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Inspection on 18/08/05 for Cedar Lodge Residential Home

Also see our care home review for Cedar Lodge Residential Home for more information

This inspection was carried out on 18th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a welcoming homely atmosphere, service users spoke of being very comfortable and that they were well looked after, and that the staff are very kind. They also spoke about the food being excellent; the choice of food seen was freshly prepared with a good variety of choice on the menu. Service users are supported to maintain links with the community attending clubs such as the women`s institute and a club for the blind.

What has improved since the last inspection?

The home has made progress in minimising the risk to service users for example around the installation of covers to radiators to ensure that no one gets burnt, however there are still some radiator covers outstanding. The inspectors were assured that these would be fitted by the 2nd week in October 2005 Improvements had been made to the individual service users care plans, risk assessments had been undertaken to identify the risk of falls and moving and handling. Action plans had been developed to support the risk assessments and how to maximise service users independence. There had also been an improvement with the implementation of pre admission assessments undertaken by the manager and social services to assess the needs of service users prior too moving into the home, which then formed the basis of the care plan. The home had also introduced a form to track all visits by healthcare professionals, and details of the visit were recorded on a separate log sheet.

What the care home could do better:

Although some improvements had been made with the care plans, there still needs to be improvements with the written information and guidance for staff for service users with identified chronic diseases, such as diabetes. Service users care plans are reviewed on a regular monthly basis however, the service users should be consulted and included in the review to ensure they are involved in any changes that may affect their health and welfare. Medication procedures need to be improved to ensure the safety and welfare of service users at all times. The home could be more consistently managed to make sure that service users are protected through good recruitment practice and ensuring that all staff employed in the home, including casual workers and volunteers have criminal records bureau checks in place and that the manager works with other agencies in the protection of vulnerable adults. There need to be a planned programme of maintenance and renewal of the fabric and decoration of the premise. To include redecoration of some communal areas and also to investigate cracks in the plaster of walls on the first floor. To improve the asthetics of the home the gardens also need some attention to the side and the rear of the home. Service users, relatives and friends would beneifit by having information of how to contact an advocacy service to have somene who will act on the independant views of the service users.

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Residential Home Hengrave Road Culford Bury St Edmunds IP28 6DX Lead Inspector Karen Howman Deborah Seddon Unannounced 18 August 2005 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 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 Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Residential Home Address Redgrave Road Culford Bury St Edmunds Suffolk IP28 6DX 01284 728774 None None Mr Micheal Spendley and Mrs Sandra Spendley Telephone number Fax number Email 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 Care Home 25 Category(ies) of Old Age (OP) (25) registration, with number of places Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered to include one named person under age of 65 with a mental disability. Date of last inspection 8th June 2005 Brief Description of the Service: Cedar lodge is a residential care home that has provided care and accomodation 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 has en-suite toilet facilities. There is a lounge and a dinning 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, the owners are currently making an additional exit from the building for service users to access the new office. Mr and Mrs Spendley became the the Registered Providers of Cedar Lodge on the 1st September 2004, although both have had involvement 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. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced, starting at 10am and took place over seven hours during a weekday. Service users, staff and the proprietor were spoken with. The registered manager was on sick leave on the day of the inspection. Service users records, policies and procedures were examined as part of the inspection and an audit was made of staff files. A tour of the premises was made. The unannounced visit was undertaken to see whether the home had addressed the large number of requirements and recommendations set at the previous inspection in June 2005. The report includes the findings of the pharmacy inspection undertaken on the 11th August 2005. A separate pharmacy inspection report has been sent to the home. As part of the inspection the inspectors spent time talking to service users in the lounge. What the service does well: What has improved since the last inspection? The home has made progress in minimising the risk to service users for example around the installation of covers to radiators to ensure that no one gets burnt, however there are still some radiator covers outstanding. The inspectors were assured that these would be fitted by the 2nd week in October 2005 Improvements had been made to the individual service users care plans, risk assessments had been undertaken to identify the risk of falls and moving and handling. Action plans had been developed to support the risk assessments and how to maximise service users independence. There had also been an improvement with the implementation of pre admission assessments undertaken by the manager and social services to assess the needs of service users prior too moving into the home, which then formed the basis of the care Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 6 plan. The home had also introduced a form to track all visits by healthcare professionals, and details of the visit were recorded on a separate log sheet. 