction. This represents an improvement on what has been in place previously. The consent to care plans and wish to participate is signed initially by residents or their representatives. Reviews are not and could usefully be discussed at intervals with representatives, or regularly with those residents who are able to participate. Health related problems recorded in daily notes are promptly referred to the GP or for other appropriate advice. The continence advisor is also involved where needed. Staff are aware of health related issues and confident that anything they identify and report when they are delivering personal care, will be acted upon by nurses in charge of shifts, or by the management team. Where residents manage medication such as inhalers, there are risk assessments. The medication administration record (MAR) chart files contain reference information for staff, including the checking process and reporting systems in the event of error. Audits are in place. The medication was administered directly from the trolley to one person at a time, and the trolley was locked in between preparation of each person’s medication. When not in use, the trolley was seen locked securely to the dining room wall. A sample of medication records was examined and these show no omissions of signatures or codes. There are appropriate gaps when PRN medication is not administered/required. The contents of the trolley are stored in an orderly fashion in containers labelled for each person. Medication such as eye drops, with a limited shelf life following opening are dated when opened, and also have a four week expiry date recorded as a reminder for staff. Controlled drugs are stored appropriately, although none are currently in use. Temazepam is recorded as a controlled drug (due to potential for abuse) and records checked at random tallied with medication available. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12 and 15 The lifestyle in the home shows increased flexibility of routine of late, better reflecting preferences. However, social and recreational interests and needs are not fully met as set out in care plans. Residents eat in pleasant surroundings of the shared dining room or their own rooms, at times convenient. However, the choice of food is not appealing to all residents. EVIDENCE: Recreational and social needs are now documented as care plan goals within each file, which demonstrates a significant improvement. However, records of recreational and social activities do not reflect the stated interests and interventions on the care plan. For example, one person had an identified interest in gardening and cooking, and support instructions to discuss these issues and encourage discussion of television programmes about these activities. The list of activities participated in contained 12 entries since admission on 25 May. For one of these the resident was away, and one recorded an outing to Yarmouth. Three were for reminiscence and the remaining 7 were all for manicure and massage. Similarly, one person’s activity record did not reflect the care plan for encouraging supported walks in the garden, and an interest in knitting and jigsaw puzzles. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 12 There had been a recent outing to Yarmouth for some residents, which had clearly been enjoyed. A hog roast has also been held to raise funds for the home, based on the notice seen. A part time activities coordinator is in post, for 10 hours each week. The increase in night staffing levels has increased the flexibility of routine for residents. Staff say that not so many people have to be assisted to bed early because they require two staff to assist each one. This also increases flexibility in the morning, according to staff, as the extra night staff means that people can get up earlier than 8am if they wish. One person spoken to likes the food offered. Both people spoken to confirm that they are offered choices, but there is too much processed food for the liking of one person who also said food or drink is sometimes not hot enough. Quantities are described as good. One cook is identified as presenting better food than the other. Tea seen as served to several people in their rooms, consisted of a choice of sandwiches and home made cakes. Not all residents can and do use the dining room. Cloths and place mats are in use, and the room is well lit with good natural ventilation. One said that they liked to have breakfast in that room but to have tea in their own room with the television. A screening tool for nutrition is in use and residents’ weights and body mass indices. Staff spoken to were aware of the needs of diabetic residents and took this into account when serving drinks and snacks. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16, 17 and 18 Residents are confident their views will be listened to, but concerned that the manager cannot always act upon them. Residents’ legal rights are protected. Staff endeavour to protect residents from abuse, but their abilities are compromised on occasions by events beyond the control of the home and the management team. EVIDENCE: There are clear records when complaints are made. The responses to these are held separately in the administrator’s office. These show prompt acknowledgement of concerns. However, one complaint made on 14th June has received only a “holding” letter in response, based on information on file, and has not been investigated within the expected timescale. There is a pattern in the complaints, which reflects recent concerns by relatives that care could not be offered, as staff would wish. These were generated throughout the period identified by the deputy manager, when staffing levels had been reduced on the instructions of the providers. Some complaints letters are at pains to say how committed the staff are, while still complaining that residents had not received personal care to the standard expected. The providers are reminded of nurses’ responsibilities under the NMC codes relating to prevention of abuse, and that this covers neglect. “Examples include failure to attend to the personal hygiene of a client…..” See staffing standards. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 14 Residents’ privacy is outlined in policy guidance and they feel this is respected. There is clear, recorded evidence with two countersignatures, of residents wishes to vote, with comment regarding those who have declined the opportunity, and those to whom postal votes have been given. This is good practice. Staff have received training in protection of vulnerable adults, delivered by one of the adult protection team. The training schedule shows that 11 people attended this training so far in 2005, and 6 in 2004. Staff spoken to have a good understanding of the need to report concerns, for example, unexplained bruising. However, staffing levels as prevailed in June, together with substantiated and partially substantiated complaints, indicate residents could be at risk from neglect caused by the owners’ instruction to reduce staffing. This led to staff being unable to deliver personal care – specifically bathing – as considered necessary. Staff are clearly concerned about failings during this period, despite their best efforts. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 Residents do not have access to safe and comfortable indoor and outdoor communal facilities. Other outcomes were not inspected but some requirements from previous inspections are noted as not yet complied with. EVIDENCE: Risk assessments were noted as necessary at the last inspection to address the overcrowding of the lounge. The rear “quiet” lounge is a very small area and it is only possible to provide furniture to one side, as this is a designated fire exit. Additionally, access to it is via a narrow corridor with corners and presenting some difficulties for manoeuvring wheel chairs. Staff say that it is difficult for visitors to see people in the main lounge due to lack of space. The dining room is cramped at mealtimes. Mobility aids cannot always be placed next to people who need them, due to the space available. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 16 Staff and residents report that the grounds have recently been attended to and tidied so that the garden party could be held, but that they had deteriorated before this and are not being routinely maintained. It is noted that locks have now been purchased for residents’ rooms and are in the process of being fitted but this is not complete. The requirement has not been repeated given progress made. The requirement regarding provision of lockable facilities has not been met. Maintenance work to the exterior of the home is in progress and so no requirement has been made. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The current numbers and skill mix of care staff just meets residents’ health and personal care needs, although this has not been so in the recent past, and problems are exacerbated by the need to carry out ancillary tasks. Residents are supported and protected by the home’s recruitment policy and practices. Improved evidence is needed that staff are competent to do their jobs having received induction training. EVIDENCE: The staff complement at present reflects the minimum standards for occupancy of 25. There are 24 people in residence. Although all 24 are not “patients” in the sense that they require nursing care, between 18 and 20, based on assessment and feedback from the deputy and two other staff, need two staff to assist with moving and handling tasks. In June from rosters, staff and resident feedback and complaints, the staffing was reduced due to the number of people classified as needing nursing care, reflecting minimum levels for occupancy up to 20 people. The register shows that at that time there were 24 people living at the home. The providers therefore failed at that time to allow for any care for those people not classified as receiving nursing care. During this time the call system was also faulty meaning that staff needed to increase checks on people for a short period. The Commission was notified in Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 18 writing of this as affecting the welfare of residents, and staffing being insufficient to carry out increased monitoring as required. Additionally, the Commission has been notified of periodic shortages of night staff based on requirement made at previous inspections. Currently there is one permanent domestic staff member employed, working 37 hours each week. One of the newly recruited carers also provides 12 hours domestic input based on contract and roster, but for the week of the inspection was already working for 48 hours in care tasks. Care staff report that any shortfall, including the need to do laundry tasks, falls to them to complete. On the afternoon of the inspection there were two full laundry baskets awaiting attention. Residents say that laundry often takes a long time to be returned, and one says that sometimes items go missing. Residents say that there were not enough staff in June, and that it is now better although people are still very busy. For the week of the inspection, there was a shortfall of domestic hours. This has meant that the management team’s suggestions about implementing a domestic cleaning schedule of daily, weekly and monthly tasks has not been possible. There are areas of the home where carpets need deep