Inspection on 23/08/06 for Cedar Lawn

This inspection was carried out on 23rd August 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 Lawn 24/01/06

Cedar Lawn 21/07/05

Cedar Lawn 18/01/05

Cedar Lawn 06/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Cedar Lawn Cedar Close Stratford On Avon Warwickshire CV37 6UP Lead Inspector Jean Thomas Unannounced Inspection 23 August 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 Lawn DS0000004214.V301526.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 Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lawn Address Cedar Close Stratford On Avon Warwickshire CV37 6UP 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) 01789 205882 01789 292752 home@str.mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Patricia Anne Dean Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: Cedar Lawn is a residential care home for older people managed by Methodist Homes. The home is registered for 34 older people requiring personal care and accommodation. The home is close to the town centre of Stratford Upon Avon and the facilities offered within the town. Buses run regularly nearby. The organisation has almost 50 care homes throughout England and Wales. Cedar Lawn was originally a large private dwelling, which has subsequently been converted and extended to provide residential accommodation suitable for older people. The main lounge and dining area are centrally located on the ground floor, however service users may also use the reception area or a sitting room on the first floor. In addition the home has a small quiet/prayer room on the first floor. All facilities, with the exception of five bedrooms, can be reached without the need to negotiate steps. Car parking is available at the front and side of the home. Extensive gardens are to the side of the home. Fees at the time of the inspection visit are in the range of £483.00 - £545.00 per week. The fees do not include newspapers, toiletries, chiropody or hairdressing. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This key inspection visit was unannounced and took place on Wednesday August 23 2006 commencing at 9.30am and concluding at 5.45pm. The registered manager was not available on the day, so the inspection was conducted with the deputy manager who was present throughout the inspection. The inspector had the opportunity to talk to three care staff, activities coordinator, cook, two health care professionals and two visitors to the home. Two service users were identified for close examination by reading their initial care needs assessments, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. Other documentation maintained in the home was examined, and this included policies and procedures, staff personnel files and training records, records pertaining to safe working practices and the arrangements for managing medication. The inspector had the opportunity to meet most of the service users and talked to four of them about their experience of the home. The service users were articulate and able to express their opinion of the service they received to the inspector. General conversation was held with other service users, along with observation of working practices and staff interaction with service users. The inspector joined service users for their midday meal. 10 questionnaire surveys were sent to service users and relatives. Four service users had responded at the time of writing this report. Since the last inspection on 24th of January 2006, we have not received any complaints; allegations of abuse or concerns and none have been received by the home. One requirement against the regulations was outstanding from the last inspection report. The trial period following admission enabled the individual to decide if the home was the right place for them. Service users confirm that they are treated with dignity and respect and are very happy living at the home. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 6 The home is well maintained, warm and clean. It has a comfortable, friendly atmosphere and provides a safe and happy environment for the service users. There are adequate toilet and washing facilities within the home. Each bedroom is individually personalised with service users possessions and is comfortable, homely and clean. The communal areas are pleasant and bright. The home is well managed and organised and medication procedures are robust to ensure the continuing protection of the service users. Inspector would like to thank staff and service users for their cooperation and hospitality. What the service does well: All four service users who returned comment cards said they liked living at the home felt well cared for and were satisfied with the overall care that was provided. One service user said, We are very well looked after here. When asked what the best thing was about the home one service users said it is very comfortable and staff are helpful. Another service user when asked the same question said, its wonderful. I couldnt fault anything there is nothing I dont like. Staff said the best thing about the home is that they put the service users first and worked well as a team. Staff feel they are enthusiastic and are well supported by the manager. The home is decorated and maintained to a satisfactory standard and furnished with good quality furnishings and fittings. Service users private rooms are personalised and are bright clean and comfortable. Communal areas are pleasant and homely and the home itself is extremely clean. A range of specialist equipment is in place for the benefit of the service users. Access to healthcare professionals is available, to maintain service users health. Service users confirmed that the staff are respectful towards them. The routines at the home are flexible, activities are available, and service users are able to choose how to spend their day. Spiritual needs of service users are given a high priority. A representative from the local church comes to the home to visit and offer communion. There is an open visiting policy, to encourage contact with family and friends. All service users said the food provided is “very good” and confirm that choices were offered. A varied menu is provided. