CARE HOMES FOR OLDER PEOPLE
Cedar Lawn Cedar Close Stratford On Avon Warwickshire CV37 6UP Lead Inspector
Jackie Howe Unannounced Inspection 24th January 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.V279309.R01.S.doc Version 5.1 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.V279309.R01.S.doc Version 5.1 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.V279309.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st July 2005 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. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over six hours and was unannounced. This was the second visit of the inspection year 2005/06. The registered manager was not available on the day, so the inspection was conducted with the assistant managers who were on duty at different times of the day. The inspection process included discussions with the assistant managers, speaking with residents and staff, examining records, reading care plans and observation of care practices, including time spent in the activity room. During the inspection six residents, five staff and one visitor were spoken with. The inspector joined residents for lunch. What the service does well:
Residents spoken with said that they are happy at the home and enjoyed living at Cedar Lawn. They spoke positively about the staff and about the ‘key worker’ system in place. ‘ I have a key worker and I will go to her if I have a problem’. Staff were observed treating residents with respect and courtesy and there was a sense of fun and laughter around the home. There are plenty of activities and opportunity to develop new interests available. One resident expressed an interest in picking up computer skills and this idea was greeted very positively. An activities organiser is employed during the week. ‘There is plenty to do to keep me occupied. What I’d really like to do is to learn to use that computer, and do it before its too late!’ The home is clean and well maintained, it is spacious and provides plenty of communal space for mixing with others, but also for quiet reflection and reading. There were no offensive odours around the home. Systems for the administration of medication are well managed. Spiritual needs of residents are given a high priority. A different resident says grace each day prior to lunch. A representative from the local church comes to
Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 6 the home to visit and offer communion and there is a variety of literature available to offer support and guidance. Staff spoken with said they felt that there was good teamwork within the home, and good standards of health care offered to residents. Senior staff in the home said that they were happy with the management of the home and that they each had areas of responsibility. 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.V279309.R01.S.doc Version 5.1 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 Lawn DS0000004214.V279309.R01.S.doc Version 5.1 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): 3, 4 All residents are assessed prior to moving into the home using documentation which meets the required standards, and the opinions of other health care professionals is actively sought. The home consults with residents and their representatives to ensure they have sufficient information about the home before choosing to move there. EVIDENCE: New paper work is now available to staff to enable a full and detailed preadmission assessment to take place with all potential residents to the home. An ‘assessment of capabilities’ had been completed on all new admissions to the home, and this was seen to cover the standards required to allow a full assessment to take place and allow the home to make an informed decision with regard to meeting an individual’s needs. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 9 A score-banding guides the staff as to the appropriate level of dependency, and it is hoped that a review system based on the same criteria will allow staff to monitor improvement or higher dependency. This has not been introduced in all files read at present. A medical form is sent to the potential new resident’s GP, and these are returned to the home and used as part of the assessment process. Staff said they found this to be very useful and informative, especially as it started a dialogue between the home and the doctor. The home regularly receives residents from other counties and in these circumstances a member of staff from within the same company, but near by, will complete the assessment using the same systems. Care management assessments are received from all residents where appropriate. Residents spoken with confirmed that they had been able to visit the home prior to moving in. One resident said that her mother had lived at the home and she had made a decision to come to Cedar Lawn whilst visiting her. All spoken with said that they felt fully informed about the home and its services. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 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 Care plans are improving with the introduction of new paper work. Some elements are full and informative. Further development is needed to ensure staff feel confident they have all the necessary information to meet individual residents’ needs. Risk management systems are insufficiently robust to ensure clear direction to staff in ways of minimising risk to individuals. The administration of medication is generally well managed. EVIDENCE: A total of five care plans were read during the inspection. New care planning processes have been introduced over the past year and some files still have paperwork from both systems. Staff are aware of this and working towards consolidating all the files. Some care plans read had been reviewed, and others had not. One care plan showed no evidence of a formal review since 2002. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 11 All care plans contained sufficient information to inform staff how aspects of a resident’s health, personal care and social needs could be met. There was evidence of risk assessments having been completed in regard to nutrition, falls, tissue viability, moving and handling and for the use of bed rails. More information is needed within the care plan to ensure staff are fully informed of how to minimise risk to residents particularly those at risk of falling. All risk assessments must be reviewed and updated to reflect changing needs, and these should be known and understood by staff, agreed with residents and recorded on the care plan. One assistant manager takes responsibility for the management of medication systems and procedures. The home has policies and procedures for the administration of medication and these are accessible to staff. Only senior staff and those trained to do so administer medication to residents. Risk assessments were seen for those wishing to administer their own medication. Medicines were seen to be stored, administered and recorded appropriately, the latest pharmacy visit was November 2005 and this was satisfactory. Controlled drugs are kept and recorded properly and stocks and records were checked during the inspection. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 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): 15 A varied and nutritious choice of foods is offered by the home in very pleasant surroundings, in consultation with service users. EVIDENCE: The inspector joined residents for lunch and this was made to be a very pleasant experience and enjoyed by all. The meal was noted to be presented well and served to residents in a way that made lunch time entertaining and a bit of an ‘event’. Each place at the table is marked with an attractive name card hand decorated by a resident in the home. Table placing changes each month to give all the residents an opportunity to move around and sit and mix with others. Residents spoke enthusiastically about this process and said how much they enjoyed meeting new people. Some residents who need assistance from staff or who have developed special friendships and prefer not to move do not do so. One table is designated each day to be ‘grace table’ and one resident offers to say grace.
Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 13 Menus are displayed on each table in good size print. There is still only one choice displayed for lunch but when the order is taken alternatives are offered if needed. Some residents were comfortable asking for an alternative, but this limited choice could put less able residents or those reluctant to ask at a disadvantage. The menu was seen to be varied across a weekly menu and offer a wholesome and nutritious diet. Residents spoken with said they enjoyed their food. ‘Meals are very good; this one was one of my favourites. The menu is changed seasonally. The home has recently employed two new cooks from Slovakia who have not yet had a chance to be involved in a new menu but some residents said they would be interested to see their contribution! Special diets are catered for as required. Some residents were seen to be receiving assistance from staff and this was done at respectfully and at a suitable pace. The kitchen was seen to be clean and tidy and in good order. Staff were dressed appropriately with due regard to health and safety. A number of staff have completed their basic food hygiene training. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff have an understanding of the prevention of abuse, which has the effect of providing a suitable protective environment for residents. EVIDENCE: Policies and procedures kept in the home are designed to protect residents. The assistant manager could not locate the ‘whistle blowing’ procedure, and staff spoken with were unaware of the DoH No Secrets document. Records accessed showed that the majority of the staff have attended training with more staff identified on the training plan to attend when places are available. The importance of identifying signs of potential abuse and adult protection issues are introduced to staff within the induction process and a video is available. Staff spoken with were aware of what could be constituted as abuse and understood the term ‘whistle blowing’. Staff were also able to describe the processes they would follow if they suspected abuse. There have been no reportable allegations of abuse or POVA referrals made in the home. Residents spoken with said they felt secure in the home and that they had no reason to complain. ‘No complaints – no reason to do so’.
Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not fully assessed, the home was observed to be well maintained, clean and well furnished. Resident’s rooms are personalised to choice and are of a good size. Communal areas are large and spacious; the dining room is welcoming and enjoys pleasant views of the garden. The gardens are well maintained, residents spoken with said they enjoyed the garden in the summer and one resident works in the garden most days helping with weeding, pruning etc. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 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): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not fully assessed there were sufficient staff on duty to meet the needs of residents. Staff appeared unrushed and calm about their duties call bells were observed to be answered promptly, and an emergency bell was quickly responded to. Training records showed that staff are well trained and given the skills to meet the needs of residents. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 17 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): 33, 38 Resident’s opinions and views used to develop the running and direction of the home. A system of risk assessment, management and recording is provided but evidence indicated weaknesses in ongoing evaluation and review and lack of detail in transferring this to care planning systems. This puts residents at risk of their needs not being met and lack of continuity. EVIDENCE: Residents spoke positively about the management of the home and of their contact with the manager and assistant managers. They discussed a resident’s group who meet regularly with the manager to put forward comments and concerns from other residents about the home. Residents said they felt confident that any concerns would be dealt with appropriately. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 18 Policies and procedures are in place in the home to ensure the safety and welfare of residents, and training records confirm that staff have attended training in Health and Safety, Control of Substances Hazardous to Health (COSHH), moving and handling and infection control. Guidance on caring for people with MRSA is available to support the infection control policy. Risk assessments to keep residents safe have been conducted, but in some cases lack sufficient detail to guide staff in safe practices to ensure that risk is minimised. Risk assessments need to be valued as more than just a paper exercise to identify a risk, but to manage and minimise it for each individual. Management of fire safety practices have improved with an ongoing training in fire procedures being available to staff. Maintenance of equipment such as hoists and specialist baths has been completed and satisfactory testing of water supplies in regard to temperature and prevention of Legionella have been undertaken. Accidents are recorded and monitored and a monthly audit is undertaken. Staff said they could not see a pattern of accidents and have appropriately informed the commission of any serious concerns. First aid boxes are appropriately placed around the home and staff have been trained in first aid. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 19 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 2 Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 20 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 OP38OP7 Regulation 13 Requirement The Registered manager must ensure that all risk assessments and care plans are completed with sufficient detail and regularly reviewed to identify, and where possible, reduce risk to residents. Timescale for action 01/04/06 Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 21 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. 2 Refer to Standard OP15 OP18 Good Practice Recommendations A second choice should be included on the menu at lunch times. A copy of the DoH ‘No secrets document’ should be kept within the home. Cedar Lawn DS0000004214.V279309.R01.S.doc Version 5.1 Page 22 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
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