Inspection on 24/05/07 for Cedar House Residential Care Home

This inspection was carried out on 24th May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cedar House Residential Care Home 20/06/06

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 Key Unannounced Inspection 24th May 2007 1:30 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.V337740.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.V337740.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.V337740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2007 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 yards 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. There is also a quiet sitting area on the ground floor. The registered provider, Mrs Jacqueline Barham, takes an active role in the day-to-day running of the home. The registered manager, Mrs Christine Ransley is responsible for the day-to-day running of the home. The range of fees for this home is between £303 and £520 Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit formed part of the overall inspection process for the year 2007/08. The content of this report also takes into account information provided to the Commission for Social Care Inspection (CSCI) by the home, health and social care professionals and other sources, since the last inspection. During the course of this visit it was possible to speak to several of the residents. A number were visited in the privacy of their own rooms and some were spoken to in the communal areas. Staff were spoken to in private and indepth discussion was held with the registered manager, Mrs Christine Ransley and the registered provider, Mrs Jacqueline Barham. Relatives who were visiting the home were also spoken to in private. Documentation, including care plans and staff files, was examined and a tour of the home was made. Both direct and indirect observation was used throughout this visit. The home has maintained and improved upon the National Minimum Standards. In particular, there has been a significant improvement in communication at all levels. Many positive comments about the home were received both prior to, and during, this visit. Comments included, “This is a marvellous home, the staff couldn’t be kinder,” “They look after us very well,” and, “ As a family, we are all very pleased with mum’s care and they make us all very welcome too”. What the service does well: What has improved since the last inspection? Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 6 Communication within the home has significantly improved. Regular meetings with the manager and the registered person have been established. There are weekly staff meetings that the manager leads. The registered person attends these meetings on a fortnightly basis. Residents, their relatives and staff all said that they felt they had been kept very well informed of recent changes in the organisational structure of the company. There have been a number of environmental improvements. The dining room, hall and landings have been redecorated and there is a new carpet in the dining room. A new training room has been created on the upper floor. Cleaning at the home has improved. There are now two cleaners, cleaning is more thorough and more frequent and rigorous checks are now made. The way the residents are offered choice has improved. For example, residents have always been able to choose to have a cooked breakfast, but in the past this has not been positively emphasised. Both the manager and the registered person are making greater efforts to ensure all residents understand this choice and that kitchen staff comply with their wishes. A post has been created for a teatime kitchen assistant. This means that care staff do not have to leave their caring duties to help out in the kitchen at teatime. Activities at the home have improved. The activities are now much more creative, for example, a “Wimbledon Week” with strawberries and cream and other tennis themes, is planned for June. The home is now providing small prizes for residents when they participate in games such as bowls and skittles. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar House Residential Care Home DS0000023381.V337740.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.V337740.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate pre-admission assessments are made. This ensures that only those residents who are suited to the home and whose needs can be met are admitted to the home. EVIDENCE: There are robust admissions procedures. Documentation concerning recently admitted residents showed that appropriate pre-admission assessments have been made. Staff said that the care plans of newly admitted residents give them plenty of information and that, during the first few weeks in the home, they add to the information, making sure that the choices, interests and likes and dislikes of the residents are recorded and respected. One member of staff spoke enthusiastically about how she had been able to shadow the manager when Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 9 she carried out an assessment. She said that she was very pleased to see how thorough this process was. Residents said that they had been able to make visits to the home prior to admission although some said that they trusted their families to do this for them. The manager said that arrangements for trail visits and overnight stays can be organised if wished. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home cares for the residents very well. Their privacy and dignity is respected and their health and well-being is promoted. This means that the residents are able to maintain their independence as long as possible and to lead interesting and fulfilling lives. EVIDENCE: A sample of care plans was examined. These were all up-to-date and in good order. They contain information about the residents’ health needs, their likes and dislikes, interests past and present and details of family contacts. The care plans are reviewed regularly. The manager said that she is constantly working to improve the care plans. Staff said that they use the care plans frequently and that they find them easy to use. They said that, as they get to know new residents they add to the information in the care plans. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 11 Health and social care professionals speak highly of the home and praise the manager for the way she maintains contact. The home has good systems for the prevention of pressure sores. Some residents have been admitted to the home, or returned from hospital, with sores. In these cases the home immediately liaises with the District Nurses and puts measure in place to relive pressure areas. Equipment for moving and handling is available and moving and handling training is up-to-date. Staff training in all areas is good and staff and keen to learn and to use good care practice. Residents and their relatives said that they receive good care and that “Nothing is too much trouble for the staff”. One resident said that she was so pleased with her care that she wrote to a national newspaper to express her satisfaction with the home and to make the point that, “There are good care homes even though the newspapers focus on the bad ones”. Residents said that the staff treat them with respect and dignity. One said, “They are always bright and cheerful, and never make you feel a nuisance, no matter what they have to do for you”. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities at the home have improved. They are now more meaningful and take into account the wishes and interests of the residents. EVIDENCE: The amount and variety of activities in the home have increased since the last inspection. Staff were very enthusiastic about encouraging the residents to participate in activities such as indoor bowls, skittles, chair exercises and bingo. The home now provides small prizes for these activities. Some residents prefer to spend time in their rooms. Thye said that they like to read their papers, listen to music and watch television. They said that staff are always helpful should they require anything and that they are never “made2 to join in if they don not want to. There are plans to broaden the scope of activities and run “themed” days. For example, there are plans to make Wimbledon fortnight “come alive” with strawberries and cream and other ideas with a tennis theme. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 13 The home manages nutrition very well. There are good systems for monitoring the nutritional well-being of the residents. On the day of this visit there was plenty of good quality, fresh produce in the home. There is a good choice of meals. Residents can have a cooked breakfast if they wish and there are two choices of meal at lunchtime. At suppertime there is a choice of a variety of hot and cold meals, such as baked potatoes, cheese on toast or sandwiches. If a resident does not like any of the choices on offer, a meal of their choice can be prepared or a nourishing drink offered. Nearly all the residents said that they enjoy their meals and have plenty to eat. However, one resident pointed out that some meals have too much gravy on them. The home should take care to ensure that all residents’ wishes are taken into account when serving meals. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are robust policies and procedures for handling of concerns, complaints and protection. This means that the views of the residents and their supporters and listened to and acted upon. EVIDENCE: There are good policies and procedures for the handling of concerns and complaints. There had been one formal complaint made since the last inspection. This was tracked and it was clear that the home handled this correctly. Although the complaint was not substantiated, the home reviewed its procedures. Staff files show good evidence of training in the Protection of Vulnerable Adult (POVA) both at induction and further training sessions. Staff were very clear about their responsibility to repost any concerns they might have in respect of POVA. They said that they would report concerns immediately to the manager. They were sure that she would act appropriately as, “She has an open door policy and always listens to what we have to say”. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is well maintained, spacious and sweet smelling. the residents a pleasant and homely place in which to live. EVIDENCE: A tour of the home was made. There is plenty of communal space. There is a large lounge, dining room and a smaller, quiet lounge. Outside there are pleasant, well-maintained gardens and a summerhouse. All areas were very clean and uncluttered on the day of this visit. Since the last inspection the dining room, hall and landings have been redecorated. There is also new lighting and a new carpet in the dining room. This has given the home a much brighter look. Bedrooms are re-decorated before new residents are admitted. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 16 This gives All the bedrooms are well furnished and personalised to reflect the lives, families and interests of the residents. The residents spoken to all said that they are very happy with their rooms. Since the last inspection two new cleaners have been appointed. The standard of cleaning in the home has significantly improved. On the day of this visit the home smelled sweet and fresh. The flat on the upper floor of the home has been rearranged. This now provides an office for the registered person, secure storage for confidential documentation and two large rooms that are used for staff training and storage of training materials. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, staff training and staff morale are all good and there are robust recruitment practices. This means that a skilled and enthusiastic staff team looks after the residents. EVIDENCE: Staffing rosters show that there are good staffing levels on all shifts. Since the last inspection an additional post of kitchen assistant has been created. This means that there is always a member of the kitchen staff on duty at suppertime. Previously a member of the care staff undertook kitchen duties at this time. This has released care staff time and improved infection control measures. Staff said that they have enough time to meet the care needs of the residents. They said that they also have time to support the residents in a variety of activities in the afternoons. They said that they love working in the home and that they are well supported by the manager, the registered person and the rest of the staff team. Residents said that the staff are very kind and always treat them with respect. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 18 Staff training is very good. Currently there are two staff taking the National Vocational Qualification (NVQ) at level 2 and one just about to finish the NVQ level 3. A great deal of training takes place in the home. The training matrix was up-to-date and showed that both mandatory and specialist training is being attended by staff. Since the last inspection a training area has been created in what was the flat on the upper floor of the home. This means that staff have a quiet area, away from the day-to-day life of the home where they can concentrate on their continuing education. The home is gradually building up a library here so that staff can access relevant information at any time. Staff were very positive about the training they have undertaken. They also said that there is an open culture in the home where they can ask, “As many questions as we need and never feel silly”. They were very positive about the way the manager helps them to learn during the course of a “normal day in the home”. One member of the care staff spoke enthusiastically about the opportunities she has been given to shadow the manager when undertaking the pre-admission assessment process. She said that she had learned a lot from this and now understood the importance of continuing the process when residents are newly admitted to the home. She said, “We are finding out about the residents all the time, making notes of their wishes and likes and dislikes and so on. Then we can care for them better if we know they like things done and what their interest are.” Regular one-to-one supervision is established and staff said that this is very helpful. A sample of staff files was examined. This included the files of the most recently appointed staff. All appropriate pre-employment checks had been made and the files were all in good order. There was good evidence on file that staff have undertaken appropriate training. The manager said that they had recently been able to recruit staff who are skilled and enthusiastic and that morale in the home is good. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 &38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Communication in the home has improved and the views of the residents and their supporters are taken into consideration in the decision making process. This means that the home is run in the best interests of the residents. EVIDENCE: Since the last inspection one of the registered providers has stepped down from the directorship of the company. Mrs Jacqueline Barham is now the sole registered person. This has clarified the lines of communication in the home and allowed for a clearer organisational direction. In depth discussion was held with both Mrs Barham and Mrs Ransley, the registered manager. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 20 They has now established clear, formal lines of communication that include weekly staff meetings led by Mrs Ransley and fortnightly meetings which are attended by Mrs Barham. Staff said that this is much better as they “know where they stand”. From discussions with Mrs Ransley and Mrs Barham it is clear that they have a sense of direction for the home and have identified aspects of the home that they would like to improve. The quality assurance at the home is good. Mrs Barham is in the home on four days a week and participates in the running of the home. On the day of this visit she had toured the home. She takes a particular interest in the activities going on in the home and makes frequent checks on the food quality. Residents are sent questionnaires every eight weeks. The manager checks these and acts when necessary. Residents said that the home is well managed and that they are asked about their views. One resident said that she was so pleased with the way the home is managed and the care she receives that she had written to a national daily newspaper. “But,” she said, “They didn’t publish it because it was god news and they don’t want to hear that. There are regular health and safety checks carried out in the home and these are well documented. No health and safety hazards were identified during the tour of the home. Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 X 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 X 3 Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP15 Regulation 16 Requirement Ensure requirement of each resident is considered when supplying meals. In particular, ensure that residents’ wishes in respect of gravy on their meals is respected. Timescale for action 31/05/07 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 OP33 Good Practice Recommendations The registered person and the registered manager should continue to work closely together to implement the continuous improvement plan for the home Cedar House Residential Care Home DS0000023381.V337740.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedar House Residential Care Home DS0000023381.V337740.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. 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