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. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4, Prospective residents can expect to have their needs identified, they can also expect to be assessed for appropriate equipment to ensure that their health and personal needs will be met. EVIDENCE: Fiveservice user’s care plans were looked at; each had a service user agreement, a pre admission assessment, which had been completed by the manager and an individual placement contract. This had been an improvement following a requirement made at the last inspection. Other service user reports consisted of a past history and hospital discharge notes. Each service user had an assessment, which had been completed by their social worker prior to admission to the home. These assessments contained twelve sections, including, a brief history of the service user, behaviour, emotional development, careers situation, daily activities, family and social relationships, financial, mental ability, personal care needs, continence, diagnosed conditions and mobility issues and planning for the future. All of this information had been incorporated into forming the service users individual care plan. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 9 The home’s statement of purpose was seen and it was noticed that the complaints procedure was missing. This document was produced and attached to the statement of purpose during the inspection. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Service users cannot be assured that they are fully consulted and made aware of factors about their ongoing health care needs. Service users cannot expect the home to ensure their health and welfare is protected due to a lack of written and planned guidance on the management of identified chronic diseases in their individual care plans, however service users can expect to have risks identified and measures put in place to maximise their independence. Service users are not protected by the home’s policies and procedure for the safe management of medication, therefore the registered person, must take steps to ensure systems in place for the administration of medicines which are safe and that the health and welfare of service users is protected at all times. EVIDENCE: Care plans had a section that service users had signed to agree with the content of the plan and giving permission for staff and other professionals to access their personal data. However, one service user spoken to told the inspectors that the doctor had visited the home, to discuss with staff how to manage their episodes of depressive illness. A letter from the doctor had been placed in the service user’s care plan explaining to staff about the dosage of PRN (as required) medication, which was to be used on a flexible dose over the Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 11 period of time the service user was experiencing heightened psychological agitation. However, this information had not been clearly explained to the service user who was not fully aware of the reason why their medication was being reduced. The service user spoken to informed the inspectors that they tried to manage their own symptoms, by walking in the garden, listening to the birds and water feature as a relaxing technique. Monthly reviews of the care plan take place, however, there was no evidence that these reviews take place with the service users input. The home has introduced a form, which has a record of all visits by healthcare professionals. A code system has been designed to reflect which health official visited, the time and the date and if they were accompanied. Details of these visits are then recorded separately on a progress form to monitor the provision of healthcare being provided to the individual service user. One service user’s care plan tracked showed regular visits from the district nurse to redress a burn area that the service user had prior to admission to the home and to monitor previous ulcerated areas. A risk assessment had been undertaken for one service user for the use of bedsides. The risk assessment identified that the service user moved a lot and there was a possibility that they would fall from bed, however, the home need to fully explore the hazards of having bedrails fitted to the bed. There was a signed agreement from the family that the bedrails be used. A pharmacy inspection was undertaken on the 11th August 2005 to follow up the issues identified at the last inspection. The following areas of medicine management were examined. Since the previous inspection of 8th June 2005, arrangements for the storage of medicines remain unchanged, however, it was again reported that an office area within the home will in due course be identified and used solely for the storage of medicines. This office had been installed at the