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 7 There is a complaints procedure and service users are aware of their rights. All spoken with said they have confidence in the staff at the home, who will listen to their concerns and take them seriously. Adult protection procedures are in place. Health and safety systems are in place at the home, fire equipment has been checked and is regularly serviced. Mandatory staff training on health and safety takes place. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 8 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 Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 9 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): 2,3 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. Service users and family members have opportunity to visit the home prior to admission. A basic care needs assessment is undertaken to determine whether the home is able to meet the individuals needs. EVIDENCE: One of three service users spoken to said she had visited the home prior to admission and two said they moved directly to the home from hospital and had been unable to visit the home. All three service users said family members had visited the home to determine suitability prior to the service user moving in. Service users confirm they were able to have a trial period at the home before deciding to move in permanently. Examination of documentation evidence initial care needs assessments occur but the information held is limited. For example oral hygiene needs, medication and sensory loss or impairment is not always included in the initial Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 10 assessment therefore prospective service users cannot be sure the home is able to meet their individual care needs. Service users spoken with said they had a contract with the home and were aware of the terms and conditions including the fees. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. The health and personal care needs of service users are not fully documented and care plans fail to provide sufficient guidance for staff on how care needs are to be met. Medication administration in the home is well managed promoting health and reduce any risks to service users. EVIDENCE: The care plans and daily records of two service users identified for case tracking were examined. The amount of information recorded varies and does not always include detailed or accurate information necessary to enable staff to meet the service users care needs. There is evidence of regular reviews taking place but care plans are not always updated to reflect any changes in needs or circumstances. For example: 1. Following a review of medication undertaken by the GP Temazepam tablets are stopped. Care records state client to be monitored during next six weeks to see how she is coping daily records fail to evidence monitoring and the care plan was not updated to reflect the changes. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 12 2. Information recorded under the heading promoting continence makes no reference to an indwelling catheter in situ for a period of four weeks. 3. Cares plan are updated to reflect a urinary catheter has been removed or the need to monitor and record fluid intake and urinary output and ensure regular toileting so as to aid continence and limit the risk of urinary retention. 4. A second care plan for a second service user with an indwelling catheter requires staff to check the catheter bag regularly. Information recorded on daily records fails to evidence the catheter bag is checked regularly and indicates the catheter bag is emptied only once each day. 5. The care plan for a service user with diabetes requires food to be monitored daily records fail to evidence effective monitoring of dietary intake. 6. Comments noted on daily records include almost slipped out of chair, wedge removed from back. A risk assessment necessary to determine whether the service user is safe has not been carried out. Although written instructions are available to staff there has been no practical training on catheter care. It is recommended that practical assessments be undertaken so as to ensure staff are both competent and capable and understand the risks associated with poor practice. Information held in the care plans includes daily routines, dietary likes and dislikes, weight monitoring and waterlow assessments to determine whether the service user is at risk of developing pressure sores. The name of the designated key worker and the views of the service user are also included in the plan. Five service users spoken with said, they were not aware of the information held in their care plan and had not been involved in any review. Two family members spoken with said they had been involved in devising a care plan for their relative, but were not aware of any review of the care plan taking place. Service users have access to a range of healthcare professionals such as a GP’s, chiropodist and optician. Daily records evidence a community nurse visits weekly to check the blood glucose levels of a service user with diabetes. Two visiting health care professionals expressed the view that service users are well cared for and the staff are able to recognise any potential problems. Pressure area care is very good and the home provides hospital type beds and mattresses if assessed as necessary. Staff follow instructions given by the nurses and information shared during staff hand over is very good. Staff are respectful and personal care or health care treatment is always provided in private. The care received by service users is of a good standard and the staff do a good job. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 13 Four service users spoken with said staff respect their privacy, promote dignity and are always respectful. One service user said, I couldn’t get better care. I love being here and enjoy the company of others around me”. Observations evidence regular and engaging social interactions taking place between staff and service users. Four service users spoken with said they do not have a key to their private room. Discussion with the deputy manager evidence only two of the thirty-one service users has a key to their room. In order to promote privacy and enhance security it is recommended that all service users should be supplied with a key to their room unless their risk assessment suggests otherwise. When a key is not supplied the reason for not doing so should be recorded in the plan of care. The home employ both male and female carers. Three service users spoken with said gender issues had not been discussed with them and two said they didn’t mind having their intimate personal care needs met by a care worker of the opposite gender. One service user said she had objected to a male carer because she felt uncomfortable. In discussion the deputy manager said he was aware of the service users concerns, which were attributed to the service user not knowing the carer. It is recommended that gender issues and the delivery of intimate personal care be discussed prior to the service user moving into the home and the service users views recorded, acknowledged and used to promote best practice. Examination of the management, storage and administration of medication, evidence medication is stored safely and securely and only administered by designated and trained staff. Risk assessments are in place for those service users who administer or order their own medicines. Medication is wellmanaged and regular internal audits ensure staff compliance with the homes policies and procedures. