Inspection on 08/01/08 for Cedar Lodge

This inspection was carried out on 8th January 2008.

CSCI found this care home to be providing an Adequate service.

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 26/06/07

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 Announced Inspection 8th January 2008 09:45 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.V357419.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.V357419.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 claire@notarohomes.co.uk www.notarohomes.co.uk N Notaro Homes Limited Position Vacant Care Home 59 Category(ies) of Dementia (59), Old age, not falling within any registration, with number other category (59) of places Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 59. 26/06/07 2. 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. The current fee level at the home ranges from £373.00 to £500.00 per week. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Since the last key inspection three random inspections have been carried out, two during the day and one in the evening. These random inspections were to investigate concerns raised and to monitor the homes progress in meeting requirements that had been made. This inspection was carried out over one day. The inspector was given unrestricted access to all areas of the home, was able to speak with staff and service users and view records. The inspector spent an extended period of time in the communal areas talking with service users and observing care practices. Although the home is registered to accommodate up to 59 people at the time of this inspection only 38 people were living at the home and one person was attending for day care. What the service does well: Many of the service users living at the home are unable to fully express their views due to their dementia, however all service users seen appeared well presented and content. There was a calm atmosphere throughout the home. All prospective service users have their needs assessed by outside professionals or the home to ensure that Cedar Lodge is suitable to meet their needs. The first four weeks of any stay is considered a trial period. Family and friends are welcomed into the home at all reasonable times. One relative commented they were able to visit at anytime. All complaints are taken seriously and action is taken to rectify any shortfalls. New staff receive copies of the homes’ policies and procedures on recognising and reporting abuse and whistle blowing. The majority of staff have received training on the protection of vulnerable adults. The recruitment procedures in the home are robust and minimise the risks of abuse to service users. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care plans continue to be basic and do not give clear information about peoples likes and preferred routines. There is very limited information about peoples’ social interests and hobbies, which results in limited social stimulation for service users who are unable to occupy themselves. There are instances where staff are not following the care plans in place. Risk assessments had been carried out but these had not been reviewed and therefore their effectiveness had not been monitored. Interaction between staff and service users was polite and friendly but there was very limited social interaction when tasks were not being performed. The Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 7 inspector spent an extended period of time in the main lounge and noted that the only time that staff entered the room was when a task, such as handing out drinks, was being undertaken. On many occasions staff walked past the open door but made no contact with service users. The TV was on in the lounge, no one was watching the programme that was on and several people were asleep. The home has made considerable improvements in the basic physical care provided to service users and now need to look at ways of providing a more person centred approach. Many of the downstairs bedrooms are locked during the day meaning that service users are unable to access their rooms without staff assistance. Although there is evidence that this has been agreed with family members there is no evidence of consultation with service users. Staff would benefit from training on the Mental Capacity Act to enable them to appropriately assist service users to make decisions. The administration of medication is safe but there are no protocols in place for the use of PRN (as required) medication. This can lead to inconsistent practice and is not beneficial to service users. The administration of prescribed creams and lotions is not adequately recorded to enable effectiveness to be monitored. 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.V357419.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager carries out pre admission assessments on all prospective service users to ensure that the home is able to meet their needs. Intermediate care is not provided. EVIDENCE: The inspector viewed the personal files of two people who had recently moved to the home. Both included assessments of need carried out by professionals outside the home and copies of the homes own pre admission assessment. The manager appears clear about the level of need that Cedar Lodge is able to meet. Staff stated that they felt that they had the skills to support the current service user group. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 10 All service users and/or their representatives receive a contract with the home, which sets out what is included in the fee and the terms and conditions of residency. There is also a service user guide which gives further information about the home and its facilities. The contract states that the first four weeks of a person’s stay is a trial period to ensure that the home meets the new service users expectations and is able to appropriately meet their needs. In addition to full residential care the home offers day care, which is an opportunity for service users to spend extended periods of time in the home before becoming a resident. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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 do not give clear information about service users likes, dislikes and preferred lifestyles, therefore there is limited guidance for staff supporting people who are unable to express their wishes on a day-to-day basis. Service users have access to healthcare professionals outside the home but assessments of need and risk are not being regularly reviewed meaning that the effectiveness of plans of care are not being adequately monitored. EVIDENCE: The inspector viewed the care plans of four people living at the home. All contained a basic assessment of need from which care plans had been developed. There was limited information about people’s likes, dislikes or preferred routines. Some files contained a very basic pen picture of the person Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 12 but again there was very limited information about likes or wishes. Neither the care plans nor the pen pictures gave adequate information about lifestyle, hobbies or interests to enable staff to assist people in their preferred way or encourage them with social interaction. Some care plans gave clear details about how to assist someone with physical needs and to monitor the care plans effectiveness but it did not appear that these guidelines were being followed by staff. For example one person had a care plan that required the service user to be weighed every two weeks but the last recorded weight entry was almost 6 weeks ago. One risk assessment was to be reviewed monthly but had not been reviewed for 5 months although there was evidence in daily records that the person had had fluctuating health during this time. At the last key inspection it was noted that although people were being weighed no action was being taken when weights changed significantly. A new weight chart has now been introduced that gives clearer guidance to staff about when action should be taken and also has a section to be completed about what action has been taken. All medical appointments are recorded and these show that people have regular access to GPs, district nurses, community psychiatric nurses and chiropodists. Currently no one living at the home has a pressure sore but tissue viability assessments are being completed and preventative equipment has been put in place where a high risk is identified. One of these assessments had not been reviewed for 11 months. The home must ensure that all assessments of need or risk are kept up to date and are reviewed regularly to monitor their effectiveness. The inspector observed that throughout the day service users were spoken to in a friendly manner and were assisted in a way that respected their dignity. Currently all service users have single rooms where they are able to see personal or professional visitors in private. Prior to this inspection concerns were raised about service users sharing underwear. Staff gave assurances that this practice has now ceased. A pharmacy inspection was carried out on the 2nd October 2007 by the Commission’s pharmacy inspector. At this time some issues were raised, the majority of which have now been addressed. The pharmacist noted that there were no protocols in place for when PRN (as required) medication should be given. At this inspection protocols were still not in place meaning that there were no guidelines for staff, which may lead to inconsistent practice. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 13 The inspector viewed the Medication Administration Records (MARs) and noted that all medication was signed in when received at the home and when administered or refused by service users. This gives a clear audit trail. Prescribed creams and lotions were not being adequately recorded so effectiveness cannot be monitored. Controlled drugs were appropriately stored and records kept correlated with stock held. Some hand written entries on the MARs had not been signed and witnessed in line with good practice guidelines and the homes own policy. Cedar Lodge DS0000059128.V357419.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. There is limited social stimulation for service users who are unable to occupy themselves. Food in the home is of a good quality and well presented. Visitors are welcome at the home at all reasonable times. EVIDENCE: The home employs an activities worker who assists people to take part in activities arranged by the home. Over the Christmas period there have been parties and musical events that have been enjoyed by many of the service users and their relatives. On the day of the inspection the activities worker was supporting people to see a hairdresser who was visiting the home. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 15 The inspector spent a large part of the day in the main lounge with service users, observing care practices. Interactions with service users was extremely task focussed. For the majority of the morning most service users received no social stimulation. Staff came into the lounge to give out drinks and biscuits but at other times walked past the door without making any comment to service users. The TV was on but many of the service users were asleep and no one appeared to be watching the programme on the TV. There were no newspapers, magazines or books in the lounge. When staff assisted service users with a task they were happy and polite and interactions were good. As previously mentioned there is limited information in the home about service users interests or hobbies. It is therefore difficult to ascertain how choices about daily routines are made. There is a variety of communal areas where service users can spend time. On the day of the inspection care staff were not seen to be present in any lounge unless they were performing a task. Two service users told the inspector that they spent their day “sitting or sleeping.” Service users are able to move freely around the communal areas. Many of the bedrooms on the ground floor are locked during the day meaning that people only have access to their rooms if they request it from a member of staff. Bedroom doors have signs on to make them familiar to their occupants. The manager stated that they are in the process of improving the