Inspection on 01/08/07 for Cedar Lodge Nursing Home

This inspection was carried out on 1st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Nursing Home 26/08/08

Cedar Lodge Nursing Home 15/08/06

Cedar Lodge Nursing Home 10/01/06

Cedar Lodge Nursing Home 07/06/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Nursing Home 58-62 Kingsbury Road Erdington Birmingham B24 8QJ Lead Inspector Kath Strong Key Unannounced Inspection 1st August 2007 09:00 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 Home DS0000063476.V341851.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 Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Nursing Home Address 58-62 Kingsbury Road Erdington Birmingham B24 8QJ 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) 0121 350 3553 0121 384 4811 United Care Ltd Ms Sonia Seymour Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (36) of places Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. That the Home is registered for nursing care for a maximum of 36 service users for reasons of old age (OP) That in addition to the manager there is a minumum of one first level nurse and five care staff on duty throughout the waking day (14hrs). That at night there is a minimum of one first level nurse and two care staff on duty each night. Ancillary staff are to be employed in addition to the minimum staffing levels to cover catering, laundry and cleaning. Issues in respect of the premises are to be addressed within timescales as agreed with Mr Patel. 15th August 2006 Date of last inspection Brief Description of the Service: Cedar Lodge is a three storey property situated within the residential area of Erdington, West Birmingham. The home provides nursing care for up to 36 persons who are aged 65 years or over and may suffer from dementia, physical disabilities or terminal illness. The home is situated approximately one mile from Erdington centre where the main shopping facilities are located and a short distance from Sutton Coldfield. There is public transport within close proximity and Gravelly Hill interchange is convenient for those travelling by car. There is ample off road parking to accommodate at least seven vehicles situated at the front of the premises. Bedroom accommodation is available on each of the three floors, there are both single and shared rooms and some have en-suite facilities. Access to each floor is by a shaft lift and the home has a good supply of specialist pressure relieving equipment and mobile hoists for the benefit of residents who have restricted mobility. Meals are prepared on site as well as laundry facilities. The communal areas are located on the ground floor. The property has an extensive rear garden, which lends itself to outdoor functions during warm weather. The structure of the home provides good potential for further development. The home owner will shortly be submitting plans to extend the premises, which if approved will result in a total of four communal rooms to give people choices about which room they wish to occupy during daytime hours. The proposed Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 5 plans indicate that there would be minimal disruption to people living at the home during the extension works. The minimum fee rate is £480.00 and maximum is £591.00 per week. Other items that are not included in the charges are private chiropody, hairdressing, magazines and newspapers. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The home did not know that the fieldwork visit would be carried out, this is to enable the inspector to obtain an actual picture of the standards of services provided. On the day of the visit, the home had 30 people living at the home. Assistance was provided throughout by the manager. At the conclusion feedback was given to the home owner, the quality consultant and the manager. Due to dementia it was not always possible to hold a meaningful discussion with people who live at the home. No Immediate Requirements were made. Information was gathered from speaking with people who reside at the home, relatives and staff. Care, health and safety and the arrangements for medications were inspected. Staff personnel files were checked and staff were observed whilst performing their duties. A partial tour of the premises was carried out. Two of the four care plans reviewed were case tracked. This involves obtaining information about individuals’ experiences of living at the home. This is done by meeting with or observing people, discussing their care needs with staff, looking at care plans and focussing on outcomes. Tracking peoples care needs and how the care is delivered helps us to understand the experiences of those people. Prior to the visit the home had completed the annual quality assurance assessment and sent it to CSCI. The information within the document advised of what the home does well, improvements made during the last 12 months and what the home would like to further improve. This provided details that contribute to the inspection process and highlights areas that may be explored during the fieldwork visit. A number of people who live at the home were requested by the inspector to complete a questionnaire. These give personal opinions about the services provided and are included in this report. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is based upon the outcomes for people who live in the home and their views about the services provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and aspects of service provision that need further development. What the service does well: People living at the home are well supported by staff in meeting their personal and healthcare needs. This indicates that a primary concern is the promotion of the health and wellbeing of people who require these services. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 7 In practice staff encourage and support people in maintaining their right to make choices about the way they wish to live and their independence but this is not always reflected in the care plans. There is an ongoing programme of improvements and redecoration of the premises to ensure that people live in a pleasing environment. Personal care is delivered in the privacy of the persons own bedroom or a bathroom thus ensuring that peoples dignity and self esteem are preserved. It was observed during the previous inspection as well as this one that the manager adopts an ‘open door’ approach to all people who wish to speak with her. This ensures that guidance, support and explanations are delivered in a prompt and professional manner. When concerns or complaints are raised these are dealt with effectively and any resultant action is identified and carried out. This ensures that people are given explanations and outcomes in a timely and professional fashion. The homes administrator was observed talking with a relative and suggested an arrangement that could be made to overcome a problem that the relative had raised. This is viewed as being good practice. Six questionnaires were received from people living at the home or representatives on their behalf. No adverse comments were made. Relatives spoken with made comments such as, “The home is very good, staff are very helpful and will do their best to sort things out”. What has improved since the last inspection? Some of the requirements made at the last inspection of August 2006 had been met. This suggests that the home is making ongoing improvements for the benefit of those who live there. All catering staff have undertaken a food standards course to ensure that meals are appropriate and healthy. All kitchen staff have had lessons in Asian cooking to ensure that culturally appropriate meals are prepared for a person living at the home. The kitchen has been redecorated and a new fridge installed to ensure that foods are safely stored and meals are prepared hygienically to prevent infections. The home is participating in an initiative that ensures that all equipment and services are provided for people who are at the end stages of life. This indicates that the peoples preferences have been actioned and all health issues have been explored to promote the persons comfort and dignity. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 8 Bathrooms on the ground and first floors have been converted to walk-in shower rooms to promote peoples ability in accessing appropriate bathing facilities. This has resulted in the home having five baths and five showers to promote peoples choices about their preferred method of bathing. A deputy manager has been employed earlier in the year and has been allocated specific responsibilities to assist with the smooth day to day running of the home. The deputy manager is supernumery for one or two days per week to permit her to carry out management tasks and the overseeing of staffs performance. Eight airway mattresses have been purchased; this is specialist equipment to use for people who may be assessed as being a t risk of developing pressure ulcers. A new hoist has also been purchased to assist staff in carrying out safe transfers of people with restricted mobility. The homes code of conduct for staff has been written in a number of different languages to ensure that all staff employed posses a full understanding of its contents. The home is a training venue for overseas student nurses who are completing an adaptation course to work in this country as qualified staff. The medication fridge that was not performing adequately has been replaced to ensure that drugs are stored at the appropriate temperature. Staff have completed mandatory training such as Fire Safety, Moving and Handling, Health and Safety and Adult Protection. Further courses have been commenced regarding the new Mental Capacity Act and Dementia Care. This provides staff with the knowledge and skills to carry out their roles effectively. The front external walls of the premises have been repainted to present a pleasing effect for people entering the premises. What they could do better: Although some work has been carried out to improve care planning it was found that little progress had been made. This needs to be addressed as a matter of priority because a requirement was made at the last inspection of August 2006 and has not been met. Staff need to explore personal preferences and individuals personal habits in respect of toileting and incorporate them into the care plans. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 9 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 Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 10 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 Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The written details that are made available to people ensures that they are able to make an informed decision about living at the home. Pre-admission assessments and information gathered indicates that the home is able to meet peoples needs. EVIDENCE: The statement of purpose was found to be extensive and appropriate during the previous inspection. The manager advised that it has not been altered and that it was available in audiocassette for the assistance of people who are visually impaired. This is viewed as being good practice. The home commences an enquiry form when people make contact about a possible admission. The form is updated when other contacts are made. The pre-admission assessment carried out for the two people who were case Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 12 tracked was checked. It included good details about health and cultural needs and appeared to include the degree of support and whether any specialist equipment would be required. This information and details obtained from other sources suggests that the home is able to demonstrate that it can meet peoples needs at the time of admission. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In practice peoples healthcare needs were being met but this was not confirmed in the care plans. Staff practices regarding the administration of medications are unsafe and put people ate risk of harm. EVIDENCE: Each person has a written care plan. This identifies the assessments carried out, care that staff should provide and a means of monitoring individuals health status. Care plans should be regularly reviewed and any changes recorded and care plans altered to ensure that all needs are being met. Four care plans were reviewed including the two who were case tracked and others with varying healthcare needs. Some changes had been made in that a variety of pre-typed forms were being used to assist staff in the care planning process. However, staff reliance on pre-typed information had resulted in inadequate details about peoples individual needs. Files were found to be indexed to promote ease of access. The annual quality assurance assessment that was completed by the home and forwarded to CSCI states that peoples Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 14 life histories and backgrounds have been commenced and are being filed in care plans. These should form part of the assessing and care planning process and be incorporated into information and staff instructions regarding how care and activities of daily living will be ensured. Some significant shortfalls were found in the care plans: • Lack of recordings about peoples cultural and spiritual needs or confirmation that the individual does not needs these • The regular recordings of ‘take to the toilet x times per day or 2 to 3 hourly fails to identify if that is appropriate for the individual. Staff need to explore where possible peoples personal habits and patterns and develop the care plan around these to promote continence as far as practically possible • A files social activities form contained little information about likes and dislikes but the pre-admission assessment states, ‘mentally alert, enjoys gardening, reading and horseracing. This suggests that there has been lack of continuity in care planning and failure to provide the reader with a complete picture of the individuals abilities and preferences • Another file in respect of activities states, ’unable to maintain social activities due to language barrier and dementia but another area of the care plan states, ‘bingo’ • The file also failed to highlight that the family members act as interpreters or that some staff may be able to communicate. There should be clear guidance provided as to how communications will be achieved • Personal hygiene needs fail to state how often, when during the day or the method of bathing that suit the individuals wishes and previous routines. Family members may provide such information, which should be included as part of the care planning process • A pre-admission assessment carried out indicated that the person is prone to falls but there was no care plan in place for this • A formal review stated, ‘he is a vegetarian’ but an earlier assessment includes information that he likes chicken • The pressure ulcer description in respect of one person was found to be poor. This does not provide adequate information for staff to monitor the ulcer • Some charts did not include the actual dates of when assessments or monitoring had been carried out. This requirement was made at the previous inspection but only limited compliance was found • There was no care plan in place for a person who has diabetes • No risk assessment had been carried out for the person who experiences difficulty in swallowing. This need was brought to the homes attention during the last inspection but has not been actioned • Failure to obtain written agreement for the use of bedrails Care plans require urgent attention to bring them up to an acceptable standard to evidence that staff are provided with comprehensive guidance and that all Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 15 care needs are being met. This is an outstanding requirement and therefore needs urgent attention. The staff handover was observed being carried out. This involves staff advising other staff who have just arrived to complete their shifts of updates of residents. Each person in turn was discussed and clarification sought as needed. Following this the controlled drugs check was carried out and carers were allocated to a group of people to look after. The handover appeared to be comprehensive. There was evidence of the services of external professionals and that the home actively seeks their advise when required. Comments were received from people who live at the home, “The care is very good, staff care for me very well, I’m well cared for, I’m very happy here and well looked after, I have no complaints”. Relatives also said, “The home is OK, staff listen and if possible do what they can to help, staff look after him very well, the home is very good, staff are very helpful and will do their best to sort things out, she is well looked after”. The arrangements for the ordering, receipt, storage, administration, recordings and disposal of medications were reviewed. All with the exception of one aspect were found to be satisfactory. Audits of blister packs and boxed medications carried out identified inaccuracies of the numbers in stock. A review of the medications and staff practices were needed to prevent the future failure in unsafe practices. No adverse comments were received from people about the way in which care is delivered. Relatives spoken with were complimentary about the care provided. Observation of staff practices and interactions with people who use the service were noted to be good. Care was being provided in the privacy of peoples own bedrooms or a bathroom to maintain their dignity and self esteem. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are physically and mentally stimulated and activities meet the majority of expectations. People are encouraged and supported in making decisions about the day to day operations of the home. Dietary needs are catered for including special diets resulting in provision of a varied and nutritious diet. EVIDENCE: The activities programme is on display on the notice board dedicated for people who live at the home. The seven day rolling programme includes such sessions as sing-a-long, exercises, hoopla, arts and crafts, sport and films, and reminiscence. The home does not employ an activities organiser; care staff are rostered in such a way that there is an overlap every afternoon. During this period a number of staff are allocated to carry out group activities and one to one sessions with people who wish to remain in their bedrooms. External entertainers also visit the home regularly to provide music, gentle exercises and other music sessions. Each person has a form that staff complete regarding their participation and satisfaction with the recreation provided. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 17 One person goes to a day centre, two people go out unaccompanied and another regularly goes out with family members to visit friends. Some people go out for walks with staff and someone had been out shopping with a carer the previous weekend. Regular meetings were being held where people are encouraged to discuss issues about the day to day running of the home and activities are usually one of the topics. It was noted that meetings have specific main topics such as meals, laundry, privacy and respect. This encourages people to consider various aspects of the services and to talk about them. A person who lives at the home said, “My son visits at 7:30pm, you can visit anytime and staff are always alright about it”. The meal menu was shown to the inspector. It offers a range of meals with choices and indicates that balanced and nutritious diets are encouraged. All catering staff have completed training in food standards and had lessons in Asian cooking for the benefit of one person living at the home. The cook has experience in cooking dishes of many countries. Specialist diets are catered for and meals were culturally appropriate for the client group. Lunch was observed being served. The kitchen staff serve meals onto plates for care staff to transfer to people. Most people were using the dining room a few remained seated in the lounge. Appropriate assistance was provided and independence was encouraged. Another inspector who was shadowing the link inspector sampled the main course. She advised that the meal was tasty and nicely cooked. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are aware of how to make a complaint and are confident that concerns raised would be dealt with appropriately. Arrangements are in place to protect people from risks of abuse. EVIDENCE: The written complaints procedure was on display on the dedicated notice board for people who reside at the home. It provides clear guidance to assist people in how to make a complaint. The home uses a complaints log to document concerns; the form provides a clear pathway of information about how and when the complaint has been dealt with. The file contained compliments as well as complaints raised since the last inspection of August last year. The number of compliments far outweighed the complaints received by the home. There were eight complaints recorded however, three concerned one person. The investigations and action taken appeared to be acceptable. The investigation of one recent complaint had not yet been completed. No complaints have been sent to CSCI since the last inspection. The written policy regarding adult protection was seen last year and was found to be extensive. The manager advised that the content of the policy had not been changed since the last inspection. An allegation made earlier in the year was unfounded; therefore no abuse had taken place within the home. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 19 All staff had received training in adult protection and those who were spoken with demonstrated that they would respond appropriately if abuse was suspected. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a safe, comfortable and pleasing environment. Recreational space and seating is limited and restricts choices. The home is hygienic throughout. EVIDENCE: The home has a good sized, airy dining room that leads out onto the garden where people were noted to be enjoying the warm weather. Staff had supplied them with hats to protect people from the heat of the sun. The garden is extensive and well laid out. The adjacent lounge does not permit sufficient space to accommodate enough comfortable chairs for number of people in the home. To overcome the problem the home owner has drawn up plans, which if acceptable to the Local Authority will provide three more lounges to give people a good range of choices about where they wish to sit. Corridors are narrow and may be restrictive to wheel chair users in some areas. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 21 The home employs a maintenance operative so that repairs can be carried out quickly to promote a safe and pleasing environment for people to live in. The cracked velux window in the staff toilet has needed repair for a considerable period of time. This puts staff at risk of injuries and needs to be addressed as a matter of priority Bathing facilities have been improved with the recent conversion of two rooms into walk-in shower rooms. There are five bathrooms and five shower rooms to ensure there are ample facilities that allow people to make choices about the method they wish to bathe. Bedrooms are located on each of the three floors; they vary in size and layout. The rooms were visited of the persons whose care plans were seen. People are encouraged to take in small items of furniture and personal possessions to make the room as homely as they wish. All bedroom doors have suited door locks so that people who are assessed as being able are offered a room key to increase their privacy. Some rooms had signage on the doors to assist people in orientating and to maintain their independence. It is recommended that the signage should be further developed. The home was light and airy and has domestic style lighting. All hot water outlets that people who live at the home has access to is randomly tested to ensure that scalds are prevented. The kitchen and laundry rooms were clean and tidy. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The allocated numbers of staff are not adequate to meet all of peoples needs. Some staff have not received sufficient training to provide them with the skills to respond if an emergency occurs. EVIDENCE: The staffing rota was reviewed. It was found that during the afternoon shifts that there were inadequate care staff on duty each day. Since the day of the visit the manager has advised CSCI that the shortfall has been rectified. This indicates that senior staff respond promptly when concerns are raised however, this report is based upon what was found on the day of the visit. In excess of 50 of staff employed have successfully completed training in NVQ level 2 and more staff were undertaking the course. This promotes an efficient workforce who will be capable of meeting peoples needs. Review of a number of staff personnel files indicated that the home has good arrangements in place for staff recruitment. These are necessary to protect people from risks of harm. New care staff undertake an induction programme that contains all of the topics within the Skills for Care package. This provides them with the Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 23 knowledge and skills about how to carry out their roles in the care sector. Other mandatory training is provided such as Health and Safety and Moving and Handling to ensure that staff provide care by safe means to protect people from risks of injuries. Other training that has been supplied include Dementia Care, Tissue Viability and Pressure Ulcer Care, Diabetes, Staff Supervision, PEG(specialist) Feeds, Continence, Nutrition, The Mental Capacity Act and Alzheimers Disease. Such training provides staff with the knowledge and skills to meet peoples’ specialist and diverse needs. Some staff had not received annual Fire Safety training. It was noted that one member of staff had not attended training for a significant period of time, this will need addressing to ensure that staff take appropriate action in the event of an emergency situation. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has a clear vision for progress of the home for the benefit of those who live in the home. The health and safety arrangements protect people from risks of injuries. EVIDENCE: The manager possesses the knowledge and skills to manage the home. She has a wealth of experience and leads by example to promote a skilled workforce. Since the last inspection a deputy manager has been appointed who is supernumery for one or two days per week. This allows her to carry out management duties to assist in the day to day operations of the home. The deputy manager has specific tasks to carry out to ensure that good standards are maintained. People and staff spoken with reported that senior Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 25 staff were approachable and willing to listen to concerns or suggested initiatives that may benefit the home. There was a good quality assurance programme in operation. Monthly audits are carried out and the registered provider supplies the manager with a written report of his findings during his monthly formal visits. Reports are developed around the findings and any shortfalls are identified and action plans collated to rectify the problems. The arrangements for the safekeeping and transactions of monies held on behalf of people living at the home were found to be good. This protects people from the risk of financial abuse. The manager holds at least six staff meetings each year. The agenda includes such topics as aspects of care, routines in the home, staffing issues and information about external agencies such as CSCI. There is a range of policies and procedure available for staff to refer to, this enables them to perform their duties appropriately. All aspects of health and safety checks and servicing of equipment are being carried out at the correct times. Fire alarms and emergency lights are tested and the findings recorded. The manager holds health and safety meetings with staff and monthly audits are carried out to promote safety awareness. These arrangements ensure provision of a safe environment for people who live at the home and al others who enter the premises. Cedar Lodge Nursing Home DS0000063476.V341851.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 2 3 X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Cedar Lodge Nursing Home DS0000063476.V341851.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 OP7 Regulation 15(1) Requirement Care plans must include: • Details about cultural and spiritual needs • Clear and appropriate staff guidance regarding how to care for people with constipation • Specific staff guidance in respect of care of people who suffer from urinary incontinence that take into account individuals normal habits/routines • Accurate information regarding peoples preferred activities • Record individuals preferences for mode of bathing, how often and time of day • All aspects of preadmission assessments to be assessed and included in care plans, such as ‘history of falls’ • Care plans must be developed for all people who have diabetes • Accurate recordings to eradicate incorrect DS0000063476.V341851.R01.S.doc Timescale for action 30/09/07 Cedar Lodge Nursing Home Version 5.2 Page 28 • information, such as ‘he is a vegetarian, likes chicken’ Clear staff guidance about methods of communicating with people. All conditions and risks must be assessed and care plans developed that take into account peoples’ personal preferences. This is required for the home to demonstrate that all aspects of care and peoples daily living preferences and to provide staff with comprehensive guidance on how to deliver care. Timescale of 31/10/06 has not been met. This is now a prority. The stock levels of boxed 10/09/07 medications must be accurate to ensure that people are receiving their medications as prescribed by medical staff. Staff allocations must be in 15/09/07 sufficient numbers to ensure that peoples needs can be fully met in a timely fashion. All staff must receive annual 31/10/07 training in Fire Safety to ensure that they have the knowledge and skills to respond appropriately when an emergency situation occurs. The home had made arrangements towards meeting this requirement. The registered person must replace the cracked overhead pane of glass in the velux window of staff toilet. Timescale of 31/08/06 has not been met. This is now a priority. 2. OP9 13(2) 3. OP27 18(1)(a) 4. OP30 18(1)(c i) 5. OP38 13(4)(c) 31/08/07 Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 29 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. OP20 Refer to Standard Good Practice Recommendations The home is requested to consider full implementation of a signage system to all communal rooms and individual bedrooms to promote peoples orientation skills and their independence. Cedar Lodge Nursing Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Home DS0000063476.V341851.R01.S.doc Version 5.2 Page 31 - 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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