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. Service users are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home seeks the views of service users and considers their varied interests and abilities when planning the routines of daily living and arranging activities. Routines are flexible and service users can make choices in major areas of their life. The routines, activities and plans are service user focused, regularly reviewed, and can be quickly changed to meet individual service users needs. EVIDENCE: The home employs an activities coordinator responsible for arranging activities for the benefit of the service users. These include: music and poems, painting, skittles, carpet bowls, exercises, prayer group, a hairdresser, a library service, outings into town and visits to a local school. In discussion the activities coordinator said she consults with service users formerly every two or three months and has regular informal discussions to determine individual needs and preferences before planning the weekly activities. Most service users participate in some form of social activity in the home and a number go out independently and others visit the local weekly market accompanied by the activities coordinator. A story time activity is Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 15 provided and mainly attended by service users with some degree of visual impairment. A number of life histories have been compiled and used in reminiscence therapy with service users. Four service users spoken with were very enthusiastic about attending activities and said they are always made aware of what’s going on and could choose which activities to participate in. Of the four service users spoken with two said they enjoy playing carpet bowls and one said, “I enjoy attending the prayer group and the Sunday church service”. One service user said she enjoyed reading and had access to a wide range of books in the home. A mobile library visits regularly to exchange books. The majority of books are available in large print and therefore generally suitable for service users with a visual impairment. On the day of the inspection a significant number of service users attended a prayer group activity and two service users spent time reading books borrowed from the library. As the activities coordinator works Monday to Friday and in an effort to ensure service users are getting sufficient interaction and stimulation from the homes activities, plans to include weekend activities are being explored. Service users confirm their relatives and friends are able to visit at any time, and that they could always see them in private, if they choose. The inspector joined service users for lunch, which was enjoyed by all. On the menu were chicken and ham quiche or corned beef served with jacket potatoes and salad followed by yoghurt or ice cream. Most service users were very able and required no assistance to eat their food. Carers were available throughout the meal to provide any necessary support and assistance. Staff responded to service users needs in a sensitive, caring and relaxed manner. Three service users spoken with told the inspector how much they enjoyed the food. The meal was attractive nutritious and plentiful. Each place at the table is marked with an attractive name card hand decorated by a service user in the home. It was agreed with service users that table placings change each month to give all the service users an opportunity to move around and sit and mix with others. Menus are displayed on each table and accurately reflect the choices available. A visit by the Environmental Health Officer (EHO) on August 5th 2006 identified a number of shortfalls in areas that are necessary to make certain that food is safe. Issues identified include: 1. Some repairs and redecoration are required in the fruit store. 2. In the kitchen, the glass roof was cracked and should be renewed. The walls and ceiling should be finished with a waterproof emulsion. 3. All stored foods should be date coded to ensure safe shelf life and if frozen; food should be labelled with date of freezing and date of defrosting. 4. Faggots were found on the premises, which were past their use by date. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 16 5. An insectocuter should be installed in the kitchen to deal with flying insects. In discussion the deputy manager said some refurbishment of the kitchen is planned and a number of the shortfalls identified have already been addressed and that a further visit by the EHO will take place to confirm compliance. New and improved lighting has been installed in the dining room thus enhancing the environment, especially for those service users who are visually impaired. This is to be commended. A tour of the kitchen found store cupboards hold a wide range of provisions and food opened and stored in the fridge is sealed and dated. Discussion with the cook and examination of documentation evidence a cleaning schedule is in place and used by staff to ensure all areas of the kitchen are regularly cleaned. Records are held of fridge and freezer temperatures and of high risk cooked foods. In discussion the cook said he consults regularly with service users about the quality and choice of food and takes into account the dietary needs, views and opinions of service users when devising menus. Comments made directly to the inspector about the food include: • I cant praise the food enough, its wonderful. • The only complaint I could make is that