environment to make it more friendly to people who have a dementia and to assist people to orientate themselves. The lighting in corridors has been improved and they are in the process redecorating. The corridor on each floor will be a different colour and service users will be able to choose what colour they wish to have their bedroom door. During the day friends and relatives visited the home. One relative spoken to stated that they are able to visit at any time and were always made welcome. The menu in the home has been updated and a picture book of all meals has been created to assist people to make choices about the food they eat. The days menu is written on the notice board in the dining room but is not prominent and service users did not know what was for lunch on the day of the inspection. The home should display the pictures from the menu book on the notice board each day. Some people have breakfast in their rooms and some people go to the dining room. The inspector noted that some breakfast trays were returned to the kitchen without the food being eaten. This did not appear to be recorded in care plans. The inspector observed the lunchtime experience. Many people waited some time before their lunch was served but everyone received a choice of drinks while they waited. Again interactions were very task focussed. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 16 The meal was well presented and people were assisted in an appropriate manner. Tables were laid with mats, cutlery and vases of flowers but there were no condiments, such as salt and pepper, available. Cedar Lodge DS0000059128.V357419.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 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes complaints seriously and ensures that action is taken in response to any concerns raised. Staff would benefit from training on the Mental Capacity Act to ensure that they are consulting service users about restrictions imposed and are assisting people to make decisions in the most appropriate way. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. All staff are made aware of the policies when they begin work at the home and sign to say that they have read and understood them. The home has received no complaints since the last inspection. One concern was raised with the Commission for Social Care Inspection and a random inspection was carried out in September 2007. This concern related mainly to personal care at the home and the unavailability of personal toiletries and underwear for service users. There was evidence at this inspection that these issues are being addressed. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 18 Service users have unrestricted access to communal areas in the home but as previously stated some ground floor bedroom doors are locked during the day meaning that people can only access their rooms by request. Staff would benefit from training on the Mental Capacity Act, as although this practice has been agreed with relatives there is no evidence to suggest that service users have been fully consulted or that the ‘best interest’ check list has been followed. The majority of staff have received training in the protection of vulnerable adults and those spoken to were aware of the ability to take serious concerns outside the home. There is a robust recruitment procedure that includes seeking written references and checking prospective staff against the Protection Of Vulnerable Adults (POVA) register. All staff undergo a Criminal Records Bureau (CRB) check before they commence work at the home. Cedar Lodge DS0000059128.V357419.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, 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 currently being redecorated to make it more accessible to people who have a dementia. 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 over three floors with a passenger lift giving access to all but three bedrooms. There are some bedrooms that lead directly onto stairs. Risk assessments have been completed in respect of these Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 20 rooms and the service users that occupy them but these have not been regularly reviewed. 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. The process of making the environment more accessible for people with a dementia has begun and there are plans for themed lounges and more points of reference around the home. The manager is using up to date research to guide the redecoration programme. 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. 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. All areas of the home seen were reasonably clean and fresh. Clinical waste bins have been ordered to ensure that waste is disposed of appropriately. Cedar Lodge DS0000059128.V357419.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, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is adequately staffed to meet the needs of the current service users group. The robust recruitment procedure minimises the risks of abuse to service users. EVIDENCE: Since the last inspection staff morale in the home has risen considerably. Staff spoken to stated that they now felt more involved and appreciated. People said that they felt comfortable to approach the manager with any worries or suggestions. All said that there were now regular meetings, which were a chance for them to view their opinions and make suggestions about the running of the home. The home employs 26 care staff, 12 have a National Vocational Qualification (NVQ) in care or an equivalent qualification. A further 4 members of staff are currently undertaking the NVQ award. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 22 All new staff now undertake a full induction programme which is documented. The inspector was able to talk with a recently appointed member of staff who stated that they had been welcomed into the home and given appropriate information. There are ongoing training opportunities for statutory training in health and safety issues such as first aid, fire safety and moving and handling. The manager explained he is in the process of creating a training matrix which will clearly show what training staff have completed and which courses staff need to do or up date. There are also opportunities for training specific to the needs of the service users at the home. Some staff have completed training in dementia care, assisting people with eating and drinking and dealing with challenging behaviour. Staff spoken to generally felt that training opportunities were now good. The manager is keen to use local professionals to expand the training available to staff. The duty rota showed that the home is adequately staffed for the number of service users currently living at the home. Staff stated that they felt that they had sufficient staff at the present time. The inspector viewed the recruitment files of the three most recently employed members of staff. All contained all information required and gave evidence of a thorough and robust recruitment procedure. Cedar Lodge DS0000059128.V357419.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): 32, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although the manager has only been in post for a very short time he is already demonstrating clear leadership and a commitment to ongoing improvement. EVIDENCE: The home has appointed a new manager who has now been in post for two months. The manager is in the process of applying to the Commission for Social Care Inspection to be registered. The manager has achieved the Register Managers Award (NVQ Level4) and is able to demonstrate that his practice is informed by up to date research and current good practice guidelines. The manager has considerable experience in Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 24 management and working with people who have a dementia and other mental health difficulties. Staff described the manager as very open and approachable. The inspector observed that the manager was comfortable speaking with, and assisting, service users, staff and relatives. There are regular staff meetings and minutes seen showed that a wide range of issues are discussed. Staff stated that the meetings were an opportunity to share ideas and not just an information sharing exercise. Formal supervision sessions for staff have been introduced which is another opportunity for people to express their views and a chance for the manager to monitor practice. Service user meetings have been introduced and these are currently been used to seek the views of service users on the care that they receive. The home also sends out questionnaires to families on an annual basis to seek views. The majority of service users living at the home are unable to manage their own finances. The home holds small amounts of money of behalf of these people to ensure that they are able to purchase small items and services when they wish to. Clear records are kept of all money held and receipts are given when money is deposited with the home. Monies are held in a shared account but individual statements are maintained and easily produced on request. Interest gained is added to each persons’ individual total. The inspector viewed the records kept and found them to be satisfactory. Various measures are in place to ensure safe practices in the home. A fire log is maintained and this shows that all staff receive regular training in fire safety. Fire detection equipment in the home is serviced by outside contractors and tested by the in house maintenance person. Appropriate measures have been put in place to minimise the risks of accidents to service users. All upstairs windows have been restricted and radiators are either covered or of the cool wall type to minimise the risk of burns. There are adequate hand washing facilities and protective equipment such as aprons and gloves are supplied. All accidents are recorded and notified to the appropriate authorities if required. All areas of the home seen by the inspector were well maintained. Appropriate insurance is in place and the certificate is displayed in the entrance foyer. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 25 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 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 x 3 3 x 3 Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation Requirement Timescale for action 31/03/08 12 (3)14 The registered person must (2)15 (2)a ensure that care plans are b reflective of the service user’s likes, dislikes and preferred routines. 13 (4) [c] The registered person must ensure that risk assessments are regular reviewed and up dated in line with changing needs and abilities. It must be clearly described within a resident’s plan of care when a medicine, prescribed to be administered, ‘when required’ may be given. This will ensure all staff do so in a consistent way. Requirement carried over from last inspection The registered person must ensure that medication, including prescribed creams, is administered and recorded in line with the homes policies. The registered person must ensure that service users are consulted on their social interests and ensure that social DS0000059128.V357419.R01.S.doc 2 OP8 31/03/08 3 OP9 13 (2) 31/01/08 4 OP9 13(2) 31/01/08 5 OP12 16(2) [m] 28/02/08 Cedar Lodge Version 5.2 Page 27 6 OP14 13(7) stimulation is provided for all. The registered person must ensure that service users are consulted about any restrictions placed upon them and a clear rationale for such restriction is recorded. This relates to the practice of locking bedroom doors. 28/02/08 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 OP28 OP12 OP19 OP22 OP8 OP18 Good Practice Recommendations The registered person should ensure that written daily records are reflective of the care given to service users. 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 service users are assisted to maintain a selection of toiletries of their choosing. All staff should receive training on the Mental Capacity Act to enable them to appropriately assist service users to make decisions. Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 28 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 Cedar Lodge DS0000059128.V357419.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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