Inspection on 10/04/07 for Cedar Lodge Residential Home

This inspection was carried out on 10th April 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 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 Residential Home 06/05/09

Cedar Lodge Residential Home 10/04/08

Cedar Lodge Residential Home 06/10/06

Cedar Lodge Residential Home 24/04/06

Cedar Lodge Residential Home 30/11/05

Cedar Lodge Residential Home 18/08/05

Cedar Lodge Residential Home 08/06/05

Cedar Lodge Residential Home 20/09/04

Cedar Lodge Residential Home 10/06/04

Similar services:

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

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

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Residential Home Hengrave Road Culford Bury St. Edmunds Suffolk IP28 6DX Lead Inspector Deborah Kerr Key Unannounced Inspection 10th April 2007 9:10 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 DS0000045594.V335961.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. DS0000045594.V335961.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Residential Home Address Hengrave Road Culford Bury St. Edmunds Suffolk IP28 6DX 01284 728744 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) Mrs Sandra Spendley Mr Michael Lewis Spendley Mrs Sandra Spendley Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places DS0000045594.V335961.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named person under the age of 65 with a mental disability 6th October 2006 Date of last inspection Brief Description of the Service: Cedar Lodge is a residential care home that has provided care and accommodation to older people since 1984. There is currently a condition of registration which allows the home to support and care for one service user under the age of 65 with mental health needs. The home is situated in a rural setting within its own grounds and adjoining woodlands on the outskirts of Culford, which is approximately five miles from Bury St Edmunds. There are no community facilities nearby and the nearest shop is in the village of Ingham. The home is spread over two floors with service users being able to access both floors by a central staircase or lift. There are 23 single bedrooms, eight of which are en-suite and one shared room, which also have en-suite toilet facilities. There is a lounge and a dining room and service users also have the use of a small sun lounge on the first floor. The homes office has been relocated to the gardens at the back of the home, in a wooden sun house type construction. Mr and Mrs Spendley became the Registered Providers of Cedar Lodge on the 1st September 2004, although both have been involved in the home for a number of years. Mr Spendleys mother owned the home prior to this date and Mrs Sandra Spendley became the registered manager on the 7th July 2003. The home has a statement of purpose providing information for prospective service users and states the current range of fees charged by the home, which ranges from £341.00 to £395.00 per week. These figures were reviewed on the 1st April 2007 and do not include hairdressing, toiletries, holiday’s, specialist dry cleaning, papers and magazines and activities away from the home. DS0000045594.V335961.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over eight hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including a pre inspection questionnaire. Additionally a number of records held at the home were inspected, relating to residents, staff, training, the duty roster, medication, health and safety and a range of policies and procedures. Time was spent talking with four staff, two visitors and a seven people living in the home. The inspector was invited to join a group of residents for lunch. The deputy manager was available throughout the day to assist the inspector and was joined by the responsible individual and the registered manager at the end of the inspection to receive feedback. A tour of the environment was made to assess progress to meet the requirements set at the previous inspection to improve the décor and cleanliness of the home. The automatic closing devices on internal fire doors were found not to be working and fire doors were being held open with fire extinguishers. An engineer had been contacted. The inspector returned the following day to check that the repairs had been carried out to ensure the fire doors were working correctly. What the service does well: What has improved since the last inspection? At the previous inspection 10 requirements were made. Evidence obtained during today’s visit found the home have met or partially met all of the requirements. Significant improvements have been made to the internal décor and cleanliness of the home. All of the toilets and bathrooms have been refurbished and thoroughly cleaned. DS0000045594.V335961.R01.S.doc Version 5.2 Page 6 Cedar lodge have been awarded a capital grant from Suffolk Association of Independent Care Providers for improving the care environment for older persons. This grant is being put towards the cost of building a conservatory, providing residents with an additional room to relax and use for activities. A review of staffing levels, in particular at weekends has taken place to ensure sufficient staff are on duty to meet the needs of the residents. Personnel files confirmed that a new application form is being used