time of the inspection on the 18th August 2005. During inspection a small number of medicines were found in the dining area bar section in a non-secured drawer. These medicines were considered to be a risk to service users at the home and were requested to be removed. During the course of the pharmacy inspection, it was noted a number of medicines in a larger open box on the floor of the office. At the time, the office door was locked, however, these were later removed. The pharmacist asked both the manager and senior member of staff about the medicines. Both confirmed that they were not aware of their existence. At the time of inspection, there was one service user self-administering medicines. On examination of the storage arrangements in place for the medicines stored in the service user’s room, it was found that they were not secured and that there was no suitable facility in place to enable secure storage. There was noted to be a recorded risk assessment in place for this service user. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 12 During inspection, an audit of current Medicine Administration Record (MAR) charts was undertaken. Records of medicine administration were noted to be mostly complete and there was some improvement in the recording of the receipt of medicines into the home, however, issues were noted in relation to record-keeping practice requiring further remedial action. In view of the findings and further concerns relating to medicine administration and record-keeping practice, the registered person must take steps to ensure safe medicine administration and record-keeping practice is upheld at all times. Records for the receipt and administration of medicines must be completed in full at all times. This issue has been identified during previous inspections and still remains unresolved. During the audit, medicines were found from records of their receipt on 23/07/05 to be unaccounted for. There were no records available at the time of inspection for their administration or disposal. Medicine stock available at the time of inspection were noted from their pharmacy labels to have been supplied at times pre-dating 23/07/05. Both the manager and senior member of staff confirmed that they were unaware of the fate or location of these medicines. It was reported that the home plans to implement service user-identifying photographs alongside medicine administration record (MAR) charts to assist in the safe administration of medicines. On conducting an audit of medicines available for administration, it was found that two medicines aspirin 75mg tablets for one service user and temazepam 10mg tablets for another service user were supplied in the Nomad monitored dosage system (MDS) cassettes but were also available in additional original containers in the medicine trolley. This is considered to present a risk of erroneous over-administration of the medicines and therefore places the health and welfare of service users at risk. At the time of inspection, there were two service users recently admitted to the home for whom medicines had been supplied in 7-day compliance aids prepared and supplied by respective service user family members. It was confirmed that the compliance aids are replaced each week by family members. The compliance aids are not prepared labelled with the contents of the containers properly indicated and identifiable. The home has provided guidance on the management of diabetes for an insulin dependent diabetic service user. The care plan, however, as yet does not Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 13 identify members of care staff who have undergone specialist training on the administration of insulin. Care planning for a service user with bipolar illness has also been improved following a recent consultant review. The letter following the review, however, states that a dose of quetiapine up to 400mg as a single dose may be justified in cases of psychological agitation whereas the care plan records that a dose of 750mg can be given. This situation is considered to be unsafe with the potential for confusion and erroneous administration of the medicine. The home has obtained a controlled drug register, however, as yet it has not been used, however there are temazepam 10mg tablets available at the home for administration. It was reported that ‘Medicine Administration Training’ by correspondence was planned for a total of 15 members of care staff and 4 or 5 initially. The home has records of insulin administration training relating to 20/06/05 however the documentation relates only to staff agreement to participate in the administration of insulin. There is currently no evidence that the competence of care staff has been assessed. It was confirmed that the home was awaiting written confirmation from the community nurse that members of staff have been trained and are competent to undertake such tasks. The pharmacist inspector was shown a copy of the revised policy document. The senior member of staff confirmed that this would be fully implemented within 7 days and that members of care staff will be provided with copies to read, understand and acknowledge. From observation service users were treated with dignity and respect, one service user sitting in the lounge had become very tangled in their clothing, staff discretely assisted the service user to their room and they was later observed to be redressed appropriately. Service users rights to privacy were promoted; it was documented in their care plan whether they chose to have their own key to their room and a lockable cabinet. Staff were observed to knock and wait prior to entering a service users room. Evidence was seen in service users care plans that the home had introduced risk assessments to assess the risks of falls, moving and handling, service user hygiene and dietary requirements. The falls risk assessments had a category of risk identified and actions and objectives advising staff how to minimise the risk of falls and subsequent injury. Alongside the risk assessment a falls diary had been implemented. Care plans seen had no record of falls. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 14 Moving and handling risk assessments identified equipment, and support and encouragement from staff. One service user was choosing not to walk due to becoming unsteady and loosing their balance, the home requested the district nurse to measure the service user for a walking frame to provide support and maximise the service users independence. Hygiene and grooming profiles and a food profile had also been implemented which gave a good overview of the service user’s needs. Service users wishes at the time of their death are recorded in the care plan giving details of whom to contact, next of kin and any religious preferences. However the homes policy for dealing with the death of a service user did not guide staff to inform the commission for social care inspection (CSCI) and needs amending. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Service users can expect to spend their time as they choose; and that they will be supported to take part in appropriate activities within the local community and that their hobbies and interests are encouraged. However, service users interests had not been taken into account with the timing of breakfast. EVIDENCE: One service user spoken with talked of going to a club for the blind once a month; they had met a person there that visits them at the home on a regular basis as a volunteer. This volunteer has helped the service user to increase their confidence and independence by helping them to acquire a lamp for the blind and support them to go shopping. This service user is also supported to attend the women’s institute (WI) to which they were a member prior to moving into the home. Another service user spoken with was very proud to show their newly decorated room, which with their permission was being used in the brochure for the home. The service user had brought their own furniture with them, they talked of “being very comfortable and well looked after, can’t complain about the staff, they are very kind to you”, however, they did state that they would prefer to have their breakfast later. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 16 The proprietor assured the inspectors that service users could choose what time they have their meals within given time limits, however, it service users need to be consulted on a more regular basis should they change their minds. Several service users spoken to described their experiences of living in the home, indicating that they were “happy here, staff are very good and kind and understanding, I can’t fault the carers”. Another commented “ I have been here for 4 months, staff are very good to us here, and they have very good food” all service users spoken to commented on the food being very good, with a variety of choice. The menu was seen for the day of the inspection, service users had a choice of shepherds pie, broccoli, beans and cauliflower or alternatively, pasta with fresh tomato sauce, or macaroni chesses, followed by fresh apple and rhubarb fool and ice cream or tinned fruit as an alternative. A list of activities was displayed on the notice board in the entrance hallway, which included communion and art classes on Tuesday’s, arts and crafts on Wednesday’s. A hairdresser visits every Thursday and bingo is held on a Friday. Records seen in care plans suggest that bingo is a popular choice. Manicures are also available daily. Other activities advertised were a Waveney Stardust boat trip, one trip had already happened on the 23rd June and another was scheduled for the 23rd August. This had proved a success judging by the feedback from service users that had been on the trip. The home had also provided in house entertainment with a group called Yesteryear Musical entertainers. Feedback from service users in general was that they would like more activities, as they can sometimes be bored. Comments made in the Quality Assurance surveys that one service user had requested gardening; another had requested “talks” and others suggested more trips. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Service users can expect to have any complaints listened to, however there is insufficient recognition of the need to work jointly with other organisations such as health and social care to ensure the welfare and safety of service users. Until all persons or volunteers working in the home have the necessary protection of vulnerable adult and criminal records bureau checks completed service users cannot expect to be safeguarded from abuse. EVIDENCE: The commission for social care inspection (CSCI) received a complaint about a service user’s admission to hospital as a result of a decline in their health. The complaint is currently being investigated. The home’s Abuse policy was seen. A requirement from the last inspection in June 2005 stated that the home’s abuse policy must have the information that all allegations of abuse are appropriately referred to social care services. The policy had not been amended to reflect this. The home has a complaints procedure and service users spoken to were clear that if they had any concerns they would complain to the manager. One service user spoken to said they would raise issues with the manager and their own family who lived locally and visited often. The complaints procedure was clearly displayed on the notice board in the entrance hall, the information to contact commission for social care inspection (CSCI) although it was noted that the home still had the contact name of the previous inspector. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 18 During the inspection a relative of the responsible individual was observed to be working on the premises. The responsible individual informed the inspector that they were not working, but just helping out doing some odd jobs around the home until they returned to college. The relative had recently been involved in a moving and handling course and was deemed to be working at the home, they did not have a criminal records bureau check (CRB) or protection of vulnerable adults (POVA first) check on their file. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 Service users can expect to live in a comfortable and homely environment with access to indoor and outdoor communal facilities, service users with visual impairments cannot expect to have the facilities, aids and adaptations to fully meet their needs. Service users can expect that the layout of the home is suitable, accessible and safe; however, a programme of maintenance and decoration of the premises needs to be implemented to ensure that the home is well maintained. EVIDENCE: The inspectors made a tour of the building; generally the home appeared to be bright and had a welcoming home environment. It was a nice sunny day and service users were making use of the garden at the front of the home and sitting in the foyer. The gardens were looking overgrown and unkempt to the rear and side of the property and needed attention. Service users rooms viewed were nicely decorated, clean and tidy and well maintained, also personalised with their own belongings. Each service users care plan seen had a chart for room maintenance and cleaning schedules; the cleaner or handyman according to the task signed these. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 20 One service user was unable to call for assistance, as the cord to their call bell did not reach their armchair. Another service user with a vision impairment was unable to call for assistance in case of an emergency, when using the bath they were unaware that a call bell was available. The toilets and bathrooms were looked at, the chair lift in bathroom 5, had a non-slip mat on the chair which was in need of immediate replacement as this was presenting a hygiene issue to service users. Bathroom number 1 on the first floor, décor was looking dated and the toilet and hand basin was dirty and shower room number 1 had a damp patch on the ceiling, which needed attention. The proprietor informed the inspectors that a new bath had been ordered to replace the existing one and that the chair lift would be disposed of, as this would not be needed with the installation of the new Excalibur bath. The inspectors were informed that the new bath had been ordered and was due to be delivered. The proprietor produced an invoice dated the 1st July 2005, which stated the bath would be delivered 4 weeks after payment. A new washing machine had been purchased and installed with a sluicing facility set at 75 degrees centigrade thermal disinfection, the machine also had a programme set at 40 degrees centigrade chemical disinfection. A senior member of staff demonstrated how the machine worked and informed the inspectors of new procedures in place when dealing with service users laundry. Trolleys were being used with two compartments one with a red lid and red bag for soiled laundry and a white lid with blue bag for all other items. It was noted that the procedure for dealing with service users laundry needed to be updated in line with the homes new procedure. Liquid hand soap and paper towels had been installed and were readily available in areas where staff were assisting service users with personal care to minimise the risk of cross infection. The home had two stair cases, the stair carpet on the stairs leading to the first floor near the entrance to the home had began to fray, the carpet presents a tripping hazard and is a risk to service users and staff, particularly service users with visual impairments. The stair well to the rear of the building near toilet number 5 there appeared to be large cracks developing in the wall around the window and down the stair wall, these will need to be investigated to ensure the sound construction of the building. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Service users can expect to be cared for by a staff team who are supervised and have the appropriate qualifications and skills to do their job, although the duty rota did not present an accurate staffing picture. EVIDENCE: The staffing roster was looked at and was found not to correspond with the staff actually on duty. The date on the roster was also incorrect, showing Thursday the 16th August, not the 18th. A previous requirement was that the rota needed to differentiate between the care hours worked by staff and the time spent on cleaning. The home has recruited a full time cleaner who works Monday to Friday between the hours of 9-5. An audit of all staff files was undertaken. All information and documents in respect of persons working in the home was seen and all staff with the exception of the relative of the responsible individual previously mentioned had a criminal records bureau (CRB) and a protection of vulnerable abuse (POVA) first checks. The files showed evidence that staff were receiving training, a range of certificates seen showed moving and handling, first aid, infection control and fire safety from a company called Flameskill and a correspondence course on administration of medication through Otley College. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 22 All staff with the exception of one night staff and the family member already identified had attended a two-hour Vulnerable Adults at Risk of Abuse training session in October 2004. The home has purchased Mulberry-training packs to use for refresher training in adult protection, infection control, food hygiene and administration of medication. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37,38 Whilst a qualified and experienced manager manages the home, a member of staff employed as domestic, activities and office worker is clearly taking a lead in the management of the home. EVIDENCE: The registered manager was on sick leave on the day of the inspection. Time was spent with the proprietor and a member of staff employed in the capacity of domestic/activities/office role. There was clear evidence throughout the inspection that this member of staff is heavily involved in the running of the home, however, their contract of employment for cleaner and job description do not relate to this post. The member of staff had been to the hospital that morning to make an assessment as to the fitness of a service user returning to the home. The job description does not cover making assessments of service users, only Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 24 reference to paperwork “is to read and write reports and take part in staff meetings as necessary.” The audit of staff files shows that this person has received all mandatory training and is currently undertaking National Vocational Qualification (NVQ) level 4 in management of care services. The home operates a quality assurance and monitoring system in a questionnaire format sent out to all service users in the home. The questionnaire is produced quarterly, feedback from the questionnaires in April and July 2005 was positive, however, repeated requests were made for more activities. It was evident that staff assisted service users to complete these questionnaires and it was suggested that the home source an advocacy service to aid service users to complete these independently. Staff files had evidence that staff supervision was taking place in the form of personal supervisory assessments; the manager discussed a different topic of service provision and their understanding of the tasks involved with the staff member, however there was little comment from the manager about staff performance. Water temperatures were tried and tested, in one bathroom. The temperature reading was 34c. Records kept in the bathroom indicated that temperatures were being checked on a daily basis and a temperature of around 40c was being recorded, however there were gaps at weekends. The home had installed radiator covers to all the main communal areas of the home, risk assessments had been undertaken to identify the need for the covers in individuals rooms, however, two service users with visual impairments had not had radiator covers installed. No risk assessments had been undertaken for the radiators in toilets, 3, 4, 5, and 6 or the shower rooms 1 and 2. The proprietor assured the inspectors that the rest of the radiator covers would be to be fitted by the 2nd week in October 2005. Risk assessments for individual service users rooms had been undertaken and the risk identified whether restrictors needed to be fitted to the windows. Falls risk assessments had been developed in the service users care plans, part of the assessment was keeping a falls diary of the individual. Care plans seen, one service user had a fall to the floor in one of the toilets on the 17th July 2005, there was no record of this in the accident book or any mention of how the service user was assisted off the floor. The home has policies and procedures in place; however, these are not dated and therefore there is no evidence to suggest these are being regularly reviewed as part of a quality monitoring system. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 25 The notice board in the entrance hallway displayed a range of information, a current copy of the homes certificate of liability dated to be reviewed 29.04.06, Fire safety report from Suffolk fire and rescue, Flame skill fire equipment service certificate dated September 2004, due for inspection September 2005. A service inspection and test record of the nurse call system, and action taken to ensure system was operating properly, batteries replaced and two lights on the first floor dated 15th August 2005. Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 3 3 2 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 2 2 2 x x 2 2 2 Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 27 YES Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 (1) (a) Requirement Timescale for action 21st October 2005 Immediate 2. 7 3. 9 4. 9 5. 9 The registered person must ensure that the statement of purpose consists of up to date aims and objectives and current charges made by the home. 14 (2) The registered person must 15 (2) ensure that service users are involved in the review of their care plans and is consulted on any changes in respect of their health and welfare. 13.2, 13.4 The registered person must make arrangements for the secure storage of medicines selfadministered and held in service users rooms by providing robust lockable storage and ensuring each such medicines are stored securley at all times. 13.2, 13.4 The registered person must take steps to ensure safe medicine administration and record keeping practice is upheld at all times. Records for the reciept and administration of medicines must be completed in full at all times. 