cleaning and there was debris on a carpet on the top floor that the domestic had not been able to attend to. Although care staff levels meet the minimum specified at present, care staff have to carry out additional ancillary duties (laundry), taking them away from care tasks. This increases the difficulty in meeting recreational and social needs. Recruitment files for two people recently appointed were checked. Each showed that references and medical information was obtained, together with certificates of good conduct from country of origin, and checks against the Protection of Vulnerable Adults register in the UK. The files also recorded receipt of the General Social Care Council Codes of Practice and notes of telephone interviews conducted. The interview notes provide for discussion about gaps in employment record. The management team have endeavoured to source language courses where this makes it difficult for staff to adequately communicate with residents. Both new staff members had induction lists on file, but only one had any evidence of competence in those areas covered. The deputy manager reports some communication difficulties with written work making this difficult. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 36 Residents live in a home run by a manager with a good understanding and competence to carry out her role. (Her abilities are compromised on occasions by the providers who operate the home.) Residents benefit from the ethos, and leadership provided by the manager of the home. Staffing levels have compromised the ability of the manager to operate the home in the best interests of residents. Staff are appropriately supervised. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 20 EVIDENCE: Known from manager’s application to register that she is a registered nurse and has a management qualification. Improvements in some areas show that she has made efforts to address difficulties within the home that fall within her remit and over which she can exercise control. Recently, instructions from the providers have compromised her abilities to perform the task adequately. The training matrix seen shows that she periodically participates in training that is on offer. Staff spoken to feel well supported and that they can go to either the manager or the deputy if they have difficulties or issues they wish to raise. Both spoke of good teamwork and morale, and feel that the manager advocates for them on a range of issues such as staffing levels. Residents confirm that they can speak to the manager and see her regularly. There is evidence in the form of notes that staff meetings are held regularly. (One was due the day after the inspection based on the notice in the staff room.) Staff feel that they are listened to they say. The newly appointed deputy says that the manager is enthusiastic and committed to the service. The regional manager makes regular monthly visits to look at service quality, and reports are thorough, showing that an appropriate range of issues as set out in regulations is examined, with remedial action identified as necessary. However, the inspector was informed that these visits are always by arrangement with a telephone call being made in advance. As such they do not strictly accord with regulations. In addition to these visits, there are other monthly audits. These show a considerable improvement between audits of health and safety. There was also a general audit and audit of premises and maintenance. The deputy manager supervises the staff team. Dates and notes were seen confirming that these had taken place according to schedule, and staff confirm participation in supervision. The dates and frequencies show that these are on target to take place with the frequency set out in standards. There are some concerns about the duration of sessions, which may be as little as 15 minutes. Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION x 1 x x x x x x STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 3 3 2 x x 3 x x Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 22 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 12 Regulation 12, 16(2)(m) and (n) 22(4) Requirement The registered persons must ensure that care needed to meet recreational and social needs is delivered in accordance with the care plan. The registered persons must ensure complaints are investigated and actions due notified to complainants within 28 days. The registered persons must provide lockable facilities for service users to store personal effects and provide keys unless contra-indicated by risk assessment PREVIOUS TIMESCALE OF MARCH 2005 NOT MET. The registered persons must explore methods of securing evidence that staff understand the induction training that has been delivered and so are competent to carry out their roles. The registered persons must ensure that visits made on behalf of the registered provider are made unannounced. Timescale for action 30/09/05 2. 16 30/09/05 3. 24 16(2) 31/12/05 4. 30 18(1) 30/09/05 5. 33 26 31/08/05 Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 23 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 7 Good Practice Recommendations The registered persons should endeavour to increase evidence of involvement of residents and/or their representatives in the review of care plans (in addition to their initial set up). The registered persons should ensure that staff responsible receive training in the delivery of supervision. 2. 36 Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Cedar House Nursing and Residential Home I55 s15626 Cedar House v233018 (un) 280705 Stage 4.doc Version 1.30 Page 25 - 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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