theres too much of it. • It’s exceptional. • If you dont like whats available you can always choose an alternative. Information noted in the home’s comments book include: • Our meals are good always. However on Sunday it was very special with a lovely roast and vegetables, then a Strawberry cheesecake that was delicious and served with politeness and gentle humour, as usual. Thank you. Breakfast commences at 7am for service users who are going out, but most choose to have breakfast between 8.30am to 9.30am. Lunch is served at 12:30pm and Tea/supper 5:30pm. It was noted that a significant number of service users chose to have breakfast in their room. Discussions with staff and examination of documentation evidence staff working with food have completed basic food hygiene training. Future staff training includes ‘Safer Food Better Business’ which includes a wide range of areas associated with the management and provision of food. All service users spoken with said they were able to exercise freedom of choice and make decisions about how and where they spend their time. Two staff spoken with confirm routines in the home are flexible and take into account the individual needs and preferences of service users. Comments made directly to the inspector include: Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 17 • • • There is no pressure to do anything you can choose what to do and when to do it exactly as you would in your own home. The staff are wonderful, nothing is too much trouble. I can go out and about just as I please. I cant praise the home enough, its wonderful. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. Service users and others associated with the service are very satisfied with the service provision; and feel supported by an organisation that has their protection and safety as a priority. EVIDENCE: The home has in place appropriate policies and procedures for the protection of vulnerable adults. Two care workers spoken with said they had attended training on adult protection issues and gave examples of what actions may constitute abuse. Both workers said they would report any issues of concern to the manager. One carer was not aware of the ‘whistle blowing’ policy or procedure but would raise any issues with the manager should she have cause for concern. In order to make sure staff have the knowledge and information they need to carry out their tasks safely and appropriately, one policy and procedure is identified each month for closer examination and used to facilitate discussion. Details of policies and procedures are displayed in the staff room. The complaints procedure is displayed in the reception area of the home and complaints, comments and compliments book is also available and includes entries recorded by service users, family members and other visitors to the home. Examination of documentation evidence the home has not received any complaints about the service since the last inspection. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 19 We have not received any complaints, concerns or allegations about this service. Comments and compliments noted include: • We really do appreciate all the care you have given her in this difficult year. I know how hard everyone tried to ensure that she was happy and took part in the life of the home. • Heartfelt thanks for your efforts. • Can you please convey to all the staff our thanks for the goodhumoured, patient and thoughtful way they have dealt with the difficulties caused by the improvements in the dining room. Five service users spoken with all said they had not had cause to complain but would do so if dissatisfied with any aspect of the service. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome is excellent. This judgment has been made using available evidence including a visit to the home. The physical design and layout of the home enables service users to live in a safe, well maintained and comfortable environment, which encourages independence. EVIDENCE: The home has 34 bedrooms 27 of which have ensuite rooms. The seven rooms without an ensuite have a private toilet and sink. There are five bathrooms one of which is fitted with a toilet and sink, three communal toilets downstairs and one upstairs. Since the last inspection new carpets have been fitted on the ground floor and the staircase. Improved lighting has been installed in all communal areas on the ground floor and has enhanced the environment more especially for those service users with a visual impairment. A bathroom on the ground floor has been refurbished and equipped to a good standard and plans are underway to Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 21 extend the refurbishment programme to include one of the bathrooms on the first floor. There were adequate communal areas for the service users; the lounge and dining areas were maintained to a good standard and very clean. A homely environment had been maintained with good quality furnishings and fittings. The lavatory and washing facilities within the home are extremely clean. Bathrooms had been adapted and toilets are located close to communal areas for the benefit of the service users. Sluices are located separately from the service users toilets and are clean and tidy. During the inspection it was noted that adaptations and equipment are available to meet the assessed needs of the service users and include handrails fitted along the corridors, grab rails in the toilets, access ramps, a lift for wheelchairs, hoists, airflow mattresses, raised toilet seats, variable height beds and a call alarm system. Bedrooms viewed are of a reasonable size and accessible for wheelchairs. Each contains a range of personal items belonging to the service user including small items of furniture and all are decorated and maintained to a satisfactory standard. Examination of documentation evidence an inventory is held of all personal items brought into the home. Rooms have a secure space in which to hold medication, (if the service user wishes to self-medicate and on completion of the necessary risk assessment), or money if they choose to manage their own finances. Adequate numbers of sockets are available and smoke detectors fitted. A significant number of service users have their own telephone in their room. Laundry facilities were inspected and found to be well organised clean and hygienic. Foul laundry is held separately in red bags and washed at appropriate hot water temperatures to ensure it is thoroughly clean and to control the risk of infection. Hand washing facilities are available in the laundry and the storage area for laundered linen and clothes is tidy and clean. Disposable gloves and aprons are readily available and used by staff when handling soiled linen or when undertaking personal care tasks. At the time of the inspection the laundry person was not at work and a care worker was undertaking the laundry tasks. Two service users spoken with said the quality of the laundry “is excellent” with items, returned promptly. Both service users said they are very happy with their accommodation and confirm that most of the furniture in their room belongs to them. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. The service ensures that all staff within its organisation receive relevant training that is targeted and focused on improving outcomes for service users. The service uses external providers to deliver this training if they have not got the appropriate skills within the organisation. This training can be small-scale and individualised if necessary in order to promote the delivery of Person centred services. EVIDENCE: On the day of the inspection there were 31 service users accommodated at the home with a staff complement comprising of the deputy manager, assistant manager, three care workers, cook, administrator, domestic assistant, activities coordinator and a maintenance person. On the afternoon and evening shift there is an acting senior and three care workers. Two care workers provide support and assistance for service users at night. Examination of staff duty rosters and discussion with the deputy manager evidence a number of staff off sick and additional cover provided by existing staff. Some carers are working what is considered to be excessive hours e.g. 7am-10pm (15hrs). One care worker covered three shifts in two days this involved working 7am - 3pm, returning to do a nightshift 9.45-7am followed by 2pm-10pm on the same day. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 23 Four service users spoken with said there is generally sufficient numbers of staff available to meet their needs but there are occasions when staff appear rushed and we have to wait longer then usual for assistance. Comments from one service user surveyed include: • I am very happy at Cedar lawn. The constant changes in staff are a bit upsetting that there is little to be done about it. We are very well served here. Three staff spoken with all said there were sufficient numbers of staff available but staff absence has placed additional pressures. The deputy manager is aware of the difficulties arranging covering for unplanned staff absence and confirms there has been a reduction in the use of agency staff. Observations throughout the duration of the inspection evidence sufficient numbers of staff on duty to meet the needs of service users’ but staff rotas indicate there are insufficient numbers of staff available to provide adequate cover during staff absence. Examination of three staff files of recently appointed staff evidence each held an application form, CRB clearance, details of qualifications and training, proof of identity and a recent photograph. Although each file checklist indicates two references have been secured but only one reference confirming fitness could be evidenced. In discussion the deputy manager said the staff had been appointed by an agency that are responsible for securing and providing the home with all the necessary documentation confirming suitability. The deputy manager had been unaware of the gaps in information and demonstrated a commitment to addressing the shortfall. Comments made directly to the inspector by two visitors to the home include: We cant fault the staff. Most caring staff Ive ever come across. Always seem to be sufficient staff on duty. 73 of staff have achieved NVQ level 2 or equivalent. Staff training records evidence a range of training and development opportunities are made available. Staff spoke positively of the training they receive. A number of certificates were seen and comprehensive training records are available and confirm courses attended include palliative care and dementia care. Examination of documentation and discussion with staff evidence new workers have thorough induction training which involves shadowing an experienced worker until they are assessed as having the knowledge and skills needed to work independently and safely. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 24 Two staff spoken with were enthusiastic about training and keen to explore any opportunities available to them. Both said the range and frequency of training is excellent. Four service users spoken with said they found all the staff to be experienced, well trained and competent and never had any concerns. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 25 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): 31,33,35,38 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. There is an open and transparent atmosphere within the home where service users and staff provided feedback on the service to ensure that the home is run in the best interests of the service users. Records are stored safely, kept up-to-date and accurate to safeguard the rights of service users. EVIDENCE: The registered manager is an experienced person who, with the staff has developed an open and positive approach creating a relaxed and inclusive atmosphere within the home. Three staff spoken with said the manager, deputy manager and other senior staff are approachable and respond positively to any issues raised. All the service users spoken with knew the name of the manager and felt confident they would be listened to and responded to appropriately. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 26 Regular staff meetings take place to enable staff to contribute to the way in which the service is delivered. The home has sound policies and procedures, which the organisation effectively reviews and updates, in line with current thinking and practice. Staff are positive in their approach to translate policy into practice. For example service users do not self-medicate until the outcome of a risk assessment is known. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. Two staff spoken with confirm feedback on performance takes place during supervision and appraisal. If they wish and are able, service users are helped to take responsibility for managing their own money. They are provided with facilities to keep their valuables and money safe. Where the home holds money on behalf of service users it works to a rigorous system, it maintains very clear records that are routinely kept up-to-date and can be used to track individual service users finances. 14 service users are subject to Power of Attorney, a number manage their own finances and family members support others. Communal areas of the home and service users private rooms all have a call alarm. A number of service users spoken with also wore a pendant alarm, which they can activate from any location within the home. Three service users spoken with said staff respond promptly to calls for assistance. Comments on one service user survey include: • I am unable to get out of my chair unaided but often find that my call bell is often out of reach. Still by the bed when Im in my chair. Therefore cannot call anybody to take me to the toilet when I need to go. This concern was raised with the deputy manager who plans to raise this with staff so as to make sure all service users have easy access to a call alarm. To ensure service users are safe the deputy manager agreed to carryout risk assessments for those service users choosing to wear a call alarm pendant while in bed. Certificates in People Handling & Risk Assessment key Trainers Certificate and People Handling & Risk Assessment Trainers Certificate confirm that two carers are qualified to train staff in manual handling and risk assessment methods and techniques. All members of staff have completed mandatory training in health and safety, manual handling, food hygiene, fire prevention and evacuation procedures, first aid and Control of Substances Hazardous to Health (COSHH). Staff were observed using moving and handling equipment confidently and appropriately. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 27 Accident reports evidence information is documented of any accidents or injuries sustained by service users or staff. Regular health and safety checks are carried out and include: the fire equipment, hot water temperature checks, water heating check for compliance with Legionella, emergency lighting, passenger lift, hoists and baths. To prevent risk of scalding records displayed in bathrooms evidence a thermometer is used to test the water temperature before service users have their bath. Examination of documentation and a hot water temperature check carried out by the inspector in one of the bathrooms evidence hot water is maintained to safe levels (41°C). Quality audits are in place and involve individual consultation with service users every six months. Each quality audit is themed and reflects one of the National Minimum Care Standards. Details of the outcome of the most recent quality audit evidence a positive response by management to any identified shortfalls in service provision. For example more staff training on adult protection and dementia care is being explored and prioritised. There is evidence that sometimes staff knock on service users doors and don’t wait for a response before entering. This issue has been raised during staff hand over and will continue to be monitored at raised at service users meetings. The quality audit evidence positive outcomes for service users. Of four service users spoken with three said they had not been asked for their views on the service and one said she had. It is recommended that documentary evidence of the process used to record, audit and analyse information obtained during the consultation process is retained so that details of the number of service users surveyed, the questions asked and how responses were recorded so that we can form a view as to the value of the strategy used to evaluate the service. The quality audit should be extended to include anonymous service user questionnaires and feedback from family members and other visitors to the home including community health care professionals. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 28 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 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14, Sched.3 Requirement Timescale for action 21/09/06 2. OP7 13 3 OP29 19 Schedule. 2 The registered provider must ensure that a full pre-admission assessment is carried out on all prospective service users to ensure that their needs can be met. The registered provider must 14/10/06 ensure that all risk assessments and care plans are completed with sufficient detail and regularly reviewed to identify, and where possible, reduce risk to service users. (Outstanding from July 2005) The registered provider must 30/09/06 review recruitment procedures in the home so as to ensure a robust and consistent approach to staff recruitment and employment practices, which evidences that staff are safe to work with vulnerable adults. A second reference must be sought for those staff identified during the inspection. Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Practical assessments of staff providing catheter care should be carried out so as to ensure the staff are competent and capable and understand the risks associated with poor care practice. Service users should be supplied with the key to their room unless a risk assessment suggests otherwise. When a key has not been supplied the reasons for not doing so should be recorded in the care plan. Gender issues and the delivery of intimate personal care should be discussed prior to the service user moving into the home and the service users views recorded, acknowledged and used to promote best practice. The manager should identify a number of qualified and experienced individuals who can be called upon to provide appropriate cover during any unplanned staff absence. It is recommended that gender issues and the delivery of intimate personal care be discussed prior to the service user moving into the home and the service users views recorded, acknowledged and used to promote best practice. The quality audit should be extended to include anonymous service user questionnaires and feedback from family members and other visitors to the home including community health care professionals. 2. OP10 3 OP27 4 OP33 Cedar Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Lawn DS0000004214.V301526.R01.S.doc Version 5.2 Page 32 - 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. 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