Inspection on 16/05/06 for Cedar Lodge

This inspection was carried out on 16th May 2006.

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

The inspector 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 Lodge 10/12/08

Cedar Lodge 08/01/08

Cedar Lodge 26/06/07

Cedar Lodge 06/02/07

Cedar Lodge 18/10/05

Cedar Lodge 17/05/05

Cedar Lodge 27/10/04

Cedar Lodge 15/09/04

Cedar Lodge 18/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Hope Corner Lane Taunton Somerset TA2 7PB Lead Inspector Jane Poole Key Unannounced Inspection 16th May 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 Lodge DS0000059128.V292252.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 Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Address Hope Corner Lane Taunton Somerset TA2 7PB 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) 01823 286158 N Notaro Homes Limited Vivienne Stewart Knighton Care Home 59 Category(ies) of Dementia - over 65 years of age (59), Old age, registration, with number not falling within any other category (59) of places Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. Registered for 59 persons in categories OP and DE(E). Numbers to include three service users between the ages of 55 and 65 years. Room 31 to used for ambulant independent service users only. Rooms 14 and 9 to only be used for service users with minimal moving and handling needs. Service users accommodated in rooms 43; 44; 45 must be continually assessed as to their mobility needs as these are only accessible via the stairs. The home to monitor dependency levels of service users overnight and increase night staff numbers accordingly when it reaches 45 service users. The home will ensure there are 4 suitably competent care staff working overnight when it reaches a capacity of 50 service users and 5 when it reaches 58 service users. The home to ensure social care hours are increased to at least 45 hours when it reaches 53 service users and at least 50 hours when it reaches 59 service users to allow for one-one social care. 18th October 2005 Date of last inspection Brief Description of the Service: Red Lodge is a large, detached, extended property, set in good size grounds in a quiet residential area, approximately 1.5 miles from Taunton town centre. The home is Registered with the Commission for Social Care Inspection (CSCI) for up to 59 service users over the age of 65 years who have a dementia. Notaro Homes Ltd owns the home. The registered manager is Vivien Knighton. A new area manager has recently been appointed to the company. Amenities are close at hand, including a Post Office, shops and pubs. Service user accommodation is on three floors. Bedrooms are found on all three floors, a lift gives access to all but 3 of the bedrooms, which are approached by a staircase. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this inspection there were 50 people living at the home. Two inspectors in the morning Jane Poole and Steve Humphries and one inspector, Jane Poole in the afternoon, carried out this inspection. The inspectors were given unrestricted access to all areas of the home, were able to speak with staff and service users and able to observe care practices. All records requested were made available. The registered manager and regional manager were available throughout the day. The CSCI met with the Responsible Individual, Company Director and Regional Manager on the 16th June 2006. At this meeting Notaro homes showed a commitment to working with the CSCI to action the requirements and recommendations of this report in order to improve the standard of care at Cedar Lodge. What the service does well: Service users stated that the staff were kind and nice. They also stated that they liked the food. The inspector observed that staff spoke to service users in a respectful, friendly manner. The main meal of the day was observed and it appeared appetising and nutritious. For the majority of service users the meal was a pleasant unhurried occasion. Many of the service users were unable to fully express their views and opinions but those spoken with, and observed, appeared content and animated. All service users have their needs assessed before moving to the home and have the opportunity to visit Cedar Lodge before deciding to make it their home. The home also offers day care and respite care giving prospective service users an opportunity to spend extended time in the home to familiarise themselves with staff and existing service users. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 6 The activity worker has worked hard to create a full programme of activities and entertainment. Service users spoken to were happy with the activities in the home. Service users stated that there were no strict routines and that they were free to choose when they got up and when they went to bed. Staffing levels in the home appear adequate for the needs of the current service user group. What has improved since the last inspection? What they could do better: Two immediate requirement notices were issued at this inspection. One in respect of the recording of controlled drugs, and the other highlighting issues of privacy and dignity. The controlled drugs register was viewed and there were two records that did not match the stocks held in the controlled drugs cupboard. The inspector observed that at lunchtime one carer was assisting two service users with their meals. The service users were sat at separate tables and the carer was moving between the two and at times left the room completely. At no time did the carer sit with either service user and the assistance was given in a very undignified way. The inspectors viewed a sample of personal rooms. In two rooms seen the curtains designed to give privacy to service users using the en suite facilities had been removed. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 7 Care plans viewed by the inspector focussed on physical needs and there was limited information on the psychological or mental health needs of service users. Many of the service users living at Cedar Lodge are unable to fully express their views or wishes and therefore care plans should be more comprehensive. One care plan did not match the care that was being given to the service user concerned. For example the care plan stated that drinks should be given half hourly but the fluid balance chart for this service user demonstrated that drinks were given approximately two hourly. The environment is safe and well maintained but does not provide a homely or stimulating environment for service users. Clear signage needs to be in place that will help service users to orientate themselves and encourage independent movement around the home. Outside the home are areas of secure attractive gardens but all doors to these areas are either locked or alarmed which means service users can not access them independently. 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 Lodge DS0000059128.V292252.R01.S.doc Version 5.1 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 Lodge DS0000059128.V292252.R01.S.doc Version 5.1 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): 1, 3, 4 & 5. Overall quality in this outcome group is good. All service users have their needs assessed before moving into the home. EVIDENCE: The home has produced a new statement of purpose that sets out the recent changes to the home. The inspector noted that service user guides were available in service users personal rooms. The inspector viewed three care plans. All contained copies of assessments completed by professionals outside the home. There was also evidence that a senior member of staff sees and assesses all prospective service users to ensure that the home will be able to meet their needs. On the day of the inspection the manager of the home went to assess a prospective service user who was in hospital. Service users and their representatives are able to visit the home prior to making any decision to move in. Cedar Lodge also offers day care and respite care which allows people to spend extended periods of time in the home to familiarise themselves with staff and other service users. Cedar Lodge DS0000059128.V292252.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 & 10 Overall quality in this outcome group is poor. Serious issues with respect to the privacy and dignity of service users were identified at this inspection. Errors in the recording of controlled drugs were noted. Service users have access to appropriate health care professionals. EVIDENCE: All service users living at the home have a personal file that is kept in the care office and is therefore available to all staff. The inspector viewed three care plans in detail. All service users have a basic assessment of daily living skills completed once they move into Cedar Lodge. The headings on this assessment are ‘Client Needs’ and ‘Nursing intervention.’ The home does not provide nursing care and therefore these headings are inappropriate. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 11 The care plans viewed by the inspector gave details of the needs of individuals focussing mainly on physical health. The home cares for service users who have a dementia and there was very limited information about how this affected the day to day life of the service user or how staff could best assist people to maintain a degree of independence. The manager and staff explained that care plans are usually compiled with the assistance of relatives or representatives. The care plans did not give details of individual likes or dislikes and had no mention of any personal beliefs, spirituality or religion that may be important in providing care. Two of the three care plans had an extremely brief life history of the person, which had been provided by family members, these had not been expanded upon during their stay at the home. There was therefore very limited information about the interests or hobbies of individuals. The homes statement of purpose states that all care plans will include descriptions of the service users preferred daily routines and likes and dislikes in relation to food. It also states that their preferences in respect of privacy and dignity especially around intimate care will be recorded. This information was not fully recorded in the care plans viewed by the inspector. One care plan did not match the care that was being given to the service user concerned. For example the care plan stated that drinks should be given half hourly but the fluid balance chart for this service user demonstrated that drinks were given approximately two hourly. One member of staff stated that ‘staff did not really use the care plans.’ Risk assessments in respect of tissue viability and falls were seen. All service users are registered with local GPs and there is no pressure on a service user to change their GP if the surgery is happy to continue to provide a service. The manager stated that since the last inspection communication with health care professionals has improved. Members of the district nursing team visit the home on a regular basis and a community psychiatric nurse visits a minimum of monthly to offer guidance and support on mental health issues. All appointments with professionals are recorded in individual files. All service users are weighed regularly and the manager monitors this. There is appropriate storage for medication including controlled drugs and medication that requires refrigeration. The inspector viewed the Medication Administration Records and found them to be correctly signed when entering the home and when administered. The controlled drugs register was viewed and there were two records that did not match the stocks held in the controlled drugs cupboard. An immediate requirement notice was issued in respect of this. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 12 At the last inspection a requirement was made to ensure that suitable telephone facilities were provided for service users. The manager explained that all new rooms at the home have telephone points and that other service users are able to use the office phone to make and receive calls. (The registered manager should ensure that this information is explained to service users and included in the service user guide.) Some issues in respect of privacy and dignity were raised with the registered manager and area manager during the inspection. The inspector observed that at lunchtime one carer was assisting two service users with their meals. The service users were sat at separate tables and the carer was moving between the two and at times left the room completely. At no time did the carer sit with either service user and the assistance was given in a very undignified way. An immediate requirement notice was issued in respect of this. The inspectors viewed a sample of personal rooms. In two rooms seen the curtains designed to give privacy to service users using the en suite facilities had been removed. Two inspectors spent the morning in the home speaking to service users and staff and observing care practices. Service users described the staff as kind and it was observed that interaction between staff and service users was respectful. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 13 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. Overall quality in this outcome group is good. There is a full time activity worker who offers a variety of activities and entertainment. The main meal of the day appeared appetising and nutritious. EVIDENCE: There are no strict routines in the home with service users choosing when they get up and when they go to bed. Service users spoken to confirmed this. One person said that meals were at set times but ‘you can eat them wherever you like.’ There is an activity worker at the home who organises group, and some one to one, activities every day. (Monday to Friday) There is a four week rota for activities and the days sessions are displayed on the orientation board in the dining room. (The notice of activities was very small and may not have been easily seen by all service users.) In addition to the daily rota there are some set activities. Two local churches hold monthly services at the home and a singer comes once a month. Canine Concern visit the home twice a week. As previously stated care plans give very limited information about individuals interests and hobbies. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 14 On the day of the inspection the activities organiser was carrying out a knitting session in the morning and there was live music in the afternoon. Activities in the home appear to be the sole responsibility of the activities worker. In the afternoon the majority of service users were in the lounge listening to live music. No care staff were present. Care staff spoken to stated that they were able to spend time with service users watching TV, manicuring nails and chatting and this was considered an important part of their role. During the day many service users were walking around the home, most looked animated and cheerful. All appeared happy to speak with the inspectors. One person stated that in the summer they were able to walk outside. In the morning the inspectors observed 11 service users in one of the two TV lounges, the TV was on loudly but no one appeared to be watching it. One person sat in this lounge told the inspector that they did not like TV but preferred music and books. The inspectors noted only one newspaper in the home and no magazines or books had been made available. The activities organiser stated that she is in the process of creating a rummage box to be left in the home. It is hoped that this will provide interest to service users. Some of the bedrooms seen by inspectors had been personalised to reflect the personalities and lifestyles of service users. The manager stated that service users are able to bring personal possessions and small items of furniture to the home. Visitors are welcome at the home at all reasonable times. Many service users stated that they enjoyed visits from family and friends. There is ample communal space in the home giving people a choice of spending time with others or quietly on their own or in small groups. There is a large pleasant dining room divided into two parts. The menu for the day is on display giving a choice of two main courses. The inspector observed lunch being served and noted that some service users were shown two options to choose from. All were given a choice of cold drinks. The meal was well presented and appeared nutritious. The majority of people who expressed an opinion stated that the food was good. It appeared to be enjoyed by everyone. The homes Statement of Purpose states that staff sit with service users at mealtimes to encourage conversation, this was not witnessed on the day of the inspection. Issues around how staff assisted service users to eat were raised with the management of the home and have been detailed in standard 10. For the vast majority of service users lunch appeared to be an unhurried and relaxed occasion. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 15 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. Overall quality in this outcome group is adequate. There is adequate information in the home to inform staff on what to do if they have concerns that someone is being abused. Service users freedom is restricted by the use of locked doors onto safe garden areas. EVIDENCE: The home has a copy of the Somerset County Council ‘Safeguarding Vulnerable Adults’ policy. It also has information in the office about forms of abuse and details of Action on Elder Abuse. One complaint has been received since the last inspection. Records show that this was investigated and resolved to the satisfaction of all parties. The manager of the home has produced a whistle blowing policy, which she has distributed to all staff. Staff spoken to were aware of the policy. The policy is well written but would benefit from clear contact details of outside agencies. The home cares for people who have a dementia and the main doors to the home are kept locked to ensure service users do not leave the building without supervision. However it was also noted that doors leading to enclosed gardens and a secure courtyard were also locked or alarmed. During the day the inspector noted that several service users attempted to go through a door to a Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 16 garden area but were unable to do so. Carers asked did not know why service users were not able to access the gardens independently and care plans gave no indication of why such restrictions were in place. There is a staff handbook which contains, among other items, an equal opportunities policy and information on harassment and bullying. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 17 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, & 26. Overall quality in this outcome group is adequate. The home provides a safe, well maintained, environment but is not homely or stimulating for service users. There are pleasant, safe, outdoor areas but these are not easily accessible to service users. Service users would benefit from appropriate signage to assist them to find their way around and more easily access their personal rooms. EVIDENCE: Since the last inspection the home has been extended to provide an extra 17 rooms. It appears that the home has undergone a major refurbishment and all furnishings appeared of a good quality. However although some efforts had been made to make the home user friendly for the service user group, such as Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 18 the introduction of colour coded doors for bathrooms and toilets, further work is needed. All corridors are of a similar colour and so do not assist people to orientate themselves around the home. There are very few points of interest and extremely limited sensual stimulation provided by the environment. There are very few pictures or homely touches in the communal areas. Various aids and adaptations have been put in place to assist people who have mobility difficulties. There are assisted bathing facilities on each floor, a passenger lift and handrails placed around the building. All bedroom doors are fitted with alarms that can be turned on or off according to the needs of the individual service user. Some service users also have pressure mats which alert staff if someone has got out of bed. This means that staff can quickly attend to the person and prevent them becoming disorientated and possibly anxious. It also alerts the staff to service users who have been assessed as being at a high risk of falling. Although there is some signage at the entrance of the building and on communal room doors there is no signage to assist people to move around independently. There is no signage on bedroom doors to enable service users to find their own rooms. Many staff commented that they had difficulty with service users who constantly wandered into other people private areas. Appropriate signage must be put in place to assist service users to find their way around and to assist people to recognise their own personal rooms. Rotas seen and discussions with the management gave evidence that agency staff are regularly used in the home. The use of signage would help these staff to assist service users around the home. There are ample pleasant, secure garden areas around the home, however on the day of the inspection all doors were either alarmed or locked preventing service users easily gaining access to outside areas. There are 58 bedrooms at the home (one can be used two people) 54 of the bedrooms have en suite facilities. Some of the en suites have curtains to provide privacy. On the day of the inspection the privacy curtains in two rooms seen had been removed and not replaced. There are a number of communal bathrooms and toilets around the home. The inspectors viewed a sample of personal rooms, some had been personalised to reflect the needs and wishes of service users. All areas seen by the inspector were clean and fresh. There are appropriate hand washing facilities around the home. All staff carry alcohol gel. Gloves and aprons are available to minimise the risk of cross infection. All areas of the home are fitted with a fire detection and call bell system. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 19 All areas of the home appeared well maintained. At the last inspection a requirement was made to ensure that all radiators were switched on and all rooms were warm. The inspector discussed this with the manager who gave assurances that this was being rectified. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 20 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. Overall quality in this outcome group is good. There is a robust recruitment procedure that minimises the risks of abuse to service users. Staff felt that they received adequate training to carry out their jobs. EVIDENCE: The home supplied staffing rotas to the CSCI prior to this inspection. These show that there are adequate numbers of staff on duty to meet the needs of service users. There is a minimum of 6 care staff on duty between the hours of 8am and 2pm, Between 2pm and 8pm there is a minimum of 5 care staff. Rotas show that these levels are frequently exceeded. The managers and all ancillary hours are in addition to this. The manager stated that the home have just increased the number of night staff to 4 each night in line with the increased occupancy levels in the home. Some staff work additional hours and agency staff are used to ensure minimum staffing levels are maintained. Staff spoken to generally felt that there were sufficient staff on duty. Service users described the staff as ‘nice’ and ‘kind.’ Staff spoken to felt that they received adequate training to carry out their roles. 30 of the staff currently have an National Vocational Qualification in care at level 2 or above. A further 8 members of staff are currently working towards this award, once the staff qualify over 50 of the care staff team will have an NVQ. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 21 In addition to this some staff are undertaking distance learning courses in care planning, dementia, safe handling of medicines and infection control. Two short training courses were arranged for the week of this inspection, one on care planning and one on managing difficult or challenging behaviour. The inspector viewed the recruitment files of the three most recently employed members of staff. All contained appropriate documentation and all had been checked against the Protection Of Vulnerable Adults register and had enhanced Criminal Records Bureau checks carried out by the provider. New members of staff felt that the staff team were very supportive. Other staff stated that they felt everyone worked as a team and shared information Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 36, 37 & 38 Overall quality in this outcome group is good. Measures are in place to ensure the safety of service users. The new registered manager has begun to put systems in place to ensure the smooth running of the home. EVIDENCE: Since the last inspection Vivien Knighton has been registered as the manager of Cedar Lodge. She is a registered general nurse and has a degree in Health & Social Care Management. In addition the registered manager there is a care supervisor who works full time in the home. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 23 The managers office is in the heart of the home allowing service users, staff and visitors easy access and enabling her to observe what is going on in the home. There are regular staff meetings to share information and the manager has recently held a service user and relatives meeting. Currently staff do not all receive one to one supervision on a regular basis as the manager is the only person who is able to carry out this task. Everyone spoken to described the manager as open and approachable and all appeared comfortable with her. The home has recently sent out quality assurance questionnaires and the inspector was able to view the returned ones. Most were positive about the care and the facilities offered by Cedar Lodge. There was evidence that the manager had addressed the few negative comments. All records viewed appeared up to date and appropriately stored. The home has a folder of policies and procedures a sample of which were viewed by the inspector. There was no evidence that these policies had been reviewed since 2002. The registered manager stated that she does not act as an appointee or power of attorney for any service user. Small amounts of personal allowance are held by the administrator. Records of these were not viewed at this inspection. Appropriate steps have been taken to ensure the health and safety of service users. A fire log is maintained, it showed that fire alarms are tested weekly and extinguishers and emergency lighting is checked on a monthly basis. All staff have received fire training. Some fire doors in the new extension were not closing fully and this was discussed at the time of the inspection. All accidents are recorded and the manager has now begun to analyse these on a monthly basis. Up to date servicing certificates for equipment were seen. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 3 1 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 2 3 3 Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 25 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 OP7 Regulation 15(1)(2) Requirement Timescale for action 30/06/06 2. OP9 13(2) 3. OP15OP10 12(4)[a] The registered manager must ensure that care plans are fully reflective of service users current needs including likes, dislikes and psychological and mental health needs The registered manager must 16/05/06 ensure that the controlled drugs register is well maintained and up to date. Balances recorded must correlate with stocks held. Immediate requirement notice issued The registered manager must 16/05/06 ensure that care is carried out in a way that respects the dignity of service users. Immediate requirement notice issued Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 26 4. OP18OP20 13 (7) 23 (2) [o] 5. OP22 23(2) [n] The registered manager must ensure that service users are able access the gardens without restrictions. Any individual restrictions must be recorded in care plans. The registered manager must provide appropriate signage in the home to assist service users to orientate themselves and move freely around the home. 30/06/06 31/07/06 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 3 4 5 6 7 Refer to Standard OP1 OP7 OP12 OP18 OP20 OP33 OP36 Good Practice Recommendations The Statement of Purpose should accurately reflect the services offered by the home. The home should develop and maintain life histories in respect of individual service users. Care staff should be encouraged to take part in activities with service users. The home should consider supplying magazines, books and newspapers for service users. The whistle blowing policy should contain the contact details of appropriate outside agencies. The home should consider ways to make the environment more homely and stimulating for service users. The home should review all policies and procedures to ensure that they reflect up to date legislation and good practice. All staff should receive supervision 6 times a year. The manager should consider how this responsibility could be delegated to other senior staff. Cedar Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Lodge DS0000059128.V292252.R01.S.doc Version 5.1 Page 28 - 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. 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