13.2, 13.4 The registered person must take steps to ensure systems in place for the administration of medicines are safe and therefore I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc By 2nd September 2005 With immediate and ongoing effect With immediate and ongoing Page 28 Cedar Lodge Residential Home Version 1.40 6. 9 7. 9 8. 7.1 9. 11.12 33.9 10. 18 11. 22.4 that the health and welfare of service users is protected at all times 13.2, 13.4 The registered person must take steps to ensure medicines are administered at the home by care staff from containers at all times prepared by the pharmacy at all times. 13.4, 15 The registered person must take steps to clarify and make accurate the contents of care plans to ensure the health and welfare of service user is safegaurded at all times. 13.4, 15 The regstered person must take steps to ensure that the health and welfare of service user is protected by providing clear written and planned guidance on the management of chronic diseases such as diabeties, pressure care and depressive illness in their individual care plans. 37 The resgitered person must give notice to the CSCI in the event of the death of a service user, including the circumstances of their death, this needs to be evidenced in the policy for staff guidance on death and dying. 12(1)(a) The homes abuse policy and 13(6) procedures must be reviewed in light of local protection procedurers to ensure that all allegations of abuse are apporpraitely referred to Social Care services. 13(4) The registered person must make sure that aids in use i.e.bedsides are assessed by a suitably qualified person such as an occupational therapist and a risk assessment is completed to ensure that all unecersary risks to the service users health and safety are identified and so far I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc effect By 9th September 2005 By 9th September 2005 with immediate effect and ongoing Immediate and ongoing 21st october 2005 21st october 2005 Cedar Lodge Residential Home Version 1.40 Page 29 12. 22 23(2)(n) 13. 25 13 (4)(a)(c) 14. 26.1 13 (3)(4)(c 15. 27.2 17 (2) Sch 4 (7) 16. 29.3 19 (1) Sch 2 17. 38.7 sch (3) (j) Sch (4 (120 (a) 18. 19.1 13 (4)(a)(c) as reasonably possible eliminated. The registered person must ensure that call bells are accesible to all service users and that they know they are available in case of an emergency. The registered person must ensure that the installation of all risk assessed radiator covers to remaing bedrooms and bathrooms is completed. The registered person must ensure that the non slip mat is removed from the bath chair in bathroom No 5 which is presenting a risk of infection. The registered person must ensure that the daily rota acurately reflects hours of staff to be worked and actually worked and dated corectly. The registered person must ensure that criminal record bureau checks are made for all employees and casual workers and vounteers working in the care home. The registered manager must ensure that any accident/incident affecting a service user is recorded in the accident book, including the nature, date and time and whether medical treatment was sought. The registered person must ensure that the carpet on the stairs at the front entrance is made safe. the carpet is fraying and presents a tripping hazard, particularly to service users with a visual impairment, using a stick to aid their mobility. Immediate and ongoing 14th October 2005 Immediate Immediate Immediate Immediate and ongoing. Immediate Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 30 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 9.1 Good Practice Recommendations It is recommended that risk assessments for service users self-administering medicines are undertaken regularly in order to ensure such medicines are properly secured in rooms at all times. It is recommended that temazepam preparations are recorded in the controlled drug register provided. It is recommended that the home requests that all medicines brought into the home on service user admission are provided in original pharmacy-prepared containers only. It is recommended that the home informs service users, relatives and friends of how to contact an advocacy service to have somene who will act on the independant views of the service users. It is recommended that the proprietor and registered manager have a planned programme of maintenance and renewal of the fabric and decoration of the premise. To include the redecoration of bathroom 1 and shower 1, also to investigate cracks in the plaster of walls on the first floor. The gardens also need attention to the side and the rear of the home. Policies, procedurers and practices are regularly reviewed in light of changing legislation and good practice advice from the Department of health, health authorities and specilaistand proffesional organisations. These should be dated as they are reviewed. Staff should formal supervision at least 6 times a year and supervision should cover all aspects of practice, philosophy of care in the home and career developments. 2. 3. 9.8 9.4 4. 14.3 5. 19.2 6. 33.9 7. 36. 2, 3 Cedar Lodge Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 31 Commission for Social Care Inspection 5th Floor St Vincent House Cutler Street Ipswich IP1 1UQ National Enquiry Line: 0845 015 0120 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 Residential Home I54 - I04 S45594 Cedar Lodge V245584 050818 Stage 4.doc Version 1.40 Page 32 - 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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