Inspection on 01/12/05 for Cedar House Residential Care Home

This inspection was carried out on 1st December 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.

Other inspections for this house

Cedar House Residential Care Home 24/05/07

Cedar House Residential Care Home 20/06/06

Cedar House Residential Care Home 18/08/05

Cedar House Residential Care Home 08/02/05

Cedar House Residential Care Home 30/06/04

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

CARE HOMES FOR OLDER PEOPLE Cedar House Residential Care Home 93 Seabrook Road Hythe Kent CT21 5QP Lead Inspector Wendy Mills Announced Inspection 1st December 2005 09:30 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 Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 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 Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cedar House Residential Care Home Address 93 Seabrook Road Hythe Kent CT21 5QP 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) 01303 267065 Mrs Jacqueline Mary Barham Mr Timothy John Barham Mrs Christine Ransley Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users with diagnosis of dementia to be restricted to one (1) whose DOB is 26/07/1910. 18th August 2005 Date of last inspection Brief Description of the Service: Cedar House is registered to provide residential care for up to 29 older people. The premises is a detached property with a garden to the side and rear on different levels and parking to the front. It is situated approximately 400 yds from local shops including a post office and a pub, a mile from Hythe centre and is on the local bus route. Each bedroom has a private wash-hand basin and call bell, some rooms have ensuite facilities. The proprietors, Mr & Mrs Barham, take an active role in the day-to-day running of the Home. The registered manager is Mrs Christine Ransley. The house has a well-maintained garden with a detached sunroom with easy access for the use of residents. On the ground floor there are two lounges and a separate dining room, which also incorporates a quiet sitting area. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection began at 9.30am and lasted seven and a half hours. Mrs Jackie Barham, one of the registered providers, Mrs Christine Ransley, the registered manager and Mrs Sara Venables, the deputy manager, assisted with the inspection. The inspector was able to speak to ten residents, in the privacy of their own rooms, during the course of the inspection. In addition, she spoke to several other residents in the communal areas. Five members of staff were interviewed in private and discussion took place with the management team. Prior to the inspection telephone contact was made with some relatives and supporters of the residents. The responses to pre-inspection questionnaires that were sent to residents and their relatives have also been considered when preparing this report. Key documents were examined and a tour of the home was made. Both indirect and direct observations were made throughout the inspection. The residents, their relatives, the staff, the registered manager and provider are thanked for the welcome they gave and for their assistance during this inspection. What the service does well: What has improved since the last inspection? The home has introduced a new complaints procedure with the objective of improving confidentiality. However, this now involves a more complex procedure for staff and it is possible that there has been some under recording of complaints since the new system was introduced. There is a new addition to the medication procedures that covers safety of medicines being taken out of the home by residents. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 6 Hand towels in the toilets are now changed twice a day to minimise the risk of cross infection, however, the home should ensure that it meets infection control standards by seeking the advice of the Health Protection Agency. 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 Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 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 Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 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, 2, 3, 4 & 5 The home’s Statement of Purpose and Service User Guide are good. They provide prospective residents and their supporters with the information they need to make a decision about moving into the home. However the home should provide more clarity about their written terms and conditions. Appropriate assessments are carried out and trial periods offered prior to residents moving into the home. EVIDENCE: The Statement of Purpose and the Service User Guide are comprehensive and easily understood. The insurance certificate, registration certificate and last inspection report were all on display in an area convenient for the residents. There are written terms and conditions of residency contained in the files of privately funded residents. However, the contracts for those who are publicly funded were unavailable for inspection. It is therefore possible that some publicly funded residents are not fully aware of their rights whilst living in the home. Charges are made for some activities that take place in the home but residents were unaware of which activities or what the charge might be. More Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 9 clarity is required so that the residents and their supporters know what they can expect to be included in the fees and what additional charges there might be. Inspection of the care plans for the most recently admitted residents showed that appropriate pre-admission assessments had taken place. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 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 The residents know that their care needs are reflected in their individual care plans. They know that their records will be kept securely and that confidentiality will be maintained. However, not all the residents feel that their views are listened to and that their choices are respected. Some feel that there is a lack of respect. The systems for the management of medicines within the home are good and there are clear and comprehensive arrangements in place to ensure the medication needs of the residents are met. EVIDENCE: Appointments with GPs and hospitals are made and kept. Transport is arranged when necessary. Most of the residents said that the staff care for them very well and treat them with kindness and respect. They were aware of that the home keeps records about them and were confident that these are kept securely. However, some residents and relatives expressed concern that their care needs are not always met. When questioned, some residents said that staff did not always respond to their requests and that, on occasions, a senior member of staff had been rude, uncaring and abrupt, saying words to Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 11 the effect that the resident was not the only one in the home. The home must investigate this and ensure that staff treat residents with respect at all times. The systems for medication were inspected. Good procedures and practices are in place and a new procedure has been introduced for when residents take medicines out of the home. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 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, 14 & 15 The home tries to ensure that the residents are able to enjoy an interesting and fulfilling lifestyle. However, some evidence was found to suggest that it does not always respect the choices and preferences of the residents and that scheduled activities do not always take place. The home demonstrates a clear understanding of the importance of good nutrition and provides appetising and nutritious meals. However, the surroundings in which meals are taken are beginning to look tired and shabby. New carpets, redecoration and better lighting would improve the dining room and make it a more comfortable place in which the residents could enjoy their meals. EVIDENCE: There are a number of activities that are scheduled to take place in the home. Care staff are expected organise sessions such as chair exercises, skittles and bingo. However, several care staff said that they did not always have time to lead the activities. Some respondents to the questionnaires said that they would like more activities and relatives said that, although the home’s brochure says that outings are organised, none had taken place. An entertainer visits the home monthly and residents are charged for this at £3 per session. However, not all the residents were aware that a charge is made for activities. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 13 Some evidence was found to suggest that the home does not take enough care to ascertain choice and provide for lifestyle needs. It was disappointing to find that one resident still had not been supplied with ice for his drinks despite this being a requirement at the last inspection. Residents said that they enjoy their meals and that there is always plenty to eat. There was a plentiful supply of fresh fruit and vegetables in the home. On the day of inspection there had been a problem with the gas cooker and the cook had managed to prepare a tasty hot meal with plenty of fresh vegetables, on a small domestic cooker two flights of stairs away from the dining room. She is commended for her commitment to her work under very difficult circumstances. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 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 The home has a complaints system that has recently been changed to improve confidentiality. The procedure is now more complex and requires revision. Staff, in general, have a good awareness about adult protection issues. However, some evidence was found that senior staff are not following codes of practice when talking to residents and dealing with their concerns. EVIDENCE: A new and more complex complaints procedure has been introduced. This means that staff now have to complete a form rather than write in the complaints book. This ensures greater confidentiality in respect of complaints, however, it is more time consuming. Some staff said that the form puts them off. They were also unclear as to how serious a complaint should be before they recorded it. They agreed that the new procedure is likely to mean that fewer complaints are recorded. The home should revisit this new procedure to see if it can be simplified. Complaints training should then be provided for staff and residents should be made aware of the new procedure. Most residents said that their complaints are listened to and acted upon but some evidence was found that not all complaints have been dealt with sympathetically. As identified in the previous section, some staff have apparently been impatient with some residents. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 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 the following standard(s): 19, 23, 24, 25 &26 The standard of the environment within the home is mostly good and provides the residents with a homely place in which to live. However, there has been deterioration in some areas since the last inspection. This detracts from the ambience of the home and now presents a heath and safety hazard. EVIDENCE: A tour of the home was undertaken in the company of the manager, Mrs Ransley. Most areas were clean, pleasant and free from offensive odours. However, the toilet in one bedroom was in a very dirty state. This room belonged to a resident who was in hospital and should have been locked. The standard of cleaning of several other toilets, particularly ensuite facilities, was poor. The registered manager said that there is only one cleaner for the whole home and it is not possible for all areas to be kept clean with the time allocated to cleaning. The carpet in the dining room is very worn and faded and now presents a trip hazard. The carpet tiles in the hall are beginning to lift and also present a trip hazard, as does an area of carpet on the first floor where there is a change of Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 16 level. An immediate requirement notice was issued in respect of these carpets. The accommodation is spacious and all bedrooms rooms are of a good size. The standard of décor is good throughout. The gardens are well maintained and there is a separate garden room and a quiet lounge. The residents said that they are happy with their rooms and that they have been able to bring items from home to make their rooms more attractive. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The staff have a good understanding of the support needs of the residents. Relationships between the staff team and the residents are mostly very positive, however, some exceptions were found. EVIDENCE: Indirect observation confirmed that the staff relate well to the residents. The residents said that most of the staff are very kind, friendly and helpful and that they come quickly if they ever need to ring their buzzer. However, there was mention of unhelpful remarks made by a minority of staff. Conversation with staff showed that they are committed to their work and they generally express a high level of job satisfaction. However, they all said that the communication difficulties currently being experienced by the registered providers can create a poor atmosphere within the home. They said that they did not think this was upsetting the residents yet but it has clearly impacted on staff morale. The registered providers must find a way of communicating effectively and ensure that their differences are not expressed within the confines of the home. Staff said that, although staffing levels have improved, there are still times when there are not enough staff to meet the needs of the residents. This can mean that there are no activities provided. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 18 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, 32, 33, 37 & 38 The registered manager provides clear leadership throughout the home. She demonstrates a commitment to self-monitoring and a continuous improvement plan. However, recent communication problems between the providers have led to deterioration in the way the home is run and a less cohesive management approach. Records are well maintained EVIDENCE: The registered manager is very experienced and demonstrates clear leadership skills. She has a comprehensive understanding of the principles of good care practice and communicates well with staff, residents and their relatives. All the staff were very positive about her ability to manage the home but said she had been put in a difficult position by the poor communication between the registered providers. Staff also said that they did not believe she was well supported by the deputy manager. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 19 Clear evidence was found to suggest that the attitude of one of the registered providers is now having an adverse effect on the home. Both staff and some residents are aware of the animosity that exists. Staff say that this is now causing a lowering of staff morale. They say that they try to keep this from the residents but believe that it will soon deter from the good atmosphere that the home used to have. Some say they have already considered looking for alternative employment because of these issues. Staff believe that there have been additional financial constraints over the past months. They believe that there has been a recent lack of investment in the home, staffing and residents activities. The registered providers have not submitted Regulation 26 reports to the CSCI since the last inspection. Whilst they both maintain a presence in the home but they do not appear to talk in private with staff or residents in order to obtain their views. Records are generally well maintained and nearly all documentation requested during the inspection was made available promptly. However, some records were apparently kept in the locked office of the registered provider and these were therefore unavailable on the day of inspection. A requirement has been made for the registered provider to supply a copy to the CSCI. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 20 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 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 2 X X X 3 2 Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP2 Regulation 5 Requirement Service users who are publicly funded should be supplied with copies of their terms and conditions. These terms and conditions should be available for inspection by the CSCI at all times. All service users should have clarity about additional charges made; for example, they should know that a charge is made if they participate in certain activities. Care plans to contain sufficient information about service user preferences and to ensure staff adhere to the guidance in the care plan. Home to ensure adequate opportunities for appropriate exercise and physical activity Home to ensure that all staff treat the service users with respect at all times. Home to ensure appropriate that an appropriate level of activities takes place within the home. Records both in care plans and in the daily record to be made of activities taking place and of any DS0000023381.V258456.R01.S.doc Timescale for action 31/01/06 2 OP7 12 31/01/06 3 4 5 OP8 OP10 OP12 12 12, 13 12, 13 31/01/06 31/01/06 31/01/06 Cedar House Residential Care Home Version 5.0 Page 22 6 OP14 12(1)(2) 7 8 OP16 OP18 22 12 (5) (a) (b) 9 OP19 23 10 11 12 13 OP26 OP27 OP30OP28 OP33 23 18 18, 19 24,26 14 OP38 23 charges made to the service users for participating in activities. Home to ensure appropriate choice is afforded to the service users. Records to be kept of personal preferences of the service users. Complaints procedure to be reviewed and staff to undergo complaints training Home to ensure good relationships between providers, management, staff and service users to ensure the protection of the service users from harm and distress. Carpet in dining room to be replaced. Carpets in hall and landing to be assessed for safety and wear. Cleanliness of home to be improved Home to ensure sufficient staff to meet the needs of the service users Home to ensure all staff treat the service users with respect and dignity at all times. Effective quality assurances measures to be put in place. The registered providers to improve communication and to send regular reports to CSCI in accordance with Regulation 26. A health and safety audit of premises to be carried out and written report to CSCI 31/01/06 31/03/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 23 No. 1. 2. Refer to Standard OP15 OP15 Good Practice Recommendations The Manager should continue to work very closely with cook to ensure that food handling is safe and that menus continue to have plenty of variety. The home should provide ice and lemon for those residents who would like this in their drinks. Cedar House Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Residential Care Home DS0000023381.V258456.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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