Inspection on 26/06/07 for Cedar Lodge

This inspection was carried out on 26th June 2007.

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 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 Lodge 10/12/08

Cedar Lodge 08/01/08

Cedar Lodge 06/02/07

Cedar Lodge 16/05/06

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 Unannounced Inspection 26th June 2007 09:30 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.V337553.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 Lodge DS0000059128.V337553.R01.S.doc Version 5.2 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 claireatnotarohomes.co.uk N Notaro Homes Limited 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.V337553.R01.S.doc Version 5.2 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. 06/02/07 Date of last key inspection Brief Description of the Service: Cedar 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, including people who require care due to a dementia. Notaro Homes Ltd owns the home. There is currently no registered manager. 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.V337553.R01.S.doc Version 5.2 Page 5 The current fee level at the home ranges from £373.00 to £450.00 per week. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection was carried out on the 6th February 2007. Random inspections were carried out on the 29th March and 9th May 2007 some of the findings of these inspections are referred to in this report. An Annual Quality Assurance Assessment was sent to the home which was completed and returned to the Commission for Social Care Inspection prior to this inspection. This inspection was carried out by two inspectors over a 6 hour period. There were 44 people living at the home including one person in hospital. The inspectors were given unrestricted access to all areas of the home. They were able to meet with staff and service users and spend time with the acting manager. Many of the service users living at Cedar Lodge are unable to fully express their views or opinions so the inspectors spent part of the day observing care practices. What the service does well: What has improved since the last inspection? Since the last key inspection care plans have continued to improve and now give more information about peoples interests and lifestyles. They still require Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 7 further improvement to ensure that they give clear up to date information for staff. Nutritional assessments have been completed and intake charts are being completed in respect of those assessed as high risk. The home has set up regular meetings with district nursing staff and members of the community mental health team to monitor the physical and mental well being of service users. At the last inspection concerns were raised about the training opportunities available for staff and since this time a full programme has been put in place. This has included; caring for people with a dementia, dealing with challenging behaviour, assisting with eating, drinking and personal care, adult abuse awareness and effective communication. Staff spoken to felt that the training had assisted them in their roles and that they now had a better understanding of the needs of the service user group. The inspectors observed the main meal of the day and noted that service users were being assisted in a much more respectful manner. There are now two sittings at each meal making the dining room less crowded and the mealtime a more pleasant occasion. It is still not clear how choices are made by service users but there are now systems in place that can be used, however all staff are not yet familiar with them. What they could do better: Staffing levels are assessed according to the number of people living at the home and do not take account of the dependency levels or needs of service users. On the day of the inspection care staff practices appeared very task focussed and not person centred. The low staffing levels means that service users’ choices are restricted; for example although there is no set time to get up or go to bed some people have to wait a long time before staff are available to assist them. On the day of this inspection some people were not washed and dressed till 11.45am. At the time of this inspection one activity worker was on holiday and the other was assisting people to attend appointments outside the home. This meant that for those unable to occupy themselves there was limited social interaction or stimulation. Two service users stated that staff are “too busy to chat.” Nutritional assessments have been completed and care plans have been created but there is no guidance for staff about how to evaluate the effectiveness of the care plan and there was evidence that not all service users were being regularly weighed. The home needs to ensure that action is taken to investigate any significant changes in weight. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 8 The environment is well maintained but it is not an enabling environment for people who have a dementia. Signage is not pronounced and all lounges and corridors are of a similar colour meaning that it is difficult for people to orientate themselves. There have been frequent changes of home manager over the past few years leading to inconsistencies in practice and instability of the staff team. Staff are not receiving regular appraisals or formal supervisions so there are no avenues for them to express their views or concerns. The recruitment procedure needs to be more robust and all new staff should be supported to complete the homes induction programme. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 9 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.V337553.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users have their needs assessed but these assessments are not readily available in the home. All service users receive a contract setting out the terms and conditions of residency. Intermediate care is not provided. EVIDENCE: Only one service user living at the home at the time of this inspection had moved in since the last inspection. The inspector viewed the care plan relating to this person. The service user had originally come to the home for a short stay and had later become a permanent resident. There was no pre admission assessment in respect of this person. However the inspector has seen evidence Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 11 outside of this inspection that prospective service users have their needs assessed to ensure that the home is able to meet their needs. All service users receive a contract of terms and conditions when they move into the home. The contract sets out what is not included in the basic fee. The contract states that the first four weeks of any stay is a trial period when only one weeks notice will be required by either party to terminate the stay. After this period four weeks notice is required. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans continue to improve but further development is needed. Service users have access to healthcare professionals appropriate to their individual needs. EVIDENCE: The inspectors viewed three care plans in detail and another two briefly. Since the last key inspection in February 2007 some improvements have been made. Assessments of need are brief but plans now contain a pen picture of the service user, which gives information about their lifestyle and interests. All service users now have their nutritional needs assessed and care plans are put in place for those who are considered to be at risk. These plans give guidance for staff about how to record food and fluid intake but do not clearly Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 13 set out the actions to take should a persons’ intake not be sufficient. One care plan seen had no recorded weight since February 2007. Staff spoken to felt that care plans did give sufficient detail and assisted them in their work. The inspectors noted that some assessments had not been updated in line with changes. For example the moving and handling assessment for one person had not been up dated following a dramatic weight reduction. The home now has regular meetings with the local district nurses and community psychiatric nurses to discuss concerns and seek advice on peoples’ mental and physical health. Staff have received training in caring for people with dementia and dealing with challenging behaviour and it is hoped that this will form part of an ongoing training programme for staff. Service users are registered with healthcare professionals appropriate to their individual needs. Staff assist service users to attend appointments outside the home. On the day of the inspection one person was assisted to attend a hospital appointment and another went to the opticians. There is appropriate storage for medication including controlled drugs and those that require refrigeration. The new manager had carried out a full audit of all medication and procedures two days prior to this inspection. This audit was extremely comprehensive and highlighted some areas for improvement. As a result of this audit additional medication training has been arranged for all senior staff in the coming days. All bedrooms have either en-suites or wash hand basins where people can be assisted with personal care in private. All rooms are currently used for single occupancy. The inspectors observed that staff interacted with service users in a respectful manner. Cedar Lodge DS0000059128.V337553.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Choices are restricted for some service users because of the staffing levels in the home. The quality of food in the home is good and there is a varied menu. EVIDENCE: There are no strict routines in the home and service users are free to choose when they get up and when they go to bed. However many of the service users require assistance with washing and dressing and due to the limited numbers of staff it was noted that some service users had to wait for a long time before being assisted in the morning which restricted their choice. The inspectors observed that some service users were still not washed and dressed by 11.45am. Breakfasts are served in bedrooms and in the dining room but there appeared to be limited support for those who required assistance with eating and Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 15 drinking. The inspectors noted that some service users in their bedrooms had eaten very little and their drinks had gone cold before being drunk. Staff have a system to record how much is eaten at breakfast but limited time to encourage or assist people. Service users who are physically mobile are able to move freely around the home, There are numerous small lounges and seating areas to choose from. Pre inspection information completed by the home states that they are planning to create ‘themed’ lounges, which will assist people to orientate themselves within the home. The home currently employs two activity workers. At the time of this inspection one member of staff was on holiday and the other was assisting people to attend medical appointments outside the home. Many service users living at Cedar Lodge are unable to occupy themselves and it was observed that there was limited social stimulation for these people on the day of inspection. It is acknowledged that usually there is a full activity programme that includes entertainment and some trips out. As previously mentioned the home has begun to include pen pictures in the care plans that provide information on service users interests and hobbies. The staffing levels in the home on the day of the inspection meant that care staff worked in a very task centred rather than person centred manner. Staff acknowledged that there is limited time for social interaction with service users although they were aware of the importance of this. Two service users told the inspectors that staff were very good but “too busy to chat.” Visitors are welcome in the home at all reasonable times. The inspectors observed visitors coming into the home in the afternoon and one stated that they were always made welcome. One care manager told the inspector that their clients’ family members felt welcomed into the home whenever they visited. Since the last key inspection, two random inspections have been carried out by the Commission for Social Care Inspection, on each occasion the inspectors have observed the mealtime in the home and noted improvements. Staff have received training in supporting people with eating and drinking and advice has also been sought from a senior member of the local community mental health team. There are now two sittings at lunch and teatime making the dining room less crowded. The main meal of the day is at mid-day and was observed at this inspection. The meal was well presented and appeared nutritious. People on the whole seemed to enjoy the lunch and there was limited wastage. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 16 There are two choices of main meal but it was difficult to see how choices were offered to people. One member of staff was seen to show a service user two meals and asked them to choose, which they did. The other service user sitting at the same table was then given the remaining meal meaning they were not able to choose. The home have also created a photographic menu book which can be used to assist people to make a choice but not all staff were aware of this. Service users asked stated that the food was good and that they received ample portions. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home fully investigates all complaints and allegations made. EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse, making a complaint and whistle blowing. All staff have received training in issues of abuse and all are familiar with the whistle blowing policy. The home has given evidence, outside of this inspection, that all allegations are taken seriously and fully investigated. The company are aware of the procedures for referral to the Protection Of Vulnerable Adults register and share information appropriately with relevant agencies outside the home. A record of complaints is kept and was viewed by the inspector. Records showed again that complaints are investigated and those seen had been concluded to the satisfaction of all parties. All new staff are checked against the Protection Of Vulnerable Adults (POVA) register and all undergo an enhanced Criminal Records Bureau (CRB) check. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 18 The home is locked by an electronic keypad but service users have unrestricted access to all communal areas inside the home and pleasant outside spaces. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained but does not provide an enabling environment for people with a dementia. Infection control practices need to be improved upon. EVIDENCE: Cedar Lodge is situated in a quiet residential area of Taunton within easy reach of local amenities such as small shops, a park and post office. Service user accommodation is arranged of three floors with a passenger lift giving access to all but three bedrooms. There are some bedrooms that lead Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 20 directly onto stairs. A requirement was made at the last inspection for risk assessments to be completed in respect of the service users occupying these rooms. At this inspection it was noted that this had not been fully complied with and there was no risk assessment in respect of one identified service user. All communal areas are located on the ground floor. There is a range of lounges and a large pleasant dining room. Outside there is an enclosed garden and a courtyard area. There is some signage in the home, whilst this is helpful for staff and visitors, it would benefit from being clearer and more pronounced to assist people with a dementia to orientate themselves. Currently corridors and lounges are similar in colour so do not help people with orientation but pre inspection information completed by the home states that they are planning to create ‘themed’ lounges. There are adequate numbers of toilets and bathrooms around the home. All areas of the home are fitted with a fire detection and call bell system which is regularly tested. The inspectors briefly toured the building and spoke with some service users in their bedrooms. All areas were reasonably maintained and clean. One bathroom was being used as a storage area and this was discussed with the manager. There is a laundry in an outbuilding, which is shared by two other homes on the same site. This was not viewed at this inspection. The inspectors observed a high number of service users with dressings on their legs. There are disposable gloves and aprons provided for staff, these are currently stored around the home. Risk assessments should be carried out to ensure that they do not pose a risk to service users living at the home. Handwashing facilities and bins are provided in bedrooms and other appropriate places around the home. In line with good infection control procedures, clinical waste bins should be foot operated. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing hours are allocated according to the numbers of residents and do not take into account the dependency level or needs of service users. There is now a full training programme but the induction programme is not being completed for new staff. EVIDENCE: Due to the decrease in numbers of service users living at the home staff numbers have been reduced. In the morning of this inspection there were 5 members of care staff on duty and the newly employed deputy manager who had only been in post for 2 days. Some of these staff assisted service users to attend appointments outside the home. The inspectors were able to talk with staff on duty. There was very low morale amongst the staff group and without exception all felt that the home was understaffed at the present time. As previously mentioned two service users stated that staff were “too busy to chat.” Staff demonstrated a commitment to the service users at the home but more than one person said that they did not feel valued by the senior management team. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 22 There have been frequent changes of home manager over the past few years and staff have been unsettled by this. There is a high turnover of staff; pre inspection information states that 15 care staff have left the home in the past 12 months. The inspectors viewed the recruitment files of the three most recently employed members of staff. All staff had completed application forms, been checked against the POVA register and undergone a CRB check. One application form did not include a full employment history and there was no evidence to indicate that this had been explored by the home. One person did not have a reference from their most recent employer and there was no written explanation of this in the file. The home has a twelve-week induction programme but two new members of staff, who had been in post for over two months, had only completed day one of the programme. A full induction pack for senior staff has also been introduced but again this has not been completed in the home. At the last inspection concerns were raised about the training opportunities available for staff and since this time a full programme has been put in place. This has included; caring for people with a dementia, dealing with challenging behaviour, assisting with eating, drinking and personal care, adult abuse awareness and effective communication. Staff spoken to felt that the training had assisted them in their roles and that they now had a better understanding of the needs of the service user group. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate systems are in place to ensure the health and safety of service users. The registered manager has left the home but an experienced home manager has been seconded to Cedar Lodge to provide leadership and direction until a new manager is appointed. EVIDENCE: The registered manager has recently left the home but the company has been quick to put in an experienced manager from another home whilst a replacement manager is sought. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 24 As previously stated there have been frequent changes in home manager over the past few years, which has lead to inconsistencies in practice and instability for the staff team. Pre inspection information provided by the home lists staff supervision as one of the areas that they feel they do well in but there was no evidence of this at this inspection. Although there is always a senior carer on duty staff are not receiving regular formal supervision. 5 staff records were seen by the inspectors, only one member of staff had received formal recorded supervision in the past 6 months and the most recent staff appraisal seen was dated 2001. Staff spoken to stated that they were not kept up to date with happenings in the home and had little opportunity to voice their opinions or concerns. The inspectors were able to meet with the acting manager who has been in post for under a week but demonstrates a good understanding of the home and the service user group. She has already identified shortcomings in the home and has begun to put systems in place to address these. A new deputy has also been appointed who has many years experience of caring for people who have a dementia. At the last inspection the previous manager had begun to send out questionnaires to service users and families as part of the quality assurance system. Audits of these questionnaires could not be found at the time of this inspection. The home does not act as a power of attorney or financial appointee for any service user but does hold small amounts of money on behalf of some people. Records of these are held on computer and were not viewed at this inspection. The home employs a maintenance person and the home appears generally well maintained. The inspectors viewed the fire log this showed that alarms are tested weekly, emergency lighting is tested on a monthly basis and staff have received training in fire safety. Records show that all lifting equipment in the home has been serviced within the last 6 months. Over half the care staff team have not received an up date in moving and handling practices but the manager gave assurances that this was to be carried out on the 12th July 2007. Portable electrical appliances were tested in March 2007. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 25 Window restrictors are regularly checked and water temperatures are taken and recorded. The home was inspected by the environmental health department in April of this year and no issues were raised. Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 26 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 X X X 2 STAFFING Standard No Score 27 1 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X 3 Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 27 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 OP38 Regulation 13(4) Timescale for action The registered person must carry 15/07/07 out risk assessments in respect of service users living in rooms were doors open by the top of the staircase. (previous timescale of 30/03/07 not met.) The registered person must 15/07/07 ensure that all care plans are reviewed and up dated to reflect current needs. (previous timescale of 15/04/07 not met.) Requirement 2 OP7 14 (2)15 (2)[a][b] 3 OP8 14(1)(2) 4 OP14 12 (2)(3) 5 OP26 13(3) The registered person must ensure all service users are regularly weighed and action is taken to investigate all significant changes. The registered person must ensure that there are adequate numbers of staff working at the home to ensure that service users are able to make choices about their daily routines. The registered person must ensure that there are suitable facilities in place to promote DS0000059128.V337553.R01.S.doc 26/07/07 26/07/07 26/07/07 Cedar Lodge Version 5.2 Page 28 6 OP27 7 OP30 8 OP33 9 OP36 good infection control measures, including the provision of foot operated bins for clinical waste. 18(1)[a] The registered person must ensure that staffing levels take account of the needs and dependency levels of service users, not just the number of people living at the home. 18(1)[a][c The registered person must ] ensure that all new staff complete the induction training programme. 24 (1)(3) The registered person must ensure that there are quality assurance systems in place that include consultation with service users and their representatives. 18(2) The registered person must ensure that all staff are appropriately supervised. 10/07/07 26/07/07 30/09/07 26/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP7 OP14 OP28 OP12 OP19 OP22 OP29 Good Practice Recommendations The registered person should ensure that written daily records are reflective of the care given to service users. Registered person should ensure that choices are offered to service users in respect of meals. 50 of care staff should have a National Vocational Qualification at level 2 or above. The registered person should ensure that all service users receive adequate social stimulation and have opportunities to take part in activities. The registered person should ensure that the environment is enabling for service users with a dementia to assist them to orientate themselves around the home. The registered person should ensure that all gaps in employment histories are fully explored and recorded and that references are sought from the most recent employer. DS0000059128.V337553.R01.S.doc Version 5.2 Page 29 Cedar Lodge Cedar Lodge DS0000059128.V337553.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!