which lists the staff’s record of continuous employment. Risk assessments have been completed to assess the risks to residents using the main stair well and for the use of freestanding convector heaters. Appropriate measures have been implemented to reduce the likelihood of injury occurring when residents use these facilities. The quality assurance and quality monitoring systems have been reviewed to include the views of family and friends as well as the people living in the home. Recommendations made by the OT and fire and rescue team have been implemented, additional ramps have been fitted to make fire exits safer in the event of an emergency. The CSCI are now being informed of events that occur which have an adverse affect on the lives of people living in the home. What they could do better: Where the manager delegates the day-to-day control of the home to the deputy manager they must acknowledge they have overall responsibility for the management of the care home. They must be able to demonstrate that they have the competence and skill to communicate a clear sense of direction, support and leadership. Consideration should be given to providing information about the home and how to complain in a format suitable for residents including those with a sensory impairment. All management, care and ancillary staff must attend training for the protection of vulnerable adults, which includes guidance on making referrals to the appropriate authorities. New employees must have structured induction training appropriate to the work they perform. Supervision of staff needs to be undertaken to monitor performance and developmental needs. The quality of the recording in the daily progress notes needs improving to ensure that they accurately reflect the resident’s health and well being. Care plans need to be further developed to ascertain the residents express wishes with regards to their end of life arrangements. This is to ensure that at the time of their death, dying or serious illness staff will treat them and their family with care, sensitivity and respect. The registered provider needs to ensure that the outstanding maintenance work within the home is completed and that they continue to keep the home in a good state of repair externally and internally. To safeguard people being scolded, the hot water thermostats must be tested and maintained on a regular basis to ensure they are set to provide hot water close to the recommended 43 degrees centigrade. DS0000045594.V335961.R01.S.doc Version 5.2 Page 7 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. DS0000045594.V335961.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 DS0000045594.V335961.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): 1, 2, 3, 5, 6, People who use the service experience good quality outcomes in this area. People who are considering moving into Cedar Lodge can expect to have information about the home and have a contract that reflects the amount and method of payment of fees. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s statement of purpose has been updated to reflect the increase in funding by social services for older people living in residential care. Each resident had been issued with a contract setting out a statement of the terms and conditions whilst living at the home. These had been discussed, agreed, signed and dated with the individual and their representative. The deputy advised they are in the process of writing to residents and/or their representative where they are privately funded to advise of the annual increase in fees. DS0000045594.V335961.R01.S.doc Version 5.2 Page 10 Information about the home, including the statement of purpose, service users guide and complaints procedure is issued to each person prior to or on admittance to the home. This information needs to be made available in different formats, which meet the capacity of the individual, including people with a sensory impairment. Three peoples’ care plans and personal files were tracked. Each person had a pre admission needs assessment completed covering all aspects of their health and personal and social care needs. The deputy manager had completed these assessments with the individual, a family representative and a social worker to ensure the home was able to meet the person’s needs and to agree a plan of care. Prospective individuals are provided with the opportunity to visit Cedar lodge before making a decision to move into the home. This was confirmed in conversation the cook who commented, “people come for a look round and normally will stay for lunch, to get an overall feeling of what the home is like”. The Home does not provide intermediate care. DS0000045594.V335961.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, 11, People who use the service experience good quality outcomes in this area. Residents can expect to have care plans, which reflect their health, personal and social care needs. However, the individual’s end of life needs need to be discussed and recorded to ensure that staff will treat them and their family with care, sensitivity and respect in accordance with their wishes as their health deteriates. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has further developed residents care plans; these now provide a comprehensive overview of the individual. They identify the preferred daily routines of the person and the interventions for carers to help support the individual where required. The daily records need to be expanded to give an accurate picture of the person throughout the day to monitor their health and well being. A monthly review sheet confirms that residents are being involved in a monthly review of their care plan, which includes a statement from the individual on how the home is meeting their needs. DS0000045594.V335961.R01.S.doc Version 5.2 Page 12 Care plans have specific forms, which record visits by the general practitioner, district nurse and other health professionals. The outcomes and course of treatment following the visit are recorded separately on a progress form. Where concerns are identified to an individual’s wellbeing, assessments have been completed and action taken to minimise the risks. These include moving and handling, falls, pressure area care and self-medicating. Inspection of these documents confirmed they are being reviewed and updated on a regular basis. The home had taken a holistic approach to meet the needs of a resident with deteriorating health, involving the relatives, district nurses and GP. The district nurse team had arranged for a bed and pressure-relieving mattress to be delivered to the home. The use of bedsides to prevent the resident falling from bed had been agreed and authorised on the resident’s behalf by their relative. A review of the policies and procedures file confirmed that the home have procedures in place for supporting people through terminal illness. However, there was no evidence recorded in peoples’ care plans of their preferences to meet their end of life needs. These need to explored with the individual so that at the time of their death, dying or serious illness staff will treat them and their family with care, sensitivity and respect in line with their wishes. The procedures for storage, administering and recording medication were reviewed. The home continues to maintain the improvements made as a result of the pharmacist inspector’s recommendations from the inspection in April 2006. Medication Administration Record (MAR) Charts are being properly completed and the correct codes are being used. The home uses dosette boxes, which are prepared on a weekly basis by the local pharmacy. An audit trail of medication is being kept, receipt of medication is reflected on the MAR charts and identifies where changes have occurred. The pharmacist provides new MAR charts, which are approved by the GP where significant changes in dosage are made. For example where blood test result undertaken by the anticoagulant monitoring service recommend a change to the persons prescription for Warfarin. The returns book identifies the date and amount of medication returned. Medicines being stored in the fridge were labelled and dated. This included eye drops, which had been dated on opening to ensure they were being used before the expiry date. The temperature of the fridge was being monitored and recorded and was seen to be with in the recommended safe limits. The controlled drugs register was seen, confirming that there is currently two people prescribed Temazepam. The stock of medication was checked against the register and was found to be accurate. Staff were observed calling residents by their preferred name throughout the inspection. Two friends have requested to share a room. A written statement in each of their care plans confirmed this was their choice and that the arrangements had been agreed with the residents and their families. DS0000045594.V335961.R01.S.doc Version 5.2 Page 13 Shared rooms have been provided with screens to ensure that the people’s privacy is not compromised when receiving help with personal care or at any other time. DS0000045594.V335961.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, People who use the service experience good quality outcomes in this area. They can expect to be consulted about activities to ensure they are given the opportunity to participate in social, recreational and religious interests of their choice. People can expect to have a good range of fresh and home cooked food as part of a balanced and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Significant improvement has been made to the provision of daytime activities available to the people living in the home. The minutes of recent residents meetings confirmed they have been involved in choosing activities according to their interests, preferences and capability. Conversation with residents and relatives confirmed this. A schedule of activities was seen displayed on the notice board in the entrance foyer, incorporating skittles, reminisance sessions, communion, mobile library visit, movement to music, armchair exercises, quizzes of choice such as, play your cards right pastimes and pets quizzes and Bingo. There was also a list of dates for sing-a-long sessions hosted by a visiting entertainer. Other activities discussed at the most recent meeting included a horseracing quiz, story telling and making hats, such as Easter bonnets. DS0000045594.V335961.R01.S.doc Version 5.2 Page 15 Activities include opportunities for residents to take part in appropriate exercise and physical activity. A group of residents were seen enjoying an armchair exercise session and another resident told the inspector they access a local gymnasium. At the recent meeting a small