Inspection on 20/06/06 for Cedar House Residential Care Home

This inspection was carried out on 20th June 2006.

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 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 01/12/05

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 Unannounced Inspection 20th June 2006 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.V300644.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 Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 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 Cedar House (Hythe) Ltd Mrs Jacqueline Mary Barham Mrs Christine Ransley Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 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. 1st December 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 home is large, a detached property with well maintained gardens to the side and rear. There is sunroom in the rear garden and parking to the front of the home. Cedar House is situated approximately 400 yds from local shops, a post office and a pub. It is 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. On the ground floor there are two lounges and a separate dining room, which also incorporates a quiet sitting area. 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 range of fees for this home is between £303.33 and £520 Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection began at 9.30 am and lasted seven hours. Mr Tim 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 seven 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. Three members of staff were interviewed in private and discussion took place with the management team. Other staff were spoken to during a tour of the home. Prior to the inspection telephone contact was made with some relatives and supporters of the residents. 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 piloted a new complaints procedure and made some adjustments to make it less complex. There have been a number of environmental improvements. New carpets have been fitted to some areas, the dining room has been re-decorated and new carpeting is on order for this area. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 6 A new staff induction programme that is in line with current recommendations has just been introduced. Environmental risk assessments have been updated and PAC testing completed. The standard of cleanliness has improved and more regular checks are made on the standard of cleanliness in the home. 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.V300644.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 Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 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. Appropriate pre-admission assessments are made. This ensures that only those residents suitable for the home are offered a place. The quality in this outcome group is good. This judgement is based on evidence gathered both before and during this visit. 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 for all residents. The home has reviewed and revised the written contracts since the last inspection. The clause that stated an additional charge for activities has been removed Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 9 and the registered provider gave his assurance that no charge has been made for activities for some considerable time. Relatives said that they were pleased with the information they were given prior to making a choice about the home. Appropriate assessments are carried out and trial periods offered prior to residents moving into the home. There was discussion with Mrs Ransley, the registered manager about the need for a written visitors’ policy. This would provide greater safeguards for existing residents by protecting their privacy and maintaining confidentiality. It is recommended that the home produce a comprehensive policy and procedure for visitors to the home. 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.V300644.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 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. More attention to detail is required when meeting the health and social needs of residents. 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. The quality in this outcome group is good. This judgement is based on evidence gathered both before and during this visit. EVIDENCE: Care plans show that appointments with GPs and hospitals are made and kept. Transport is arranged when necessary. All 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, it was noted during the inspection that the Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 11 home had not responded in a timely way to some requests from residents. For example, some residents had asked for specific items to be purchased on their behalf and this had not been done. Both the registered manager and the registered provider said they would rectify this situation immediately. Good procedures and practices are in place for the management and administration of medicines in the home. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The home tries to ensure that the residents are able to enjoy an interesting and fulfilling lifestyle. More attention to detail in respect of the choices and preferences of the residents is needed. The home demonstrates a clear understanding of the importance of good nutrition and provides appetising and nutritious meals. The quality in this outcome group is good. This judgement is based on evidence gathered both before and during this visit. EVIDENCE: Some evidence was found to suggest that the home still 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 two inspections. Residents said that they enjoy their meals and that there is always plenty to eat. The freezers, refrigerators and store cupboards were all well stocked on the day of inspection Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 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 the following standard(s): 16, & 18 The home has a sound complaints system and adult protection policies and procedures. This means that the residents are protected from all forms of abuse. The quality in this outcome group is good. This judgement is based on evidence gathered both before and during this visit. EVIDENCE: A new and more complex complaints procedure was recently introduced. This system has been piloted and some changes made to ensure it is easy for residents, their supporters and staff to understand. There is greater confidentiality in respect of complaints. Most residents said that their complaints are listened to and acted upon and staff said that they would always make a complaint on behalf of a resident if necessary Staff have a good awareness about adult protection issues and said that they would have no hesitation in reporting another member of staff if they felt it necessary. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The standard of the environment within the home is good. This provides the residents with a safe and homely place in which to live. The quality in this outcome group is good. This judgement is based on evidence gathered both before and during this visit. EVIDENCE: A tour of the home was undertaken in the company of the manager, Mr Barham, one of the registered providers. There has been a significant improvement to the environment since the last inspection. All areas were clean, pleasant and free from offensive odours. There has been an increase in the hours the cleaners work and this has improved the standard of cleanliness in the home. There are now more residents in the home and it will be important to continue to monitor the level of cleanliness in the home as the workload increases. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 15 The carpet tiles in the hall have been secured and new carpets have been fitted to the upstairs landings. The dining room has been re-decorated and a new carpet is on order for this room. 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 garden room is accessed by a walkway and is little used by residents. On the day of inspection, it was a little untidy. Residents said that they did not like to use this room as they felt isolated and were worried that they might be left there with no means of calling the staff. It is recommended that this room be tidied and that residents are encouraged to use the room for activities with a member of staff in attendance. The residents said that they are, “more than happy,” with their rooms. Most residents have brought items from their own homes into their rooms. This gives them a comfortable and homely feel. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 16 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 and Relationships between the staff team and the residents are positive. The home provides a good level of training for the staff. This means that the residents benefit from a well-informed and competent staff team The quality in this outcome group is good. This judgement is based on evidence gathered both before and during this visit. EVIDENCE: Indirect observation confirmed that the staff relate well to the residents. The residents said that the staff are very kind, friendly and helpful. Staff said that they feel the atmosphere in the home has improved although they still feel this could be improved. They said that there are enough staff to meet the needs of the residents although they identified a time in the afternoon when there is additional pressure on staff. It is recommended that staffing levels at times when there is additional pressure be reviewed. There are three new members of staff. The home has devised a new induction programme in line with the most recent good practice recommendations and the new staff are currently taking part in this training. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 17 The staff records of the new members of staff were examined. All appropriate checks had been made prior to allowing these staff members to start work in the home. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 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, 36 & 38 The registered manager provides clear leadership throughout the home. Communication within the home has improved but work on this must continue. Records are well maintained and Health and Safety in the home has improved. The quality in this outcome group is adequate. This judgement is based on evidence gathered both before and during this visit. 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. Staff said that she is very supportive and listens to their concerns. However some staff were not confident that she always acts in a timely way to address concerns. This may be because they do not receive enough feedback on concerns that they have raised. It is recommended that the registered Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 19 manager checks that all staff are kept informed, where appropriate, about the concerns they have raised. There are regular staff meetings and a written record, available to all staff, is kept. One-to-one supervision for staff has now been established. The registered manager said that she tries to ensure this happens every eight weeks. The registered providers are making stronger efforts to improve communication. Staff said that there had been some improvement although they were not confident that the improvement would continue. It is very important that the registered providers find a way of maintaining and improving on the progress they have made so far. No Health and Safety hazards were noted during a tour of the home. All the Health and Safety hazards that were identified at the last inspection have been addressed. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 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 2 3 X 3 3 X 3 Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 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 OP8 Regulation 12, 13 Requirement More attention to detail to be applied when meeting the health needs of the residents. Home to ensure appropriate clothing is obtained for those residents who need loose and cool clothing in hot weather. Home to ensure appropriate choice is afforded to the service users. Records to be kept of personal preferences of the service users. This requirement is carried forward from the previous two inspections with an extended compliance date. Home to continue to improve relationships between providers, management, staff and service users to ensure the protection of the service users from harm and distress. Timescale for action 20/06/06 2. OP14 12(1)(2) 30/06/06 3. OP18 12 (5) (a) (b) 30/06/06 Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 22 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 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. Cedar House Residential Care Home DS0000023381.V300644.R01.S.doc Version 5.2 Page 23 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.V300644.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!