Inspection on 19/04/07 for Cedar Lodge Nursing And Residential Home

This inspection was carried out on 19th April 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 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 Nursing And... 05/09/05

Cedar Lodge Nursing And... 27/04/05

Cedar Lodge Nursing And... 20/10/04

Cedar Lodge Nursing And... 18/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Nursing And Residential Home St Catherine`s Road Frimley Green Camberley Surrey GU16 6PY Lead Inspector Lesley Garrett Unannounced Inspection 19th April 2007 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 Nursing And Residential Home DS0000017597.V333117.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 Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Nursing And Residential Home Address St Catherine`s Road Frimley Green Camberley Surrey GU16 6PY 01252 837019 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) cedarlodge@forestcare.co.uk Forest Care Limited Mrs Jane McAuley Care Home 63 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (62) of places Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to four (4) service users falling within the category DE(E) Dementia over 65 - may be accommodated. Up to 56 of the 63 beds may be used for the provision of nursing care for older people from the age of 60 years. 5th September 2005 Date of last inspection Brief Description of the Service: Cedar Lodge is a purpose built nursing and residential home, set in its own landscaped gardens. The home is surrounded by woodland, which creates an atmosphere of peace and tranquillity. The home is privately owned and managed by Forest Care Ltd. Accommodation is mainly in single rooms with en-suite facilities, although there is capacity to accommodate couples in shared bedrooms. The home is situated in the outskirts of Frimley Green in a quiet location, with ample car parking facilities. All around the home there is excellent access to the garden for wheelchair users. At Cedar Lodge there is a home manager and a clinical nurse manager. It is the clinical nurse manager that is registered with the Commission as the Registered Manager for the home. The fees for this service range from £650-£750 per week. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 0945 and was in the service for four hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner and manager, and any information that CSCI has received about the service since the last inspection. The Commission had sent out questionnaires to the home but these had not been responded to. The registered manager was not available on the day of the visit but the inspector was able to speak to her the next week. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. What the service does well: What has improved since the last inspection? The two requirements from the inspection in September 2005 have now been met. Staff has received their training in safeguarding adults and the financial records for service users personal money has been improved Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users only move into the home following a full assessment of their needs. The home has no intermediate care beds. EVIDENCE: The staff member stated that all service users have a pre-admission assessment prior to moving into the home. The registered manager or another nurse carries this out. The nurse also stated that service users could spend a day at the home to sample the service for themselves. Care plans are generated from this assessment. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to this service. Service users have individual plans, which reflect the care and support they require and their health care needs are fully met. The medication policies and procedures that are in place and implemented by staff protect service users. The privacy and dignity of service users is respected. EVIDENCE: We sampled three plans of care for service users. These are stored together in large ring binder folders and one nurse is responsible for each folder. The documentation was not all kept together for example the daily notes and wound care plans were kept separately. We spoke with the manager about this following the site visit and she stated that it has been set up this way to ensure the nurses evaluate, review and change when necessary the plans every month. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 10 It will be a recommendation at the end of the report that the registered manager considers changing to individual plans to make sure there is an individual holistic plan of care, which is easily accessible for all staff delivering care. This will also protect the confidential nature of these files. The nurse stated that the home has good support from their local general practitioner (G.P.) who visits every week. A chiropodist visits every six weeks, a dentist who will visit when necessary and opticians who visit every six months also supports the home and service users. The nurse told us that the home has a local pharmacy that supplies all medications for service users in blister packs. The medications are delivered every month and the home has a contract for disposal of unwanted medications with another supplier. There is a clear audit trail for all medicines that are destroyed and this record is kept at the home. Medication administration records (MAR) were sampled and it is recommended that where changes are made to the MAR by staff that these handwritten entries contain two signatures. The nurse showed us the home’s privacy and dignity policy and it was stated this is a subject that is discussed during all new staff induction. Staff were observed to be knocking on service users doors prior to entering and their preferred name was being used .as documented in their individual plans of care. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Some activities take place and visitors are welcomed to the home to maintain contact with their family members. Service users are helped to exercise some choice over their lives and a balanced diet is provided and taken in appropriate surroundings. EVIDENCE: The nurse stated that the home has no activities organiser but an extra member of staff is allocated every day to arrange the activity that has been arranged for that morning. On the morning of the site visit we observed a member of staff helping service users to throw beanbags through hoops. There was a programme of activities displayed on the notice board to show when an outside entertainer had been arranged. Other activities organised have been bingo, tabletop games and gardening. The nurse stated that a new activities organiser had been recruited and will start her new job soon as she is a current member of staff. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 12 The nurse told us that visitors are welcomed at the home any time and can stay overnight if their relative is unwell. On the day of the site visit we observed visitors coming and going. One visitor told us ‘we visit our friend every day and we are very happy with his care’. We were also told that local schools visit at Christmas to sing carols for the service users and a trip to the local theatre was enjoyed. On the day of the site visit service users were observed to be in the garden enjoying the sunshine. We observed that rooms occupied by service users had been personalised with their own possessions around them. Choice is given to service users as much as is possible and the nurse stated that service users can get up in the morning when they would like and go to bed at a time that would suit them. On the day of the site visit the chef was unavailable and the home manager was in the kitchen. A four-week menu is rotated with choice given for each meal. Service users are asked on the day for their preferences and a cooked breakfast is always available if requested every morning. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 13 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 service users are protected by the homes complaints policy. The safeguarding adults policies need to be improved to safeguard the service users from abuse. EVIDENCE: The complaints policy is available for all service users and in reception there is a comments book available for all relatives or representatives to write in. The nurse stated that the home had only received one complaint since the last inspection but the complaints log was unavailable on the day of the site visit. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The home has its own policy for safeguarding adults but the nurse stated that the policy the staff are taught are the local authorities procedures. The local authority policy that the home had was out of date and the registered manager was aware of this and will up date the home’s copy. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 14 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a well-maintained environment, which was clean and hygienic. EVIDENCE: We toured the building and found that service users were either in their bedrooms or sitting in one of the lounges available to them. Bedrooms had been personalised and service users can bring in their own furniture if they wish. All bedrooms have en-suite facilities. Corridors are wide allowing easy wheelchair access. The home has a full time laundress and the nurse stated that she had received infection control training and uses and understands the use of the red dissolvable bags to ensure that soiled washing is separated. The laundry was large and tidy. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 15 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 numbers and skill mix of staff meets the needs of service users. Recruitment folders need to be checked to ensure all documentation is in place for staff to ensure that service users are adequately protected. EVIDENCE: We observed the staff rota on the day of the site visit and the rota that had been sent with the pre-inspection questionnaire. It showed that adequate staff was on duty with a good skill mix. The nurse stated that there are waking night staff and we observed domestic staff in sufficient numbers to meet the needs of service users. The nurse stated that some care staff hold the national vocational qualification (NVQ) at both level 2 and 3. The staff are enrolled at a local college and this training in on going. The nurse also said that these staff was also enrolled on a nationally recognised training programme. We sampled three recruitment folders for the staff and found these folders to be disorganised with information kept in several different places. We spoke to the registered manager following the site visit who stated that she was not responsible for the recruitment folders. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 16 To ensure ease of monitoring by the registered manager the home should follow robust recruitment procedures to ensure that service users are protected. A recommendation to organise staff recruitment folders will follow at the end of the report. Following a discussion with the registered manager concerning the storage of sensitive documents for example the criminal record bureau checks she consult with the appropriate authority to seek guidance for their destruction. The nurse and the pre-inspection questionnaire demonstrated that training takes place at regularly at the home and this includes the mandatory training for example safeguarding adults, fire awareness, manual handling and food hygiene. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management structure at the home is potentially confusing for service users their relatives and external professionals and feedback on the homes service is not sought from service users or any other stakeholders. The financial systems and health and safety of service users are generally protected. EVIDENCE: The registered manager was not on duty on the day of the site visit and the home manager was preparing lunch, as the chef was not on duty that day. We had the opportunity to speak with the registered manager following the visit and following this discussion found that the management structure within the home confusing. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 18 Allocation of responsibilities is split between the registered and home manager and staff and relatives can speak to either manager but there appeared no clear communication link to bring this information together. When telephoning the home to speak to the manager you are asked if you want the home or clinical manager and this can cause confusion for both service users and their representatives. There will be a recommendation that there is clarification of the role of the registered clinical manger (registered manager) and the home manager for the benefit of the service users their representatives, staff and those external to the home. We sent to the home some survey forms for the service users, their representatives and other stakeholders for example the G.P., chiropodist or care managers. None were returned to the home. The registered manager stated that she had left them in reception if anyone wanted to pick one up. The registered manager stated all policies and procedures within the home are audited regularly by an outside company and adjustments made where necessary. Relative support group meetings are held but these are informal and no minutes are kept and there are no such meetings for service users. It will be a requirement at the end of the report that the registered manager seeks the views of service users, their representatives and other stakeholders in the home and that these are published and made available to current and prospective service users. The nurse stated that service users could give personal allowance money to the home for safekeeping. All receipts are kept and individual entries are made. We did not sample this system on the day of the site visit. During a tour of the building we observed door wedges being used on most of the bedroom doors on the ground floor. It will be a requirement for the home to consult with the appropriate authorities to check the suitability of this practice. Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 20 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 OP33 Regulation 24 Requirement To establish and maintain a good system for evaluating the quality of the services provided at the care home taking into account the views of the service users, their representatives and those external to the home. To speak to the appropriate authority concerning the use of door wedges to ensure the safety of service users in the event of a fire. Timescale for action 19/06/07 2 OP38 23 19/05/07 Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that each service user have their own individual plans of care instead of the information for service users kept in different folders. This will also protect the confidential nature of these files. It is recommended that all hand written entries on the medication administration chart contain the signature of two members of staff. All the recruitment folders must be organised and contain all the information that is required in Schedule 2. 2 3 OP9 OP29 Cedar Lodge Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Nursing And Residential Home DS0000017597.V333117.R01.S.doc Version 5.2 Page 23 - 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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