minority of residents identified they would like more outings. Places of interest, for example Abbey Gardens, Waveney Waters and the seaside were suggested. The notice board was advertising a Waveney stardust boat trip scheduled for summer; two people had entered names on the list. The lounge has been redecorated and the bar at the end of the room has been removed to create an activities area. Table and chairs have been provided and a collection of board games and cards for residents to use as and when they choose. The owners have been successful in obtaining a capital grant form the Suffolk Association of Independent Care Providers. This money is being used to put towards the cost of building a conservatory, which will provide residents with alternative area for relaxing and other activities. The visitor’s book reflects that residents receive regular visits from family and friends. Relatives were seen visiting during the inspection and confirmed that they are made to feel welcome at any time; one commented Cedar Lodge is like “home from home”. Relatives confirmed that the home support residents to celebrate special occasions such as anniversaries and birthdays. This was confirmed by a series of photographs on display in the corridor showing residents enjoying a party and blowing out candles on their birthday cake. Time was spent talking with the cook. They confirmed that all food is home made and cooked using fresh ingredients. Residents had the choice of whole salmon with seafood sauce or turkey and potato pie, accompanied with a selection of fresh vegetables, followed by peach and apple crumble. They had also made fresh mushroom soup for tea. Fridges and freezers were well stocked with quality foods. These were being stored correctly and in line with food safety legislation. The inspector was invited to have lunch with a group of residents. General discussion took place about the quality of the food; residents were complimentary about the cook and described how they had prepared a beautiful Easter lunch of turkey and all the trimmings and a separate poached gammon. Each person was served their meal, at the table and was given a choice of water or squash to accompany their food. Meals were nicely presented and each resident received appropriate sized portions, with a choice of second helpings if required. The mealtime was seen to be a social event, which was unhurried allowing residents time to eat their meal. DS0000045594.V335961.R01.S.doc Version 5.2 Page 16 Residents with dexterity problems due to arthritic conditions had been provided with specially adapted cutlery to help maintain their independence to eat their meal unaided. DS0000045594.V335961.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, People who use the service experience adequate quality outcomes in this area. People living in the home can expect to be protected by the home’s procedures for dealing with complaints. However to ensure people are protected from abuse all persons working in the home must have training to ensure they are aware of the correct procedure for reporting allegations of concern or abuse to the appropriate authorities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy was seen displayed on the notice board in the entrance hallway. Each person on admittance to the home is provided with a copy of the complaints procedure. However consideration should be given to providing this information in a relevant format and language, which will meet the capacity of the individual. The complaints log confirmed that one complaint has been made about the home since the previous inspection. This was an anonymous complaint, which was made to the Commission for Social Care Inspection (CSCI) in December 2006 relating to incidents where staff were smoking in the home. The manager was asked to investigate the incidents relating to the complaint being made. As a result of their investigations, staff are no longer permitted to smoke inside the home. Residents who choose to smoke have a designated smoking area. DS0000045594.V335961.R01.S.doc Version 5.2 Page 18 The home has developed their own policies and procedures for the protection of vulnerable adults, which make reference to the Suffolk inter agency policy for reporting allegations of abuse. However, a recent allegation was not referred to social services, customer fist team in accordance with the guidelines. The manager had followed the home’s complaints procedure and had investigated the incident. They notified the CSCI three days after the incident had occurred and were advised to make a protection of vulnerable adults referral. A lack of understanding of the safe guarding procedures and how they work delayed the investigation, which created additional anxiety for the residents, relative and staff member involved. The registered person, registered manager and deputy manager were advised that they and all the employees at the home must attend updated protection of vulnerable adults training, which includes guidance for reporting all allegations or concerns to the appropriate agencies to ensure the safety and protection of the residents. Also the whistle blowing procedure identifies staff responsibility to report their suspicions or evidence that abuse or neglect of a resident has occurred, this policy needs to be amended to reflect the procedures for reporting such incidents. DS0000045594.V335961.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,25,26, People who use the service experience good quality outcomes in this area. Residents can expect to live in a home that is safe, comfortable and clean and have access to specialist equipment they require to help maximise their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four requirements were made following the previous inspection with regards to making necessary improvements to the maintenance, décor and cleanliness of the home. Significant improvements have been made; the owners have employed a contractor to undertake some of the remedial repairs to ensure the safety of the people living in the home. Where it was identified that carpets were fraying, lifting or rippled these have been repaired and secured and no longer present as a tripping hazard. The plasterwork on the landing and in toilet number six has been repaired and repainted. New curtains have been purchased and hung at the landing windows. DS0000045594.V335961.R01.S.doc Version 5.2 Page 20 All toilets and bathrooms have been redecorated and tiled. New fixtures and fittings have been brought and fitted, which includes taps and grab rails, with the exception of toilet number 4, which still requires replacement taps. These are pitted and rusting. There remains a problem in shower room 1, following a leak, which has been repaired, however the ceiling around the skylight is stained brown. This was first identified at the inspection in April 2006 and still needs to be addressed. The hallway and lounge have been decorated. The lounge is much brighter and has a new carpet laid. An activities area has been developed at the far end of the room with table and chairs provided. Planning permission is in the process of being obtained to erect a conservatory leading off from the lounge, which will provide additional space for seating and activities. New wicker furniture has been purchased for the foyer. The sun lounge on the first floor has facilities available for residents to make tea or coffee and to entertain guests in private. To protect resident’s safety all radiators throughout the home have been guarded with covers made specifically to fit the radiators. All fire exit doors, which had raised thresholds, have now been fitted with made to measure ramps to ensure safe exit to wheelchair users and people using walking aids. The fire service have agreed that the fire door from the lounge to the outside can be locked but not bolted as was previously the case. The registered provider has identified this as an issue and is to have a push bar fitted for emergency use. Previous concerns where a resident had fallen and broken both wrists when using the main staircase have been addressed. All residents have been risk assessed as to their ability and confidence to use the staircase. Where residents are at risk they have been advised to use the lift or request staff support to assist them down the stairs. Additional measures have been taken by fitting a grab rail along the wall at the top of the staircase. The deputy also demonstrated the pressure mat fitted at the top of the stairs which activates an alarm when pressure is applied. The previous inspection highlighted concerns about cleanliness and hygiene of the home, in particular toilets and bathrooms. A thorough clean of the home has taken place and the premises were found to be clean, with no unpleasant odours. The downstairs bath has had the lime scale removed and new taps fitted and is now operational. A bath chair has been fitted to enable resident’s easy access into and out of the bath. Residents were observed using aids and equipment to maximise their independence. A number of residents mobilise using walking aids. An assisted bath has been installed on the first floor and toilet raisers have been provided to aid people to access toilet and bathing facilities independently. A resident gave a demonstration how they used a mechanical armchair to help them stand form the sitting position. DS0000045594.V335961.R01.S.doc Version 5.2 Page 21 There is an adequate supply of liquid soap, paper towels in bathrooms and toilets and disposable aprons and gloves where staff are required to assist residents with their personal hygiene. The laundry room is situated on the first floor, with a smaller washing room on the ground floor; this is for washing general items such as tea towels and towels. The laundry upstairs has a sluice disinfector to sterilise toileting aids to ensure they are kept clean and reduce the risk of infection. Two trolleys are provided to transport dirty laundry and soiled linen. Soiled linen is placed in a bin on the trolley inside red dissolvable bags and placed in the washing machine on a separate wash on a sluice programme. DS0000045594.V335961.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): 27,28,29,30, People who use the service experience adequate quality outcomes in this area. People living in the home are safeguarded by the home’s recruitment procedures, however residents cannot be assured that new staff receive appropriate training for the work they are to perform to meet their individual assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff roster was seen which confirmed a review of staffing has taken place. An additional member of staff has been allocated to work at the weekends. Staffing levels now consist of 3 carers on the day shift between the hours of 8am to 6pm, 2 carers working 5pm to 10pm and two waking night staff between 10pm and 8am seven days a week. Additionally the staff are supported by the manager, deputy manager and a cook. Three staff files seen confirmed the home operates a thorough recruitment process, which includes obtaining all the appropriate paper work including Criminal Bureau Records (CRB) check and Protection of Vulnerable Adults (POVA) checks. All staff files seen had a statement of terms and conditions of employment signed and dated. A previous requirement was made for the home to explore the employment history of potential employees to ensure there are no unexplained gaps in their carer. A new application form has been introduced which requires the applicant to complete a record of their employment with corresponding dates. DS0000045594.V335961.R01.S.doc Version 5.2 Page 23 The home has recently recruited a new member of staff. Although the new member of staff has been booked to commence training for protection of vulnerable adults, there is no formalised induction programme. This training needs to introduce the employee to the principles of care, safe working practices, the organisation and role of the worker and the experiences and particular needs of the resident group. The process of induction was discussed with the deputy manager and information given directing them to the Skills for Care Common Induction Standards (CIS). Records confirmed that existing employees have completed training using local resources and a long distance learning provider. Recent training consists of fire safety, moving and handling, diet and nutrition, food hygiene, medication administration and infection control. The learning provider has tailored training packs, which` specifically relates to Cedar Lodge. They consist of information and question and answer sheets, supported by test papers during and at the end of the course. These papers are marked externally by the provider and certificates issued on successful completion. Information obtained from the pre inspection questionnaire identifies that 62 of staff hold National Vocational Qualifications (NVQ) at level 2 or higher. Three staff spoken with during the inspection confirmed they felt supported in their work and were clear about their roles and responsibilities. They felt they worked well as a team and were mutually supportive and appreciative of each other. DS0000045594.V335961.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): 31, 33, 34, 35, 36, 37, 38, People who use the service experience adequate quality outcomes in this area. Management approach does not ensure that the policies and procedures are always adopted in the home. Where there had been progress in the development and supervision of staff, this practice has not been sustained. In order to increase resident’s safety regular maintenance checks for the regulation of water temperatures must be undertaken. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager holds a National Vocational Qualification (NVQ) level 4 and has a minimum of twenty years experience of working at Cedar Lodge. Whilst qualified and experienced the manager relies heavily on the deputy manager for the day-to-day control of the home. The deputy manager has recently completed NVQ level 4, management in care services. DS0000045594.V335961.R01.S.doc Version 5.2 Page 25 The quality assurance survey completed in October 2006 incorporated feedback from residents, relatives, friends and health professionals. The home provided the CSCI with a copy of the results of the survey, which covered feedback on care received at Cedar Lodge, quality and choice of food, accommodation, activities and staff support, attitude and professionalism. Changes made in October 2006 to the quality assurance surveys have produced more detailed results, however information on the number of surveys returned would help to give a clearer picture. The most recent survey has enabled the home to identify areas of good and not so good performance, which they can use to make the necessary improvements. The CSCI requested and were provided with a copy of the homes financial and business plan. From the information provided by the responsible providers it would appear that the home is financial viable. The proprietors of the home do not act as appointee for any of the people living in the home. Families or power of attorneys manage the financial affairs of the residents. Resident that are able manage their own finances and have access to a lockable cabinet in their room. Environmental Health visited the home for a routine inspection of the premises in March 2007. They inspected the use of the better food safer business pack, and noted that the home had stopped completing the documentation. On the recommendation of the environmental health officer the staff have resumed the daily checks and a four weekly review to ensure the home are meeting the required food safety standards. Environmental health commented that the level of cleaning was now satisfactory, however the cleaning records were not being completed. They have recommended that the home replace the existing wallpaper and the wooden kitchen cupboards with more suitable alternatives that can be kept clean. Overall the environmental health officer commented that the standards of cleanliness and food hygiene were much better than the previous visit. The fire doors in the main corridor on the ground floor were being propped open with fire extinguishers. The registered provider explained that they had had a power surge, which had knocked out the electricity supply, which had affected the automatic release magnetic connections on all the internal fire doors. An interim risk assessment had been completed assessing the fire doors to be held open during the day but kept closed at night as a low risk to resident’s safety. The registered provider confirmed that they had contacted the electricity supplier and fire alarm specialist who where due the next day to make the necessary repairs. The inspector returned the following day to confirm the repairs had been made. The electricity supply had been repaired, the fire alarm engineer had not yet arrived they were due later that afternoon. This was confirmed in writing and by telephone the following day. DS0000045594.V335961.R01.S.doc Version 5.2 Page 26 The fire logbook seen confirmed that weekly checks of the alarm system, emergency lighting and fire extinguishers take place. Staff are receiving fire safety instruction and are involved in regular fire drills. The hot water tap in the bath on the first floor when tested was in excess of 50 degrees centigrade. The registered provider readjusted the thermostatic valve, which was checked again at the close of the inspection and the water was found to be at the safe recommended temperature of 43 degrees centigrade. At the previous inspection the staff supervision format and procedure had significantly improved. Disappointingly, through discussion with staff and a review of their files confirmed this has not been maintained. Pre inspection information reflects that policies and procedures are being maintained and reviewed. A sample of policies and procedures seen at the inspection confirmed this. However it was identified that the guidance is not in all cases being followed, for example, a recent allegation was not referred to social services, customer fist team. Similarly, the home has a procedure for supporting residents through terminal illness, however care plans do not reflect peoples expressed wishes with regards to their end of life arrangements. Risk assessments have been revised and cover resident’s health safety and welfare. These include the arrangements to meet previous requirements for residents whom choose to have freestanding convector heaters and for residents using the stairs unsupported. DS0000045594.V335961.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 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 2 2 3 3 3 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 3 3 2 3 2 DS0000045594.V335961.R01.S.doc Version 5.2 Page 28 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 OP11 Regulation 12 (3) Requirement Further work needs to be undertaken to develop the palliative care and end of life needs of residents so that at the time of their death, dying or serious illness staff will treat them and their family with care, sensitivity and respect. All management, care and ancillary staff must attend training for the protection of vulnerable adults to include guidance on making referrals to the appropriate authorities. The proprietor must ensure that the outstanding maintenance work within the home is completed (as detailed in the environment section of this report) and that the home is kept in a good state of repair externally and internally. Persons employed to work in the care home have training appropriate to the work they perform including structured induction training. Timescale for action 29/06/07 2. OP18 13 6 31/05/07 3. OP19 23 2 (b) 31/05/07 4. OP30 18 1 (c) (i) 29/06/07 DS0000045594.V335961.R01.S.doc Version 5.2 Page 29 5. OP31 10 6. OP38 13, 4 (a) The manager must acknowledge they have over all responsibility for the management of the care home and be able to demonstrate that they have the competence and skill to communicate a clear sense of direction, support and leadership. To safeguard people being scolded, the hot water thermostats must be tested and maintained on a regular basis to ensure they are set to provide hot water close to the recommended 43 degrees centigrade. 11/04/07 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The service users guide and other information about the home needs to be available in formats suitable for the people for whom the home is intended, for example appropriate language, pictures and where possible photographs. The recording in residents daily progress notes needs to be expanded to give an accurate picture of the person throughout the day which provides an overview of their health and well being. The whistle blowing procedure needs to be amended to reflect the homes adult protection policies and procedures. Staff should receive structured formal supervision at least 6 times a year. Part of the supervision process should include all aspects of best practice in accordance with guidance written in the homes policies and procedures. 2. OP7 3. 4. OP18 OP36 DS0000045594.V335961.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000045594.V335961.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. 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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